Academic Patient Communication for Nursing Students

Academic Patient Communication for Nursing Students The Patient Care (Feel-Link) Project (PCP(FL)) is to help students to develop a patient-centered approach to the practice of medicine. To achieve this, I and a medical student, Nicole need to follow and interview a patient in an effort to discover the patient lived experience regarding issues of health and illness. In this essay, the first PCP(FL) visit, my thoughts and feelings will be described and evaluated based on evidence from the literature sources. Griffiths and Crookes (2006, p.186) suggest that multidisciplinary teams are needed in the health care system to provide holistic care to patients with optimal use of existing resources, and limited cost. This project is the first step in enhancing interdisciplinary co-operation and understanding between nursing and medical students. Both I and Nicole are required to fill in a problem-oriented patient record (POPR) after each visit. We have to co-operate with each other to recruit and interview one patient with the help of nurse specialist (diabetes), Ms. Shimen Au at the Ruttonjee and Tang Shiu Kin Hospitals. The patient that we had recruited called Mrs. Leung who is a 52-year-old housewife. She is currently married and lives with her husband. Her husband was unemployed and they had financial support offered from the government. She was suffered from diabetes mellitus, hypertension, and rheumatoid arthritis about ten years ago and first diagnosed to have bipolar affective disorder at age of 22. After we had explained the aims of this project to Mrs. Leung, she signed two identical consent forms, one copy to be kept by the patient whilst the other to be returned to the tutor. Then, Nicole asked some basic demographic data based on the personal particular form. Mrs. Leung answered one by one accordingly. The POPR also requires us to gather very specific information, such as the past medical history and family backgrounds. When I had asked Mrs. Leung whether she had any children, suddenly the atmosphere in the room became silence. Mrs. Leung was not saying anything for a few seconds, and then she stated she did not have any children. I felt surprised that a married woman at her age should have more than one child already. She explained that doctors had recommended her not to be pregnant in the past. So she was currently living with her husband only but she claimed that the relationship between she and her husband was poor. She had a conflict with her husband just before taking taxi to the hospital. She honestly knew that the reasons why her husband always grumbled about her because of her laziness to cook and buy the necessities. There were quarrels with her husband almost every day. She felt guilty about it. I thought this might be caused by her mental illness and chronic diseases. According to Friedman (2002, p.193), social isolation is a major problem that chronically ill patients experience. Social relationships are often disrupted and jeopardized because of the patientà ¢Ã¢â€š ¬Ã¢â€ž ¢s decreased energy, limitations in mobility, communication impairment, or time required for symptom control. Mrs. Leung usually slept for 13-14 hours per day but she graded the quality of sleep was poor. Even she rated her current level of health as very poor. She described her mobility in daily life had been affected by rheumatoid arthritis causing the swelling the knee joints and interphalangeal joints of hands. Therefore she never did any exercise. I was worried that she would become obese and thus increase the risks of falling and having cardiovascular diseases. I felt regret I had not encouraged Mrs. Leung to do some simple exercise regularly so as to keeping active and not staying in bed for all days. I needed to find some suitable exercise for her and advise her to do exercise in the next visit. Friedman (2002) points out à ¢Ã¢â€š ¬Ã…“illness is especially likely to be subject to the influence of other people since it usually has important implications for a personà ¢Ã¢â€š ¬Ã¢â€ž ¢s friends and associatesà ¢Ã¢â€š ¬Ã‚  (p.64); Mrs. Leung was concerned that her first love with a Japanese man at the tender age of 19. She was still thinking about him and she had tried to commit suicide in the past. When her husband heard about she was talking about that Japanese man, they would have quarrels for a long period of time. The negative emotions could really influence people around the patient. I was speechless at that time and I could only say to Mrs. Leung that her husband was care about her and tell her not to think about the past anymore. I thought I would perform better in the next visit as I had known some basic information of Mrs. Leung already. In conclusion, I think it is right that a nurse must be able to express opinions clearly and confidently. Good communication skills are essential for nurses, and are important in nearly all aspects of medicine. I feel that I will be more confident in dealing with patients and more effective in taking a patient medical history, for example. Developing greater confidence in how I communicate can lead to patients having greater trust in me as their nurse. Improving my skills in this area will also make me more effective in discussing cases with colleagues, and in participating in teams when necessary. This visit made me realized that I can talk confidently once I overcome my initial fears. It demonstrated to me that in order to make progress or create positive change you must first acknowledge that a problem exists. This is a lesson which may be useful in better understanding patient behaviour and attitudes. Often the first step to improving a situation, or dealing with a problem, is accepting that some change is necessary; and I might be more able to impart this information to patients having experienced this visit. Overall, this visit has had a positive impact on both my studies and on the development of skills needed in my future career. (Word count: 988words)

America and the Korean War :: History, Cold War

With the Allies achieving victory in Europe and Japan, Korea, which had been occupied by Japan since 1910, would be placed under the temporary control of Russia and the United States. Korea was divided into two separate states at the thirty-eighth parallel with Russia holding the North and America holding the South (Uschan 36). As the relationship between Russia and America turned for the worse, leading to the Cold war, both attempted to gain as many allies as possible to support them (Bachrach 11). The American government felt it was their duty to stop the Soviet Union and issued the Truman Doctrine, which was a policy to fight Communism around the world (Uschan 27). Therefore the U.S involvement in the Korean War was justified as a way to prove that the U.S would not allow the Soviet Union to spread Communism without a fight. After the events of World War II, the world was left with two major superpowers: the United States and the Soviet Union. Both sides of the conflict were balanced in power and a nuclear war was possible. Most fighting was indirect with neither nation sending armed forces at each other (Smith 30). Because these nations were the world’s superpower, they held a major influence on other world counties and used foreign nation’s conflicts as a way to challenge each other. America began to grow a fear of communism, known as the Red Scare which would only escalate as China fell to Communism (Helbertsam 587). Around 1947, South Korea was one of the only areas in northeast Asia not under communist rule (Bunge 22). It began to appear that the Soviets were taking territory they were likely never to give up causing U.S. officials to realize that they had to make a claim on part of Korea (Uschan 25). While under the rule of the U.S and Soviets, North and South Korea were supposed to have an election that would reunite them sometime after World War II. However the Soviets prevented this and kept a hold on North Korea (Williams 41). Eventually the U.S and Soviets began to form separate groups in order to make a unified stance against each other such as NATO and the Warsaw Pact making the unification even more unlikely between the two sides of Korea. On June 25, 1950 North Korea attacked South Korea; because the invasion was led by a Communist force it gave the U.

Stefan’s Diaries: The Craving Chapter 10

November 6, 1864 Damon is back, though it seems he was never actually gone. He has been watching me, baiting me, controlling me. He is the puppet master and I am his hapless marionette, forced to do his bidding. Until I saw Damon, I had not realized just how fond I had become of the Sutherlands, of how they eased my loneliness and gave me hope that I might not have to live in exile. Though I knew I had to leave them, I had dared to hope that by proving I could stay in control around them, my journey through this world might ultimately be less solitary. But Damon knows me all too well. He might have compelled the Sutherlands to accept me, but he didn't compel me to stay in their presence. I could have slipped out this morning, could have run off in the park, could have disappeared into the crowd at the ball. And yet I stayed, because, as Damon no doubt predicted, I liked being part of a family again, even if just for a few fleeting days. Damon's plan terrifies me – precisely because I don't understand it. Why New York? Why the Sutherlands? Why involve me? If Damon was able to orchestrate everything, to so seamlessly weave his way into the Sutherlands' lives and pave the way for my arrival, why stage such a spectacle? Why bother with a marriage? Why not just take Winfield to the bank and compel him and the teller to empty his vast accounts? Does he intend to live as a human? Does he need the marriage for legitimacy in New York society? Is he simply intent upon torturing me? Or is there something I'm missing? Some secret aim I can't possibly begin to imagine†¦ All I have are questions. And I fear that the answers won't come until the first dead body shows up. Later that Monday afternoon, I stood on the roof deck of one of the most amazing Federal-style houses ever built. Slim columns supported a soaring porch over a formal entrance, to which a grand, curved driveway rolled up as royally as a red carpet. From casement to cornice every detail was thoughtfully considered and never overdone. The dining room, large and oval, was (as near as I could tell) exactly the same as the one in the White House. The White House. In our new capital. That's the sort of place the Commandant's House was, as befitted the man who looked after the Brooklyn Naval Yards. What it lacked in size and modern touches (such as the Sutherlands' residence), it more than made up for in perfectly manicured lawns, a fine orchard, and a spectacular view of Manhattan. The property was perched almost on a cliff surveying the East River and the city that was under the Navy's protection. Commodore Matthew Perry himself had lived there earlier. I sighed at its magnificence. â€Å"No,† Bridget said, shaking her head decisively and heading back downstairs, picking up the train of her skirts in a very businesslike way. Her little entourage followed, laughing good-naturedly. â€Å"It's too white,† joked Bram. â€Å"It's too small,† added Hilda. â€Å"But it's incredible! The views! The size! The†¦Ã¢â‚¬  I said. â€Å"What's wrong with this one?† â€Å"Placement. It's in Brooklyn,† Bridget said, barely acknowledging her fiance. â€Å"No one goes to Brooklyn to be married.† Winfield and his wife looked at each other with old love, clearly remembering their own wedding. Apparently it had been quite modest – he had not made his fortune yet. Neither one of them had minded. And yet they were willing to indulge their youngest daughter in her most expensive flights of fancy. Lydia smiled and murmured something to Damon, who wasn't really paying attention. She didn't mind where she was married. While it was to be a double feature with us two â€Å"happy† couples tying the knot at the same time, she had graciously allowed her sister to decide all the details. The Sutherlands were at least nominally Episcopal, but apparently neither Damon's nor my religion, or lack thereof, was a bother, nor was a proper church necessary to the proceedings; a family chapel – a very rich family's chapel – would be enough. Bridget was very modern that way. â€Å"So why did we bother seeing those mansions on Prospect Park?† Margaret muttered. â€Å"If Brooklyn is out, I mean.† â€Å"I rather liked the one with all the Romanesque arches,† I said, eager to get this portion of the sham weddings out of the way. â€Å"Fear not, brother,† Damon said, chucking me on the shoulder. â€Å"Only four more to go. Back in Manhattan.† We clattered down the steep, wooden, and rather old-fashioned stairs to the ground floor, thanking the butler for letting us in. Then it was a walk back down to the Fulton Ferry landing, where a boat would take us across to a veritable caravan of carriages for the long uptown commute. â€Å"This would be a nice place for an ice cream parlor,† Lydia remarked, walking around the dock pensively. â€Å"You want an ice cream?† Damon asked, as if to a four-year-old. If being with Bridget was bad enough, with me constantly cringing at the things that came out of her mouth, the nervous tension of waiting for Damon to say or do something horrible was even worse. I was on pins and needles the entire day. Because Damon would say something horrible, at some point, to Lydia, as soon as he tired of playing the game of attentive suitor. His attention span for games – other than ones he was betting on – was incredibly limited. â€Å"Yes,† Lydia said. â€Å"And there's no ice cream here. And there should be.† â€Å"Won't matter,† Bridget said, trying to add something useful to the conversation. â€Å"Soon there's going to be a giant bridge and this will all be shaded off and there won't be anything except for loud carriages and the stink of horses.† Bram, the original source of this information, shook his head. â€Å"No, Bridgey, the angle is fine. Look where the sun is†¦Ã¢â‚¬  I leaned on a dock railing, surveying our little party. The girls in this setting looked like a scene from a painting, the four ladies' cheeks rosy with sunlight and the exertion of the day, the long ribbons from their straw hats blowing in the wind, their fluffy walking skirts swept up against their legs by the sea breeze. They were all beautiful, and for just a moment I could forget my present situation. Margaret bought a paper from a newsboy to read on the trip over. It was a fine day for a boat ride and strangely the East River didn't repel me the way fresh running water usually did. Bridget went to sit down inside the ferry, not wanting any more sun on her skin, which was ironic and hilarious considering my own situation. I was relaxing for the first time that day, my face up to the sun, letting my Mediterranean skin take on a bronzed, healthy glow. And then Margaret plopped down in the seat next to me. â€Å"You seem to be at least a bit more reasonable than the other fiance,† Margaret snapped. â€Å"Tell me. What do you want with my family. Money? The business? What?† I groaned inwardly. â€Å"You have to believe me,† I said, fixing her blue eyes with my own hazel ones. Without compelling her, I willed my voice to sound as genuine as I could. I took her arms in my hands, which was bold, but I needed her to understand. â€Å"I am not after Bridget's wealth. All I want is your family's safety and happiness. I swear to you by whatever you want.† â€Å"That's just the problem. I don't know what your word is worth. I don't know you. Nobody knows you,† Margaret said. Sighing, she took off her hat. â€Å"It's just†¦ so†¦ odd. I can see why Bridget likes you, you're certainly handsome and well-mannered†¦.† I cast my eyes down, embarrassed. â€Å"But really – no papers, no history, just an escapee of the South? This is Bridget we're talking about. She wanted Papa to take us all on a tour of Europe so she could capture the heart of a king, or prince, or at least a duke. Nothing less than royalty for her. And no offense, you're about as far from royalty as one can get.† â€Å"Well, and Lydia got her count, I suppose.† â€Å"Yes,† Margaret said thoughtfully. She eyed me, pushing a black tendril of hair back behind her ear. â€Å"And what about Damon DeSangue†¦Ã¢â‚¬  I shrugged, trying to look innocent. â€Å"What do you think of him? The two of you have been†¦ unusually close since your double declarations of love.† I stared into the distance south, where the mighty Hudson and East rivers joined and became the sea. I shaded the city from my eyes, blocking it out, and the sun was bright white and rose over ancient, exotic waters. How much could I tell her without endangering her? She seemed to be the only one in the family with a sensible head on her shoulders. I thought once more about Katherine and whether my family would have been better prepared with some warning. â€Å"Don't trust him,† I finally admitted, hoping I wasn't putting her at greater risk. â€Å"I don't.† â€Å"Hm.† She looked over at Damon, who was talking animatedly with Bram and Winfield. â€Å"Neither do I.† Bridget had chosen the next few venues to visit as far away as it was possible to get from where we were. The mansion of the Richards was near Fort Tryon on the northern tip of Manhattan, while the Fulton Ferry dock was at the southeastern end. The slow ride in our carriages from downtown gave me an almost panopticon's view of city life. Slowly going up Fifth Avenue, I was amazed by the sheer difference in fortune of the people who made their home in New York – from the often shoeless newsboys and schmatta, or rag-sellers, to people like Winfield, who sat in his gilded private carriage, puffing on a cigar. We stopped for lunch about halfway there at the Mount Vernon Hotel on Sixty-first Street, where Bridget continued to discuss her outfit for the wedding. â€Å"†¦ and Darla had her dress in muslin, out of respect for the war, but it's almost over, and I think I should have a new pair of earrings, don't you, Papa? Stefan, darling, there is the most fantastic pair of pearl earrings†¦Ã¢â‚¬  Damon cleared his throat. â€Å"Bridget, you should absolutely have new earrings. And your outfit sounds good enough to eat, don't you agree, Stefan?† I stood up from the table, unable to enjoy the nice repast of cold chicken, fresh bread, fish, and tea that had been set before us, and unable to listen to another word of my fiancee's mindless prattling or my brother's endless teasing. â€Å"I must go take some air,† I excused myself, and would have stumbled over the bench on my speedy way out if I didn't have the grace of a vampire. I should not have been exhausted; I'd endured far worse. Living hungry in the middle of Central Park and hunting small prey was far more physically demanding than sitting in a carriage, looking at houses, and listening to the youngest member of the Sutherland family babble on about meaningless things. But as I had not fed since the squirrel the day before, I was famished and weak, as if I was enduring a transatlantic journey. A quick, silent trip to the kitchens revealed exactly what I had hoped – rats, of course. Not too many, and mostly in the breezeway between the cold house and the pantry. With a flash of my hand I grabbed one and broke its neck, sucking the poor thing dry, all without losing control. It was easy, with such disgusting fare. A low noise, a muffled sigh, made me turn and look up guiltily, rat blood leaking down my lips. Damon stood there holding a waitress around her throat, fangs out and ready to feast. She had the dumb, slightly breathless look of someone who was under a spell. â€Å"I see we both slipped out for the same thing,† Damon said, pleased. He raised a lip in disgust at the rat in my hand. â€Å"Although, really, you can do better.† He lifted his head back, ready to tear – â€Å"Please – don't†¦Ã¢â‚¬  I put up my hand helplessly. â€Å"Please don't kill her,† I begged. Damon paused. â€Å"All right,† he said gamely. â€Å"I won't kill her. As an early wedding present! Just for you.† I closed my eyes, seeing the horror of the future before me. By implying he wasn't going to kill this girl, as a present, there was the assumption that there would of course be other murders, later on.

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