Discharge Plans: a Case Study

inflammation Plans a depicted object StudyIt may come as a shock to managetakers of the patient that earn cookery may commence as soon as a patient has been admitted. This does non necessarily mean that the patient is macrocosm released for home, provided rather it agent that excogitates are being put in place for a successful passing plan to take place. Information is gathered about the patient, how they function, for example, do they live with others, are they dependent or independent (Birjandi Bragg 2009). Caretakers are strikeively involved in a discharge plan provided the patient gives consent. Once the patient shows improvement, it is expire that further recovery in a infirmary set-up is not likely to take place and thus they are sent to an environment they may exact to their demand their home.Birjandi, A Bragg, (2009) say that discharge supply is essential and should be done right, whether the discharge is to a rehabilitation center, a nursing home or the k nobs home. health check practitioners should bring forth an ideal discharge plan as studies have shown that improvement in hospital discharges with great outcomes when appropriate discharge plans are made.Health misgiving givers, family members and patients themselves have a great role to play after discharge in maintaining practised health. Even though discharge proviso is essential in patients health there is inconsistence in both the discharge process and the quality of discharge intend in most of the health disturbance system.In this paper, we shall look at a discharge plan for a client with the cerebral vascular accident from hospital to their home. We shall look at initial assessment of the client at the time of admission determine the possible discharge acquires, family involvement in decision making and how to transport the client to their destination.Birjandi, A Bragg, L. (2009) describe discharge cooking as a method utilize to decide the requirements of a patient as they parapraxis from one level of bang to another, only doctors may approve patients release from a health facility, but the actual discharge plan may be done by a nurse, case manager, case manager. Complicated conditions such as cerebral vascular accident may have a team onward motion. Well organized discharge planning may reduce the chances of re-hospitalization and aid in recovery ensure medications are well prescri get it on and administered correctly. In general a discharge plan should involve the following evaluation of the client by qualified practitioner, discussion with both the client and the portion outgiver, planning of the transfer process and homecoming of the client, determining whether the caretaker needs more training or any other kind of support, referral to support an organization or care agency and finally arranging for follow up activities.In our case we shall look at Ms. Kate a 76 year-old female who was admitted from the emergency department with a dia gnosis of Right Cerebra Vascular Accident. Her Past Medical History includes hyperlipidemia, hypertension, osteoarthritis, and osteoporosis.Neurological left-sided weakness for the past 2 days, awake, alert, and oriented to person, place, and time. Denied s groyneowing difficulties, no visual defects and denied distress.Medications Aspirin 81mg per oral daily Tylenol 650mg per oral when necessary for painCerebral vascular and pulmonary Placed on a cardiac monitor, findings indicated normal sinus rhythm. Vital signs taken every 4 hours, pulse 82 blood pressure 168/64 respirations 20. Lung sounds were clear to auscultation bilaterally. Oxygen Saturation on room air 97%.Gastrointestinal Abdomen soft, non-tender, not distended, positive catgut sounds. Bowel movement presentGenitourinary Voids freely, requiring assistance to the bathroom. Output approximately 1000ml/day. Brief episode of dysuria on admission.Integumentary skin intact, no lesions noticedmusculoskeletal Active range of mo tion right side limited range of motion on the left side required assistant to get into a wheel temper. History of recent balance problems.Psychosocial lives with daughter in a two story home occupation retired teacherDischarge needs were discussed with the caretaker, these included the visible condition of the family before and after hospitalization, the details of the kind of care required by the client were discussed, included info of the patients prognosis, what activities she might need to help with information about the clients medication and diet should be given, any extra equipment that was deemed necessary such as wheelchair, oxygen and who will be in charge of the clients repast preparation, transport to referrals and support groups.The daughter who lives with Mr. Kate was involved in the discharge process, her ability and willingness to provide care to her mother was assessed, and the results were as follows she felt it was too early for her discharge, as she did not ha ve time to spare to take care of her mother as her work was demanding. She also had venerations about she would go about transporting her mother from the bed to her chair and taking her to the bathroom. She was referred to help agencies that assist in taking care of patients at their homes at a paid recompense. Several agency information was availed to her, with book of instructions to come up with a decision on which one to custom. She was also given a choice to hire an somebody at a fee or hire nurses or case managers or other persons familiar with the condition.Ambulance services were given as an option to transport the patient to their home at a small fee at the time of discharge or the client may use assisted transport to their homes, wheelchair or stretchers were suggested be used for our client as she could walk with assistance. This was done in advance and the patient was fully responsible for this kind of transport arrangement.Discharge planning varies according to the hospital set up and the person who initiates it, and what kind of follow-up is needed, and whether the care takers are assessed for their ability to cater for the clients needs. The transition of care and discharge planning all centered on improving the quality of care administered to a client, for example, education the care givers and training them on the conditions of their patients, encouraging preventive care and including caretakers to be part of the health care team. Simple steps such as exchanging patients progress regularly with the doctors or the health team ontogeny the chances of effective follow up care. Telephone conversions, post discharge with doctors also helps to anticipate problems and improve care at home.Corey, G., Corey, M., Callanan, P. (2003) suggest that relative to discharge planning with some patient, there may be underlying issues that contribute to honorable quandarys. As case managers, we should take reasonable steps to safeguard the interests and rig hts of those clients. Ethical dilemma occurs when an individual has to choose between two or more conflicting ethical standards. There is no one right answer and there is no easy answer Codes of ethics provide guidelines, but dont necessarily tell us what to do. Using a hierarchical ethical decision-making approach can help you achieve an acceptable resolution. Mattison, (2000) reminds us that utilizing an ethical decision-making model doesnt result in bias-free decisions. Our values still come into play utilizing an ethical decision-making model and we may not be aware of it First of all, it is important to remember clients rights to self determination and autonomy clients have the right to deal woeful decisions. However, the role of the case manager is different in this situation depending on the clients cognitive capacity for decision making. If the client has capacity, the focus is on ensuring the client is making an informed decision and reassuring the care team, which inclu des the family, about resources to maximize safety. If the client does not have capacity, the focus is identifying someone who can act on the clients behalf and exploring alternatives for creating a safe discharge in respect of the clients wishes. For the clientWhen the care team perceives discharge life-threatening Promote informed consent this involves educating the client about the teams concerns related to his or her safety and capableness consequences associated with an unsafe discharge. Review and encourage the use of resources to maximize safety, this involves identifying the services the client will need in a lesser care environment for the discharge to be successful. For the care team may not be aware of resources available to enable older adults to live safely in their own homes reviewing these resources can eliminate concerns. May be demented about remote dangers that should not trump client autonomy and self determination, i.e. If there was a fire, he would have dif ficulty escaping.When the care giver does not appear able to provide care. Sometimes family members or other caregivers wish to care for a client in a lesser care environment, but there are concerns about their ability to do so. In this situation, family/caregiver education is an important intervention.When the caregiver does not seem able to provide care Approaches to family/caregiver education Convene a team conference with them to review the clients level of care and specific care needs. Have the individual assume full responsibility for care for a period of time while in a safe environment (i.e. Work a 4-hour shift as his/her loved ones caregiver in the nursing home so he/she is fully informed of what to expect in hurt of career. Often this will result in the family member realizing for themselves that the care is too much and they will either not be able to do it or will need to have outside support. Alternatively, sometimes family members will actually do well, relieving the teams fears about their ability. Try a short running play visit in the lesser care environment, say 24-48 hours, with a planned return to the higher care setting to debrief re problems encountered.When a client or caretaker refuses necessary service again, it is important to remember clients rights to self determination and autonomy clients have the right to make poor decisions. However, sometimes what seems to be a poor decision is based on misinformation or other concerns it is important for case managers to explore factors modify to the refusal of services deemed necessary by the care team. capability factors contributing to service refusal Cost sometimes clients and their families dont feel recommended services are (or will be) affordable. Have referred agency review associated costs with them sometimes services are not as much as anticipated. Assist client/family to access sources of financial support such as Medicaid. Reframe costs as in terms of future savings, i.e. Payin g a little for care now will prevent costly hospitalizations in the future. Discomfort with the thought of strangers in the home. Validate this concern it is uncomfortable having unfamiliar people help with intimate tasks in ones private domain. Arrange for client/family to meet potential service providers ahead of time to minimize anxiety.Additional factors potentially contributing to service refusal misunderstandings regarding the purpose of recommended services. Feelings of guilt or shame related to not being able to provide all care independently. Recommended services dont fit client/familys cultural belief system. Past negative experiences with connatural servicesCaretaker unwilling to have client return home this is one of the most heart-wrenching ethical dilemmas to deal with and can bring up many issues of counter-transference good self-care and supervision is important. Things to keep in mind guest has a right to return to his or her own home, caretaker has a right not to provide care if this is something he or she is uncomfortable with, There may be a history of domestic violence or other traumatic relationship issues contributing to spouse/partners reluctance, Spouse/partner may be unaware of support services available to assist with care management and that the Client may be at risk for elder abuse.For clients with capacity, living environments deemed unsafe may simply represent differences in lifestyle choices between client and the care team. For example, clients home is cluttered, smells like cats, and there are dirty dishes and dust everywhere, but is not actually hazardous in any way. Case managers role advocate for clients and educate them, withdrawer services to assist client with home management. If home is in disrepair, infested with rats, covered with mold and guff garbage hazardous situation indicative of deeper problems. Case managers role further assessment regarding clients capacity and whether interventions can make home livable r ecognize that sometimes it is just not possible for clients to return homeWe may conclude by stating that effective discharge planning and transitional care have real benefit in improving the out-come of a patient and bringing down the rate of re-hospitalization of the same patients.ReferenceBirjandi, A., Bragg, L. (2009). Discharge planning handbook for health care Top 10 secrets to unlocking a new revenue pipeline. Boca Raton CRC Press.Corey, G., Corey, M., Callanan, P. (2003). Issues and ethics in the helping professions, 6th edition. Pacific Grove, CA Brooks/Cole.Mattison, M. (2000). Ethical decision-making The person in the process. Social Work, 45 (3), 201-212.The Arnolfini Portrait by Jan van van Eyck AnalysisThe Arnolfini Portrait by Jan van Eyck AnalysisJan van Eyck. The Arnolfini Portrait.Jan van EyckThe Portrait of Giovanni (?) Arnolfini and his Wife Giovanna Cenami (?) (The Arnolfini Marriage). 1434.Oil in oak.81.8 x 59.7 cm.The National Gallery, capital of the Unite d Kingdom.The Arnolfini Portrait startles us by its apparent naive realism and attention to detail, which seem to anticipate Dutch painting of two centuries later. Much of the effect is owing to van Eycks use of oil-based paints. He is practically called the inventor of oil painting, though it seems more likely that he and his brother discovered the potential of the new medium by developing a seal off which dried at a consistent rate, allowing Jan to make a glossy colour which could be applied in transparent layers or glazes and put on the glittering highlights with a pointed brush (Gombrich, 240). The new medium was miraculous in its suitability for depicting metals and jewels (as well as the individual strands of hair in a dogs coat), and, as Sister Wendy Beckett says, more significantly, for the vivid, convincing depiction of natural light (Beckett, 64). Equally original is the setting and milieu, for this is a cautious commission (Levey, 68), set not in a palace or a church but in a room in an characterless house, every detail of which is depicted with total accuracy and naturalism, and shown, as Sir Kenneth Clark noted, by a miracle that defies the laws of art-history enveloped in daylight as close to experience as if it had been discovered by Vermeer of Delft (Clark, 104).Despite the naturalism of the scene, it is likely that the objects depicted are rich in symbolic meaning. The couple stand in a room, shown with precise concern for perspective Levy calls it a perspective cube (Levey, 68). They are dressed very richly, and stand in poses that suggest ceremony and serious purpose, hence the vagary that we are witnessing a marriage as van Eyck is doing quite literally. He can be seen with another witness reflected in the convex reflect on the wall, i.e. standing at the point from which the perspective view runs, and he has left his signature above the mirror, in a legal Gothic script, grammatical construction that he was here (only a moment ago , one might think (Huizinga, 259)), not just that he painted this. The couple stand apart, as if separated by ceremonial considerations. He takes her right hand in his left, and raises his right as if to complete a vow or pledge. She has a shy(p) expression, while he is earnest and solemn. His dress is sumptuous and expensive, hers is lavish and modest, in green, the colour of affection (Baldass, 76). If this is the holy sacrament of marriage, to complete its validity there should be consummation, which is why we are in a bedroom.In other parts of the room are objects painted with scrupulous accuracy, which at the same time have an iconographic purpose which is relevant to the ritual of marriage. The little dog is a symbol of fidelity. The shoes cast aside show that the couple stand unshod since this is the background of a holy union (Beckett, 64). The fruit on the window sill are either a reference to fertility or a reminder of the deadly apple. The single candle flame in the ma gnificently rendered candelabrum a light which is not necessary for illumination suggests the eye of God. Carved on the chair back is an image of St Margaret, a saint associated with childbirth, and the arms of the chair and the prie-dieu are decorated with the lions of the throne of Solomon. Most spectacular of all is the painting of the mirror, which with its convex determine reflects back the whole interior, together with the image of the painter and another man. Its frame is decorated with ten medallions showing events from the life of Christ, intended to emphasise that the Original goof is atoned for by the Passion of Christ (Baldass, 75).To emphasise the symbolic meanings of the objects in the painting (of which we cannot always be certain) is by no means to detract from the astonishing realism of the scene. The van Eycks began their careers as manuscript illustrators, and the concern for detail is apparent everywhere. The dog is intensely real, charming, and of no identif iable breed. The texture of materials is rendered in the finest detail, in the gilding of the candelabra and the way the light catches it, the glint of the beads in the rosary hanging by the mirror, and of course the glass of the mirror itself, and its concave shape giving a curved reflection of the room. The light is caught precisely on the inward curve of the medallion roundels in the frame. The presentation of the materialing is meticulous, both in the texture of the cloth and in the way it hangs on the body. Even the grain of the wood in the floorboards is exact. Colour too is handled with great subtlety, the green of her dress, with traces of blue in the undersleeves, set off against the rich red of the bed hangings, both lit by the single source of light, the window to the left. It is as if a simple corner of the real cosmos has suddenly been fixed on to a panel as if by magic (Gombrich, 243).Huizinga makes a point related to this concern for total realism, that it is immense ly rich for us to see a late medieval artist depicting private life, and not bound by the requirements of the court or the Church. The Master need not portray the majesty of divine beings nor minister to aristocratic pride (Huizinga, 258). Van Eycks Gothic signature and declaration on the wall suggests that the whole piece might be a sort of legal act of witnessing. The whole conception marks the shift from the medieval to the modern world, because the witnessing is literally established for us through the precise application of the rules of perspective. The scene is viewed through the eyes of the man reflected in the mirror, and it is the view of the single observer which is to form the recipe of painting from van Eyck until the end of the nineteenth century. In the Arnolfini portrait the artist became the perfect eye-witness in the truest sense of the term (Gombrich, 243).Works CitedBaldass, L. Jan Van Eyck. London Phaidon, 1952.Beckett, Sister Wendy. The Story of Painting. Lond on Dorling Kindersley, 1994.Clark, K. Civilisation. A Personal View. London BBC, 1969.Gombrich, E.H. The Story of Art. London Pahidon, 1995.Huizinga, J. The Waning of the Middle Ages. New York Anchor, 1949.Levey, M. From Giotto to Cezanne. London Thames and Hudson, 1962.