Discharge Plans: a Case Study

leave out Plans a Case StudyIt whitethorn baffle as a shock to selltakers of the patient that bump off g agencying may commence as soon as a patient has been admitted. This does non necessarily mean that the patient is being write outd for plaza, and rather it performer that plans are being put in place for a thriving fire plan to take place. Information is ga on that guide ond about the patient, how they live, for example, do they live with sepa straddles, are they dependent or independent (Birjandi Bragg 2009). Caretakers are shapeively pretendd in a electric offload plan provided the patient gives consend. erstwhile the patient shows improvement, it is clear that further recovery in a infirmary set-up is non likely to take place and thus they are sent to an environment they may adopt to their necessitate their home.Birjandi, A Bragg, (2009) say that discharge planning is inseparcap subject and should be dvirtuoso right, whether the discharge is to a ren ewal center, a nursing home or the clients home. wellness check practitioners should ask an ideal discharge plan as studies take in shown that improvement in hospital discharges with great out induces when appropriate discharge plans are made.health fear givers, family members and patients themselves have got a great role to play after discharge in maintaining good health. Even though discharge planning is essential in patients health there is inconsistence in some(prenominal) the discharge performance and the quality of discharge planning in most of the health safekeeping 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 conviction of admission coiffure the possible discharge takes, family involvement in decision making and how to channel the client to their destination.Birjandi, A Bragg, L. (2009) describe discharge planning as a method used to decide the requirements of a patient as they channelize from one level of foreboding to a nonher, only doctors may approve patients release from a health facility, and the actual discharge plan may be done by a nurse, publication omnibus, case manager. tortuous conditions much(prenominal) as cerebral vascular accident may have a squad approach. Well organized discharge planning may reduce the chances of re-hospitalization and aid in recovery ensure medications are comfortably prescribed and administered correctly. In general a discharge plan should involve the fareing evaluation of the client by qualified practitioner, discussion with both the client and the phencyclidine hydrochloride, planning of the transfer process and homecoming of the client, de stipulationining whether the do bytaker urgencys to a greater extent development or whatsoever other physical body of retain, referral to support an organization or care agency and finally arranging f or 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 diagnosis 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 somebody, place, and time. Denied s bulwarkowing difficulties, no visual defects and denied pain.Medications Aspirin 81mg per oral daily acetaminophen 650mg per oral when necessary for painCerebral vascular and pulmonary located 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, non distended, positive bowel sounds. Bowel effect presentGenitourinary Voids freely, requiring supportance to the bathroom. Ou tput approximately 1000ml/day. Brief installment of dysuria on admission.Integumentary skin intact, no lesions nonicedMusculoskeletal ready range of social movement right side limited range of motion on the left side required assistant to get into a wheelchair. History of recent balance problems.Psychosocial lives with daughter in a 2 story home occupation retired teacherDischarge needs were discussed with the caretaker, these include the physical condition of the family before and after hospitalization, the tokens of the kind of care required by the client were discussed, included information of the patients prognosis, what activities she might need to help with information about the clients medication and diet should be given over, any extra equipment that was deemed necessary such as wheelchair, oxygen and who will be in charge of the clients meal preparation, transport to referrals and support groups.The daughter who lives with Mr. Kate was involved in the discharge proce ss, 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 non have time to spare to take care of her mother as her work was demanding. She besides had meets about she would go about transporting her mother from the bed to her chair and winning her to the bathroom. She was referred to help agencies that assist in taking care of patients at their homes at a paid payment. Several agency information was availed to her, with instructions to come up with a decision on which one to use. She was also given a choice to hire an singular 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 a ssistance. This was done in ad forefrontguardce 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, pedagogy 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 exc interruption patients progress regularly with the doctors or the health team increase the chances of potent follow up care. Telephone conversions, post discharge with doctors also helps to sojourn 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 contri only whene to respectable dilemmas. As case managers, we should take reasonable steps to safeguard the interests and rights of those clients. ethical dilemma occurs when an individual has to choose between two or more conflicting ethical standards. There is no one right dissolver 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 privy help you achieve an satisfactory resolution. Mattison, (2000) reminds us that utilizing an ethical decision-making model doesnt result in bias-free decisions. Our set still come into play utilizing an ethical decision-making model and we may not be aware of it First of all, it is principal(prenominal) to remember clients rights to self ending and autonomy clients have the right to make poor decisions. However, the role of the case manager is different in this situation depending o n the clients cognitive capacity for decision making. If the client has capacity, the focus is on ensuring the client is making an aware decision and reassuring the care team, which includes the family, about resources to maximize safety. If the client does not have capacity, the focus is identifying someone who washstand 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 unsafe Promote informed consent this involves educating the client about the teams concerns related to his or her safety and potential consequences associated with an unsafe discharge. study 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 on hand(predicate) to enable older adults to live safely in their own homes fr eshen uping these resources can eliminate concerns. May be worried about remote dangers that should not trump client autonomy and self determination, i.e. If there was a fire, he would have difficulty 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 tickm able to provide care Approaches to family/caregiver education Convene a team conference with them to look backward the clients level of care and specific care needs. crap the individual assume full responsibility for care for a degree of time while in a safe environment (i.e. lock 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 terms of career. Often this will result in the family member re alizing for themselves that the care is too some(prenominal) 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 trial visit in the lesser care environment, say 24-48 hours, with a planned return to the higher(prenominal) 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 contributing to the refusal of services deemed necessary by the care team. Potential 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. paying a little for care now will prevent expensive hospitalizations in the future. Discomfort with the thought of strangers in the home. Validate this concern it is disquieting having unfamiliar people help with intimate tasks in ones private domain. Arrange for client/family to meet potential service providers in advance of time to minimize anxiety.Additional factors potentially contributing to service refusal misunderstandings regarding the utilisation of recommended services. Feelings of guilt or shame related to not being able to provide all care independently. Recommended services dont turmoil client/familys cultural belief system. Past negative experiences with exchangeable servicesCaretaker unwilling to have client return home this is one of the most heart-wrenching ethical dilemmas to deal with and can bring up some issues of counter-transference good self-care and supervision is important. Things to keep in mind Client 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, match/partner may be unaware of support services usable 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 settle 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, offer services to assist client with home management. If hom e is in disrepair, infested with rats, covered with mold and decomposition reaction garbage hazardous situation indicative of deeper problems. Case managers role further assessment regarding clients capacity and whether interventions can make home livable recognize that sometimes it is just not possible for clients to return homeWe may conclude by stating that in force(p) discharge planning and transitional care have real pull in 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 van Eyck AnalysisTh e 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, London.The Arnolfini Portrait startles us by its apparent realism and forethought 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 frequently called the inventor of oil painting, though it seems more likely that he and his comrade discovered the potential of the new average by developing a varnish 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 bourgeois commission (Levey, 68), set not in a palace or a church but in a room in an ordinary 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 observed by Vermeer of Delft (Clark, 104).Despite the naturalism of the picture show, it is likely that the objects depicted are rich in figureic meaning. The couple stand in a room, shown with precise concern for office Levy calls it a perspective cube (Levey, 68). They are polished very richly, and stand in poses that suggest ceremony and serious purpose, therefrom the supposition that we are witnessing a marriage as van Eyck is doing quite literally. He can be seen with another witness reflected in the convex mirror 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 sound Gothic script, saying 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 honoring considerations. He takes her right hand in his left, and raises his right as if to fatten out a vow or pledge. She has a shy expression, while he is earnest and solemn. His dress is sumptuous and expensive, hers is lavish and modest, in green, the colour of mettle (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 th at the couple stand unshoed since this is the ground of a holy union (Beckett, 64). The fruit on the windowpane sill are either a reference to fertility or a reminder of the fatal apple. The single candle flame in the magnificently rendered candelabrum a light which is not necessary for illumination suggests the midriff of God. Carved on the chair back is an image of St Margaret, a perfection associated with childbirth, and the arms of the chair and the prie-dieu are decorated with the lions of the throne of Solomon. Most undischarged of all is the painting of the mirror, which with its convex shape reflects back the whole interior, unitedly with the image of the painter and another man. Its frame is decorated with ten medallions viewing events from the life of Christ, intended to emphasise that the Original Sin is atoned for by the rut 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 identifiable 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 talent a curved reflection of the room. The light is caught precisely on the interior curve of the medallion roundels in the frame. The presentation of the clothing is meticulous, both in the texture of the cloth and in the way it hangs on the body. Even the penetrate of the wood in the floorboards is exact. Colour too is handled with great subtlety, the green of her dress, with traces of relentless in the undersleeves, set off against the rich red of the bed hangings, both lit by the single sou rce of light, the window to the left. It is as if a simple corner of the real world 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 immensely valuable 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). vanguard 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 advance(a) 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 beholder which is to form the convention of painting from van Eyck until the end of the 19th 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. London 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. invigorated York Anchor, 1949.Levey, M. From Giotto to Cezanne. London Thames and Hudson, 1962.