Examples Of Good Clinical Care Nursing Essay

Examples Of Good Clinical Care Nursing Essay The GMC states that being able to provide good clinical care is fundamental to becoming a doctor1. I must strive to learn and understand the concept of good clinical care so that it is put into practice throughout my future career in the medical profession. I have chosen three specific examples from this year which have helped me analysis, understand and reflect upon the importance of good clinical care in medical practice. Example 1: My first example occurred during a primary care consultation. I was asked by the GP to take the patients history, which I was really quite nervous about, as I had only done so once previously. I proceeded to take the history of the patient, asking the necessary questions. The patient complained of having episodes of shortness of breath. After taking what I thought to be a full history, the GP took over and asked a few vital questions. She asked the patient about his psycho-social history, which I had completed overlooked during the consultation. The patient actually explained that he was recently divorced and had a very stressful job has made him anxious and stressed over the past few months. The doctor explained to the patient that it was quite likely these respiratory problems were due to his stress and anxiety. The GP then asked if there were activities he enjoyed doing in his spare time, and if he had friends and family whom he could talk to. The GP advised him about local support groups available. However, the doctor did perform a chest examination and provided the patient with a peak-flow meter to take home as an investigation measure. Lessons learned: This example taught me the importance of taking a full history in a consultation. The GMC states that one must adequately assess the patients conditions, taking account of the history (including the symptoms, and psychological and social factors).1 I felt embarrassed and disappointed at myself for missing the psycho-social history. It proved to be a vital part of the diagnosis, because if it was simply overlook, the patient may have been wrongly diagnosed and managed. The doctor was quite sure that the problem was due to his anxiety, but still crucially performed a full chest examination, which helped to rule out other conditions, in accordance with the GMC guidance, a doctor should where necessary, examine the patient1. The combination of a full history and examinations/investigations, where necessary, is fundamental to provide good clinical care for your patients. It has been noted by research that understanding each patients biological, psychosocial and cultural background is the foundation of effective patient care.2 Aims: I recognise that various improvements are needed during my medical education. I will practice my consultation skills on a regularly, both on patients and on friends and family. I will especially try to make the most of consultation skill sessions led by the medical school throughout the course, and ask for constructive feedback for guidance in areas needing improvement. I am currently studying the Calgary-Cambridge guide3 on performing a medical interview to make sure I remember all the appropriate points needed to perform a successful consultation. My examination skills will also need to be practised vigorously. Part of building the doctor-patient relationship is performing the appropriate examination. I will set aside 2 hours a week for revision of examination techniques, not simply to pass my OSCEs, but so that as a Doctor I will feel confident and competent to examine and treat my future patients. Example 2: The next case which I feel represents an important example of good clinical care occurred on a home visit to a patient, who had been diagnosed with rheumatoid arthritis over 30 years previously. I was there to discuss her condition and ask all the relevant history which was needed to write a comprehensive logbook. The patient explained that she regularly visited various healthcare professionals in order to control her symptoms. She visited the GP surgery each week for intravenous methotrexate injections, had check-ups with the rheumatology consultant every 6 months to discuss treatment dosage and options, and a physiotherapist every month, to aid with mobility. The patient explained she plays an active role in deciding what treatment is best for her, and had recently (after a discussion with her consultant), decided against a new biologic treatment. She had been given a full explanation about the medication she is on and sticks to her treatment vigorously as she understands the implications of not doing so. The patient felt very happy with the service she received from the NHS. Lessons learned: This case has taught me about the importance of on-going management and treatment of conditions. There must always be good communication between the GP, hospital and other healthcare professionals in order to provide good clinical care for the patient. The GMC state that one must keep clear, accurate and legible records regarding patients, to prevent confusion or mistakes being made.1 Another important issue is to understand the roles of each healthcare professional, which was highlighted in this case. The GMC states that decisions should be arrived at through assessment and discussion with the patient.4 The patient had an active role in decision-making regarding her medication, which she felt very happy about. Hence, it appears vital to show respect to the patient, but also be willing to listen to the patient when deciding a treatment plan. This is in accordance with the GMC guidance stating one must respect the decisions and rights of patients.4 In order to gain full compliance from the patient, providing adequate education is paramount. The patient felt she had been educated suitably about both her condition and treatment, and so she complies fully with her treatment plan, hence communication skills are vital. Research conducted by doctors, which has been published in the BMJ, have concluded that when doctors use communication skills effectively, both they and their patients benefit.5 Providing education about a condition or treatment plan for instance, will require explanation on a level which the patient can understand and follow. Aims: Understanding the roles of other healthcare professionals is important for providing good clinical care, which I am to improve by working hard during IPL sessions during my time at university. I will choose IPL during my third year, even though it is optional, as I can see the relevance and significance of it for providing effective health care for the patient. I will also aim to shadow not only doctors, but other healthcare professionals too. The GMC state that a doctor or medical student must behave with courtesy4 and respect the decisions and rights of patients4, which I feel is something I have always achieved, yet understand that complacency should never be allowed to creep in. The GMC also states that keeping up-to-date records1 and completing work on time4 are important aspects of good clinical care, and so I aim to be thoroughly organised during this course, making sure PBL work is completed on time, and good notes are kept, filed in organised folders. This should prepare me for the organisation levels required as a doctor. Studying conditions very thoroughly, and speaking to as many patients as possible throughout my medical education, will gain me experience at delivering information to patients, hence better at providing education for my future patients. Example 3: My final example from this year occurred on my first day of primary care, and is the most memorable day of my medical education to date. The GP arranged for a patient to come in for a general check-up, simply to demonstrate some basic clinical skills. I remember a feeling of excitement and anticipation of the morning ahead. After the check-up, the patient was asked if he had been feeling fit and well recently, and he casually replied that he had been having pain urinating. The GP seemed quite concerned and asked for a complete history and a urine test, which showed up blood and infection signs. Due to his age and symptoms, the GP decided that these concerning factors needed to be investigated further by the Urologist, who she referred him onto. The patient wanted to know the possible implications, and the GP decided that the patient ought to know that there was a small chance that the possible diagnosis could be prostate cancer. She delivered the news in a very sensitive and empathetic fashion. I remember the patients face went white and he was utterly alarmed by the news. I also felt shocked, and a great deal of empathy towards him. The patient was however grateful that the doctor had decided to refer him on immediately. When the doctor left the room for a moment, the patient asked me about the implications of prostate cancer. I apologised and told the patient I was a first year medical student and therefore not informed enough to talk about any such implications. Lessons learned: The GMC state that one must recognise and work within the limits of your competence and refer a patient to another practitioner, when this is in the patients best interest1. The GP recognised the possible implications of the problem and made a decision that it needed further investigation from a specialist in the area. The GP recognised her limitations in this area of medicine, and correctly referred the patient. I should remember and employ as a basic principle working within my limits of competence throughout my future career. Maintaining the doctor-patient relationship, which is based on mutual trust and respect, the GP decided to inform the patient that there was a possibility of prostate cancer. I feel it is very important to keep the honesty as otherwise the relationship will break down, and good clinical care will therefore suffer as a result. When asked about the implications of prostate cancer, it was important for me to accurately represent my position or ability4. Any advice or views given by myself could have been wrong, and therefore caused further harm and distress to patient. Also, misrepresentation of myself is a fitness-to-practice issue and I do not wish to represent myself in this way. I could have handled the situation better on reflection, and been more empathetic, but my nerves and the shock situation hindered me. Hopefully over time, I will develop the professional skills to be more confident in such situations. Aims: My goal during my medical education is to realise my limits. Setting time each day for work and recreation will give me a balanced life, and help me progress at a steady and attainable pace. It is imperative for me to ask more questions (to the appropriate people) and ask for help with pieces of work when I do not fully understand something. I acknowledge I currently do not do this enough, as I sometimes feel embarrassed to ask for help, but during my time as a clinician in the future, getting a second opinion, or just a piece of advice from a colleague will be essential for the provision of good clinical care. I am currently trying my best to get more actively involved in my PBL feedback sessions and ask questions on areas which I lack understanding in. I am finding this very beneficial for my education, and helpful in combating embarrassment I may feel when asking for help. Another aim is to always remember to introduce myself correctly to patients during consultation, so they unde rstand I am a medical student, therefore causing no confusion of my position or ability. Conclusion: Provision of good clinical care is essential as a Doctor. My scenarios have taught me the value being aware of the GMC guidelines, and reflecting upon my performance constantly throughout both my medical education and career, ensuring good clinical care is provided as a fundamental principle of clinical practice. My experiences this year have not only improved my clinical skills, but on reflection, have made me question my approach to different tasks, which with the goals I have set, I hope to improve.

The American Involvement in the Cold War

The role of America at the end of World War II was where the origins of policing the world originate. America had been engaged in a very costly war in terms of dollars as well as lives. But, despite the expense the United States came out of World War II better than any other nation that was involved. The Second World War was a battle between the Allied and Axis Powers. The Allied Powers consisted of the United States, Great Britain, the Soviet Union, China, and France. This war was seen as the fight against Nazi Germany, and therefore resulted in a majority of the battles fought on German and Russian soil. The aftermath left the Soviet Union in bad shape. Close to twenty million Russians had died fighting the war, which accounted for about eight percent of their population. Conversely, none of the fighting was done on American soil, and while the United States suffered in terms of casualties it was nothing compared to the loss Russia had endured. Because the war would not end until the Axis Powers fully surrendered to the Allied Powers, the United States was forced to use the first atomic warfare in history. The atom bomb would later serve as America's greatest possession. Stalin, the Premier of the Soviet Union had always distrusted the American and English intentions. Because of Stalin's aggression and attitude pertaining to Soviet influence on Europe, the postwar stance on Russia had turned into a standoff. This became the origin of the Cold War. The Cold War, seen as a battle between communism and capitalism, was â€Å"in reality a more complex struggle over a broad range of ideological, economic, and strategic issues. † Over the next several years the United States would spend more money on military and defense than ever before. Several measures were taken to ensure that the same mistakes at the end of World War I would not be repeated. The first in a series of measures was a postwar conference involving President Truman and the Soviet Foreign Minister, V. M. Molokov, where Truman controlled the entire meeting and basically scolded the Soviet's for not honoring agreements on Poland. Truman â€Å"told the Russians just where the got off and generally bossed the whole meeting. † This symbolized America's strong-arm stance against communism and signified the position we would hold throughout the Cold War. The next step in Truman's agenda was to work with Congress to pass the National Security Act of 1947, which was designed to strengthen defense operations. This act created a single Department of Defense, and created the Central Intelligence Agency, or CIA. These two new agencies acted as the first step in atomic warfare management. Continuing to act as police of the world and leader of capitalism, Truman drafted the Marshall Plan. The Marshall Plan, which complemented the Truman Doctrine, â€Å"was a program of large scale economic and military aid to Europe. Considered by some, this was the most â€Å"innovative piece of foreign policy in American History. Where over the next four years the United States contributed over $12 billion to a highly successful recovery effort. † The Soviet Union stilled commanded a blockade on highway, rail, and river traffic to West Berlin. As a result, the United States responded by entering into a peacetime military alliance; this being the first time since the American Revolution. The North Atlantic Treaty Organization (NATO) a project costing $1. billion, enabled the basing of all four United States Army divisions into Western Europe. Twelve nations agreed to sign this pact that stated â€Å"an armed attack against one or more of them in Europe or North America shall be considered an attack against them all. † Consequently, a few months later, Stalin â€Å"lifted the blockade which had made the city a symbol of resistance to communism. † Between the creation of NATO, the National Security Act and CIA, and the Marshall Plan, America was dictating their position with Russia and communism. These measures made it possible for Americans to become more comfortable with the Cold War. While all of these governmental policies were being put into action, Americans were settling back into the ideology of family and free enterprise. The post-war period became one of the most exciting in American history. With the rising economy and feeling of consumerism, Americans were rebounding from their efforts in World War II. Capitalism was on the rise and the â€Å"Apple Pie† portrait of middle class suburban families was shaping the country. America was now the wealthiest country in the world and Americans had â€Å"accumulated savings of $140 billion† in 1945. â€Å"Over the next two decades the gross national product more than tripled,† signifying prosperity. Between 1945 and 1960, the gross national product would grow from $213 billion to more than $500 billion, while real income would rise 25 percent. Included in these figures was the percent of American families owning homes, which grew from 43 percent to over 60 percent in this same time period; this created the suburban explosion. This suburban lifestyle was intended to symbolize the superiority of capitalism over communism and imply that the American way of life would win the Cold War. † Americans were again beginning to see the capitalist society they fought for, and the confidence level of the country continued to rise throughout the 1960's. The people cannot create a great nation themselves; great leaders must direct them. Besides the three Presidents who led America throughout the end of World War II and through the Cold War, there were many influential voices that helped to shape the views of the public. Among these influential people was a man named George F. Kennan. He was a member of the United States embassy to the Soviet Union and author of the â€Å"long telegram† which was sent to the heads of state in Washington D. C. In his telegram, Kennan described the Soviets as insecure, inferior, and less advanced than Americans. â€Å"As Russia came into contact with the economically advanced West, fear of more competent, more powerful, more highly organized societies,† was the general message Kennan was trying to get across. Because he saw the country from the inside Kennan also believed the United Sates should † pursue a policy of firm containment†¦ at every point where the Soviets show signs of encroaching upon the interest of a peaceful and stable world. † This opinion and idea of the relationship between the United States and Russia should have been widely accepted by Americans. They backed this idea of aggressive behavior, rather than a passive approach to the Cold War. Conversely, postwar liberal such as Henry Wallace, â€Å"a Progressive Party leader, continued to seek cooperation with the Soviet Union and defended the participation of Communists in their organizations. † These ideals were quickly silenced. The American majority, being extremely anti-communist, felt relations with the Soviet Union should be harsh and firm. This period introduced American dominance in foreign policy. The ideals of personal freedom and opportunity were the driving forces behind Western philosophy throughout the Cold War. Not only were these principles showcased, they were set as the benchmark of equality for the human race.

Lord Of The Flies By William Golding - 1381 Words

An issue going around for many years lately has been the abuse of power. It is not always abusing power; It is abusing rights as well. In William Golding’s Lord of the Flies, the abuse of power and rights is represented by only a few characters and is portrayed many times. Ralph and Jack, the two main characters, both abused their power by controlling the actions of the groups. Golding illustrates that having too much power can lead someone or something to making the wrong choices or making the choices that benefit only themselves. Jack and Ralph were put with the task of being in charge of the two groups and to control everyone s beliefs and ideas about survival. Throughout the paper, the idea of abusing power will be shown by how politicians have abused and taken advantage of their rights, how bullies use their strength to take charge of other people, and also by the idea of dictatorship. In Lord of the Flies, the idea of dictatorship is shown when the children first got to the island, their leader was kind of known to be a dictator. Ralph took it upon himself to call a meeting, making him a dominating candidate for their voting. Not only Ralph, but Jack thought to take charge too. Jack separated from the civilized group and started leading his own group. Even towards the beginning of the story, Ralph said that, â€Å"I expect we’ll want to know everyone’s names, and make a list. We ought to have a meeting†(Golding 11). The key words in that statement are â€Å"WeShow MoreRelatedLord Of The Flies By William Golding869 Words   |  4 PagesLord of the Flies Psychology Sometimes people wear fake personas like a cloak over their shoulders, used to hide what is really underneath. This harsh reality is witnessed in William Golding’s classic Lord of the Flies, a novel that is famous for not only its sickening plot, but also for the emotional breakdowns all of its characters experience. These issues are akin to those shown in certain real-world psychological experiments. A summary of Golding’s Lord of the Flies, combined with the evidenceRead MoreThe Lord Of The Flies By William Golding1347 Words   |  6 Pages The theme of The Lord of the Flies, by William Golding, is the reason society is flawed is because people are flawed. Although Piggy is knowledgeable, he has many flaws including his laziness and physical inabilities. Ralph is an authority seeker. He sets rules and laws, yet does little to enforce them. Ralph wants to be the ruler, without doing the work to enforce his laws. Jack is persistent. He is rude, harsh and violent in or der to get what he wants. He wants to be supreme. Piggy’s flaws areRead MoreLord Of The Flies By William Golding1123 Words   |  5 PagesIn the novel Lord of The Flies by William Golding, the characters Ralph, Piggy, and Jack represent important World War II leaders Franklin Roosevelt, Adolf Hitler, and Winston Churchill. Golding, who had served in World War II, was well aware of the savagery created, and used it to base his book on. Ralph represents Franklin Roosevelt , Jack represents Adolf Hitler, and Piggy represents Winston Churchill. Ralph being of the novel’s main protagonist is important in the outcome of the story becauseRead MoreThe Lord Of The Flies By William Golding1065 Words   |  5 PagesThe Lord of the Flies Essay The Lord of the Flies written by William Golding and published on September 17, 1954 is a story told about a group of stranded boys and their fight for survival against the wilderness and themselves. In this story many signs of symbolism are used by Golding to point out certain aspects of society that Golding thought strongly of. This story on first read may just seem to be a survival- esque piece of literature but, on a deeper look one can find Golding’s true motiveRead MoreLord of The Flies by William Golding619 Words   |  2 PagesGovernments are no different; they fight for power just like the rest of us do. They just do it on a much bigger scale. Qualities from Oligarchy, Totalitarianism, Democracy, Dictatorship, and Anarchy governments are used in several parts of Lord of The Flies that represent different characters and different situations. An Oligarchy is a small group of people having control of a country or organization. A Totalitarianism government is a form of government that permits no individual freedom and thatRead MoreThe Lord of the Flies by William Golding1306 Words   |  5 PagesIn The Lord of the Flies, William Golding creates a microcosm that appears to be a utopia after he discharged from the British Royal Navy following World War II. After an emergency landing, Golding places a diverse group of boys on the island that soon turns out to be anything but utopia. The island the boys are on turns out to be an allegorical dystopia with inadequate conditions (Bryfonski 22). The boys reject all lessons they learned from their prior British society, and they turn towards theirRead MoreLord of the Flies by William Golding932 Words   |  4 Pagesdiscussing two particular themes from a novel called Lord of the Flies by William Golding. Lord of the Flies was written in 1954 after World War II. Ruler of the Flies is a purposeful anecdote about something that many readers can’t really describe. Individuals cant choose precisely what. Its either about the inalienable underhanded of man, or mental battle, or religion, or personal inclination, or the creators emotions on war; however William Golding was in the Navy throughout World War II, or perhapsRead MoreLord Of The Flies By William Golding1383 Words   |  6 PagesAccording to Lord of the Flies is still a Blueprint for Savagery by Eleanor Learmonth and Jenny Tabakoff, the words â€Å"I’m afraid. Of us† first appeared in Golding’s novel 60 years ago. Lord of the Flies by William Golding follows a group of schoolboys trapped on an island after a plane crash during a world war. At the beginning, they celebrate as the y have total autonomy as there are no adults around. They attempt to establish a civilization but when order collapses, they go on a journey from civilizationRead MoreLord of the Flies, by William Golding1055 Words   |  5 Pages In William Goldings Lord of the Flies a group of English school boys crash land onto an uninhabited island somewhere in the Mid Atlantic ocean. Ralph, the protagonist and also the elected leader, tries to maintain peace and avoid any calamity on the island. However, Jack is neither willing to contribute nor listen because he is jealous of Ralph and has a sickening obsession with killing boars. Ralph has some good traits that help him maintain peace and balance for a period of time. He is charismaticRead MoreLord Of The Flies By William Golding Essay1475 Words   |  6 Pages Outline Introduction Short intro for Lord of the Flies Short intro on Gangs The bullying and group mentality demonstrated in gangs has resemblances to the characters in Lord of the Flies. II. Bullying/Group mentality Gangs Drugs/Loyalty B. Lord of the flies Jack kills the pig/Jack and Ralph fight III. Effects B. Lord of the flies Jack killing the pig aftermath Violence IV. Conclusion Gangs are considered a group of people that have a common link together

Using the Spanish Verb Tratar

It may not seem logical that the same Spanish verb might mean to try and to treat, but such is the case with tratar. Tratar is a fairly common verb that also has other meanings that dont seem particularly related. In general, though, the word has to do with dealing with a person, activity, or thing. Often, the meaning of tratar depends on the preposition that follows, although even that isnt always a sure guide. Perhaps more so than with most verbs, you need to rely on the context of the sentence to determine the meaning. Common Meanings of Tratar by Itself One of the most typical uses of tratar is to refer to treating someone or something in a specified way: Nos trataban como a animales y en ocasiones peor. (They treated us like animals and sometimes worse.)Siempre he estado en paz debido a la forma en que mi madre me tratà ³. (I have always been at peace because of the way my mother treated me.) ¡No me trates como a un nià ±o! (Dont treat me as a child!) More specifically, tratar is often used to refer to medical treatment. La enfermedad de Lyme se trata con antibià ³ticos. (Lymes disease is treated with antibiotics.)Los mà ©dicos van a tratar de detener la hemorragia con medicamentos. (The doctors are going use a treatment of stopping the hemorrhage with medications.)Trataron el dolor con morfina por casi una semana. (They treated the pain with morphine for almost a week.)El hospicio trata al paciente como a una persona en su totalidad. (A hospice treats the patient as a person in his or her totality.) Using Tratar With De When tratar is followed by the preposition de and an infinitive, it meant to try or attempt: Aquà ­ no tratamos de ganar mentes y corazones, porque es irrelevante. (Here we are not trying to win hearts and minds, because it is irrelevant.)Trate de nadar por lo menos una hora y quince minutos. (Try to swim at least an hour and 15 minutes.)Los participantes del estudio que fotografiaron sus alimentos perdieron mà ¡s peso que aquellos que simplemente trataron de comer mà ¡s sanamente. (The study participants who photographed their food lost more weight than those who simply tried to eat more healthily.)Tratarà © de esturiar todos los dà ­as que pueda excepto los lunes. (I will try to study every day I can except for Mondays.)Trata de ponerte en mis zapatos. (Try to put yourself in my shoes.) When the reflexive form tratarse is followed by de, it indicates the subject of something or what its about. Fahrenheit 451 trata de una sociedad totalitaria donde los libros està ¡n prohibidos. (Fahrenheit 451 is about a totalitarian society where books are banned.)Se trata del coche de mi padre, doy una opinià ³n de primera mano. (On the subject of my fathers car, I am giving a firsthand opinion.) ¿De quà © trata? Whats it about?La vida se trata de contentamiento y gratitud. (Life is about contentment and gratitude.) Using Tratar With Con When either tratar or tratarse is followed by con, the preposition usually meaning with, it can refer to a relationship between two or more parties. Note that in some contexts, tratar con can instead me to treat with. Este cambio afectarà ¡ la manera en que usted trata con su compaà ±Ãƒ ­a de telà ©fonos. (This change will affect the way you do business with your phone company.)Con respecto al amor, no me trato con gente mayor que yo. (When it comes to romance, I dont have relationships with people older than I am.)Sin embargo, muchas veces se tratà ³ con à ©l. (Nevertheless, I often had dealings with him.)Los compaà ±eros tratan con mucho respeto. (The companions treat each other with great respect.) Key Takeaways Tratar often means to treat, as in treating someone or something a certain way, or in providing medical treatment.Tratar de when followed an infinitive usually means to try or attempt.Tratarse de is used to indicate what something is about.