Glasgow Coma Scale  

What does it test?

Can you think of any portion of the test that might be affected by a patient who is intubated?  

What are the guidelines when administering it?

How is it scored?  What is the highest score?   What is the lowest score?

When should the nurse notify the health care provider after completing this assessment? Why? (Which scores or changes in scores would be most concerning prompting the nurse to notify the HCP because of them)

What are your thoughts??

The health and vitality of Americans are critical to the productivity and innovation essential for our nation’s future. Hence disease prevention is more important in everyday life. The National Prevention Strategy is a model for our nation to provide the most useful and attainable means for leading a healthy lifestyle. This broad plan includes four strategic directions that serve as the base for all prevention efforts. The National Prevention Strategy such as the Patient Protection and Affordable Care Act will change our nation’s health-care system to prevention and wellness rather than the treatment of sickness and disease. The main strategies to be followed to achieve this prevention and wellness plan are to provide Healthy and safe community environments by increasing the quality of our nation’s air, land, and water, to avoid exposure to environmental hazards. Similarly, increasing the clinical and community preventives services such as immunizations and cancer screenings will reduce subsequent health care costs. Also, people should be empowered to be responsible and informed to practice a healthy lifestyle such as healthy & nutritional foods, exercises, and establishing positive social interactions. Eliminating health disparities are also another important aspect so that a disproportionate burden of illness and disease can be avoided (Benjamin, 2011).

      National Prevention Strategy has also identified some important priority areas to improve the health of the American people, particularly those who are disproportionately affected by disease and injury. These are tobacco-free living, preventing drug abuse and excessive alcohol use, healthy eating active living, injury- and violence-free living, reproductive and sexual health and, mental and emotional well-being (Benjamin, 2011).

      Everyone will interact with a nurse at some point in their lives. Nurses are high-level thinkers with exceptional skills and considerable ability to communicate, negotiate, coordinate, and collaborate in order to deliver care (Sullivan, 2004). When nurses are working within a health promotion model, every interaction with a client can be an educational intervention (Rankin 2005). For example, while changing the dressing of a diabetic foot ulcer, nurses get the opportunity to educate the requirement of regular blood sugar testing and diabetic control. When a patient comes to a clinic or doctor’s office, with a cut, it’s the perfect time to check the chart for the last tetanus booster. Similarly, during a home visit to discuss newborn care, it is the perfect opportunity for the nurse to discuss the childhood vaccine schedule, recommended vitamin supplements, or even the developmental milestones of an older sibling. This way, nurses are practicing health promotion strategies constantly (Jones, 2015).

REPLY 1

It’s important for nurses to provide culturally competent care. It’s important to assess the importance of a client’s culture/ethnicity (and their accompanying beliefs and values) when planning, providing, and evaluating care. Nurses’ practice must incorporate cultural needs and beliefs into their nursing practice to provide care that is individualized for the client and appropriate to the client’s needs (Cultural Awareness and Influences on Health: NCLEX-RN, 2020).

In the Asian culture, there is often a belief that terminally ill patients should not be informed about their prognosis, and many believe that speaking of it may bring bad luck or a poor outcome (Ritter & Graham, 2017, P. 235). Except in emergency situations in which a patient is incapable of making an informed decision, withholding information without the patient’s knowledge or consent is ethically unacceptable (AMA, 2020). After completing a cultural assessment, if the patient holds this belief, I would respect the cultural practice and withhold the information. 

The patient would be encouraged to specify preferences regarding the communication of medical information, preferably before the information becomes available (AMA, 2020); it’s important to honor a patient’s request not to receive certain medical information or to convey the information to a designated surrogate, provided these requests appear to represent the patient’s genuine wishes (AMA, 2020). For the family who believes this, “decisions and communication are often considered the responsibility of the oldest male in the family, and can be seen as a moral obligation for that person to act in that capacity” (Ritter & Graham, 2017, P. 235). 

For health care providers to balance the patient’s right to know with respect to the cultural practices and beliefs of the family, it’s important to: assess the amount of information the patient is capable of receiving at a given time, and tailor disclosure to meet the patient’s needs and expectations in keeping with the individual’s preferences; Monitor the patient carefully and offer full disclosure when the patient is able to decide whether to receive the information (AMA, 2020). 

In short, each year, the United States becomes more diverse, with people of different races and religions, and with differing beliefs about medicine and medical care. As nurses, we owe it to our patients to provide them with the best care possible in ways they find appropriate (Reed, 2017).

References

AMA. (2020). Withholding Information from Patients. Retrieved from https://www.ama-assn.org/delivering-care/ethics/withholding-information-patients

Cultural Awareness and Influences on Health: NCLEX-RN. (2020). Retrieved from https://www.registerednursing.org/nclex/cultural-awareness-influences-health/

Reed, C. (2017). Cultural Competence. Retrieved from https://journals.lww.com/ajnonline/Fulltext/2017/07000/Cultural_Competence.5.aspx

Ritter, L.A., & Graham, D.H. (2017). Multicultural Health (2nd ed.). Burlington, MA: Jones and

Bartlett Learning. ISBN: 9781284021028

REPLY 2

        Health is viewed as a cultural concept, and culture determines how we perceive the world. Therefore, respect for cultural practice in Asia is predetermined because culture helps shape how both the patient and the healthcare provider perceive illness and what they believe to be its cause (Fowler et al., 2011). I will only respect the culture if I lack the knowledge and skills of delivering bad news, the appropriate provision of optimal care to a dying patient, and the compassion to ensure that the patient retains his or her self-worth even at the time of his or her death. 

      According to Rosenberg et al. (2017), negative information should be briefly relayed to patients. The author recommends that the information be rehearsed to communicate the bad news concisely and how the healthcare team is committed to the patient’s support and treatment at the terminally ill stage. A good example of a prognosis that should be delivered to the patient, especially by word of mouth, is as follows: ‘The tests done on your collected samples have confirmed that your condition arose from a malignant tumor (sad news). Therefore, I have informed a radiotherapist and the oncologist to speak with you about the condition and then advise you further. Once I receive the recommendations from their examinations on you, I will decide on what best treatment to give to you (doing something about it). As things unfold, I will always be around to discuss with you on how we will go on with the treatment.’ Maintaining a silent observation at this point will lead to the patient’s psychological condition’s best results (Sarafis et al., 2014). Therefore, I will respect the culture, but any information that must reach the patient will always be delivered just as the profession prescribes.

        Healthcare providers can balance the patient’s right to know their prognosis concerning their cultural practices and beliefs. To achieve such a balance, healthcare personnel should always try hard to become culturally sensitive (Chaet, 2016). Such sensitive care can be achieved through creating awareness, avoiding assumptions, and learning about other cultures. In any social issue, the first step is always to be aware. Any competent healthcare provider must always be endowed with culturally sensitive care. A good nurse or doctor will always strive to become culturally sensitive personnel while letting others understand their line of duty (Swihart & Martin, 2020). Secondly, a good healthcare provider should always avoid making assumptions because it is always important not to assume matters that you are not familiar with. Making such assumptions can cause a breakdown of trust and rapport between the healthcare provider and the patient. Lastly, a good doctor or nurse should always learn about other cultures. Learning a patient’s culture includes their medical history, medications, and current symptoms. Learning different cultures will involve immersing oneself in the culture of others. 

     In conclusion, it is always essential to have a truthful and open communication between the patient and the medic. Such open communication will enhance trust in the relationship and respect for autonomy. On the other hand, not fully disclosing information to the patient is an ethical breach because it brings the clash between the physician’s duty of promoting the patient’s health and the physician’s respect for the patient’s autonomy.

References:

Chaet, D. H. (2016). AMA Code of Medical Ethics’ Opinions Related to Discrimination and Disparities in Health Care. AMA Journal of Ethics, 18(11), 1095-1097.

Fowler, F. J., Levin, C. A., & Sepucha, K. R. (2011). Informing And Involving Patients To Improve The Quality Of Medical Decisions. Health Affairs, 30(4), 699–706. https://doi.org/10.1377/hlthaff.2011.0003

Rosenberg, A. R., Starks, H., Unguru, Y., Feudtner, C., & Diekema, D. (2017). Truth Telling in the Setting of Cultural Differences and Incurable Pediatric Illness. JAMA Pediatrics, 171(11), 1113–1119. https://doi.org/10.1001/jamapediatrics.2017.2568

Sarafis, P., Tsounis, A., Malliarou, M., & Lahana, E. (2014). Disclosing the Truth: A Dilemma between Instilling Hope and Respecting Patient Autonomy in Everyday Clinical Practice. Global Journal of Health Science, 6(2), 128. https://doi.org/10.5539/gjhs.v6n1p128

Swihart, D. L., & Martin, R. L. (2020). Cultural Religious Competence In Clinical Practice. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK493216/

All replies must be constructive and use literature where possible.

Your assignment will be graded according to the grading rubric.

The Assignments

Respond to at least two of your colleagues by recommending strategies for improving the effectiveness of their group therapy sessions. Support your recommendations with evidence-based literature and your own experiences with clients. Support your responses with evidence-based literature with at least two references in each colleague’s response with proper citation.

Colleagues Response # 1 

Older adults have experienced a lot of challenges in life that should  be talked about which focuses on using psychotherapy therapeutic approach to resolve. Their developmental stage is different and unique from other stages such as children, adolescents, and young adults. For a facilitator to understand the adult’s challenges is very important and reduce their challenges because sometimes they are afraid to share them with others who are not within their age. When the younger clients start coming to therapy sessions, the older clients think that their issues are part of young adulthood which will lead to successful therapy. Group psychotherapy benefit the older adults because they are set up in small groups to focus on interpersonal therapy and cognitive behavioral therapy. The therapist will help the elderly clients to develop healthy social behavior and ways in interacting with others using interactive skills. The group interact well with the therapist by using psychotherapy that focus on psychodynamic approach. Using this approach helps the elderly clients to reduce the fear of shame. Listening and addressing issues that comes up during the group session help reduce any biasness. Another sensitive approach during the therapy session is reminiscence group therapy where the therapist will provide structured settings where the elderly clients can share their previous experiences among their peers, and it involves direct interpersonal interaction as a way of creating universality of their issues. In this therapy session, a standard socialization platform for the elderly clients is provided.

           In this group therapy session, it is done in a controlled setting where clients that are involved are between 60-65 years of age. The main important focus during the therapy is to promote social behavior and interpersonal interaction within their age group and also to improve their social and quality of life at their last stage of life. During the session, some issues came up and some degree of resistance were also involved during the therapeutic process. For example, some of the elder clients were not opening up to express themselves. The group session provided sometimes for the clients to share any age-related issues and social contact at the same time receiving any informed feedback from the therapist. “As a clinical psychologist, identifying such resistance in the interactive process ensures the success of the therapy” (Cheston & Jones, 2009).

           Some challenges came up during the therapy session while working with this age group such as cognitive challenges which may hinder the process of education. During a normal process of aging, there are different changes that will affect the client’s level of cognition which will affect their learning process at their age. To get some information from an adult sometimes is difficult because some of the clients are ashamed and bothered by the therapist thereby them showing low cooperation. Another challenge that they encounter is therapy planning which involves the adults to be involved and cooperative during the sessions. Some of the clients may feel threatened due to the clam environment while others might not, and this will warrant their setting to be tricky to accommodate everyone. These counteracting preferences are normal parts of aging (Cheston & Jones, 2009).

           The best method for the therapist to use during adult sessions is group therapy because it will handle the psychosocial and cognitive concerns that may arise with the adults. Also, the therapist will provide a focused method to care to the adult in addressing their challenges that affect them during this stage of life. This is will help the therapist and the adults to improve the effectiveness of the therapy.

Colleagues Response # 2

The group I observed last week was a group of couples in group couples counseling. They were in week 5 out of 12 weeks of group therapy. There were 6 total couples in the group, mostly in their 40s and 50s. This group, nearing the midway point of group therapy, was in Tuckman’s norming phase. In the norming phase, group members are beginning to settle in and their roles within the group are becoming defined. They are resolving differences, appreciating each other, and respecting their leader. They are able to ask for feedback from each other and are able to make strong commitments to the group (Tuckman, 1965).

I also witnessed Tuckman’s performing stage, where goals are achieved (1965).  In this phase, the leader does a lot of delegating and developing of team members. It is evident that the leader (my preceptor) is working towards this goal as she frequently asks members to provide their own feedback when other members speak. 

Some issues that were present during this group include the common issues in group settings, such as some members not feeling comfortable enough to participate and others monopolizing the group. Some of the techniques my preceptor used were behavioral modifications such as behavior exchange procedures and alternating of “caring days” as couples cognitive behavioral therapy techniques (Nichols & Davis, 2020).