Health Care

1 Understand why communication is the working setting 1. 1 Identify the different reasons people communicate                                                                                           As a human being we have the sense to have others around us and as a result it is essential to communicate. Communication is a two way process and is a vital tool in our lives so it is very important to have a good communication. Reasons to communicate: -To express needs -To share and exchange ideas -To give and receive information and instructions -To socialise and share experiences -To build relationship To reassure -To express feelings and emotions -To understand and to be understood 1. 2 Explain how affective communication affects all aspects of the learners work. Within the care setting it’s vital to communicate with people at all time. Effective communication is important as ensures that is clear, concise, accurate, informative and most of all non-judgemental. Communication ensures affective team working and continuity of care. 1. 3Why it is important to observe an individual’s reactions when communicating with them Communication is a two-way process when two individuals interact with each other.

One person is de sender and the other person automatically becomes the receiver. Observing face and body reaction is very important because only 70-80% of communication is verbal so for that reason if you don’t pay attention you can miss out on a large proportion of the communication. When working with an individual, supporters must get to know the person well and learn the best way to communicate with them as everyone has different needs. 2. 1Show how to find out an individual’s communication and language needs, wishes and preferences.

There are many ways of communication and people communicate in all sort of different ways, for that reason we should try to communicate with the person we are caring for in the easiest way as possible. One of the ways to find out a person’s needs and preferences is by asking the person themselves as they are your best source of information. Otherwise you can speak to a family member or a close friend as they will probably have a great source of information. Another way to find out your clients wishes and preferences is by reading their care plan or asking a colleague with previous experience with a client. . 2 Demonstrate communication methods that meet an individual’s communication needs, wishes and preferences. Overcoming language differences and communication. First of all you will need to find out where the person is from and their culture, a use of a dictionary in their language will also help and be prepared to learn a fill words in their language. Other ways of overcoming the language barriers is the use of flashcards to indicate there needs but the most effective way communication with a person who speaks another language is a non-verbal communication.

The use of gestures can also be helpful but bear in mind that some gestures can be extremely offensive in some cultures. An interpreter is also another alternative in a serious discussion. A smile and a friendly face can be the key to overcome communication barriers. Meeting communication needs for someone with a hearing impairment. First of all make sure the persons hearing aid is working properly, installed with working batteries, clean, and that the person hearing aid is fitted correctly. Ensure the place where you sitting is quiet, light, and close enough so that the person can see your face clearly.

Some people with hearing impairment will lip read while others will use a form of sign language for communication. Give the service user extra time to process what you are trying to say, speak clearly and in the right tone of voice. Meeting communication needs for someone with visual impairment. As a carer we should know that a person with visual impairment is not sure what is going on around them because of their disability. The ways of overcoming that barrier: – making sure that you introduce yourself when entering their room -speaking clearly in a right tone of voice using touch to the hand and arm as saying you are concerned and sympathetic -find out from the client what system of communication they require -never take the arm of someone who is visually impaired to help them move around, allow the person the person to take your arm and ask for guidance. Meeting communication needs of people with physical disability. – There is different ways to deal with disability because it would depend on the nature of the disability or illness. For example if your client had a stroke you will need to use very short sentences, speaking slowly and allowing the person to process what you have said and compose a reply.

Using gestures and simple questions which only need a yes or a no answer is always a good method of communication. Writing, drawing or using flash cards is also another way of communication. – Neurone disease or cerebral palsy can also lead to speech difficulty, it means that there is no need to speak slowly as the person will understand perfectly what you are saying but it will be difficult to reply back to you. Also you will have to become familiar with sounds and the way the person communicate. Meeting the communication needs of people with a learning disability.

When working with people with learning disability you have to adjust to their way of communication. You should gatherer essential information about the person and their level of understanding and kind of communication is most effective. One of the ways to communicate with a person with learning disability is physical contact, some people have a better understanding with physical level rather than a verbal level, but this will depend in each individual. 2. 3How and when to seek advice about communication The best way to find out in who to communicate with a person is asking themselves.

However if communication is not possible you can ask their family or a close friend. Nevertheless when communication is hard and you fill that the person you are communicating with is not capturing the message you should seek advice by asking your line manager in getting specialists or organisations involved and helping you to communicate. There are many organisations with specified knowledge about communication with individuals with sensory loss. Do not assume you can do everything yourself. You should seek advice whenever you have doubts so you can provide the best service possible. . 1 Identify barriers to effective communication There are many barriers which effect communication. Culture is one of them. We take for granted that everyone has the same view of point of communication. In some cultures a younger person shouldn’t have eye contact with the oldest and some articular gestures can be very disrespectful. The is also the language barrier, so remember when communicating with a person who speaks a different language from you, you should speak clearly, using proper words without abbreviation, in a right tune of voice.

Communicating with people with sensory loss can be a barrier. The best way to overcome the barriers: -list the problems to the communication. -list the ways you could try to overcome the communication problems. 3. 2Demonstrate ways to reduce barriers to effect communication -making the person feel as comfortable as possible -use gestures and pictures -give extra time for the person to process what you have said -smile, showing a positive expression -be warn and encouraging -make use of a dictionary if needed -speak clearly in a right tone of voice check hearing aid to see if it is working properly -use appropriate signing -use writing communication -reduce noise and improve lighting -repeating information if necessary -keep calm and remain patient -keep conversation sort and simple with someone who has difficulty in replay -judge appropriate level of communication -make sure conversation has been understood Remember you should always give your client the opportunity to express their needs and preferences Demonstrate ways to check that communication has been understood Making sure the person understood the conversation is vital.

You can do that by: -listening effectively -ask the person to recap the discussion -maintain eye contact, to the person’s reaction -use of body language -make use of questions like (what, how, why, when and where) -showing interest to the conversation by leaning slightly -check their facial expression to see if the person has engaged in the conversation. 3. 4 Identify sources of information and support or services to enable more effective communication Language issues: You may need the service of an interpreter.

You can find details of how to contact one from: your line manager, social services, police, embassy or the consulate of the person in need. Illness that affect people’s ability to produce sounds, use their neck and facial muscles may need the use of assistive technology. Some people will need advice of a speech and language therapist. People with sensory loss can use the NRCPD. This includes sign language, interpreters, lip readers, deaf blind communication and note takes. 4. 1Explain the term confidentiality

Confidentiality means not sharing information about someone’s private personal information without their knowledge and consent. 4. 2Demonstrate confidentiality in a day-to-day communication in line with agreed ways of communication All the information someone gives or is given on their behalf to an organisation is confidential and it should not be passed on. In some situations personal information needs to be passed on to a hospital, residential home, to a private agency. However only the information which is required should be given.

It is unethical to disclose of any information or talk about peoples personal issues with family, friends and colleagues. 4. 3 Describe situations where information normally considered to be confidential might need to be passed on There are many situations where confidential information should be passed on. If you receive an information about child abuse you should report the information even if the child refuses to agree. But if an adult or an elderly person has been abused you have to have their consent, you can only persuade them to allow you to pass on the information.

Police might need personal information about an individual if they have been involved in a serious crime. In a situation when an individual threats to harm someone else or if they put others in danger. 4. 4 Explain how and when to seek advice about confidentiality If you are unsure when to maintain confidentiality you should seek advice from your manager whether is regarding clients or colleagues. Maintaining trust and relationship with others is very important so check the organisation on information and confidentiality

The Blue Cross and Blue Shield Association is a well established family of health benefits companies providing health services for 100 million Americans. Blue Cross insured approximately 12,300 active groups as of October 1, 2005. The groups had a total of 47,000 enrolled subscribers and 92,000 members. This contrasts with 13,800 groups as of January 1, 2003, with 58,000 subscribers and 115,000 total members. Nationwide, more than 96% of hospitals and 91% of professional providers contract with Blue Cross company — more than any other insurer.

Blue Cross offers a variety of insurance products to all segments of the population, including large employer groups, small business and individuals. The Blues currently serve 85% of Fortune 100 companies and 76% of Fortune 500 companies. Moreover, the Blues have enrolled more than half of all U. S. federal workers, retirees and their families, making the Federal Employee Program the largest single health plan group in the world. The Blue Cross and Blue Shield companies enroll in the Federal Employee Program (FEP) — the largest privately underwritten health insurance contract in the world — more than 5. million federal government employees, dependents and retirees. Blue Cross company established the appropriate operating mode according to the special needs of the local community, brings high-quality, affordable health care services to the American public, including low-income people, the elderly and urban residents. The applications will involve patients, doctors, businesses, medical education and research institutions and government decision-making bodies, and many departments.

Kuan-Chung (Bill) Wu HPM540: Professor Kamke HPM540: Case Study 3: Performance Management at Intermountain Healthcare 1. What is your assessment of the Performance Management system developed at Intermountain Healthcare? – The Performance Management (PM) system developed by Intermountain has become a model for many healthcare organizations. Intermountain’s PM system includes the following elements: 1) Identifying six most important performance criteria, 2) Developing goals for different groups within the organization, and 3) implementing the goals by creating an incentive compensation scheme.

This PM system design has proven to be effective in many perspective, ranging from individual staff to administration and to the organization as a whole. First and most importantly, this PM system aligns Intermoutain’s mission and values/commitments to its employees and their performances. Their employees and administration do not just talk about their values, they live those values – committing to best practice with quality and accountability.

Secondly, this PM system is effective in regards of beneficial and useful as development tool and administrative tool. The system not only allows administration to accountably designed, implemented, reached, and evaluated the goals for different groups in the organization, but also allows employees to engaged and contribute organizational goals by developing their career and earning incentives. As a result, different groups in the organization were able to remain focused on accomplishing all the goals as a whole team.

Lastly, most employees in Intermountain had positive and fair views for the PM system. For example, employees in Intermountain expressed embarrassment, rather than complaints of not getting incentives, when they did not reach a certain objective, even it was missed by less than 1%. Lastly, this PM system allowed administration and management team at Intermountain to effectively and accurately measure employee performance, such as using balanced scorecard and data shown in Exhibit 8 and 12, as well as the cost of providing services.

The PM system created by Intermountain has served to be a model for healthcare organizations to face future challenges due to the Affordable Care Act as well as other changes in the nature of running a healthcare business. Lastly, they were able to realize the goal of recruiting and retaining the best employees. 2. In what ways could it enhance or detract from the organization’s strategic objectives? – There were many ways this method could enhance the organization’s strategic objectives.

First, the important performance dimensions were identified – these constituted the big picture of the organization strategy and allowed the big picture to flow all the way down to every individual staff. Everyone in the organization could all know about organization’s objectives and commit to achieving them. Moreover, as described in a the section of Clinical Goals, this system allowed the goals of five dimensions of performances to flow in a topdown fashion, the goals for the Clinical Goals were developed in a bottom-up fashion.

This enabled the organization to have a continuous circle of performance management loop similar to Figure 10-1 in the textbook, which shows a linkage from organizational strategies to feedbacks collected from organizational results. The ways that this system would detract from organization’s strategic objective is the finance for implementing these strategies, as mentioned in last section of the article. The clinical performance improvement initiative had resulted in revenue losses.

If Intermountain did not have enough cash on hand, this performance management system would not work so efficiently. The other way that could detract the strategic objective is that data could be manipulated to make the performances 1|Page Kuan-Chung (Bill) Wu HPM540: Professor Kamke looked well on the graph/table/figures. This is because the incentives is generated by good data, and it is very easy for these data to be manipulated. 3. How are physician incentives at Intermountain unique? Why did they take a ifferent approach to physician performance as compared to other employees? – Physician incentives at Intermountain are unique because physicians are divided into two groups (employed and non-employed aligned) and incentive plans designed for each group have different programs. For employed physicians, three approaches were implemented for incentives: 1) Peer pressure, in which open discussion where held to examine physicians’ performance, 2) Public Recognition, in which best practice was recognized at the corporate level, and 3) monetary incentives for meeting clinical standards.

For non-employed, aligned physicians, who accounts for 2/3 all physicians using Intermountain, the organization has adopted the strategy to engage these physicians through peer-to-peer competition and a reliance on academic literature and internal data in a given clinical area. Here we can see that there are a lot of physician communication and engagement for supporting physicians to receive incentives, which are different approaches than other employees such as managers and staffs who earns incentives through achieving individual and corporate level goals.

In my opinion, physicians have their incentives different than just monetary incentives is because health care is a service business and physicians are the centers for providing different kinds of services to patients. In many cases, physicians are the decision makers who may influence the outcome of these services. Therefore, it is essential for physicians to know what each other is doing with transparent and evidence-based communications so the effective services can be learned and implemented by different physicians.

Moreover, the increased communication would enhance the aspect of coordinated care which would help both the physician and organizations to reduce the cost of their services. The other reason that different approaches were implemented for physicians might be because they have already been earning high levels of compensation and need something different than monetary incentives, in contrast with those who are in healthcare administration. 4. How might this system also improve the performance appraisal process? –

Performance appraisals are used to assess an employee’s performance and provide a platform for feedback about past, current, and future performance expectations. In Intermountain’s performance management system, there is a continuous goal development and implementation, as well as feedbacks to the senior management. The senior management team then provides recommendations for the group that develops the organization’s goal to make sure what the organization expects for everyone. In other words, the expectations, whether they are past, current, or future, are transparent to all employees.

Another aspect that I believe this system helps to improve the performance appraisal process in its uses. The textbook states that organizations generally use performance appraisal process in two conflicting ways – administrative and developmental. However, Intermountain’s performance management system seemed to resolve this conflicting issue by its incentive compensation scheme. As described by Dan Zuhlke, the Vice President of Intermountain HR, the potential bonus or incentive is based on the fulfillment of the combination of individual level goals and corporate level goals.

This helps to solve the conflict of uses because both administrative and developmental actions can be accomplished simultaneously under this system. Lastly, under the physician incentive system, open discussions and peer-to-peer competition allowed physicians to gain constructive feedback or improvement ideas from others. The physician incentive system essentially served as a virtual platform for care givers to learn what the expectations are. 2|Page

Accountability inside the health care industry S. Thomas University of Phoenix Leadership and Performance Development HCS/475 Paula Smith March 25, 2010 Accountability inside the health care industry Accountability by definition can best be described as “the perception of being held answerable for one’s actions or decisions” (Gelfand, Lim, and Raver, 2004, pg. 138).

Unfortunately, for some Americans the terms “accountability” or “accountability standards” appear to be nothing more than cleverly marketed buzzwords that are used to fool imprudent consumers into a believing that there is a system of proper checks and balances within American businesses (Hughes, 2004). After all, for years the American public has taken a front roll seat to watch business after business fold because their company executive were brought up on charges of accounting fraud, theft, or ethical violations (Valentine, Godkin, Page, and Rittenburg, 2008).

The cynicism of these detractors is clearly understandable, considering that to date only a handful of executives have been successfully prosecuted or charged with a crime. Despite the validity of the detractors argument, there is one fact that these cynics seem to forget and that is, “the concept of accountability dates back to the time of Aristotle”, who back then, contextualized the subject in terms of justice, punishment, and social control (Gelfand, Lim, and Raver, 2004).

In fact, accountability is a topic that has been closely aligned with psychology, politics, law, education, health care, and organizational behavior (Gelfand, Lim, and Raver, 2004). Indeed, accountability and accountability standards are a crucial component of each and every discipline, especially in the field of health care. Health care is a unique business in that; the industry has a fiduciary duty to federal, state, and local governments. Not only do professionals mployed within the industry have different professional and ethical obligations but every decision or judgment that is made will also have a direct impact on the way care is delivered. Nonetheless, the doubts and misgivings of the American consumers has forced health care organizations into taking a more hands-on approach toward fostering a climate of accountability inside organizations. These consumer demands forced organizations to implement transparent accountability standards.

Furthermore, there are two successful approaches that businesses have used to shift to a more productive stand. The first is by establishing strategic performance objectives and assessing their effectiveness (Mulvaney-Harris, Zwahr, and Baranowski, 2006). For instance, in the past if a nurse made a medication error by giving a medication a patient was allergic to the prevailing wisdom was to subvert the incident or keep the knowledge of the incident within the department where it occurred.

Back then, the protocol for medication errors was to inform the physician, charge nurse, department manager, and lastly the nurse supervisor. Now instead of containing these incidents within the department, hospitals managers are instead using these incidents as a teachable moment and to gather data. Meaning, that instead on punishing the employee or firing them, managers are revisiting incidents, patient loads or training procedures to make certain that employees are properly trained or reviewing the processes before a medication is given (St. John Medical Center, 2004).

The second approach that successful organizations have used is to incorporate systems of “checks and balances” that are interdependent throughout their businesses. The sole purpose of instituting a system of checks and balance is to ensure that there is an internal control mechanism in place to impede fraud, waste, or abuse. In the example of the medication error, the system of check and balances that was instituted created an audit trail by purchasing an automatic medication dispenser that would only release medication designate for that specific patient (Business Dictionary, 2010).

If another medication error occurred, this error could be traced to the nurses for that patient, the pharmacy department who stocked the dispenser, and the physician who ordered the medication. For some health care facilities, employing a system of balances entails giving mid-level managers the authority to make decisions and the related responsibilities to verify execution is distributed among different departments (Business Dictionary, 2010). The unexpected benefits of implementing organizational checks and balances systems have permanently transformed today’s health care organizations.

Specifically, the corporate backing of internal accountability standards has created a positive work climate that promotes greater understanding and support for the organizations’ mission, while simultaneously enhancing the decision making abilities of managers (Mulvaney-Harris, Zwahr, and Baranowski, 2006, pg. 438). To continuously promote or foster these productive environments 21st century health care facilities will have to keep establishing strategic performance objectives to gather data, measure it, and assess the procedures’ effectiveness. Not just to quell the voices of cynical detractors but also to run efficient organizations.

References Business Dictionary (2010). Definition of checks and balances. BusinessDictionary. com Retrieved on March 23, 2010 from http://www. businessdictionary. com/definition/checks-and-balances. html Gelfand, M. J. , Lim, B. C. , and Raver, J. L. (2004). Culture and accountability in . organizations: Variations in forms of social control across cultures Science-Direct. Human Resource Management Review. Vol. 14: Iss1. Elsevier Science Inc. Retrieved on March 20, 2010 Hughes, S. (2004). Critics warn of push to weaken corporate accountability laws CQ Weekly- banking & Financial Services.

Retrieved on March 21, 2010 from Sage Publications Mulvaney-Harris, R. R. , Zwahr, M. and Baranowski, L. (2006). The trend toward accountability: What does it mean for HR managers? Science-Direct. Human Resource Management Review. Vol. 16. Elsevier Science Inc. Retrieved on March 20, 2010 St John Medical Center (2004). SOP: Medication Errors. St. John Medical Center Tulsa OK Retrieved on April 2004 Valentine, S. , Godkin, L. , Page, K. , and Rittenburg, T. (2008). Gender and ethics: Ethical judgments, ethical intentions and altruism among healthcare professionals. Retrieved from Emerald, on March 23, 2010

Provide support for mobility (HSC 2002) Outcome 1 Understand the importance of mobility 1. define mobility Mobility is defined as, * being able to move or be moved freely and easily * the ability to move physically * The ability to move a part of the body 2. explain how different health conditions may affect and be affected by mobility No matter an individuals age, level of disability or infirmity it is important that everyone maintains some level of exercise. There are a vast range of disabilities and conditions which can result in mobility difficulties.

Some of the most common on-going or permanent conditions result from muscular and skeletal disabilities and from on-going medical conditions which affect mobility. Some examples of disabilities and conditions which can have an impact on mobility are: Back and neck problems, accidents or injury leading to long term disability, arthritis and any other condition affecting the joints, dementia, amputation, fibromyalgia, multiple sclerosis, partial or total paralysis, cerebral palsy and head injury.

Other conditions such as respiratory and cardiac diseases, epilepsy, diabetes, cancer and AIDS can all have an impact on co-ordination, dexterity, strength, speed and stamina. There are a vast range of health conditions which can be improved by mobility, here are a few. After an individual has suffered a stroke areas of their body will be weak and it is important that a physiotherapist devises a programme of exercise to strengthen the weak areas in order to regain the mobility.

After joint surgery such as hip replacement exercise is key to making a full recovery and mobility of the joint. For individuals who are asthmatic or with chest problems, exercise can expand airways to make breathing easier. 3. outline the effects that reduced mobility may have on an individual’s well-being Both mobility and physical difficulties, and regular or constant pain can impact on an individual’s overall sense of wellbeing. Some people may be affected at times by low-self esteem and self confidence, and motivational difficulties.

Keeping mobile is extremely important for health and for giving an individual increased self esteem and a sense of well being. It is vital as we get older to maintain our mobility, to help us remain active as an elderly person and avoid having to sit in a chair all day. Being mobile enables individuals to remain independent. Being able to go when and where they want when they want without having to rely on others for assistance can make a major difference to individuals lives. 4. describe the benefits of maintaining and improving mobility.

It is important to maintain and improve mobility and this can be done through exercise. The for any individual regardless of the level of their disability are both physical and an emotional improvement in their condition. Physically exercise increases heart and lung activity which improves and strengthens the cardiovascular system, which controls breathing and blood circulation. Physical exercise also increases the use of muscles which improves the muscles strength and tone. It also improves sleep and burns calories to keep our weight balanced.

Frequent and regular physical exercise boosts the immune system, and helps prevent the “diseases of affluence” such as heart disease, cardiovascular disease, Type 2 diabetes and obesity. It also improves mental health, helps prevent depression and helps to promote or maintain positive self esteem. By maintaining and improving an individual’s mobility it will increase their independence and freedom to choose actions and destinations. Outcome 2 Be able to prepare for mobility activities The learner can: 1. gree mobility activities with the individual and others Exercise can be both formal and informal. It could also take place as a group or as an individual. Exercise as a formal programme will be assessed by a physiotherapist and will help to increase mobility, improve strength stamina or suppleness. An exercise programme has usually been devised by a specialist in order to meet a specific outcome, so it is important to encourage the individual to follow the programme by explaining it’s importance and getting them to agree with it.

You need to carry out an exercise programme exactly as specified in the care plan and record and report the outcomes and any problems at each step. Others involved in an individual’s mobility activities could include an occupational therapist, physiotherapist, G. P. or community nurse. If the mobility activities are less formal and the outcome required is to maintain the individual’s mobility on a daily basis this can be done through active support and encouragement. You should encourage the individual to do things for themselves and participate in activity and exercise where possible.

An example would be to encourage their participation in household activities You should identify and agree with the individual the best way for them to maintain their mobility and any preferences to the form of exercise they prefer. It is important to ensure the individual agrees as it is important they are willing to participate in order for the programme to work. 2. remove or minimise hazards in the environment before beginning a mobility activity It is important to carry out a risk assessment of the environment prior to beginning a mobility activity.

This is to ensure the health and safety of the individual and yourself and prevent any accidents or injuries from occurring. You need to carry out a risk assessment in relation to both the activity and the individual. This will include * The floor surface is safe and free of trip hazards * The support the individual needs in the area of equipment and number of carers * Ensure any walking aids to be used are being used properly and have been measured correctly for size of the individual

If the individual is wheelchair bound or bed bound * Ensure the chair/bed is stable and the brakes are on 3. check the suitability of an individual’s clothing and footwear for safety and mobility The individual should be wearing comfortable, easy wear clothing items to allow for mobility and unrestricted movement. Shoes should be comfortable and firm and offer good support and with non slip soles. The correct type of clothing is also important to preserve an individual’s dignity if they are bending and stretching. . check the safety and cleanliness of mobility equipment and appliances. Any equipment used should be checked to ensure it is safe and clean before use. Any walking aids should be measured correctly and be the correct size for the individual. Usually any equipment to be used will be recommended by a professional such as a physiotherapist or occupational therapist, who will ensure the individual can used the aid correctly and safely. Walking sticks – for an individual needing some support, mainly to give confidence

To ensure a walking stick is the correct height for the individual you need to ask them to hold the stick in the hand opposite their “bad” side if there is one otherwise in their dominant hand eg right or left handed. Their hand should be level with the top of their thigh when resting on the stick, elbow slightly bent, shoulders level. Ensure the ferrule (suction foot) is not worn to avoid the stick slipping when leant on. Quadrupeds and tripods – for individuals who have difficulty walking on one particular leg Quadrupeds are for individuals with very poor mobility in one leg such as hip r knee degeneration or stroke. To ensure this is the correct size use the same method as described for the walking stick and again check the ferrules are not worn. Walking frames – for individuals needing considerable support Again use the same method to measure if they are the correct size as with the walking stick and again check the ferrules are not worn. Wheelchair All wheelchairs should be fitted with the appropriate cushions to minimise the risk of developing pressure area problems Outcome 3 Be able to support individuals to keep mobile 1. romote the active participation of the individual during a mobility activity Active participation is a way of working that recognises an individual’s right to participate in the activities of everyday life as independently as possible; the individual is regarded as an active partner in their own care or support, rather than a passive recipient. It is important to encourage active participation of the individual during a mobility exercise through encouragement and support. You should encourage them to stretch just a little more or try one more repetition, providing it is following the set plan of care.

Instead of clearing away their crockery after a meal, encourage them to assist you where possible. Don’t use a wheelchair to move an individual around just because it is quicker. It is important to give an individual the time to do things at their pace rather than at yours. Sometimes a specific piece of equipment may be able to be used to assist the individual to participate in the move. For example – an individual may be able to transfer themselves from a wheelchair to a chair either by the use of a transfer board or simply by sing their upper body strength to slide across, once you have removed the wheelchair arm for them. This encourages the individual to exercise their upper body muscles and actively participate in the move, rather than you using a hoist to transfer them. 2. give feedback and encouragement to the individual during mobility activities. It is important to encourage and support an individual during mobility activities. This will increase their confidence and affect how well the individual carries out the activity.

It is also important to ensure that the exercise is not too difficult or painful for the individual as this will make them reluctant to participate. Always report this if the individual is suffering pain or discomfort during the activity. Discuss any reluctance they may have to participate with them especially if the plan of care advises they are capable of the activity. It may be a lack of confidence or fear of falling which is stopping them from participating. Gentle encouragement, support and discussion will encourage the individual to be more willing to attempt the activity.

Never be tempted to change the exercise activity which a physiotherapist has recommended, because an individual finds it easier as this could cause further mobility problems or pain. You can give an individual feedback on their improved mobility. Remind them of how much they have improved since starting the mobility activities, for example, “When you started these moves Mrs B you could only do five repetitions now you can do fifteen and twice as quickly”. Outcome 4 Be able to observe, record and report on activities to support Mobility

The learner can: 1. observe an individual to monitor changes and responses during a mobility activity As a carer you are in a good position to be able to monitor changes and responses to an individual’s mobility activity. These observations are vital when planning the care an individual needs. If you observe the individual having difficulties or improvements in their mobility, if the individual complains of pain or suffers the loss of confidence in a particular technique, it is important to report and record this.

Who you report these changes to, will depend on the plan of care but it could be your senior or manager, the GP, community nurse, occupational therapist or physiotherapist. For example As a carer it may be your role to encourage and monitor how many times an individual is able to squeeze a rubber ball, to strengthen their hand and arm muscles after a stroke. By counting and reporting on the number of repetitions carried out you will enable the physiotherapist to see any improvements in the individual’s mobility. 2. record observations of mobility activity

Recording an individual’s progress on a mobility activity is important. You need to carry out an exercise programme exactly as specified in the care plan and record and report the outcomes and any problems at each step. This is necessary as the physiotherapist will need to review what progress the individual is making, so that the exercise programme can be adjusted as and when needed. You will need to note how often the individual carried out the exercises and if you noticed any improvement to their flexibility or strength, alertness, general level of fitness and mobility.

This should be recorded in the care plan notes. 3. report on progress and/or problems relating to the mobility activity including: * choice of activities If an individual enjoys a particular form or type of mobility activity, this should be recorded so that other are aware. It should also be reported to the person in charge of their mobility activity plan eg Physiotherapist. They will then be able to write an exercise plan to suit the individual based on the type of activities they enjoy.

There are numerous mobility activities which individuals could take part in, some as a group activity and some as individuals, formal and informal. It is important that an individual agrees with the activity and also cooperates in it otherwise the activity will not take place or benefit them. * Equipment * Appliances These are items which assist an individual to become or continue to be mobile, by providing support. This includes walking sticks, crutches, quadrupeds and walking frames, transfer boards, wheelchairs, mobility scooters etc.

It is important to monitor and regularly check how an individual is progressing when using any type of mobility appliance or equipment. As their mobility changes so might the aid they need for support change. If an individual has been using mobility equipment or appliance for support, whilst recovering from an injury or illness, it is important to encourage them to manage without it, before they become too dependent on it. If you feel an individual is not managing to use an appliance or piece of equipment correctly or safely, you should report this immediately the support provided. It is important to immediately report on any problems regarding the mobility support provided to an individual. This could be that you feel the support is inadequate or even excessive. For example the plan of care advises two carers assist the individual to move with the aid of a hoist, where you feel one carer would be sufficient as the individual is able and willing to use a transfer board, because their mobility had improved. You should always report accurately any observations you make regarding an individual’s support needs.

Unit 3: Promoting good health AO1-Section D (This paper got the full 3 marks) Quality of life is how satisfied we are with our lives and whether there are parts of our health that affect this or inhibit this. For example if there was a lack of money in a family due to little financial support then their quality of life would not be good. This is because they would not be able to afford the necessities of life and other recreational activities.

The job of a kidney is to filter the blood and get rid of waste products; it also balances levels of electrolyte in the body, it controlling blood pressure, and stimulates the production of red blood cells. Your kidneys filter wastes and excess fluids from your blood, which then exit your body in your urine. When the kidney fails, these things are not done efficiently and so therefore can cause serious harm to your body. The signs and symptoms of kidney failure develop slowly over time if the kidneys function continues to progress inadequately.

Rachel Warren, daughter, sister and mother of 2 has Kidney failure. She is 33 years old and is currently paying the mortgage of her 3 bedroomed home. She is in full time work and works from 7am till 3pm and has been working here for 13 years this has affected her whole life in many different ways. However her physical health and social health are the major things that have been affected by this illness. She began showing signs of kidney failure when she was out on a walk with her family in the countryside walking up a steep hill.

This is where Rachel started to feel weak and light headed, so therefore did not feel physically able to carry on with the hike. It was then that it was recommended to her that she got tested as it ran in the family. The first signs of kidney failure in Rachel were, swelling of the legs and hands and puffiness around the eyes, high blood pressure, increased urination at night and pale skin. Kidney failure has affected her quality of life ever since. PHYSICAL HEALTH Rachel’s physical health has been strongly affected by her kidney failure.

One physical effect of kidney failure is that she gets worn out and feels weak so cannot do physical activities for long periods, therefore she has little energy to do the things she enjoys most in life: For example: Dog walking with her friends and close family every Sunday. She has felt out of breath and so cannot do this for a long time without feeling the need to rest at frequent periods. This is caused by Anemia which means there is less blood flow to the brain. Anaemia is something that occurs when one has kidney failure.

This can cause a build-up of fluid in the lungs; a low oxygen count in your body can be the main symptom of this. As a result of this it meant that Rachel was feeling cold all of the time and often burnt herself in the bath or on a hot water bottle. This has affected her quality of life because it caused her pain and discomfort which should not occur on an everyday basis. Three days before being called for her kidney transplant, Rachel was put on dialysis which uses an artificial device to clean and filter the blood of waste products.

This caused her major pain and distress, Rachel says that this was ‘one of the most painful experiences she’s ever been through’. She said the pain was mainly in her shoulder and it felt like she was being ‘dragged down to the floor’, this affected her quality of life as for those three days she had a dependence on medicinal substances and medical aids. After the transplant Rachel still has to take drugs each day prescribed to her by her doctor, this affects her physically as if she did not take them then her body would reject the kidney.

However after the surgery Rachel felt more active and so could go on long day walks again with her friends without getting out of breath. Her skin also looked noticeably healthier which brought out a new confidence within her. Once more she is now able to feel different temperatures and so no longer burns herself and feels discomfort through this. This surgery has improved her quality of life greatly and without it she would not be the person she is today, as without surgery or dialysis the kidney disease could have been fatal.

After the surgery Rachel felt more active and so took up a new hobby of zumba which even a year on she still enjoys. She also is participating in a great swim to raise money for chronic kidney disease research, which has shown she is physically up to the challenge and so her quality of life is the best it could be for someone with her condition. SOCIAL RELATIONSHIPS Rachel’s social health was affecting her quality of life in many ways. Due to her kidney failure she was unable to go out and meet her friends because she would get worn out very easily, even if it was just walking to the shops.

This meant meeting her friends was very difficult unless they visited her. Due to this she felt tired all the time and so spent a lot of her time sleeping and sitting down, this affected her social life within the family as she was unable to join in with the activities her children were doing. This meant her family and friendship relationships were altered and slowed down causing her to feel stressed due to lack of connections. Rachel had to visit the hospital in Cambridge once or twice per week to have a check-up. This was 63. 5 miles away and took her 2 hours to drive it each way.

Not only did this mean that she had a financial strain due to petrol costs, but she had less time to visit her friends and family so personal relationships were affected. When Rachel was on Dialysis she didn’t feel up to meeting people as she felt stressed and depressed for a little while. This affected her quality of life because the medicine given to her made her lack confidence within herself and so therefore didn’t feel like going out and meeting new people. Therefore she did not have full social support from friends and work colleagues.

After Rachel had the surgery she was confined to bed for 3? days after the transplant. Due to her appearance she didn’t want people to see her and make them worried so her social life halted for that time. This meant she didn’t have all the support she could have had and so made her quality of life low because of her lack of social and emotional support. She also did not go back to work for 1 ? months after the surgery so she could recover, this meant all her work colleagues were unable to support her and she was unable to help them in with the workload.

This made her feel useless and annoyed to not be able to keep herself busy, this meant her quality of life was lessened as she had not been able to work and so was unable to complete her daily activities. After the transplant she felt much more active and was able to carry on with all she had done previously. This included visiting her family and friends therefore she felt less stressed and a rise in support from her personal relationships throughout this experience. She was able to enjoy her life and had full support from her friends, family and colleagues.

In conclusion Rachel’s physical and social health has been greatly affected by kidney failure. If she did not have the kidney transplant and the drugs to prevent her body from rejecting the new kidney, she would not be able to enjoy the high quality of life she has today or even be able to live it. This is because if she had not had the surgery or dialysis her condition could have been fatal. Her physical health and social health are the main factors that affect this, however she was also affected by her level of independence and her psychological health (the ways someone thinks, learns and concentrates).

The Health Care Delivery System: A Blueprint to Reform Meredith King Ledford Jeanne M. Lambrew David J. Rothman John D. Podesta Abstract This paper explores a published book of concern with the American health care systems and top three health care issues. It shows an overview and recommendations of our health care delivery systems and an overall blueprint for reform. Ledford and Lambrew offer recommendations to promote quality, efficiency, patient-centeredness, and other salient characteristics of a high performing health system.

The blueprint is a vision of how different parts of the system should be structured and how they should function ( (Meredith King Ledford, Jeanne M. Lambrew, David J. Rothman, & John D. Podesta, 2008) The Health Care Delivery System: A Blueprint to Reform Medicare is one of a governments program that shows one of America’s biggest issues. An estimated 2. 3 trillion was spent on health care in the United States in 2007, and the cost of health care continues to grow at an astromical rate. (Ranawat) Growing concern about the rate of health care spending has forced policymakers to evaluate new cost control solutions.

Increasing spending on Medicare has focused policymakers’ efforts to help control expenditures but it doesn’t help the underlying fundamental flaws. Decreasing reimbursements will likely prompt many physicians to reconsider their participation in the Medicare program (Ranawat). (Meredith King Ledford, Jeanne M. Lambrew, David J. Rothman, & John D. Podesta, 2008) Included some insights on provider payment incentives, one incentive would be to revamp the process for updating the relative value scale used in Medicare’s physician fee schedule so that the relative values more accurately reflect relative costs.

Medicaid is a federal and state program that is funded by taxpayers’ income tax payments to the government’s general revenue. Medicaid is one of the largest items in the federal budget, and its cost is growing at a rapid and unsustainable rate. The federal costs of expansion in Medicaid will be about 100 billion annually by 2020. (Edwards, 2010) Federal debt is spiraling out of control, and federal health programs are one of the main reasons why. The cost of Medicaid has grown explosively.

Researchers have shown that spending jumped from $118 billion in 2000 to $275 billion by 2010 (Budget of the U. S. Government, Fiscal year 2011 Washington Printing Office 2010. The Health Care Delivery System: A Blueprint to Reform Conclusion and Future Study In order to gain a complete understanding of the government payment programs and different issues we face in the United States, it would be necessary to conduct a study that examines all aspects of Medicare and Medicaid. This would include The Centers for Medicare & Medicaid Services (CMS) www. ms. hhs. gov, U. S. Census Bureau or The Official U. S. Government Web Site for people with Medicare (www. medicare. gov). References Works Cited Edwards, C. (2010). Medicaid Reforms. Meredith King Ledford, M. , Jeanne M. Lambrew, P. , David J. Rothman, P. , & John D. Podesta, J. (2008). Government Payment Programs and Issues. In M. K. Ledford, & J. M. Lambrew, The Health Care Delivery System: A Blueprint for Reform (pp. 1-128). Center For American Progress. Ranawat, A. (n. d. ). Medicare. Issues of America.