Effective pain relief in postoperative patients Essay Example for Free

Effective pain relief in postoperative patients Essay Pain is physiological mechanism and a means of the body alert the person about either currently present or impending damage to it. It can be defined as the â€Å"unpleasant sensory and emotional experience associated with actual or potential damage† (Gelinas, 2004). Consequently, the words discomfort has also been used interchangeably with pain in the past and can be defined as a â€Å"negative affective and/or physical state subject to variation in magnitude in response to internal or environmental conditions† (Gelinas, 2004). Pain is a very important component in care of the surgical patients, both preoperative and post operative. Surgery itself afflicts large amounts of trauma on the patient. The pain that the patient has to incur afterwards adds his anxiety levels and stresses the body. Lack of or inadequate amounts of pain management by the staff, impacts the patients healing process. Their mobility and in the long terms their duration of hospital stay is also affected. It is important that, for optimal patients health management and care, a means tool must be available to measure the patients pain assessment and relief requirement through pharmacological and non pharmacological means. Little research has been done to properly assess and document the prevalence of pain and its management protocols in post operative patients. The pain scoring systems are available to attempt to quantify pain and manage it accordingly. These subjective ones include the categorical rating scales (CRS) in which patient rates pain from â€Å"No† to mild moderate or severe. Another one is the â€Å"Visual Analog score (VAS) where the individual scores are placed on a 10-cm line where the left anchor point is labeled â€Å"no Pain† and the right anchor point is labeled â€Å"worst possible pain†. Since every patient has a varying threshold for pain, and requires varying levels of drugs, to over come the pain, it is better for there to be both a subjective indicator for pain as well as an objective one, that is to say, that the nurses an also assess how much pain the patient is in, by using a tool she is provided with. Cardiac surgery is a major thoracic surgery and patients post operatively require lot analgesics to manage pain so that their morbidities associated with pain (like pain in breathing, walking etc) can be eliminated. Usually morphine is used for the purpose of pain relief but there are indications that Fentanyl can perform a similar relief without much of the side effects associated. There needs to be some focus into this theory. This can be achieved by placing 2 similar populations of adult cardiac patients who have just undergone cardiothoracic surgery on morphine or Fentanyl. As is the standard procedure nowadays, quality indicators, both subjective and objective can be used. The VAS pain scoring card can be provided to the patients for them to record the different levels of pain that they feel. The nurses would be provided with indictors to record objective findings which can indicate pain. â€Å"These can be physiological and behavioral indicators. The physiological indicators can be clustered into cardiovascular, respiratory and cerebral responses† (Gelinas, 2004). Pain associated responses would include tachypnea in respiratory, tachycardia and increased blood pressure in cardiac and raised ICP in cerebral responses. After assessment of the pain levels with the quality indicators, the pain management drugs will be administered and later the subjective and objective pain assessment will be repeated to see which drugs effects were greater and lasted longer. A study conducted by Celine Gelinas on critically ill incubated patients, to find out what are the protocols and tools used to assess pain management are and if the patients were being given effective relief. He used subjective as well as objective tools. The results revealed that physicians placed no role in documenting pain in patients. Most of the reporting was done by nurses and the patients. It was also noticed that nurse’s assessment of pain was much less than that reported by the patients themselves. The research concluded that the documentation overall about the pain and its management was incomplete in general with little attention being given. The research also noted that even after being notified about the pain, its effective management only took place 60 percent of the time. (Gelinas, 2004). In and interventional study conducted by Francoise Bardiau in 2003, the quality indicators e. g. VAS were introduced in the surgical and anesthesia department. After a survey of assessment of knowledge of nurses, VAS to assess pain was the nurses worked to improve pain management. After further surveys, it was noted that initiation of programs to setting of quality indicators improves the overall pain management system. (Bardiau, F. , M, 2003) Idvall E tested a 5 point scale to measure the effects of quality indicator maintain pain relief measurements. â€Å"The results suggest initial support for the new instrument as a measure of strategic and clinical quality indicators in postoperative pain management, but it must be further refined, tested and evaluated†. Idvall E 2002) a multidisciplinary program development was introduced based on evidence based medicine to focus on construction of proper management protocols to implement clinician as well as patient based pain relief programs â€Å"The results suggest that addressing pain management through a variety of strategies targeted at the level of the institution, the clinician, and the patient may lead to desired changes in practice and better outcomes for patients. .† Bedard, D (2006). A survey conducted on post operative cardiac ICU patients, about their pain experiences revealed that despite the pain management regimes in place nowadays, the pain frequencies, and intensities were the same as they were more than a decade ago. Pain management is a vital component of patient care. Quality of pain management can only be assessed through proper indicators. These can be multimodal. The patient populations on which these indicators can be applied are preoperative and postoperative patients. Post operative cardiac patients under nursing care can benefit well from implementation of quality indicators such as VAS. In the nursing profession subjective scoring by the patients themselves enables the nurses to manage the pain properly. This will lead to quicker recovery by the patients and earlier discharge. In the long term this means leads financial implications on the patients due to reduced hospital stay. Also nursing work load gets reduced as the patient tern over is increased. The healthcare cost gets reduced. A Post operative pain management (POP) project was conducted in 2003. A nationwide survey was done to see the implementation of quality improvement projects in the field of pain management, it was noted that more than 70% of the hospitals were reportedly satisfied with the implementations and the outcomes of the quality improvement programs. Based on the analysis, it is noted that on the positive side, proper implementations of the quality indicators and improvement programs in the healthcare system and especially in the ICU and surgical wards, the patients stay can become quite comfortable. The stay can be reduced and the cost of healthcare to the system, the insurance companies, and the patient themselves can be reduced. In the other hand we can clearly see that by using the indicators we in effect are placing more workload on the nurses. If the subjective VAS and the objective physiological changes in the patient has to be monitored regularly just to assess the pain levels, a lot of quality time will be wasted. This time could have been used to tend to more critical patients. Now the question arises if it is worth the effect to implement the QI programs. The answer would lie in Force field analysis and the Lewin’s theory. If the benefits out way the set backs, we can implement the system. The idealistic thing would be that we assess the pain management needs of each department of the health care system and implement the QIs in the ones in which the implementation benefits out way the costs.

Manage the Cultural Differences while Working with People from other Cu

Nowadays, as we all notice that the world is getting flatter. More and more people are getting the chance to work with people from other culture. It is not only limited to the people from the developed countries like Americans and Europeans. People in the developing countries are also open to the opportunity to work with people from other culture. Understanding that culture difference is heavily rooted in people’s everyday behavior is only the first step to get to work with people. Coping the way foreigners do with the local culture is the key point to be successful in working with people from other culture. Misunderstanding the culture and behavioral difference can lead to problems and alienation, even confrontation, between colleagues and ultimately the collapse of partnership. Being self-centered and refusing to social with the local culture would also lead to the failure eventually. When people from the different culture meet or a person goes to a different country, they are expecting to have a culture clash, which includes the communication, leadership and organization and etc. The communication problem would the language barrier, but most time it is more than just the language difficulties. How to get the message across can vary and greatly impact the communication. In the video, Building the Transnational Team, it clearly shows that everybody can speak the same international English, but everyone understanding one another is the challenge. First, when the native English speaker talking with another non-native speaker, if he or she speaks too fast and uses slang terms, the non-native speaker would totally get lost and feel frustrated. Like in the video, Luis from Spain who speaks English but has limited understanding of ... ... will help people from different culture work efficiently together. The change would be in communication, leadership and organization. In the video, five people finally realize that they have to manage the culture difference before they can talk about business. They figure out the way to have a better communication by using simple English and also they could like to phone call and fax both to satisfy people from different culture. Furthermore, strategic change will be implemented which means to adapt or create organization policies which take into account cultural differences. Particular attention should be paid to policies or programs that have been developed to meet the requirements of one culture and are then imposed internationally. The key thing to work with people from different culture is to manage the cultural difference and cope to different cultures.

Hays Views on Gatsby Essay

Hays, Peter L. â€Å"Oxymoron in The Great Gatsby.† Papers on Language & Literature 47.3 (2011): 318+. General OneFile. Web. 19 Oct. 2012. There are significant paradoxes throughout F. Scott Fitzgerald’s (life and) work frequently represented by oxymorons, of which Wolfsheim’s eating with â€Å"ferocious delicacy† (75) is only one of the most apparent and, as such, very possibly a clue to the paradoxes in the novel. Kirk Curnutt in a review of Fitzgerald’s short stories remarks that the titles Flappers and Philosophers and Taps at Reveille â€Å"are clever conceits whose effectiveness depends upon one’s fondness for oxymoron† (157). Keith Gandal, in a recent book, writes of â€Å"Gatsby’s famous doubleness †¦ as chivalrous lover and cold-blooded killer.† Gandal continues, though I am using his words for a different purpose than his: â€Å"His doubleness may have a mainstream enough historical correlative† (119 ).(1) One prominent instance of doubleness is evident in his approach to Daisy in the novel. Could a man who â€Å"knew women early†Ã¢â‚¬â€œI presume knew them in the Biblical sense–â€Å"and since they spoiled him he became contemptuous of them† (104), be so intimidated by Daisy, especially since he’s already slept with her (156)? Could someone so ruthless in both the army and business be so timid in dating? Gatsby is plainly not a sexual innocent afraid of sex, another nearly 40-year-old virgin. Far from it. He has had five years of tutelage under Dan Cody, sailing three times around the continent, having women rub champagne in his hair, and visiting the Barbary Coast (106-07), which Matthew J. Bruccoli glosses in his notes to the novel as San Francisco’s â€Å"honky tonk district† (213), plainly a euphemism. We don’t know what Gatsby did for the next five years (from Cody’s death in 1912 until America’s entrance into the war in 1917 [106]), but thereafter he rose through officer ranks to become a major in the army during World War I and then briefly attended Oxford. Are we to expect that he led a celibate life all those years except for his one brief affair with Daisy? There is, of course, a social gap between him and Daisy, and this causes him insecurity in approaching her and proposing that they start their life over. But he did date her before and successfully seduced her. And at Oxford he must have met women of a social status comparable to Daisy’s. In addition, he now foolishly believes that the money he has earned erases much of that social gap so that no one will think, as he tells Nick, that â€Å"I was just some nobody† (71), â€Å"some kind of cheap sharper† (145). He also believes, erroneously, that in social situations, as opposed to business ones, he must not do â€Å"anything out of the way† (84). That being the case, one has to wonder what he and Daisy do on their afternoons together at his house. Nevertheless, Fitzgerald has established him both as â€Å"a regular tough† (84), someone who looked like he had killed a man, and a very proper and timid individual on social and sexual matters, or as Fitzgerald himself phrases it, â€Å"an elegant †¦ roughneck† (53), another oxymoron. What constrains Gatsby is his extreme romanticism, his beli ef in the American myth that one, through hard work, can achieve anything, whether reliving the past or marrying Daisy in proper social splendor in Louisville so as to confirm his rise in American society (see the paraphrase of Poor Richard’s Almanac and Horatio Alger at the end of the novel). He wants nothing to tarnish his ideal of marrying Daisy in society, the perfect couple on top of the wedding cake, and he wants the social acceptance and respect denied him at St. Olaf College (105) and by the Sloanes and Buchanans of the world. What has happened, of course, is that following his seduction of Daisy and one special kiss, he â€Å"wed his unutterable visions to her perishable breath †¦ and the incarnation was complete (117). The religious language, particularly for one raised as a Catholic, as Fitzgerald was, is telling. Daisy embodies the idea of perfection for Gatsby, an almost unapproachable ideal of social success and self-realization. Thus his Grail is â€Å"the unreality of reality† (105), another paradox, and as Tom attacks him in the suite of the Plaza Hotel, â€Å"only the dead dream fought on as the afternoon slipped away† (142). But there are other contradictions as well, such as the characterization of Wolfsheim as a sentimental crook (7 7), and Gatsby’s facial expression, â€Å"definitely unfamiliar and vaguely recognizable† (127). Throughout there is Gatsby’s real criminal corruption fronting his romantic â€Å"incorruptible dream† (162). Nick, too, has his doublenesses. Initially Nick’s father tells him that â€Å"all the people in this world haven’t had the advantages you’ve had† (5), presumably material advantages. But Nick interprets the statement to mean â€Å"a sense of fundamental decencies is parcelled out unequally at birth†(6), something very different, and a belief that qualifies Nick very much as a snob. Nick praises himself for honesty after writing the woman others believe him engaged to, because of his affair with Jordan Baker (63), but he doesn’t bother writing her two pages earlier while he’s conducting a relationship with a girl from the accounting division of his bank, incongruously named Probity Trust; the reason is obvious: the girl from accounting is clearly not from his social station and thus not marriageable, as Jordan is, and thus the putative fiancee need not be bothered by a mere summer romance while Nick takes his pleasure with the girl from New Jersey. Nick also assures Daisy and Jordan that the telephone call Tom receives from Wilson, after Wilson has discovered Myrtle’s infidelity, is â€Å"a bona fide deal† (122); the deal Tom has offered Wilson, however, is anything but in good faith: he has used the potential sale of the car as a way to approach Wilson’s garage to talk with Myrtle. His actions, car for woman, are repeated when he takes Gatsby’s car to drive to New York City in exchange for Daisy. And Nick describes Tom oxymoronically as a priggish libertine (137). We also have Fitzgerald’s assault through Tom Buchanan and Jordan Baker on the remnants of muscular Christianity and the Frank Merriwell novels he grew up with. The 20s were the era of Babe Ruth’s carousings and infidelities, missing games due to what sports writers reported euphemistically as stomach aches, due to the Babe’s prodigious eating, which they may have been, in conjunction with massive hangovers, or possibl y alcohol poisoning or even venereal disease.(2) His two daughters were born out of wedlock, not reported by the papers. Nor was Ty Cobb’s racism, not that most Americans at the time would have cared. Sports writers protected athletes to preserve the image of them as role models. The book jacket from a Frank Merriwell reprint says Frank’s â€Å"deeds will appeal to every boy and girl who strives for fair play and seeks to improve or to excel.† The inside copy calls the series of novels â€Å"Fascinating stories of athletics. †¦ They are extremely high in moral tone and cannot fail to be of immense benefit to every boy who reads them† (251).(3) Merriwell was an All-American football player at Yale, linking him to Tom Buchanan, who was a â€Å"national figure† at Yale (10), and who is not of high moral tone, cheating on his wife during their stay at Santa Barbara (82), in Chicago (139), and again on Long Island. But unlike the Merriwell book copy that calls the book beneficial only to boys, Fitzgerald is an equal-opportunity employer, allowing Jordan Baker to be bo th a sportswoman and an incorrigible liar and cheat at golf (62). Why write about national figures in sport only to tear them down? Why pepper the novel with paradoxes and oxymorons? Fitzgerald saw contradictions in the national psyche. Malcolm Cowley’s image of Fitzgerald as the man at a dance and also the poor boy outside with his nose pressed to the glass admiring and wondering how much everything cost is apropos (xv): Fitzgerald saw both sides and recorded both. His statement in The Crack Up that â€Å"the test of a first-rate intelligence is the ability to hold two opposing ideas in the mind at once, and still retain the ability to function† (69) speaks to his awareness of doublenesses and contradictions in America, and he strove to record them, even as one reality denied another dream. His awareness of his own self-contradictions–realistic romantic, spoiled priest–created a style incorporating contradictions. The country was changing in many ways. It was still ostensibly a Puritan nation, yet sex was everywhere. A production-mode economy was shifting to a consumer economy. The automobile had changed living, travel, dating, and business in the United States (subject of other books, not this paper), and Fitzgerald emphasizes this change with his frequent mention of cars–Nick’s, Tom’s, Gatsby’s several, Wilson’s–and â€Å"wayside garages [with] new red gas-pumps† (25). The middle classes were rising on the post-war prosperity that, until 1929, seemed as if it could not end. Nick is a bond salesman, and â€Å"Young Englishmen †¦ were all selling something: bonds or insurance or automobiles. They were †¦ agonizingly aware of the easy money in the vicinity and convinced it was theirs for a few words in the right key† (46). Myrtle dreams of marrying Tom and improving her station, and Mr. McKee needs only an introduction to Tom’s East Egg friends to move up the social and financial ladder, figured by that Jacob’s ladder, the blocks of the sidewalk that â€Å"mounted to a secret place above the trees† (117). Fitzgerald’s allusion to Lothrop Stoddard by way of Tom points to the fervent eugenics movement of the day (208), and Tom fear’s that his aristocratic position is challenged by non-Nordic races and by nobodies from nowhere (137) is seconded by Mr. Sloane from East Egg who is â€Å"haughtily† determined that Gatsby should not attend his dinner party (109). And their fears have some justification, as the guest list from Gatsby’s party reveals, with its intermingling of old money and nouveaux riches, of elegant and coarse: Homeric Ulysses linked to common Swett, Southern nobility Stonewall Jackson married to Jewish Abrams, a menagerie of Civets, Hornbeams, Blackbucks, and Leeches together with such obvious immigrants as Mulready, Cohen, Da Fontano, and Rot-Gut Ferret, along with Belchers, Smirkes, and a Hip (66-67). The old established order, figured by Daisy’s and Jordan’s privileged white girlhood in segregated Louisville, is under assault, as indicated by the incursion into society of recent immigrants and by the Negroes driven by a white chauffeur (73). Gandal states that Gatsby’s officership was another such sign of change, promotion by meritocracy rather than by family or education alone. But these changes in reality were not accompanied by corresponding changes in the national myths. Athletes were heroes, reality be damned. African-Americans could hire white chauffeurs, but their opportunities, even in the non-segregated North, were limited, and they were still subject to prejudice, as Nick’s reaction to them makes clear. Despite our myth of a classless society, classes were still very distinct in 1925, as Fitzgerald knew all too well from his experience as a poor boy at Princeton and in his courtship of Ginevra King, (4) and as Nick points out in his distinction between West Egg and East Egg (9). Mr. Sloan and Tom Buchanan insist on their own social superiority to Gatsby, just as Nick does to Wolfsheim and to the girl from the accounting department of his bank. Even Daisy finally realizes the safety of staying â€Å"with her own kind,† those of her social class, however repellent her husband is. Despite our national myth of equal opportunity, it does not exist, as we know but Gatsby doesn’t. He thinks that he can do anything, even repeat the past (116). Not being a sports hero, like the aforementioned Babe Ruth or Ty Cobb (who retired wealthy with Coca Cola and GE stock), Gatsby’s opportunities for the quick cash to win Daisy are limited, so he turns to crime, as did many during Prohibition. Corruption was pandemic, from Al Capone to Teapot Dome, the sale of national oil reserves by the Secretary of the Interior. Fitzgerald mentions two so-called robber barons, men who built huge industries through monopolization, John D. Rockefeller (31) and James J. Hill (176) (whose mansion was up the street from the Fitzgeralds’ St. Paul home), men who â€Å"saw the opportunity† (78), just as Wolfsheim did in fixing th e World Series. The line between sharp business practice and criminal activity was thin and almost invisible then (and recently as well), as Fitzgerald has Gatsby imply when talking to Tom about Walter Chase (141), a friend of Tom’s who came to Gatsby looking for money. One day selling alcohol was legal; the next it wasn’t. One day monopolies were good business; then they were declared illegal. Getting a card from the pplice commissioner to fix traffic violations is simply a courtesy; fixing the World Series is criminal. Tom, Myrtle, Jay, and Daisy all commit adultery. Some students may think Tom and Myrtle’s affair is cheap and disgusting, Jay’s and Daisy’s romantic, but both are the same morally and legally, yet we still have the myth of family values preached to us, despite the behavior of our legislators. Nick feels himself morally superior to Tom’s infidelities, Jordan’s lies, to Wolfsheim’s and Gatsby’s criminal acts, yet he’s an accessory after the fact of murder, concealing vital evidence from the police. Myrtle’s sister Katherine lies at her sister’s inquest, a loyal act of perjury that Nick praises as showing a â€Å"surprising amount of character† (171). Lovely Daisy is a hit-and-run killer. Appearances are deceiving. The America that Fitzgerald portrays is riddled with corruption, yet we still maintain the myth of the city on the hill, â€Å"the green breast of the new world† (189), the beacon to the world for democracy and opportunity. I have difficulty crediting Gatsby as a coherent human being, but as a symbol of the elusive American dream, I find him perfect. He consummately embodies the contradictory qualities of this country, our saying one thing while doing another, our clinging to myths that have little basis in reality. As a well-behaved, socially conscious crook, he is a paradox, an oxymoron, and an exemplary American.

Argumentative Essay On Marijuana - 1203 Words

Marijuana, also known as cannabis, is referred to as many different names by people from different parts of the world. It is used for both medical and recreational purposes. Smoking marijuana, eating it within foods, vaporizing it, and using it as an extract are some of the ways individuals consumed it. Some people use Marijuana because of the physical and mental effects it has on the physical body. After consuming marijuana, a person experiences feelings like heightened mood, increase in appetite, change in opinion, and euphoria. When smoked, the impact is often experienced after a few minutes, but when cooked or eaten one can take thirty to sixty minutes to experience any effect. Marijuana has a short-term and a long-term impact on†¦show more content†¦According to Steven Belenko and Cassia Spohn, these psychoactive characteristics have a detrimental impact on individuals of society. More often than not, they hinder progress, and this may lead to stagnation among the most affected groups, which in this case comprises of adolescents and young adults. The division and conflict in the discourses concerning the drug arise from the societal impact marijuana has in America with statistics showing that approximately 48% of the populace above the age of twelve is involved in substance abuse. On the other hand, some studies posit acute consumption of this drug results in the production of dopamine in the brain that is responsible for the development of addictive tendencies (Belenko, and Spohn 24). It is important to consider that marijuana is already classified under the Schedule 1 drugs, as stipulated by the Controlled Substance Act. Therefore, efforts to legalize its consumption will impede the endeavors of the government on its war against drugs. In the contemporary world, the increase in crime in America has been linked to substance abuse, with marijuana being one of the dominant drugs in the market together with cocaine and heroin. There have been numer ous cases where families and communities have become devastated because of the bearing cost of excessive marijuana consumption. Recently, the states ofShow MoreRelatedArgumentative Essay : Legalization Of Marijuana1387 Words   |  6 PagesAmanda Montoya April 14, 2014 Kathy severance Argumentative essay #2 Legalization of Marijuana Marijuana has been used in religious ceremonies or for medical purposes for thousands of years. I have always been against the use of Marijuana up until four years ago when my husband at the age of twenty seven underwent invasive surgery on his knee and has never been the same since. 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By 1927, the production and possession of marijuana had been outlawed throughout the United States, causing a prohibition that is still in effect 80 years later. Since then, the world has seen the violent rise of drug cartels and the high price of fighting illegal marijuana use (Narconon). Marijuana should be legalizedRead MoreThe Legalization of Marijuana: An Argumentative Essay1704 Words   |  7 Pagesï » ¿Legalization of Marijuana When it comes to the American war on drugs, marijuana is one of the biggest enemies. And in view of the fact that alcohol and tobacco, two life threatening substances, are officially permitted it is a pertinent question to ask why marijuana is not (Chopra et al 2002). The taxpayers of America can to a degree answer this question when they fill out their tax forms and when they hear the ruthless oratory used against marijuana by the government. 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