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User Journal

Journal: REFLECTIONS

Journal by ten000hzlegend
Demonstrate a basic knowledge of professional regulation
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Through this I have learned to act professionally when deciding a patients best course of treatment, taking into regard their present condition and well-being along with their own wishes and independence in how their treatment proceeds

Demonstrate a basic knowledge of self regulation
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This entails me to act responsibly under any circumstance regarding a patients well-being, also taking into account my own views on a particular treatment and how those views may conflict with professional guidelines but must not over-rule them under any circumstances

Recognise and acknowledge limitations of own abilities
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Through this I have gained insight on how best to accomodate a patients needs without risking their immediate health in any way, this also helps me gain valuable practice and referral to new treatments being administered by a higher grade nurse or equivalent

Recognise situations that require referral on to a registered practitioner
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In a ward situation, I have realised the importance of recording and referring any abnormal signs and results from a patient immediately onto their doctor, charge nurse or available member of staff. Not only does this give the patient assurance in their condition and encouragement but also allows no delay in further treatment if deterioration occurs in the patient i.e if cardiac arrest is imminent

Demonstrate respect for patient confidentiality
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Through this I have learned to treat the patient as an individual and not as a name on the check list, regardless of their personal attitude towards staff or own emotional and physical state, this entails giving them as much privacy as requested

Identify ethical issues in day to day practice
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Through this I have found it necessary to not only treat the person with as much respect I would give someone out-with hospital, but to disregard their physical conditional as much as possible and deliver a content of service and treatment that they would expect of themselves and agree wholly to, whether or not they agree to treatment is up to them and not for me to judge upon or forcefully change

Demonstrate and identify key issues in relevant legislation relating to mental health
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My observed ward held a number of mentally unwell patients at any time, therefore it was necessary to research and relate their condition in regards to their treatment and also relate to them on a personal level

Demonstrate and identify key issues in relevant legislation relating to children
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Not observed in the workplace as all patients I cared for were above 18

A willingness to accept responsibility for their actions
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Through this I have realised that a patients recuperation could falter and possibly be threatened by any professional misconduct, accidental or otherwise, willingness to own up to any faults or flaws in my own work and treatment administered to patients can correct the situation with the help of others without further setbacks or negative consequences

Punctuality
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Through my own mistakes in punctuality, I have realised that a nurses day must run to a set plan, it is important for the patients that would be in my care that they are included in each of my tasks, they could possibly miss out or be delayed in receiving a wash, personal grooming and more immediate concerns such as drug administration, each can have a knock on effect, disrupting the ward flow and disrupting not only the staff, but the patients welfare

Respect For Colleagues
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Through this I have learned that because of a wards structure, nurses operate alongside each other and must trust one an-others instructions, advice and records pertaining to patients, any disruption for instance, two members of staff who refuse to talk, can prove troublesome in helping the patients and communicating information to doctors, secondary care team staff and visitors, who require up to date information and need staff to be able to work alongside one another to enable a smooth running of the ward. Any trouble must be talked over privately and any issues, stamped out and agreed upon to maintain efficiency

Truthfulness
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I have been working in a Cardiac And Recuperation Ward, as such, it is a high risk ward. It is important in every single case to record and present information that will used by the higher care team accurately, any deviations or mistakes could cost the patient perhaps a delay in their administration or prescribed care plan. When faced with visitors who require information, moral stances must go to one side and they must be told their relatives or friends condition with accuracy and with a reasonable forecast in their condition

Attendance
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From my own irregular attendance, I have came to discover how disruptive even a day here and there off working in the ward can be, any long term plans cannot be followed through both on nursing and patient sides and most notably, how a ward is staffed and ran with the acceptable number of people, any less than a full compliment can cause considerable distress to other members of staff as they have to try and do basically two jobs at once

Enthusiasm For The Role
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In my abilities as an observer of the ward, I found that general nursing and auxiliary nursing entails a great deal of motivation beyond the need to work, nurses cannot find themselves stagnating in their career and must at all times, even under pressure, put all concentration and focus on their job, if they do not, patients and staff around them suffer

A willingness to seek supervised practical help to aid professional development
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Through this I have gained insight on how best to accomodate a patients needs without risking their immediate health in any way, this also helps me gain valuable practice and referral to new treatments being administered by a higher grade nurse or equivalent, and also allows me to put that experience and observation into practice straight away

Understand the possible barriers to communication
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I have realised the possible embarrassment that people may have if they lose the powers of speech or motor control, I have gained valuable lessons in how to communicate effectively with people through any means they know and not discriminate towards them because of their disability, loss of speech or prolonged degradation of speech can result from a number of factors, so it is important to find these and deal with it accordingly

Demonstrate Sensitivity In Interactions With Patients
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Throughout my time in the ward, I have came to the realisation that patients are individuals, therefore they have not only a physical side to treat but their emotional well-being must not be hampered in any way, in a situation that requires privacy, perhaps washing and toilet functions, the patient must be asked if they require any assistance and privacy must be ensured at all times, this enables them to put trust in their nurse. Also, a nurse must not in any way ask the patients for information that does not correspond to the short and long term care plan without due reason and with permission from the patient first

Acknowledge the boundaries of a professional care relationship
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As a nurse, I am expected to retain my professional role at all times during my work, therefore I am not in any position to offer off-hand or negative comments towards patients, neither is it within my role to speak freely about conditions or people within the ward

Contribute to measures to ensure the privacy of the patient
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Through this I have learned that a patient under my care must always be ensured of their privacy, this is achieved by asking them whether they require privacy to be with family members, friends etc... or are receiving treatment in their bed and require the curtains pulled around them and so on

Contribute to measures to ensure the dignity of the patient
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Through this I have learned that patients must at all times retain overall rights to their "personal space", this means for example, requesting assistance in washing and toiletry functions and consultations with their doctor and care team, all this must be under strictest confidentiality, either in conversation or in action i.e going to the toilet and ensuring they are not seen by anyone else, are not spoke about negatively by anyone else and are comfortable enough in their position without further embarrassment or hassle

Understand the importance of patient empowerment
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Patient empowerment allows the individual to decide and be made aware of all choices and alternatives in relation to their time in the ward, interactions with the care team and their care plan. Any decisions that are initially suggested to them must be made clear and agreed upon wholly, this relates to a patient with full mental grasp, alternatives for patients with some mental degradation can be placed with relatives, close friends or higher consultants who feel a particular course of action is best for them

Understand the need for the care worker to operate as an advocate for the patient in certain situations
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As I worked in a cardiac ward, the number of patients who experienced some cognitive difficulties ensured that their appropriate care worker made decisions on their behalf and got their own good, these decisions are made on solid facts from records and consultations with other care team members in regards to further recuperation

Demonstrate fairness and sensitivity when responding to patients from diverse circumstances
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Through this I have learned to accomodate a patients individual decisions and choices no matter what their background, sexual orientation or religious beliefs, these make no impact in providing the most constructive plans regarding their recuperation

Recognise the needs of patients whose lives are affected by disability
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Through this I have came to respect and realise the full extent that a persons disability can affect their life and how they are able to lead a full life without hindrance

Demonstrate an awareness of assessment strategies to guide collection of data for assessing patients
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In the cardiac ward, there are many forms of data that are needed for long-term planning for a patient, along with my case study, I researched forms of data collection including basic blood pressure results, diabetes results, electrocardiograms and heart sensor ultrasounds, these enabled me to get a full grasp of what planning takes place for each part of a persons physical ailment and also taking into account secondary care team members who may wish to perform stamina and mobility assessments, diet checks and future housing assessments if required

The ability to discuss the prioritisation of care needs
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From this I have learned that a patients needs are not uniform and are subject to a number of physical and mental assessments, these include whether or not they are able to mobilise when required, able to feed and administer drugs themselves and so on... all these can have a knock on effect of the overall care plan so the most important needs need addressed first

Awareness of the need to re-assess patients as necessary
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Through this I have discovered that a patients condition can fluctuate over time, this allows for the care team to constantly forecast changes and refinements to their on-going treatment without fear of treatment becoming necessary or providing too little for the patient etc...

Inclusion of physical, psychological, social and spiritual needs of patients
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I have realised in my time in the ward environment that a holistic approach to patient care is important as each particular need needs to be addressed, not just their physical condition

The ability to identify care needs based on the assessment of a patient
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Through this I have learned that a patient may exhibit certain conditions within the hospital environment and just not the initial symptoms, these must be picked up on and treated accordingly

Effective communication skills
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A nurses role must include providing accurate and up to date information to care teams, patients and visitors without error and without hesitation to provide information when it may be vital to a patients recovery

Maintaining Confidentiality
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The data protection act of 1999 ensures ward staff and patients alike of absolute non-disclosure of information pertaining to their condition, treatment, whereabouts and so on, these issues must be in place and acted upon by nursing staff at all times

Effective observational skills
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Through this I have learned that a nurse must also be adequately equipped to observe any changes in a patients manually i.e without blood pressure machines, pulse monitors etc... these small signs that may appear could have negative consequences later for a patient if no action or no warning is given by a nurse

Taking physiological measurements
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My time spent in cardiac and college has allowed me to equip myself with intermediate skills to observing patients and taking measurements, using manual aids such as blood pressure pads and electronic equipment such as electrocardiograms, these are also complimented by visual cues such as increased respiration, changes of skin tone, pulse rates, breathing rate etc...

Safe practice in moving and handling
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I have trained in safe moving and handling and I have learned later on that it is essential for both nurse and patient to observe and follow these procedures as to cause no long-term injury or cause accidental injury to a patient who for example may be very frail and requires alot of assistance when moving

Essential first aid and emergency procedures
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In a ward setting, patients may exhibit abnormal signs at any time, may pass out or fall, causing sometimes bad injury, basic first aid training will help the majority of these cases

Safe practice in administration of medicines
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Through this I have learned that particular drug types, if mistakenly given to the wrong patient, can have adverse effects on their condition, they may be allergic to certain drugs etc... so all drug output must be checked twice over with doctors and charge nurse before final administration

Meeting emotional needs
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Through this I have learned that a patient must be treated as an entire individual as emotional unwellness can have a detrimental effect on their physical recuperation, this can be achieved by having them speak to a hospital councillor or simply taking time to speak to a member of staff if they request

Meeting physical needs
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Every patient must be treated with the same amount and level of care as expected from the nurse, this includes evaluating and detecting any signs of physical discomfort if not given by the patient and correcting them accordingly in any situation

Nervous System
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Question Two

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Johnson's Model Of Care broke ground in such that the affliction was taken out as part of the priority and the patient themselves was treated individually as the most important aspect of improving their condition. Because of Thomas' co-operation with care staff but steadfast refusal to exercise in his own time, the Johnson model was theorised to incorporate behavioural change over a period of time, resulting in an equilibrium where the patient believe they are suited to their environment, Thomas' progress has stagnated i.e he does not progress in developing mobility comparable to what it was before the road accident and the final notes include an idea for alteration in coping with a wheelchair bound patient. The theory consists of a behavioural system comprising of seven sub-systems

Attachment - Inevitable closeness to those who care and help
Achievement - Realising Thomas' own goals and successfully reaching them
Aggressive Tendencies - Faltering at those goals, resulting in aggression at himself
Dependance - If reliance on others is needed for physical and mental support
Sexual Needs
Ingestive Systems
Eliminative Qualities

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The Henderson Care And Nursing Model integrates the nurse as the "second person" in a patients recuperation, they are at every stage of treatment and recovery so therefore, for example, the nurse is a patients arms, mobility, therapist, carer, communicator etc... and this in turn allows the patient full independence even when their physical and mental state does not allow them on their own

The model incorporates four belief systems

Physiological - The patient has the necessities of day to day living such as normal respiration, plentiful nourishment, ability to regularly discharge waste and alter their position when required and when in distress, full rest and relaxation, changes of clothes when needed, the ability to change their surroundings to suit them and so on

Sociological - All actions undertaken by a patient must further not only their treatment but must also be undertaken to allow accomplishment in themselves

Spiritual - That the patient has full rights and freedom to practice their religious beliefs and this does not become a hindrance to their recuperation

Psychological - Every part of a patients recuperation can have negative effects on that person if it fails, it can cause relapses of trust, attitudes towards carers and their own self-confidence

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Question Three

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In regard to Thomas' physical health, the spinal injuries received, in whatever scale, are always very dangerous due to the spines intolerance to prolonged pressure and strain, Thomas's may find that he can regain mobility from a wheelchair but loss or degradation of some motor control.
His accident and long-term rehabilitation may have brought some loss of memory, the unwillingness to perform tasks may be related to Thomas possibly being unable to remember simple things, an example includes preparing a meal or dressing correctly.
Prolonged absence from work may find him under continued pressure to return and at the same time, further his recuperation, perhaps leading to more stress which could hinder his recuperation

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Question Four

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With Thomas' apparent refusal to take up regular rehabilitation exercises, he would be best helped by a recuperative care program, this provides Thomas with a trained physiotherapy worker, regular monitoring with his social worker and a pre-planned set of goals, each focusing first on regaining full mobility, exercise to build on what motor control is being improved, diet management, medical treatment when necessary, a full course on day to day task management and planning for any modifications to his home. Encouragement through each of these stages is recommended as much as possible with the aid of family members and friends, as Thomas has difficulty maintaining regular mobility exercises, feeling as if he is failing etc... Independent living can be achieved from house modifications, grip bars, walk in washing facilities, lowering of switches, wheelchair ramps if needed and emergency contact cords

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Question Five

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As Thomas refuses to commit to exercise plans, this is may be a sign of sudden but prolonged in-confidence within himself, before the accident he kept fit and was no doubt proud of his physical activities so the mental block of beginning from scratch the basic skills he used before without conscious effort is now enough to almost completely hinder his progress in physically recuperating.
Thomas' refusal to see his children is also a sign of his in-confidence and his "shattered" self-image, it may be that without the added encouragement of his children, he will find that trying to set goals, for example, 100% walking function will be hard alone, it may also be he does not want his children to see their father in such a immobile state because as before, he was at a peak physically.
As Thomas spends more time voluntary immobile, his body will suitably react and "intensify" his condition. If Thomas begins to try and reach a more mobile way of life, his body may be dormant, loss of sensory and motor function will accelerate leading to possible limits to how fully mobile he could be, it is vital for him to begin recuperation of his physical abilities as soon as possible.
User Journal

Journal: Thomas

Journal by ten000hzlegend
Question One

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The nervous system comprises of three main sections, the brain, which receives all input from the nervous system, the peripheral nervous system and the central nervous system. The peripheral nervous system comprises of sensory neurones, messengers from stimulus receptors that provide the central nervous system with information about our bodies stimuli, and motor neurones, also leading to the central nervous system. The central nervous system is the term for our brain and spinal cords linked function. The peripheral consists of the somatic nervous system comprising of neurone banks which lock onto the sensory sensations i.e sight and smell and delivers them to the cerebral cortex within the brain where they are interpreted on a conscious level, some signals are then fed to motor components (efferent nerves) which in turn allow conscious control over our limbs. The automatic nervous system within the PNS delivers sensory input from each major organ through the spinal nerves to the brain (mainly the hypothalamus and medulla). The ANS then splits into two parts, the sympathetic and parasympathetic systems. The impulses received into the brain from the sensory and central organs are then sent back out through the sympathetic and parasympathetic nerves. The sympathetic link with nerve bodies within the spine, resulting in stimuli finally being conveyed controlling our unconscious reflexes, digestive functions, rate of breathing etc...

The central nervous system comprises firstly of the spinal cord. This cord running down the back relays all signals from the PNS directly into the brain and afterwards receives information from the cerebral cortex to our muscle groups located on the skeleton, heart and within the arteries. The brain receives all input, sensory or otherwise from the PNS and spinal cord

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Question Two

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Johnson's Model Of Care broke ground in such that the affliction was taken out as part of the priority and the patient themselves was treated individually as the most important aspect of improving their condition. Because of Thomas' co-operation with care staff but steadfast refusal to exercise in his own time, the Johnson model was theorised to incorporate behavioural change over a period of time, resulting in an equilibrium where the patient believe they are suited to their environment, Thomas' progress has stagnated i.e he does not progress in developing mobility comparable to what it was before the road accident and the final notes include an idea for alteration in coping with a wheelchair bound patient. The theory consists of a behavioural system comprising of seven sub-systems

Attachment - Inevitable closeness to those who care and help
Achievement - Realising Thomas' own goals and successfully reaching them
Aggressive Tendencies - Faltering at those goals, resulting in aggression at himself
Dependance - The need to find support on those around, to ensure constant encouragement
Sexual Needs
Ingestive Systems
Eliminative Qualities

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The Henderson Care And Nursing Model integrates the nurse as the "second person" in a patients recuperation, they are at every stage of treatment and recovery so therefore, for example, the nurse is a patients arms, mobility, therapist, carer, communicator etc... and this in turn allows the patient full independence even when their physical and mental state does not allow them on their own

The model incorporates four belief systems

Physiological - The patient has the necessities of day to day living such as normal respiration, plentiful nourishment, ability to regularly discharge waste and alter their position when required and when in distress, full rest and relaxation, changes of clothes when needed, the ability to change their surroundings to suit them and so on

Sociological - All actions undertaken by a patient must further not only their treatment but must also be undertaken to allow accomplishment in themselves

Spiritual - That the patient has full rights and freedom to practice their religious beliefs and this does not become a hindrance to their recuperation

Psychological - Every part of a patients recuperation can have negative effects on that person if it fails, it can cause relapses of trust, attitudes towards carers and their own self-confidence

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Question Three

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In regard to Thomas' physical health, the spinal injuries received, in whatever scale, are always very dangerous due to the spines intolerance to prolonged pressure and strain, Thomas's may find that he can regain mobility from a wheelchair but loss or degradation of some motor control.
His accident and long-term rehabilitation may have brought some loss of memory, the unwillingness to perform tasks may be related to Thomas possibly being unable to remember simple things, an example includes preparing a meal or dressing correctly.
His home at the time of the accident would have obviously been wholly unsuitable for a disabled person, therefore his care plan, when drawn up, must include modifications that will be carried out, grip bars, washing facilities, assistance with steps or easier access to various areas, if not in place, this could affect Thomas' level of mobility, already faltering

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Question Four

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With Thomas' apparent refusal to take up regular rehabilitation exercises, he would be best helped by a recuperative care program, this provides Thomas with a trained physiotherapy worker, regular monitoring with his social worker and a pre-planned set of goals, each focusing first on regaining full mobility, exercise to build on what motor control is being improved, diet management, medical treatment when necessary, a full course on day to day task management and planning for any modifications to his home. Also, because Thomas feels he cannot do this to the best of his abilities, family and friends must ensure his recuperation goes smoothly, encourage him when he fails or feels that he cannot recover from his injuries as planned. Because full recovery may not be possible, rehabilitation may be necessary to accomodate Thomas to the fullest in regards to his optimum mobility, homes designed to provide full accessibility to the wheelchair bound etc...
Thomas before the accident was fully fit and mobile, because of his limited mobility, independent living can be achieved by firstly outlining and detailing his learning in how to use various aids, even wheelchair manoeuvrability and handling, and also refitting his home, if not moving, to be more accessible as outlined above

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Question Five

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As Thomas refuses to commit to exercise plans, this is may be a sign of sudden but prolonged in-confidence within himself, before the accident he kept fit and was no doubt proud of his physical activities so the mental block of beginning from scratch the basic skills he used before without conscious effort is now enough to almost completely hinder his progress in physically recuperating.
Thomas' refusal to see his children is also a sign of his in-confidence and his "shattered" self-image, it may be that without the added encouragement of his children, he will find that trying to set goals, for example, 100% walking function will be hard alone, it may also be he does not want his children to see their father in such a immobile state because as before, he was at a peak physically.
As Thomas spends more time voluntary immobile, his body will suitably react and "intensify" his condition. If Thomas begins to try and reach a more mobile way of life, his body may be dormant, loss of sensory and motor function will accelerate leading to possible limits to how fully mobile he could be, it is vital for him to begin recuperation of his physical abilities as soon as possible.
User Journal

Journal: Nursing Speech Therapy Remediation

Journal by ten000hzlegend
required but is the only option available.
Because nurses operate on different training and grades, the levels of their abilities can differ in relation to a patients specific care needs, therefore specific treatment and procedures can be out-with a nurses abilities, a student for example, may find catheter changes or multiple IV inputs not part of their experience on a practical level and any undertaken without supervision may cause risk of injury to the patient. A speech therapist has many roles such as interpreter and consultant, knowing when to stop any interaction of patient treatment in relation to their abilities is essential, it may cause relapses in therapy and "false positives" in a patients speech i.e re-learning and forming normal speech but forgetting it again.
Nurses, in any situation must be aware of their limitations as seen above, but a patients recovery can be hampered by a number of unknown factors, these include mobility loss, emotional and mental difficulty and unknown factors at home, recognising these is essential and part of their work but referral to the correct health care groups must be followed through, a nurse cannot take on the role of a occupational therapist or a social worker etc... The same applies to speech therapists, any unknown factors out-with their abilities must be referred.
Professional supervision is a reliable tool for ensuring a nurses standard of work is constantly high and also ensuring any changes and proposals made to any form of treatment with a patient is up to date and the best for their recuperation, this includes new nurses being supervised though sub-dermal treatments even to basic patient care duties. Speech therapy is a constantly revised profession, therefore all new and experienced workers attend and are supervised by fellow therapists, this also as with nursing is to ensure that the level of care and treatment being administered is high, especially as recuperation rates are in some cases, slow and can take months of work to reach normal speech function again
User Journal

Journal: Case Study

Journal by ten000hzlegend
1 - This assignment is based on information given by the client and relevant medical records obtained from the ward only, permission for full disclosure within this assignment was given by both client, relatives and ward sister, any reproduction of this information found out-with this copy is not permitted to be kept by college or nursing staff.

William Redfern, aged 54, was born on 25/09/1949 in Dunmurry, just south of Belfast in Northern Ireland, brought up in what was described as a comfortable middle class setting. His mother did not work and his father was an accountant with the government. He has a brother and sister, both eighteen years his junior, soon after their birth, their father, Louie, died of a heart attack, he was described as being a healthy man who did not smoke, rarely drank and in relatively good shape for his age. This was recorded as being a condition that ran through the family, weakened hearts and artery problems, notably in himself, his father and uncle. The usual childhood ailments appeared such as chicken pox and measles. Leaving school to join the Royal Academy Of Drama And Arts, he moved to Strathaven and took a position as a sales assistant to fund his courses. He later gave up acting to pursue a career in sales where he is currently. Being of an average frame, he did not drink and gave up smoking a year before any illness or conditions became apparent. In summer 2003 he began experiencing irregular chest discomfort, not any particular pains. Having had them for a few days, he consulted his G.P and was found to have some blockage of his main arteries feeding blood to the heart, deteriorating rapidly, William was brought into hospital and at 3am the morning after admittance, suffered a heart attack. Fortunately, being under supervision, survived and was transferred to intensive care for eight weeks, in which time he received a triple heart bypass and an artery valve replacement which stabilised his heart

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User Journal

Journal: Healthy Eating And Diet

Journal by ten000hzlegend
http://www.bbc.co.uk/health/yourweight/eatingwell_life2.shtml

http://www.age-net.co.uk

http://www.nutristrategy.com/digestion.htm

http://www.hebs.scot.nhs.uk/

http://arbl.cvmbs.colostate.edu/hbooks/pathphys/digestion/smallgut/absorb_minerals.html

http://www.show.scot.nhs.uk/thpc/

http://www.learn.co.uk/citizenship/topicallessons/elderly/article1.asp

http://www.foodstandards.gov.uk/multimedia/pdfs/eatingforlaterlife.pdf

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In this assignment, I shall be detailing the dietary and health needs of older and elderly persons

1 - A Balanced Diet
2 - The Digestion And Absorption Of Nutrients
3 - Preparation And Processing Of Food
4 - Inadequate Diet And Health
5 - Finance And A Healthy Diet
6 - Influences In Eating Behaviour
7 - Guidelines For Healthy Eating

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1 - For older adults, physical requirements decline due to less frequent physical activity, allowing less overall calorie consumption, but vitamin and mineral (i.e Iron) intake increases, becoming more pronounced in elderly people (For example - Supplemental vitamins such as Vitamin D which helps calcium mineralisation of bone structure). A balanced diet for someone aged between 55 and 75 includes basic staples that are rich in starch i.e bread, potatoes and rice, this being the most abundant in the overall diet due to the less-efficient breakdown of nutrients in an older persons body and slower metabolism which can subside any benefits

(Diagram - Diet Pyramid)

Fruit, being rich in most notably Vitamin C, allows for an increased immune system response as this declines as a person reaches their 60's. Meat, dairy and high fibre foods such as cereal are recommended as long as they do not contain alot of or are complimented by cooking fats, high salt intakes and any sugar. This diet is subject to diverse change as many older people may have difficulty eating and digesting food

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2 - Digestion is the mixing, transport and breakdown of food into the various requirements of the body that it uses to stay healthy, the five major nutrient groups break down as follows -

Proteins - Meat and most vegetables contain the most protein delivered to the body, these are broken down by stomach juice, containing enzymes and is then delivered to the small intestine where the intestinal lining completes the breakdown, turning the initial protein into amino acid, the basic requirements for body repair, from these, absorption occurs through the intestine hollows to the bloodstream and allows further cell build-up, repair and removal in the body

(Diagram - Primary Digestion and Absorption Route)

Carbohydrates - An older person will take in an abundance of carbohydrates from, for example, breads and pasta as seen above, they are split into two types, digestible carbohydrates which do not contain fibre and non-digestible, digestible carbohydrates are broken down by saliva enzymes firstly, maltase is the outcome, type of molecules that derive from starch, this then is brought to the small intestine, where it is converted into glucose, only then can absorption occur into the bloodstream primarily and this is used later to provide additional energy

Fats - Once fats are ingested, they are immediately dissolved to stop any blockages in intestinal and bloodstream routes, fats comprise of very large molecule clumps and bile acid from the liver break these down which allow movement into local cell groups without danger, once the transport is complete, the cells contribute to "reforming" the molecules again at which point they can be used to provide energy

Vitamins - There are two types of vitamins, water-soluble and fat-soluble, these are pivotal in the overall role of the digestion system as they allow the later absorption of minerals and amino acids into the bloodstream for example

Minerals - Mineral digestion occurs at the small intestine, normal concentrations must be regulated as they can cause toxic side-effects at abnormal levels, the most common, calcium and iron, are brought into the enterocyte, specific cells of the actual intestine, and then transported straight into the bloodstream and extracelluar fluid without intervention

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3 - Older people, especially the elderly can find food preparation and finding non-processed food a hindrance, this may be due to physical limitations and mobility, especially when trying to go to supermarkets or even transport groceries etc... because it is advised that they eat freshly prepared food, soft and carbohydrate rich i.e bread, it is perishable after only a few days but retains much of the initial nutritional value, as seen below, high-yield and long life foods do not retain all of their nutrition i.e tinned foods and recently frozen foods. Food poisoning can prove fatal, especially with people with previous heart or immune system conditions, improper use of processed foods, after expiry date or stored incorrectly, sometimes due to increasing confusion after an illness or a condition, can lead to salmonella from eggs and more commonly, campylobacter, that can cause severe respiratory problems and loss of bowel control

Most foods subject to preparation in a recommended older persons diet consist of whole meals, relatively little snacks and fat and sugar based foods. The nutritional impact of whole meals is affected by factors such as what sources of food are being used, frozen or fresh - and whether or not they have the capacity to fully cook for themselves

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4 - Because of the negative changes that occur to an older persons physiology, it can cause irreversible degradation if an improper diet is kept. Practical abilities to actually consume food can include poor dental health, most apparent in elderly people, swallowing and sensory deprivation and loss of acute motor control over time, these in turn effect the actual types and frequency at which food is consumed. Most notably is a low calcium intake from dairy products, this can cause weakening of the bone structure, lowered metabolism and more commonly, osteoporosis, a disease that causes recurrent joint and bone fractures. the Malnutrition Advisory Group reported in 2003 that one in seven people in the UK are improperly nourished. Because of the move away from fatty and salty products, continuing high consumption of fatty foods cause high cholesterol, a primer for heart disease and more commonly, strokes and peripheral vascular disease and at above the age of fifty, can be very serious. This in turn causes considerable strain on the NHS due to effects relating to a bad diet, 41 percent of people aged 55 to 70 have a limiting illness or disability, a majority due to prolonged health and diet concerns

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5 - Statistics shown in the 2001 Scottish Census show that over a quarter of people near or beyond retirement age live on half the mean annual income of a normal household, barely on the poverty line, a majority of that income goes to electricity, heating and gas bills, therefore for many, obtaining adequate food can prove difficult, resorting to somewhat cheaper and nutritionally inadequate products, highly saturated fat foodstuffs for example. A comfortable living is based primarily on a persons social setting, a less well-off area consists of low-income households with a large elderly population, therefore the choice of food available is restricted by budget. "High-yield" foods, which can be bought in quantity from local supermarkets allow incomes to stretch but at some sacrifice of carbohydrate rich foods and dairy products that deliver suggested daily intakes, especially as a older persons physiology demands more and more vitamin and starch rich sources.

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User Journal

Journal: Thomas' Recuperation And Nervous System

Journal by ten000hzlegend
Question One

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The nervous system comprises of three main sections, the brain, which receives all input from the nervous system, the peripheral nervous system and the central nervous system. The peripheral nervous system comprises of sensory neurones, messengers from stimulus receptors that provide the central nervous system with information about our bodies stimuli, and motor neurones, also leading to the central nervous system. The central nervous system is the term for our brain and spinal cords linked function. The peripheral consists of the somatic nervous system comprising of neurone banks which lock onto the sensory sensations i.e sight and smell and delivers them to the cerebral cortex within the brain where they are interpreted on a conscious level, some signals are then fed to motor components (efferent nerves) which in turn allow conscious control over our limbs. The automatic nervous system within the PNS delivers sensory input from each major organ through the spinal nerves to the brain (mainly the hypothalamus and medulla). The ANS then splits into two parts, the sympathetic and parasympathetic systems. The impulses received into the brain from the sensory and central organs are then sent back out through the sympathetic and parasympathetic nerves. The sympathetic link with nerve bodies within the spine, resulting in stimuli finally being conveyed controlling our unconscious reflexes, digestive functions, rate of breathing etc...

The central nervous system comprises firstly of the spinal cord. This cord running down the back relays all signals from the PNS directly into the brain and afterwards receives information from the cerebral cortex to our muscle groups located on the skeleton, heart and within the arteries. The brain receives all input, sensory or otherwise from the PNS and spinal cord

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Question Two

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Johnson's Model Of Care broke ground in such that the affliction was taken out as part of the priority and the patient themselves was treated individually as the most important aspect of improving their condition. Because of Thomas' co-operation with care staff but steadfast refusal to exercise in his own time, the Johnson model was theorised to incorporate behavioural change over a period of time, resulting in an equilibrium where the patient believe they are suited to their environment, Thomas' progress has stagnated i.e he does not progress in developing mobility comparable to what it was before the road accident and the final notes include an idea for alteration in coping with a wheelchair bound patient. The theory consists of a behavioural system comprising of seven sub-systems

Attachment - Inevitable closeness to those who care and help
Achievement - Realising Thomas' own goals and successfully reaching them
Aggressive Tendencies - Faltering at those goals, resulting in aggression at himself
Dependance
Sexual Needs
Ingestive Systems
Eliminative Qualities

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The Henderson Care And Nursing Model integrates the nurse as the "second person" in a patients recuperation, they are at every stage of treatment and recovery so therefore, for example, the nurse is a patients arms, mobility, therapist, carer, communicator etc... and this in turn allows the patient full independence even when their physical and mental state does not allow them on their own

The model incorporates four belief systems

Physiological - The patient has the necessities of day to day living such as normal respiration, plentiful nourishment, ability to regularly discharge waste and alter their position when required and when in distress, full rest and relaxation, changes of clothes when needed, the ability to change their surroundings to suit them and so on

Sociological - All actions undertaken by a patient must further not only their treatment but must also be undertaken to allow accomplishment in themselves

Spiritual - That the patient has full rights and freedom to practice their religious beliefs and this does not become a hindrance to their recuperation

Psychological - Every part of a patients recuperation can have negative effects on that person if it fails, it can cause relapses of trust, attitudes towards carers and their own self-cofidence

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Question Three

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In regard to Thomas' physical health, the spinal injuries received, in whatever scale, are always very dangerous due to the spines intolerance to prolonged pressure and strain, Thomas's may find that he can regain mobility from a wheelchair but loss or degradation of some motor control.
His accident and long-term rehabilitation may have brought some loss of memory, the unwillingness to perform tasks may be related to Thomas possibly being unable to remember simple things, an example includes preparing a meal or dressing correctly.

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Question Four

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With Thomas' apparent refusal to take up regular rehabilitation exercises, he would be best helped by a recuperative care program, this provides Thomas with a trained physiotherapy worker, regular monitoring with his social worker and a pre-planned set of goals, each focusing first on regaining full mobility, exercise to build on what motor control is being improved, diet management, medical treatment when necessary, a full course on day to day task management and planning for any modifications to his home.

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Question Five

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As Thomas refuses to commit to exercise plans, this is may be a sign of sudden but prolonged in-confidence within himself, before the accident he kept fit and was no doubt proud of his physical activities so the mental block of beginning from scratch the basic skills he used before without conscious effort is now enough to almost completely hinder his progress in physically recuperating.
Thomas' refusal to see his children is also a sign of his in-confidence and his "shattered" self-image, it may be that without the added encouragement of his children, he will find that trying to set goals, for example, 100% walking function will be hard alone, it may also be he does not want his children to see their father in such a immobile state because as before, he was at a peak physically.
As Thomas spends more time voluntary immobile, his body will suitably react and "intensify" his condition. If Thomas begins to try and reach a more mobile way of life, his body may be dormant, loss of sensory and motor function will accelerate leading to possible limits to how fully mobile he could be, it is vital for him to begin recuperation of his physical abilities as soon as possible.
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Journal: Isabel

Journal by ten000hzlegend
(1) - When Isabel is in the ward before discharge, the nursing team can firstly ensure Isabel can regulate and monitor her diabetic condition, in relation to her continuing memory loss, this may prove either difficult for regular monitoring or even impossible. Ensuring she knows if and when to seek advice when diabetic symptoms become worse or erratic must be resolved at the ward level. Along with her renal failure, the ward staff can record when Isabel is able to properly maintain bowel control, noting if she needs changes made to her accommodation when discharged because of that, also related is her bowel movement, whether or not she is either

1 - Regular, able to use the toilet when needed and not when it may become involuntary after long periods
2 - Able to realise she has to go to the toilet when needed

Because her cardiac condition is unstable, her mobility has faltered and as such, the ward team may have been called upon on occasion to help her with more day to day tasks such as a getting out of bed and washing, the nursing team must also in this case, refer any such cases to the social care team so they can forecast changes made to her care plan and accommodation

The ward team must be aware of her physical and mental awareness when she is discharged, which will deteriorate, overall, they must record any and all difficulties Isabel has had and what negative side effects of treatment she has encountered. In the ward, a patients symptoms and difficulties come to light and are a precursor to any problems in their own homes, where these negative effects cannot be resolved so soon or as well, it is important for the nursing staff to then work alongside the social care team in not only highlighting these for reference and to work a solution out, but also continually monitor progress the patient makes in recuperating, unfortunately, in Isabel's case, her conditions have only furthered her deterioration, especially when she was brought to the ward for the pulmonary embolus, this condition can cause very low blood pressure and a near absent pulse, very dangerous for a patient with cardiac trouble

The health and social care team work for Isabel to best integrate her back into the community, any changes and records of her ill health and physical activity from the ward team are used to plan out all changes

1 - Dietary requirements and any changes to her day to day diet
2 - Changes to her home, whether it be safety measures such as emergency alarms, walk-in showers and washing apparel, more stringent security i.e house alarms
3 - Enabling Isabel to find help if needed in neighbours and close friends as her family are not nearby to be called on, as they are elderly themselves, this precaution has to be kept as more of an emergency, although the social workers must be made aware of any close ties to with Isabel and neighbours in this situation
4 - Giving Isabel the chance to become familiar with her physical treatments, diabetic injections that can be carried out in the home etc...

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(2) - The primary health care team for Isabel consists of a district nurse and a health visitor

The district nurse is a general nurse with experience in community work, they are connected to GP's in order to help patients such as Isabel who is increasingly unable to leave her home to receive treatment which doesn't require frequent hospital stays

The health visitor is also registered as social worker, they will provide Isabel with the skills required to treat herself and give health information, they also can warn of potential limiting factors to her mobility around the home and community

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(3) - As above, beginning with discharge, the social workers assigned to Isabel will make an outline of any safety concerns in her home setting, ensuring maximum mobility, they also work with health visitors to ensure not only is Isabel receiving adequate treatment in her home, but is also administering it correctly due to her failing memory. Once initial treatment is underway, occupational therapists can help "climatise" Isabel to the changes in her home, whether it be a new bathing system or emergency cords and assistance intercoms, her mobility records can be passed onto physiotherapists and any dietary requirements and changes will be made useful by resident dieticians

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(4) - Isabel is becoming increasingly frail, both physically and mentally, as such, many activities such as washing and cooking become increasingly hazardous

(Risks)

1 - Isabel may find cleaning tiresome and exhausting, over time, her accommodation may become unsuitable, dust and dirt will affect her health over time

2 - Due to her forgetfulness, leaving a bath running or forgetting to turn off the cooker, although rare, can happen

3 - Since her mobility has decreased, moving around her home, if it has steps, can be dangerous, less voluntary motor control can become at the least, a hindrance, and a hazard, leading to accidents, falls and serious injury

4 - Toxic and chemical based substances can be confused with other household items, can lead to digestion or unchecked use

5 - Insecure house equipment such as televisions, light fittings etc... which require irregular maintenance

6 - The increasing treatment she receives and must maintain herself could fall behind and for example, a catheter change may not be followed through properly, although this fully would not be done alone, when it requires drainage, it may be blocked, leading to considerable distress

(Measures Taken)

1 - Her care worker could arrange for regular dusting and cleaning, this would be a considerable improvement over Isabel trying to clean on her own, and would enable her lungs and cardiac condition to not deteriorate further due to external health hazards

2 - In some circumstances, timers can be set on potentially hazardous appliances, but her carers could enforce to her the need to remember when and IF she has ran a bath or turned on the cooker etc...

3 - Allowing guard and grip bars around the wall can enable Isabel to further her "feeling" of safety, if she falters or temporarily unable to walk anywhere, as seen above, if there are steps, the carer can help in the purchase of a stair-lift and a walk in washing facility, which takes the need to be off her feet as much as possible

4 - Labelling of hazardous substances must be made, and all non-vital equipment, products and material must be taken out the house

5 - Safely attaching all large and free utilities will reduce the risk of injury through tipping etc... and also raising the ambient light level at night will allow Isabel to notice any dangers and move more freely around her home

6 - Social and care workers must keep regular health check sessions with Isabel, to ensure she is following her own personal care plan, especially as her memory deteriorates
User Journal

Journal: Pregnancy

Journal by ten000hzlegend
Pregnancy - S (Heart) X

Being a teenager is often a maze, story follows rumour, myth follows endless school yard gossip, when it comes to sex, it's strange isn't it how a small insignificant word has gradually found itself to be a recurring theme as you enter young adulthood, as above, sometimes the facts aren't so clear from a friends tale

Conception
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The act of having sex is engraved into our minds, especially in high school, that somewhat insightful chapter will be skipped for now, but conception is fundamentally the most complex stage for both men and women

(Diagram - Sperm And Egg)

As soon as the egg is fertilised, a womens body goes under immediate changes, essentially in that moment, there are two lives, both requiring resources to grow and remain healthy until the moment of birth, signs such as morning sickness do kick in very early, a few days afterwards, but remember, so can a bad flu or virus, if you ever do have unprotected sex and you are or feel rather sick, do obtain the advice of a close friend, relative or your doctor straight away, yes it may be a daunting thought but there is no room for "what-ifs" especially regarding pregnancy.

The early weeks of the pregnancy mark subtle changes to the body, skin feels tender, becoming tired very easily and feelings of sickness continue, remember, the stomach doesn't begin to show expansion until twelve weeks, so the body seems to alert the mother in other ways

(Diagram - Little Embryo)

The picture above is rather strange, in reality, that little blob is roughly ONLY three times larger than the full stop at the end of this sentence. It's obviously tiny, but already, the brain is forming an incredible 250000 cells per minute, the backbone and nervous system are developing and a baby is growing from the egg

A womens breasts, tender as before, begin to swell rapidly, almost overnight in some cases, in anticipation of producing milk for her child, this in turn fattens out the hips and joints.

(Diagram - Ultrasound)

As sure as we've all seen our own scans taken from our mothers, the baby takes on a discernible human form (no pun intended)

At six weeks, the heart has formed, the heartbeat is clear and can be heard during a scan, quite a moment for expecting mothers. Hand in hand with physical changes unfortunately are emotional changes, mood-swings and feelings run high, these are common, sort of like the body reacting to it's new conditions and experiences, rarely though do they begin to interfere in day to day life

The bump finally shows, a somewhat proud moment for a mother, progesterone and oestrogen are two hormones in the body, they basically control emotional change and how you feel inside, well there are FOUR times the amount as before, so the body reacts accordingly... meaning you react accordingly

<--- :-p

Those dreaded spots and blotches that plagued us all may come back due to the abnormal hormone level in the body, to the dismay of some

And yes, it's maternity time around two to four months at most, so waking up for a few days to find your clothes don't quite fit requires an urgent dash to Mothercare!

At three months, the tiredness begins to dissipate, allowing a mother to get through the day with little worry, the body may take time to accommodate to all the changes but at this point, the baby is forming internal organs, it's eyes and ears are nearly formed and it may begin to flex it's developing muscles

The face begins to be "tested" in a sense, all manner of facial expressions take place as lips and brows form

From this point onwards to around seven and a half months, the pregnancy becomes almost routine, the baby grows as expected and the body is stable enough to develop around it, sleeping patterns may be disturbed but it is only for a short time, mostly due to anxiety about the impending birth

The baby will move with every opportunity, bringing the mother along for the ride

(Diagram - NICE picture of pregnant belly)
User Journal

Journal: Speech Terapy And Nursing

Journal by ten000hzlegend
This report will highlight the differing regulation guidelines for general nursing and professional speech therapy - As of 2004

1 - Professional training and registration
2 - Principles of the profession
3 - Code of conduct
4 - Continuing professional development
5 - Evidence based practice
6 - Methods of quality assurance and improvement within the professions
7 - Ethical issues and professional boundaries

(1)

Nursing
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General nursing involves a standard three year course at a medical based college or university, the minimum entry requirement is five GCSE's. The course revolves around both theory based and practical experience. Afterwards, a nursing student may undertake further studies to obtain a diploma in nursing. All new nursing staff must register with the Nursing And Midwifery Council, set up to regulate professional standard setting across all nursing practices

Speech Therapy
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Speech therapy is a standard degree course, a minimum of two years allows both theory and clinical training to be completed, entering into registration afterwards, a more common three year course enabling one hundred and five weeks full work also allows registration with the Speech and Language Therapist Board

(2)

Nursing
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Nursing was the benchmark and is the de-facto standard for the care profession, every patient cared for by a nurse must be delivered the same quality and quantity of attention and care as allowed by the individual, regardless of background, ethnic standing and moral beliefs, confidentiality must be maintained at all times and trust from patients must be obtained and kept to allow the maximum level of care being delivered and ensuring that their health is maintained

Speech Therapy
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Speech therapy as with nursing, follows the same rigid guidelines, every effort must also be made to have the patient co-operate in every action taking regarding their rehabilitation

(3)

Nursing
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A nurse's personal code of conduct follows rules designed to allow accountability in the workplace and when dealing with patients

- View the patient as an individual
- Obtain consent before treatment and care is followed through
- Protect and respect confidential information
- Maintain co-operation with team members
- Maintain professional knowledge and competence
- Be trustworthy, further your trust
- Identify and when able, minimise risks and concerns with patients

This code of conduct is the template for registration within the Nursing and Midwifery Council

Speech Therapy
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Speech therapy is regulated through the health professions council, they follow the same personal codes of conduct as with Nursing

(4)

Nursing
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Developments in nursing allows a nurse to continually update their knowledge of medical treatment and care based practice, this is achieved by attending semi-regular courses for registered members of a nursing team and published journals. The register is for nurses who are committed full time to their profession, as such, they must work 40 out of 52 weeks in the year and complete no less than 1250 hours ward based work whilst attending update courses

Speech Therapy
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Speech therapists registered under the health professions council must undertake no less than ten half days a year out of work to commit to development programs, these include local Speech Therapy groups, mentoring activities, training trainee therapists, firstly under supervision and presentation / contribution work to fellow workers

(5)

Nursing
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Nurses are regulated by their own professional standards that they lay down, they must ensure their ward area is within acceptable hygiene and safety standards for patients, also ensuring their well-being is not compromised in ANY situation, the role of a nurse is to assist an individuals needs, whether it be in the prescription of medication, familiarity in their surroundings i.e a more frail elderly patient and ensuring they are comfortable in both body and mind

Speech Therapy
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Speech therapy entails a great deal of interaction between patient and worker, therefore they must ensure all progress in recovery and recuperation of speech abilities is not superseded by mental or traumatic difficulties i.e loss of speech due to an accident, stroke etc... and that does not become a precursor to a possible relapse of communication abilities

(6)

Nursing
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General nurses operate on a hierarchical standing, as seen above, each action taken by a nurse must be without alternative and must stand to a strict level of scrutiny if it is found to not be the best decision that could have been taken, as such, each nurse must be completely up to date with medical practice and know exactly how to treat patients where no complaint can be made and understand not only what is best for the patient, but what the patient wants for themselves, nurses understand that an individuals rights under the patients charter must accomodate their own personal and professional viewpoints on care

Speech Therapy
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Speech therapy comes under regulation from the health professions council, as such, any disciplinary action and any guidance that has to be taken with workers comes from them, they base their rules on

(7)

Nursing
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As seen in a nurses code of conduct, moral and professional guidelines dictate every action a nurse takes, a patient may find themselves unable to confide and trust a nurse with personal information, even if it is important to their current level of care and medical treatment, consent must be given by the individual or a close family member before treatment is carried out regardless of urgency, except in extreme circumstances. Knowledge of current practices must collaborate with the overall nursing team, important in risk management for example

Professional boundaries include generally not disclosing any information given to a member of staff, either personal or that could have implications for the safety of others and themselves, legal matters that are discussed will in some cases have to be disclosed to, for instance, the ward sister or a confidential meeting with other members of staff or the police if they are believed to have implications outside the law

Speech Therapy
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Speech Therapy comes under the same guidelines as nursing, but also takes extra attention for the treatment and possible "embarrassment" of a patient, as speech therapy sometimes a slow and progressively difficult task, any members of staff found to be possibly ridiculing a patient will be disciplined immediately, this will then be followed by investigation into the patients emotional state as well as potential setbacks to their treatment, this of course, is only one example, the professional boundaries are resolute in ensuring the confidentiality and trust put o the patient
User Journal

Journal: RACHEL AND REBECCA

Journal by ten000hzlegend
(1) - The Children Act, introduced in 1989 enables the state to initially consult with children that may be at risk from elders and make judgements regarding their well-being and safety in a home environment

The following regulations make up the act

- A child's future welfare is the sole consideration of any action undertaken
- Parental responsibility supersedes the concept of rights to a child
- A child has the decision to disassociate from their birth parents at any time
- The state requires to identify children in risk
- The state also has responsibilities in ensuring a child's safety

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The Child Protection Act 1999 takes into consideration who is working with children, either in a social setting or school and whether they are suitable, for instance if they have previous convictions and charges regarding children or they are unable to work alongside children in fear of their well-being

The act comprises of four main stages

- That a legal list of people proved unsuitable to work with children remain on there indefinitely as they could prove a hazard to children
- That current care workers are checked alongside the Child Protection Act list to see if they hold previous charges of any kind
- When children are put into care, the responsible organisation involved obtains criminal checks without delay to ensure long-term care can be maintained
- Anyone found to hold previous convictions is immediately disclosed as not to endanger the welfare of children

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(2) - A children's psychologist could be linked with both sisters to help them come to terms and deal mentally with the neglect and abuse they received, since it would have long serving memories, the psychologist must be aware of their past history with their parents and how the overall relationship with them became more and more negative as time went on, Rachel only talks about the days leading to the attack, therefore the psychologist must try to obtain information that could be used in the criminal charges without causing further disruption to their emotional well-being

A physiotherapist, after initial treatment and recuperation periods, will be needed to guide the sisters into normal health again, because they are both five years old, their physical development must be brought back to normal as soon as possible otherwise later degradation and stunted growth could occur, the physiotherapist must also outline a sensible eating and diet plan

Social workers that could work alongside Rachel and Rebecca for periods are essential to help the children become re-accustomed to a home environment, whether or not the children have been in normal surroundings, the social worker can also introduce them to household safety i.e cookers and provide them with the necessary "home sense" when and if they are relocated to a new family and environment

A long-term councillor, after Rachel and Rebecca are settled and in a secure environment, may be needed to help them relieve the emotional burden that is presently in place, their neglect must not become a template of their views on how adults and carers treat them and their physical abuse cannot be repeated, so therefore the councillor must help them in a sense, re-evaluate their views on home life and also re-integrate them with friends in school and locally where they reside as it appeared they had not been outside playing and socialising for some length of time

The police, along with a children's psychologist will be on hand to help Rachel and Rebecca bring forward any information they can to shed light on the overall neglect that had occurred

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(3) - While the sisters are in hospital, health and oral hygiene checks can begin to ensure they are physically stable and during their hospital stay, a short-term care plan must be set up to provide them with the necessary diets and physical recuperation periods to ensure a full return to health

The patients charter will allow Rachel And Rebecca some freedom in how their treatment progresses, whether or not they require psychiatric care as well as more long-term counselling regarding their previous abuse. Their discharge from hospital will allow them to enter into an educational support program designed to provide abilities to catch up with their current year in school, teachers and tutors supervising their progress in school must be made aware of their previous experiences

Continuous care after hospital must be maintained until a suitable foster family is found, this includes social workers checking regularly with their progress, if they are finding associating themselves with others difficult and their initial refusal to either remain silent or talk only about the attack becomes a setback to become stable again, these factors must become immediately aware to the workers and must be solved during the discharge, pre-relocation stage

A community nursing officer can also alongside social workers, help the children in detailing how to look after themselves i.e hygiene and basic dietary requirements on a long-term basis, this includes a long-term care plan to be set up once relocation has been found

The long-term care plan will be set up with the foster family, it includes the past history of Rachel and Rebecca, special requirements if needed and can accommodate future changes in their recovery, especially mentally

The confusion of a staff member is measured by the length of his memos. -- New York Times, Jan. 20, 1981

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