Hospital at Home

A new model of nursing involves providing hospital level care for patients transitioning to living at home. This model can improve the efficiency of hospitals and other facilities by lengthening the time between hospital stays and facilitating better medical outcomes. The recovery of any patient in the context of their own home will always feel better. The care plan can thus be carried out with minimum discomfort of the patient. And lack of malaise will always trump pharmaceuticals, or so many psychologists believe. Patients can therefore meet the demands of their illnesses and meet their healthcare challenges without having to encounter a fearful hospital experience and culture shock.
The patient eligible for Hospital at Home must have sufficient oxygen flow and non-ischemic chest pain or absence of chest pain. After meeting clinical criteria for eligibility, the Hospital at Home patient will part of a new and progressive service model for acute-care candidates. The resources such as oxygenation and infusion are mobilized, the service performed at the patient’s home, and the nurse provided for “outpatient” aftercare. Thus the patient receives the best in skilled postprocedural nursing, without the awkward and often uncomfortable (and frequently painful) transportation hiccups, to and fro.
The patients feel they have more control over their lives while in their homes, while a hospital is a sterile and unwelcoming environment that maximizes the unknown element of any serious medical procedure. The room in a hospital may have to be shared with another person the patient find threatening. Occupying a hospital bed in a room with a stranger can be overwhelming for a patient already uncertain about their outcome. The noise and intrusions of people such as nurses. physicians, housekeeping, technicians, phlebotomists, administrators, case managers, and records clerks, can be annoying. The coming and going of such people in their space can keep patients awake, disturb their slumber patterns, and fan anxiety.

Hospital at home involves skilled-nursing level care and aftercare attributes without high hospital costs. Hospital at home allows a patient to receive nursing facility level care, specialty treatments, and adjunct technical nursing services in the comfort of familiar surroundings. Often just the proximity to friends and family can assist patients in recovery and recuperation. Hospital-at-Home is rated highly by caregivers, nurses, patients, and family members. This factor alone should become a consideration when reviewing scenarios for medical procedures.

Medical centers across the country favor Hospital at Home (Hah!)as a way to ease the burden on limited-bed hospitals and medical costs the patients at the same time. Hospital-at-Home is a care model that can be adapted for metropolitan or suburban community recommendations. Usually these costs factor into the overall cost of any hospital stay. By shaving the expense of hospital level services with adjunct mobile providers, health management organizations can more feasibly recommend in-patient stays and facility admissions without the likelihood the procedures will be rejected on a basis of cost.

Not every patient adapts to services in a hospital environment. Privacy, communication, access to the physician and a case manager can complicate the overall scenario. Reducing the cost by up to one-third is one advantage of Hospital at Home. But in addition to cost concerns, a patient can regain the rights of residency and all the benefits it confers. Patients can use their home phone, computer, receive mail, host pets, and receive visitors any time of the day or night. Patients can enjoy all the benefits of their home surroundings while getting optimum care. These can be important advantages when a patient envisions a planned and necessary medical procedure.

    Many people are not comfortable in hospitals and grow nervous at the thought of staying in one

. The may have negligible confidence in the “system”. Distance, cost, and awkward transportation issues may make the whole idea of a hospital procedure, no matter how needed, become a horror. And many seniors are homebound and have limited access to hospitals and other needed. Given these problems, a decline may be envisioned by the physician recommending the procedure. But Hospital-At Home is likely to be sponsored by the HMO the patient belongs to, on a cost basis alone.

The complete package of services and the organization necessary may be beyond their grasp. But Hospital at Home allows for these vulnerabilities and assists many seniors and homebound others to gain their medical services without negative outcomes. And many patients rightly fear the contagion and infection that many medical professionals know is present. Hospital admission and continued skilled nursing can present many more problems than a patient is willing to deal with. But pre-treatment in a clinical setting and follow-up services after the performed medical service enables patients to receive vital and necessary treatment, and then recover in the comfort of their own home.
The modern world allows technical mobile access to treatment and lab services like phlebotomy, radiography, dialysis, and skilled nursing bedside care. Acute medical problems grow scary for the individual patient uncomfortable alone in a hospital bed, surrounded by strange noises, equipment, and people. Just the sound of their home and natural surroundings and resuming regular living patterns can ease patients back to recovery. The outcome of any hospital procedure or service will be improved for every patient. Additional follow up testing, such as EKG, PICC line placement or removal, X-rays, ultrasound or others, can be dealt with at home.

Evaluation of HaH candidacy starts with the Emergency Room staff. They will be trained to identify the patients that require inpatient services but may benefit better by being treated at home. The clinical eligibility criteria will be part of an attribute list developed by the Hospital at Home model. A team will be assigned to prepare the patient for Hospital at Home services and scheduled in conjunction with their medical procedure or treatment. The quality of the ultimate outcome can be radically improved on a per-patient basis. Less stress, fewer complications, reduction in the mortality rate, and more value for each element of care should contribute to the Hospital at Home model being used more and more. Satisfaction from use of the Hospital at Home model is had by the patient, by the caregivers, and by the HMO, and ideal result.

Nursing Study Guide: Depression

One of the biggest challenges facing the adult nurturing and caregiving patient populations is depression.
Careers and unemployment can both cause toxic stress in some people. Without positive well-being, a corrosive anxiety builds. Negativity can wind itself into behavior and thinking patterns.
The nurse in the Emergency Room and the nurse in the long term care facility will see depression at work in patients. And especially the home health nurse will see private pain and suffering on the part of their primary charges. Each kind of nurse will have to develop a technique for intake, analysis, interaction and treatment with a patient diagnosed with depression.

No longer is depression a disorder without a face. Tragedies in almost every state have appeared in bold face type. As a workplace hazard, across the United States,  an incident of violence or self-harm,  involving a depressed and mentally disordered person increases every day.

Nurse intake workers must carefully evaluate patients prone to addictive habits such as smoking, drinking, abuse of controlled substances, or unchararacreristic or destructive behavior.

The use of chemical substances and pharmaceuticals the treatment of depression has given rise to is a concern for many socially oriented activist groups and health maintenance organizations.

A variety  of caregiving professions, such as nurses, counselors, physicians, specialty providers, and treatment experts have been wrestling with the health problem that depression poses for centuries.
Today depression problems can cause an airline captain to plummet his plane and its passengers to their deaths. The depressed conductor of a rail train can lose focus and wreck the train cars, throwing everyone aboard off the track to injury or worse. Depression and other mental health issues are now squarely on the public eye.

First described in the literature of Freud as a “malaise”, postJungian medical practitioners regularly recognized symptoms of the disorder as far back as the early 1900’s. What became a cocktail party anecdote at first began to gain steam in the medical community. By the time World War One, military doctors were inventing wartime medications to combat this strange phenomenon.

Depression can present similarly in persons by unusual or destructive behavior, excessive alcohol and drug use, mood swings, or chemical imbalances in the blood. Lab tests can screen for these indicators,. which is why Emergency Room admissions will usually have a toxicity panel and blood gas analysis ordered before key triage decisions are made

It is the numbing of depressive individuals’ “inner world” that leads to an addiction to sleeping pills, diet pills, pain pills. and other abuses of limited- schedule prescriptipn medication.

Also, certain incidences of depression syndromes can affect people experiencing a significant life event. PTSD survivors survive traumatic combat ecperiences even though all persons with PTSD did not share the same exact event.

Depression can be suffered among persons who live similar but disparate lives. Today, patients can employ various strategies and methods to combat depression and the behaviors it exacurbates and the condition it worsens.

The patient groups and subgroups, as well as pools of invidividuals who have shared a significant life event, can fall into varying levels of depressive behavior.

People who survived the 9/11 terrorist attack on New York, for example, may have experienced a kind of depression called “survivor’s guilt.” Sufferers of this and many other types of depression are urged tovtalk to support groups and seek treatment from a licensed and qualified healthcare provider.

Nurses will often observe the symptoms of depression in both long-term and acute-care patients. In many cases, an acute-care life event such as a stroke, a heart attack, or a seizure might be triggered from conditions linked to depression.
The patient’s health and safety are paramount at all times. High blood pressure, drinking, drug abuse, atypical personality traits and characteristics of self harm might signal the presence of a depressive person or a depression disorder. Information regarding past treatments of depression be available in the medical chart.
The professional and care plan interventions for depression also can be psychological. A trained medical professional can analyze the patient’s history and recommend coping strategies. Together with a psychologist, the patient can try exercises aimed at breaking down the supporting anxieties of the depressive condition.
One thing a medical expert on treating depression will do is examine what circumstances or scenarios trigger the patient’s depression. Gaining perspective on one’s life and using physical and mental energy can give a patient a more level understanding of exactly a threat really is.
Mental health professionals have worked hard to remove the stigma of depression.Encouraging a patientbto get treatment is a much more effectice intervention.
After a treatment referral is done, outreach to a qualified provider is made. This depressopn therapist can devise techniques that eliminate the focus on negative patterns, self-destructive behavior, and developing a sad or poor attitude that can lead to a negative spiral.

At this point ending isolation and developing resources to prevent downswings in mood is a key dual goal. Gaining control of flexibility and less destruction to extremes can allow a person with depressive tendencies to steer themselves away from harmful behavior and towards goal-centric future rewards.

Handling Patient Visitors

Until you see the light in a patient’s eye, when their relatives come, how their face lights up, you just haven’t lived. The sum total of life is right there. The programmatic dynamic of parents raising children is reversed. The residents (parents) now received the care from visitors (children). It is a singular statement in every individual patient’s case what kind of care they get from family members. Just as people look the other way in a community when children are abused, a low-level nursing home gathers the neglected ones together. It takes a compassionate care nurse approach to make sure patients don’t feel neglected or overwhelmed.

Nurses in any pay range should report any examples of abuse to their nursing manager or as an anonymous complaint to the regional ombudsman. The County Health Facilities Director may also take an anonymous complaint alleging abuse. Nurses in acute care and skilled nursing should counseled to look out for signs and symptoms of abuse and should make an assessment in the chart accordingly. If patients should complain of missed medications, pain, unusual symptoms or worries concerning their care, the charge nurse should be notified.

The sliding scale of who and what family members come to visit is one nurses will become familiar with. Some visitors only show up once a year, on birthdays or anniversaries. Some people bring the whole family, and it can be overwhelming for a recovering patient or fragile resident. Sometimes visitors bring children or babies to encourage the older resident or family member to enjoy the family life absent in a skilled nursing facility or acute care hospital.

Nurses should make sure visitors should wash their hands before skin or physical contact with the patient, administer or deliver no medications or narcotics, and otherwise observe infection control best practices at all times in and around the patient‘s room and bathroom. Visitors and family, friends and relatives may not realize that resident of a skilled nursing facility or patients in acute care are extra vulnerable to viruses, colds, and other communicable diseases. Diabetic patients should be discouraged from overdoing it indulging on special “treats’ that can harm their health and change their blood sugar and cause a crisis.

Others come every weekend, and bring things or even help with the physical care and chores of a nursing home patient. usually, among nurses, this will reflect the status of a patient’s relationship to the visitor. Nurses should be vigilant if a patient shows a marked dejection after certain visitors come, or a tendency to depression after no visitors come. Such patients should be redirected to group activities or have the activities director contact relatives and suggest a family visit.

While financially the nurses know and differentiate between cash-pay residents and Medicaid or Medicare recipients, technically there should be no cognizance of the patient’s status when treating them or attending their bedside needs. health care should be available to everyone regardless of the ability to pay. By seeing the way the patients are treated, some nurses also differentiate between patients who receive visits and those who do not. This can be an unfair but persistent bias.

There is one simple rule for this: the family members and visitors of a nursing home patient will track neglect or have conversations with the patients where criticisms or reports might reach the ears of others. It is essential in some cases to keep frequent visitors’ parents (patients) well cared for, as the family member will appear at any time all day, or stay during significant parts of the day during one single shifts. That one family member will not see the effort the nurses put forth for the rest of the shift for the rest of the floor, but they can make enough noise t bother the managers and owners of the facility for months.

It is hard to watch a CNA or LVN favor a patient or set of patients whose relatives frequently visit, while the ones who need contact and pepping up most fall to the end of the range. One can watch a single nurse neglect a patient’s bed, person, or dignity outright, and hustle to the next room to cascade attention and caregiving on the least in need patient in the place. But this is what happens when nurse managers do not periodically refresh the training and motivation of nursing staff.

Any nursing home patient that has a visit from a relative or friend, social worker or investigator from the county health department, must have them sign in to the visitor’s register. there is usually a physician’s room or private area where an investigator can conduct I interviews or research charts. Additionally, medical records staff will make themselves available t assure any visitor they receive the most assistance possible.

Patient Care and PTSD Cases

Nurses looking to get traction in the occupational workplace should be vigilant protecting the rights, privacy, and quality of care given when a PTSD situation arises. Patient care can include special cases, patients whose fears and experiences have traumatized them. These patients come from domestic situations, armed services experiences, violence and sexual assaults, where PTSD clouds the victim’s thoughts with shame, doubt, and a negative spiral of blame and inertia.

A professional nurse should tread carefully and follow the charted behavioral interventions and therapeutic approaches to the letter. Some patients who have genuine elements of PTSD in their makeup may have yet to be diagnosed. Post Traumatic Stress Disorder is a  condition whereby certain other conditions may be affected, such as ulcers, high blood pressure, depression, and more. Nursing practice for such (PTSD) patients includes maintaining a calm, relaxing environment where pain and anxiety are reduced in every way possible.

Disorders like PTSD come from traumatic incidents in the patient’s past, and may be unknowingly triggered without sincere and through querying of the patient’s social profile. A nurse can request a referral from the primary care physician for a psych referral. Any nurse should be careful not to disclose any specific medical information to observers or passersby. This is a HIPPA violation. Nurses should re-orient the PTSD patient (when acting out or presenting symptoms) back to their room and make the assessment in a private setting.

Document carefully any interactions with the patient that cause you concern. Make sure that you follow the best nursing practices when a PTSD incident occurs. When dealing with a patient who is confused, lost, or suddenly bewildered by where they are, or if they forget what they are doing, be prepared. If the PTSD patient shows exaggerated reaction to noise, other patient’s conversation, amplified reaction to nearby distractions, and has poor tolerance to exterior sounds, check with the charge nurse for further instructions. .

The physician’s instructions for treatment should include necessary approaches for environmental comfort. Refer to the patient’s medical chart and care plan for instructions and advice. Patients’ response to their intake survey should indicate what likes and dislikes they will respond to and against. PTSD patients must avoid trigger incidents or scenarios to avoid recurring attacks of anxiety and panic attack crisis.

These behavioral afflictions are defensive disorders the human psyche concocts to shield a person from environmental/mental pain or abuse. This patient will be wary, vigilant, and acutely (and sometimes aggressively) combative against unknown situations. Often sufferers of PTSD are extremely vocal. Nurses can utilize this feature of the patient profile to engage them out of a negative spiral. Redirect the mental focus of the PTSD patient onto a pleasant matter or other topic, such as movies or books, poetry or sports. Avoid discussions of politics or crime.

PTSD is a misunderstood disease which many old-school nurses may scoff at or otherwise fail to evaluate a patient for. Nurses should tread carefully with diagnosed PTSD sufferers and use exceptional patient courtesies to make sure such patients feel insulated from their triggering episodes. PTSD should never be made to feel threatened or stressed. This constitutes patient abuse. Nursing or facility staff who persist in creating tense or uncomfortable incidents, or provoke the patient should be reported both directly to management and reported anonymously to the State Nursing Board or the LVN/Psychiatric Nursing Association.

Incidents which recur in the PTSD patient’s life are the situations with sounds, odors, or persons who spark the Post Traumatic Stress Disorder are responsible for triggering painful situations and outsize scenes within the patient’s room, ward, or floor. Nurses and nursing aides of such patients should make sure all patient needs are addressed during each shift. Lab technicians or phlebotomists new to the patient should be escorted by familiar staff. In this way, proper nursing patient care makes certain that the accidental triggers of a particular trauma do not become re-created and take the patient by surprise.

   PTSD patients rely on skilled nursing staff for optimum recovery outcomes. And more educated consumers will know the difference between incompetent nurses and those who just choose to disregard noted interventions.

Dengue Fever Study Review

Dengue fever, a one rare tropical disease more prone to be common in Malaysia, South America, or South Sea islanders, is a spreading community health threat in settled countries. Unpoliced immigration from countries with little or no sanitation, poor innoculation records. Vaccination problems and low health standards is infiltrate more vulnerable healthcare environments every day.

These health threats are getting worse. The CDC cited in its July 2010 report that dengue fever is transmitted by mosquito bites, and where surface water cultures and agronomies are present. In time these figures and for other diseases like AIDS have grown worse. In South Africa, transmitted diseases have crossed over into population threats for travelers. Incubation can allow for re-uptake of diseased matter to likely insects, And in some (notorious) cases, rare hospital-based person-to-person transmission. .

For civilized societies, the prevalence of immigrant residents working in unsanitary health conditions near surface water with little or no medical care ensures an epidemic of a once rare tropical disease. Harking back to distant eras when medicine as it is practiced today was in a stone age of ignorance, dengue fever was also called break-bone fever for the level of pain and bone damage the dengue visited on its victims. The more serious phase of dengue fever (DHF) can cause fatal occurences of circulatory failure, shock, and multiple organ failure leading to death.

Evincing symptoms of dengue fever are back-of-the-eyes headache, an ache or pressure in the temples, arthritis flare ups, or “ghosting”, myalgia, contact rash, ecchymoses, and interior oral bleeding or nasal bleeding from mucus tissues. Clinical examination and patient history can indicate dengue fever, as well as dengue fever viral matter in the immunoglobins of IgM and IgG. An assay capture test should be run for patients exhibiting these symptoms without exclusive indications from existing conditions. Re-infection of dengue fever can occur, so patient history with respect to dengue fever is critical.

Brain damage from shock can affect the pathology of the organism as a whole, as well as exacerbate any existing medical condition. Patients in this state exhibit multiple systemic vulnerabilities. The intensity of dengue fever continues to a more serious stage, the DHF. Dengue Hemorrhagic Fever, a potential cause of death, may last two to seven days with fever, abdominal pain and vomiting throughout.

Fever can abate during the DHF phase of dengue fever without the condition being recovered from. Dengue fever wellness plans require patient assistance via nursing and leaves patients bedridden through the course of recovery.

Nursing students and community care professionals can estimate a possible case of dengue fever from lab tests showing hematocrit increase, thrombocytopenia in the blood cell count, and leukopenia. Long term complications for recovered dengue fever patients  include myocarditis, encephalopathy, and liver failure. The dengue fever has no vaccine treatment as of yet. An estimated fifty to a hundred million cases a year of dengue fever infect the known human patient population.

Patients who might experience basic symptoms of dengue fever should be questioned for recent activities such as drinking local tap water, ingestion of imported fruit, outdoor recreation near surface water areas, and foreign travel to tropical weather states (such as Florida) or Indian, South American, or Middle or Far Eastern countries where modern sanitation is compromised. Flower beds, standalone planters, pet dishes, and rain collection containers can collect mosquito infected material and spread the disease.

Mosquito repellants and double screens can increase protection from dengue fever contraction. Parents (and caregivers)should look for clothing that “holds” DEET or other mosquito repellant products well. Clothing and skin can be sprayed. Worldwide children age 15 and below represent 90% of severe shock cases of dengue fever, termed dengue shock syndrome (DSS). But American patients of dengue fever can be adult or juvenile. Astonishingly, the disease can be benign. Nurses should screen for background on foreign travel to rule out the patient being a carrier.  The coagulation into the bloodstream and tissues causes the denge hemorrhagic fever. DHF patients can develop shock (DSS).

But dengue fever today exists in the United States and modern civilized countries in an outbreak that makes medical healthcare communities uneasy. Nurses must be up to date and wary of new presentation of likely symptoms. What used to be an exotic disease can now come by courtesy of a local canal or aqueduct. Water literally around the house, such as lawn irrigation or plant beds can serve as mosquito nesting grounds. Climate change, weather patterns, and activity involving egg travel in produce or lawn products, for example, can spread the disease further.

 

 

 

1 2