Treatment Of Clostridium Difficile Infection Health And Social Care Essay

Treatment Of Clostridium Difficile Infection Health And Social Care Essay As a nurse working in acute medical ward for elderly, I work closely with patients with C. difficile infection. I have noticed the effect of C. difficile infection in elderly can be fatal. C. difficile is a gram positive anaerobic bacillus. They colonise in the oxygen deficient areas of the body. That can cause life threatening conditions, including diarrhoea, colitis and septicaemia and resulting death. C. difficile infection can cause serious illness and a significant cause of patient morbidity and mortality. It is a major cause of hospital acquired diarrhoea. C. difficile infection can cause serious illness and hospital outbreaks .It can cause significant financial burden on NHS. It is estimated that the increased length of hospital stay itself can cause an excess of around  £4,000 per patient. The number of death certificates mentioning C. difficile infection in England and Wales fell by 29% between 2007 and 2008 ,after increasing every year since records began in 1999(National Statistics,2008). According to Weston (2007), Clostridium difficile was first identified in 1935s, but until the late 1970s it was not identified as the cause of pseudo membranous colitis following antibiotic therapy. C. difficile infection is more common in elderly (over the age of 65). People who have a long stay in health care settings, those who have recently had gastrointestinal surgery and those who have a serious underlying illness that compromises their immune system are also at high risk to get C. difficile infection. In-patients are also at high risk if there are hospital outbreaks. Poor infection controls are also an important risk factor. Causes Antibiotics are considered as the most important cause for C. difficile infection. Any antibiotic can cause C. difficile infection, but Broad spectrum cephalosporins, broad spectrum penicillin and clindamycin are most frequently implicated. The second most commonly named antibiotic is Co amoxiclav (Health Protection Agency, 2008). The use of proton pump inhibitors such as lansoprazole, omeprazole and pantoprazole are also potential risk factor for C. difficile infection (Leonard et al., 2007). The disruption of normal harmless bacteria in the gut, because of antibiotic therapy also allows the C. difficile to multiply to greater number. The bacteria start to produce toxins. The antacids suppress the gastric acid secretion and as a result, C. difficile bacteria, including the spores are less likely destroyed. The reason for community associated C. difficile infection was unclear but it is become clear that the reasons for the majority of the infections are associated with antibiotic pr escriptions or hospitalisation (Wilcox et al., 2008). Transmission The transmission is through faecal-oral route. The infected patients acquire the organisms directly from other patients with diarrhoea. The route of transmission may be direct, via the hands of health care workers or via the hands of patients or via the environment. Asymptomatic people who are colonised with C. difficile are also can be able to transmit the disease. About 3% is the colonisation rate in healthy adults, but this increases to nearly 20 % in older people especially in chronic care wards. The spore form of C. difficile can survive in the environment for five months or more on hard surfaces. It is considered that the primary route of transmission of C. difficile infection via healthcare workers hand. Clinical features and pathogenesis The most important clinical feature is sudden onset of offensive smelling diarrhoea during a course of antibiotic or who had antibiotics with in the previous two months. Patients may pass soft or watery stool more than twice daily or in more severe cases more than 20 times accompanied by severe abdominal cramps (Weston, 2007). Abdominal distension, fever and dehydration may also be present in more severe cases. Unless C. difficile is diagnosed, the patients can be miss- diagnosed with irritable bowel syndrome. C. difficile infection is a major health problem worldwide that leads to increased morbidity and mortality. Healthy adults carry around 500 species of bacteria in the colon, 90% of which are harmless (Weston, 2007). C. difficile colitis results from the disruption of normal colonic flora and C. difficile colonises in the oxygen deficient areas of intestine. The spores are able to replicate and produce toxins that can lead to mucosal damage and inflammation. In a healthy adult t he normal colonic flora inhibit the growth and colonisation by C. difficile. The antibiotic therapy may disrupt the normal flora and allow the C. difficile to colonise very rapidly. After colonisation the organisms produces two protein exotoxins( Toxin A, an enterotoxin and Toxin B , a cytotoxin) in to the colonic lumen. These are responsible for diarrhoea and colitis. Toxin A binds to the receptors in the intestine and cause extensive tissue damage, inflammation and oedema. Both toxins posses cytotoxic activity against cultured cells by same mechanisms but they differ in cytotoxic potency, toxin B is generally 1000 times more potent than toxin A and to play a major role in activating inflammatory repose (Weston, 2007). Toxin B is more important than toxin A in the pathogenesis of C. difficile infection in man. According to lab test reports there are 100 different types of c difficile stains. The most recognised epidemic types is ribotype 027.The most important feature of ribotype 027 is hypertoxin production, 10 to 20 times more toxin than other stains. The C. difficile infection caused by ribotype 027 are more likely to be severe with increased complications such as renal impairment, severe colonic dilatation and sepsis (Freeman et al., 2007).The clinical features include increased severity of illness, failure to respond to antibiotics ,abdominal distension. Raised CRP and rising WCC particularly in patients who may have appeared to respond to antibiotics and deterioration in condition and appears to have higher mortality rate. Diagnosis Laboratory studies of stool sample will help to detect c difficile infection. Stool culture will help to detect the presence of difficile with toxin production. Stool enzyme immunoassay (ELISA)will detect both of the toxins ( A or B). For toxin B Stool cytotoxicity assay will be positive.Endoscopy may demonstrate ,but it is the least sensitive for diagnosing C. difficile as compared to stool assays., Sigmoidoscopy alone may not reveal any abnormality if the disease is confined to the right colon. Colonoscopy is more useful. Because of the risk of perforation Sigmoidoscopy and Colonoscopy is contraindicated in patients with colitis (Weston, 2007). Treatment The treatment of C. difficile infection depends on the severity of the illness. At my work place, the patient is closely monitored and isolated. A stool chart is maintained using Bristol Stool Chart. All antibiotics that are not required are stopped. This will help the normal bacteria to thrive again in the gut. If any patient develops C. difficile infection at my work place, we conduct a thorough investigation for the causes and we notify the antibiotic management team to review the patient. The team will review the patient in the ward (rounds Wed/Fri.) or via the phone. There will be a root cause analysis to find why the patient developed C. difficile infection? In some patients fluid and electrolyte replacement and nutrition review may also be necessary. In mild cases of C. difficile infection, patients are monitored for 48 hrs before starting antibiotics. In severe cases, antibiotics may need to be administered immediately. Metronidazole and Vancomycin are the two preliminary ant ibiotics used in the treatment of the infection (Weston, 2007). Usually a 7 to 10 day of therapy is required. Oral metronidazole 400mgs eight hourly for seven to ten days is the first line of treatment. It is contraindicated in women who are pregnant or who are breast feeding. The most recognised side effects of the metronidazole are an unpleasant metallic taste, nausea, vomiting, diarrhoea, abdominal pain, headache, pruritus, rashes, dizziness and reversible neutropenia. Vancomycin is known to cause the spread of vancomycin resistant bacteria. Vancomycin is used for severe, life threatening cases of C. difficile infection. It is also used for patients unable to tolerate metronidazole and failed treatment with metronidazole. Vancomycin is expensive. Oral vancomycin is not completely absorbed or metabolized in the gut and is excreted in the stool unchanged. This is ideal in the treatment of C. difficile infection. The recommended oral vancomycin doses for adults are either 125mg or 500mg four times daily. The use of a rectal vancomycin enema (500mg diluted in 1000ml of 0.9% sodium chloride injection) is also an alternative. A recurrence of symptomatic disease with re infection occurs in 5-20% cases. Management of repeated relapses is more difficult. The options include slow tapering of vancomycin or metronidazole over a period of six weeks and vancomycin combined with rifampicin for seven days. There are also case reports of successful treatments with intravenous immunoglobulin which contains antibodies to c difficile toxins. The studies shows oral administration of limited bacteria or yeast helps to reconstitute the gut flora and there is a potential to prevent infection.The ability of these organisms to colonize and also to prevent and treat the c.difficile is unclear. (Department Of Health, 2009). Surgery may be needed for small number of cases especially if C. difficile infection progress to fulminant colitis and perforation. Loperamide (anti diarrhoea drug) is contraindicated for C. difficile infection because this will slow down the clearing of toxic bacteria (Weston, 2007). Prevention Control Preventing the spread of C. difficile can be challenging as hospitals tend to have an increasing population of elderly, debilitated and susceptible persons, which naturally increases the number susceptible hosts within the environment. Isolation Isolation should be implemented in conjunction with the infection prevention and control measures to minimise the risk of spread to other vulnerable groups. Private room/side room is recommended, especially for patients who are fecally incontinent. Cohort symptomatic C. difficile associated disease patients only with other symptomatic C. difficile infected patients, to minimise environmental contamination. Patients with C. difficile infection may be moved to other rooms or bays when the diarrhoea ceases (no diarrhoea at least 48 hours) (Department Of Health, 2009 and Health Protection Agency, 2009). Hand washing Barrier nursing Contact precautions should be used for C. difficile infected patients with diarrhoea. Proper hand washing is essential. Alcohol-based hand gels are not effective in reducing the spread of the organism and are not recommended. Disposable gloves and aprons should be worn when caring for the patients. It is recommended that not to share the equipments between the patients. It is a good practice to inform healthcare workers and visitors that a patient is on contact precautions, such as labelling the door of the room, without disturbing patients privacy. Last year we (My work place) spent  £1,280.32 for soap, alcohol, gel and moisturiser. Environmental Cleaning The environment of a patient with C. difficile infection should be cleaned thoroughly at least twice per day. An approved hospital disinfectant-detergent should be used for all environmental cleaning. Terminal cleaning (stage cleaning) of ward area is essential after the discharge or transfer or death of a patient with C. difficile infection. (My ward) Decontamination of equipment Do not share equipments among patients to prevent cross infection. Commodes and bedpans are heavily contaminated with spores and are considered as vehicles of cross infection in C. difficile outbreaks. It is ideal that symptomatic patients have their own commodes or toilet facilities. Proper disinfection must be essential. Transfer of Patients Transfer of patients with C. difficile infection or disease to another ward, unit, or to the long term care facility must be informed prior to the transfer that the patient has C. difficile infection. Same notice must accompany transfer of patients with C. difficile infection to a long term care facility (Department Of Health, 2009). It is not necessary to have absence of diarrhoea or negative stool cultures before the transfer of a C. difficile patient to a long term care facility. On the patients discharge, we need to notify the primary care physician (My ward). Rectal Thermometers Since the outbreaks C. difficile in hospitals and long term care facilities, rectal thermometers are restricted to use. For the routine use Electronic tympanic thermometers are recommended (Department Of Health, 2009) Education Ward should conduct training programmes to the health care staff. Ensure that patient / family information leaflets are given out. Anti microbial management team It is the responsibility of the hospital trust to develop anti microbial management team. That should consist of a consultant microbiologist, pharmacist and prescriber. The trust also needs to develop restrictive antibiotic guidelines. These guidelines specifically need to address to avoid the use of broad spectrum cephalosporin, broad spectrum penicillin and clindamycin especially in elderly and minimise the use of fluroquinolones, carbapenems,that we follow in my work place. It is also a good practice to have an infection control link nurse to each and every ward. It is their responsibility to do proper training for staffs and auditing the clinical area. Outbreaks of C. difficile infection in Long Term Care Facilities An outbreak of C. difficile infection is defined as three or more cases of symptomatic C. difficile infection mainly in the same area of the hospital ward within a period of seven days. Infected patients should be placed in isolation room or cohorted. Patient(s) can be removed from precautions if there is no diarrhoea .There is no need to wait for negative stool culture to remove the patent from precautions. An education program regarding C. difficile infection and its transmission and prevention should be conducted to all health care workers. Need to highlight the use of gloves and aprons and moreover proper hand washing. The health care facility need to monitor for any significant episodes of C. difficile infection, and then need to liaise with local health department for further assistance (Walker K et al., 1993). Possible Solution Conducting education programmes and workshops for health care workers and public to increase the awareness of C. difficile infection can contribute a major role in reducing the number of C. difficile infection cases within the healthcare system. Need special attention to personal hygiene. The primary route transmission is via the hands of healthcare workers and other patients and residents. It is very important to perform proper hand washing and barrier nursing (gloves, gowns). Environmental hygiene is also very important factor in controlling C. difficile infection. Regular and proper cleaning of patient rooms with anti bacterial cleaning agents is essential as C. difficile toxins can stay in the environment for several months. Changing the way doctors prescribe antibiotic therapy is also an important strategy in control the C. difficile infection. Because C. difficile infection is always associated with the use of antibiotics, It is also recommended to have an antimicrobial management team for each hospital (Department Of Health, 2009). In cases of recurrent C. difficile infection experts agree that the non antibiotic treatment have a positive impact. The use of toxin binders neutralises the effect of toxin producing stains and to helps the intestinal flora to restore .Tolevamer, developed by Genzyme Corporation is the first non antibiotic treatment approved for C. difficile infection (www.mediscape.com). Mandatory surveillance of C. difficile infection in the United Kingdom When looking at surveillance reports, many of the hospitals in the UK have been affected with outbreaks of C. difficile.  We can see that the large increase in the number is between 2000 and 2007.It is the responsibility of the  hospitals in the UK has to measure and report to the Department of Health.  The surveillance should include the number of positive cases, number of severe infections, the number of required surgery cases and number of deaths. The surveillance of C. difficile infection is taking to get a target for 30% reduction from 2007/2008 numbers by 2010/2011.  In 2007-2008, there were 55,498 cases reported across England. In 2008-2009, the cases reported dropped to 36,095. i.e., cases dropped by 35%. Last year our target (My hospital and my community) was 180. The number of cases reported was 171, 98 of which are from hospital (7 cases from my ward).This year, the target is 155. Social, economic and political issues. C. difficile infection is expensive to the NHS. The total identifiable increased cost of C. difficile infection causes an excess of  £4000 per case. Such high costs can be used to justify expenditure on personnel and/or other control measures to reduce the incidence of this hospital-acquired infection. There are notable outbreaks of c. difficile infection worldwide since 2003.Outbreaks was reported in Montreal, Quebec and Calgary, Alberta, in Canada. Approximately 1400 cases affected, death count 36 89.A similar outbreak reported at Stoke Mandeville Hospital in the United Kingdom between 2003 and 2005, in which 33 patients died. In 2007 Maidstone and Tunbridge Wells NHS Trust was heavily criticized by the Commission, have heightened media and made public awareness. In 2009, four deaths reported at Our Lady of Lourdes Hospital in Ireland also thought to have links to Clostridium difficile infection. The prevention and control of C. difficile infection in health care settings is bec ome a global public health challenge.(Health Protection Agency 2009) Conclusion C. difficile infection is a major problem in hospitals that is associated with the use of antibiotics. C. difficile infection also recognised as one of the major health care associated infection. It is estimated that C. difficile infection affects between 40000-60000 people in the UK every year. The prevention and control of C. difficile infection is very important. The three main elements of prevention are: Need to restricted use of antibiotics; Strict isolation precautions and barrier nursing when looking after patients with diarrhoea and Through cleaning of clinical areas. Poor hand washing is known to play a key role in the spread of infection. Hand washing facilities in the hospitals such as the number of hand washing sinks and their position, and type of taps are also need to be inspected. Hand washing protocols is low in many hospitals. C. difficile infection needs treatment only if it is symptomatic. Most of the people make full recovery and in rare cases the infection can be fatal. Infection control teams need to develop education programmes to improve compliance and regular auditing. It is everybodys business to participate to prevent and control C. difficile infection with in the health care system. The health care workers need to follow the hospital infection control policy.

Operating Plan Essay

We will First Operate in major tube metropoliss. get downing with Bangalore. and so Mumbai. Delhi. Chennai. Goa. Pune. Kolkata. Gujarat etc. After Targeting to these metropoliss. we will seek to aim the rural India which is about 70 % of India. How will we advance? We will advance through ADVERTISEMENT in ONLINE FORUM. SOCIAL NETWORKING SITES. Locally celebrated Theaters. Souvenirs given to clients. App Stores. humanoid market apps. PRINT MEDIA which is about read by every other individual normally. like Hindu. Times of India. etc in Bangalore and besides some local trade names etc. What will be our gross revenues publicity activity? Peoples would be able to book a whole new wave for household acquire together. a birthday party with their films. counter tiffin or dinner etc all made available in the coach. with some anterior engagement of minimal 7 yearss. Besides if a school or college wants to demo a educational reappraisal. or a documental to their pupils. the squad may take attention. travel to school and demo assist them with all things they needed with anterior engagement. We will be besides publishing a base on balls which will be a three clip one-year base on balls in which you can see film thrice a month with that base on balls delivering every clip you come. This will be chiefly for our twenty-four hours today clients. The one-year base on balls will besides incorporate vouchers for free Zea mays everta. or some price reduction on repast and besides some other value added services. How Will We Sell? Our chief purpose is to gain net income with making a strong client relationship. We will sell our Tickets through our ain web site. Bookmyshow. com. After some clip in long term we will do our ain apps in Iphone. android market. Ipad etc. The Timings will be pre decided. and a hebdomads timetable will besides be decided. which will demo non merely new films. but sometimes a educational movie. and local linguistic communication movies of the metropolis we operate in. Where will we park? We will park our cinevan in a short distance from our clients place. A soap of 1 kilometer far in any vicinity we decided. We will park someplace where there is ample of infinite for vehicles to come and travel. This will assist in modulating the traffic. We will besides take anterior permissions for all our topographic points. etc How will we acquire our train? We will import in the beginning and so we will seek and improvize our squad and add some interior decorators who can plan our train which will be more broad etc. our current train will suit around 70 people at a clip. How will Caravan be like? Caravan will be a coach which will hold a same experience as if you are sitting In a multiplex. The Acoustics section will be taken attention of and a finest of all will be used at that place.

Care at the end of life Essay

It is a fact that humans are born to die. What was once considered a natural part of life has changed to an experience that may be more painful for the patient, family, and caregivers due to the advances in medical care. New procedures have allowed life to be extended longer than ever before. The question is: has the dying experience improved? This paper will include a review of death and dying from the perspectives of the patient and caregivers. An unfortunate case will be discussed, and the organizational structure, culture, and governance that led to this situation will be reviewed. Recommendations for the changes necessary to prevent such cases in the future will be included. Ms. Smith was a 66 -year -old female with breast cancer that had metastasized to her lungs and liver. She had two adult daughters who lived in her home town and one of them had a young child. Mr. Smith was a 70- year-old retired factory worker. Ms. Smith had gone through lengthy chemotherapy and radiation treatments that had left her weak and debilitated. She developed pneumonia and experienced a respiratory arrest. She was placed on a ventilator and was weaned off the ventilator after two weeks. She remained in the Intensive Care Unit (ICU). Her family stayed with her as much as the ICU visiting hours allowed, but she was often alone and told her family that she was in pain and wanted to die. The nurses were  concerned about her pain needs, but were also worried that too much medication could cause another respiratory arrest. Ms. Smith languished in the ICU for two months until she did have another respiratory arrest and died without her family at her side. She and her family had agreed that she would not go back on the ventilator, and the physicians had written a Do Not Resuscitate (DNR) order. They had planned to move her from the ICU, but they hesitated to place her on a regular floor. Everyone involved in the case believed that it was not handled well, and a team was assembled to determine how to improve the care of the dying. A review of the literature found that this institution was not alone with their concerns that the care of the dying needed to improve. Autonomy is one of the core bioethical principles that focuses on the right of every individual to make choices regarding health care decisions. Providers and caregivers spend a great deal of time instructing and coaxing patients to take control of their own health. But these providers are often surprised and upset when patients with life-limiting illnesses express a desire to control the timing and circumstances of their end-of-life experience (Volker, Kahn, & Penticuff, 2004). In their study, they found that people with advanced cancer expressed a wide variety of preferences for personal control and comfort, and that many wanted to remain as involved as possible in their daily lives for as long as possible. Organizations can play a key role in policy changes to support the needs of these individuals. Providers are trained to see death as the enemy, and sometimes forget that death is a natural part of the human experience. Joe Cantlupe’s story in Health Leaders stated that â€Å"we don’t always deal with the issues of death and dying very well in our culture† (p. 14, 2013). The Institute of Medicine published a report that concluded that many patients die in pain, are not referred to hospice in a timely manner, and the improvements in care have not led to improvements in care at the end of life. Fortunately, there have been efforts to study the patient’s perspective of death and dying as well as the perspectives of nurses and physicians. These studies are leading to a better understanding of the experience and the methods needed to improve the quality of end of life care (Cantlupe, 2013). It may seem strange to consider quality about end of life care, but it is recognized as an ethical obligation of health care providers and organizations. Singer, Martin, and Kelner studied 126 patients on dialysis, diagnosed with AIDS, or residents of long-term care facilities, to determine their views on end-of-life issues. Their results identified five domains of quality care at the end-of-life. These were â€Å"adequate pain and symptom management, avoiding inappropriate prolongation of dying, achieving a sense of control, relieving burden, and strengthening relationships with loved ones† (p. 163, 1999). The participants expressed fear of lingering or kept alive when they could no longer enjoy their lives. Many stated that they would not wish to go on life support if they were not going to improve or have a chance to live a normal life again. Several mentioned that being placed on life support was the same as being a guinea pig. There were conflicting reports on the choice of dying at home or in a hospital. Some wanted to be at home, but others felt that was a burden on the family (Singer, Martin, & Kelner, 1999). Another study by Gourdji, McVey, & Purden in 2009 interviewed palliative care patients about the meaning of quality of life at this stage of their illness, and the factors that would improve their quality of life. They found that several factors, including their approach to life, their approach to their illness, and their ideal of quality of life shaped their end-of-life experiences. These patients stressed that they most wanted to continue what they had been doing for most of their lives for as long as possible. They also wanted to help others when possible and live in a caring environment. They often mentioned the use of humor and a positive attitude in the environment. When they discussed their illnesses, they expressed frustration with their physical limitations, and hopelessness when the disease reoccurred. As providers began to understand the gap between their traditional training and the needs of patients, researchers began to evaluate the skills needed to provide a better quality of end-of-life care. Nursing had long considered the choices made about artificial nutrition or hydration, palliative treatment, or symptom control to be in the medical domain, and the nursing role was often unclear. Nursing is involved in the end-of-life care. They are with the inpatient on a 24-hour basis, they use a  patient-centered approach to care, and they have experience and expertise in caring for dying patients and their families. Case studies have found that the nurses’ involvement in end-of-life care is not only about the technical decisions in the care process, but also that the daily interactions that nurses have with patient’s vulnerabilities make them ethically sensitive to the needs of the patient and family (Gastman, 2012). The International Council of Nurses (ICN) developed a code of ethics that stated that nurses are responsible to alleviate suffering as well as promoting health and preventing illness. By expanding the scope of end-of-life care beyond the narrow medical definitions, and aligning the code of ethics with a broader definition of end-of-life care to expand beyond the hospital setting, nursing can become more involved in end-of-life care (Shigeko, Nague, Sakuai, & Imamura, 2012). The role of the primary care provider in end-of-life care has also been studied, and these studies have found that despite the continuity and comprehensiveness of primary care, few Americans die under the care of their familiar provider. Many patients have reported feeling abandoned by their primary care provider at the time of death. Care at home by primary care providers benefits many patients and the health care system overburdened by hospitalization cost (Silveira, & Forman, 2012). On the other side of the care spectrum, the role of the intensive care provider also can be improved. White and Curtis (2005) studied the need and the impact of shared decision- making on critically ill ICU patients. They found that while involving families in end-of-life decisions is a complex task that requires excellent communication skills, the more time spent with families discussing and explain the issues, the higher the family satisfaction. The hospital where Ms. Smith died was the average institution with an organizational structure that included a Chief Medical Officer and Medical Directors of each specialty area. There was a Chief Nursing Officer as well as Nursing Administrators responsible for the care of patients. They had been very focused on treating illness, and considered themselves successful. The review by the improvement team helped them to see that they needed to change their perspective and consider less paternalistic alternatives to caring for patients at the e nd-of-life. These alternatives usually save cost as well as providing better care at end-of-life. The reimbursement for palliative care programs has been slow, and this has  prompted many hospitals to team up with local hospice programs or nursing facilities to decrease cost. Palliative care has been shown to extend the life of patients, reduce cost, and be more satisfying to the patient and family. Multidisciplinary teams that include physicians, nurses, social workers, psychologists, and spiritual counselors, work together to relieve the suffering, pain, depression, and stress that is often a part of chronic illness. These teams may also include nutritionists and therapist when needed by the individual patient. These programs listen to even the simple requests of patients and families. They work with the patient to get them to the best environment for them and to allow them dignity and control at the end of life. These teams are also moving to the outpatient area to prevent or decrease hospi tal admission and improve quality of life (Cantlupe, 2013). Conclusion Ms. Smith’s hospital should implement a multidisciplinary palliative care team. They should also add education to the program so that the patients and families are better informed about the results of care decisions such as ventilation, hydration, and nutrition. The hospital personnel need to be trained about palliative care and shift their paternalistic approach to a patient-centered approach. It is doubtful that Ms. Smith would have remained in the ICU for two months if there had been a palliative care program in place. She may have been able to transfer to an inpatient hospice center where her family could stay with her, and she would not have died alone and in pain. References Cantlupe, J. (2013, September). A fresh look at end-of-life care. Health Leaders, 12-22. Gastman, C. (2012, September). Nursing ethics perspective on end-of-life care. Nursing Ethics, 19(5), 603-604. Retrieved from http://search.proquest.com.ezproxy.apollolibrary.com/docview/1041054841 Gourdji, Iris. McVey, L., & Purden, M. (2009, Spring). A quality end of life from a palliative care patient’s perspective. Journal of Palliative Care, 25(1), 40-50. Izumi, S., Nagae, H., Sakurai, C., & Imamura, E. (2012, September). Defining end-of-life care from perspectives of nursing ethics. Nursing Ethics, 19(5), 608-616.

The Pan Africanism For Beginners - 1823 Words

The Pan-African movement as described in Lemelle’s Pan-Africanism for Beginners is a set of ideas and ideologies containing social and cultural, political and economic, material and spiritual aspects. Each aspect is accompanied by a plethora of historical figures and terms unique to the movement described thoroughly in the text and the presented glossary. The piece makes it easy to understand all the information accompanying each topic. While it does have its strengths and weaknesses, the book as a whole creates and explains a diverse scope of information. It describes the beginnings of Pan-Africanism and shows how the beliefs of many influential people have stemmed from the notions and dreams of years passed. As a learning experience, Lemelle s Pan-Africanism for Beginners provides a strong broad base of knowledge. Instead of concentrating on the specifics of Pan-Africanism, it covers a broad range of topics, from the Diaspora to Garveyism to the Harlem Renaissance. Because there are so many people and movements associated with Pan-Africanism, it is nearly impossible to go into detail about every important event in one book. Even so, Lemelle provides enough information to convey the complexity of Pan-Africanism. By including its many facets, Lemelle is able to spark an interest in the reader so that they can focus on specific research. For instance, when Lemelle explained the Conference of Independent African States, he described that the purpose of the conference wasShow MoreRelatedThe Pan Africanism For Beginners1829 Words   |  8 PagesThe Pan-African movement as described in Lemelle’s Pan-Africanism for Beginners is a set of ideas and ideologies containing social and cultural , political and economic, material and spiritual aspects. Each aspect is accompanied by a plethora of historical figures and terms unique to the movement, well described throughout the text and in the presented glossary. This book makes it easy to understand all the information accompanying each topic. While it does have its strengths and weaknesses, thisRead MorePan Africanism For Beginners Essay1481 Words   |  6 PagesSid Lemelle hoped for his book, Pan-Africanism for Beginners, to be a comprehensive guide to the complex concept of Pan-Africanism. Lemelle begins the book by broadly defining Pan-Africanism to mean the inclusion of â€Å"all people of African ancestry living in continental Africa and throughout the world.† This definition sets the foundation for his analysis of Pan-Africanism. Pan-Africanism for Beginners explores the major leaders and events associated with Pan-African sentiments chronologically. The