Personal+Reflections+and+Analysis+of+Wit (1)
Personal Reflections and Analysis of Wit (the movie).
The movie Wit portrays a highly educated patient who is a professor, Dr. in Philosophy, as a main character of the film named Vivian Bearing who is battling Stage 4 ovarian cancer. The movie scrutinizes patient’s perceptions, analysis, and encounters of healthcare system while undergoing extensiveexperimental treatments and fighting for her life.
By watching this firm, a viewer can witness so many gaps and unprofessional situations that Vivian had to patiently face. It may perhaps, help us, healthcare professionals, become more aware of what it is like to be on the other side of disparity and will give us a conscious and sensitive insights of what one may refrain from while taking care of vulnerable mentally and physically patients in need for help.
The movie and unprofessionalism begins with Vivian sitting at the visit with her doctor, Dr Kelekian, who right then and there breaks the news to her about her medical condition. He uses solely medical terminology with her while telling her what treatment she will have to undergo without giving her any options or reflecting back on her feelings or concerns. It was a pretty chilling encounter; it would make any individual feel lost and helpless regardless whether one has a higher degree of education or none at all. There was loss of concerns and patient education in that encounter.
The film is portraying healthcare providers as arrogant, full of themselves, heartless, and mechanical individuals who forger to address and totally neglect human’s feelings, concerns, and emotions. They treat patients such as subjects rather than human beings; for example, the terrible scene during theground rounds. Vivian was resting in her bed when she saw a group of people coming to her andsurrounding her. It was Dr. Kelekian himself, his fellow Jason Posner, and medical students. No oneasked Vivian that time for the permission to attend to her. No one gave her any options. While disturbing her peace, they all stood over her discussing the medical condition, signs and symptoms of condition, side effects of treatments, etc… Jason was so proud and full of himself to point out that one of the most common side effects was that patient was bold. Mind you, no one addressed or spoke toVivian at that time; instead, the talk was over her lying in bed.
At some point, Vivian stated that the healthcare system as a whole does not care about her but views her as a “specimen jar…..white piece of paper that has black marks”, she also stated that she was tired of multiple “informal tests”. She never once felt that the attention was on her or her needs. Other encounters such as with Jason, she felt so humiliated, because he was her former college student, to have him do her assessment, history, answer some questions ,and especially a pelvic exam. Again, no one gave Vivian any options; she was just expected to comply…. And initially, during that scene, there was no shop around, until Vivian was already naked lying in a lithotomy position ready or pelvic examination. Only at that point of care, Jason realized that he needs another female present to perform such. He left the doors right open, disregarding the patient’s privacy and left looking for a nurse. Upon completion of the pelvic exam, Jason’s face said it all: not a good news. However, as usually, there was no communication, awareness, or education with the patient. Jason just left the examination room without any comments what so ever; Vivian was left with the nurse, guessing and wondering.
During one of the encounter with Vivian, Jason even referred to oncology and cancer as “fabulous” when Vivian asked him why he chose such specialty. I think it was so inhumane and insensitive because there was Vivian who was suffering from the killer cancer and there was Jason who admired and looked up to that same killer with admiration and excitement.
Through the movie, nurse Suzzie was acting as the patient’s advocate when it came to chemotherapy approaches, attempts to advise doctors for PCA pump as a form of analgesia, yelling for DNR status, and generally comforting talks, hand rubs, and support on the daily basis until the last day.
This movie is very educational as it provided us with the unique opportunity to the patient’s insight of the healthcare system as a whole depicting all the pros and cons and teaching us the concept and importance of simple communication, reflection, education, professionalism, and caring….. as it is so missing in this film.
Assignment # 6
Ilona Rizzo
Nur 4130
Prof Zimmerman
04/24/2013
Based on this assessment tool, my dominant learning style is
a. ________________________
Sensing and visual learner, as I scored 9 out of 11 under such making it the
preferential learning styles above others. Sensing learners tend to like learning
facts and solving problems by well-known methods rather than experiencing new
options. Visual learners remember best what they see: pictures, diagrams, flow
charts, time lines, demonstrations, and etc.
b. Based on this exploration of information, when faced with conflict, I am most apt to
When faced with conflict, I am initially forcing (calm score) and collaborative (storm score) when things are not easily resolved. I ensure that all views are explored and treated with equal considerations even though it may not be agreed upon. I greatly address and devote more attention to my argument so that others can understand the logic and benefits of such. I actively explain my ideas meanwhile trying to understand others. When faced with a conflict, I try to be reasonable and get at least partial solutions if not all can be achieved; therefore, I collaborate.
c. Based on this assessment tool, my personality style is
My personality style is extrovert. I easily tolerate noise and crowds. I do tend to talk more than listen. I am easily distracted and seek the center of attention and action. I meet people readily and join in many activities. I like and enjoy working and talking in groups.
d. Based on the self assessment tool above, my personality style is __extroverted_ , sensing, thinking, and judging__
3.3 In the article “Improving Critical Thinking and Clinical Reasoning”, the author describes the difference between critical thinking (CT), and clinical reasoning (CR).
CR is a specific term that usually refers to assessment and management of patient problems at the point of care. CT refers to reasoning about issues pertaining to teamwork, collaboration, and streaming work flow. CT refers to “important thinking” that is inevitable in order to assess and manage a given situation. CT requires personalizing, analyzing, and concluding a given situation.
According to the author, problem solving techniques alone are not enough without critical thinking. One with CT acquires desires to improve, learn, enhance, as well as broaden knowledge and skills, and to find was to make current practices more efficient and effective.
CT will greatly impact my practice of nursing and precepting as it will broaden my horizons to effective thought process, communication, suggestions, knowledge, and desire to be more open to learning new things, teaching new ideas to my pears, and improve the healthcare delivery system as a whole.
http://ce.nurse.com/RetailCourseView.aspx?CourseNum=ce168-60&page=1&1sA
3.1 In the article “Bridging the Generation Gaps”, author describes five generations and their views on life, work, and culture of healthcare practitioners in order to be effective providers when working with patients and other healthcare professionals of different age groups. The five generation are: veterans ( born from 1922-1946), baby boomers (born from 1946-1964), generation X (born from 1964-1980), generation Y (born from 1980-1995), and generation Z (born from 1995-2012). The author groups and separated the five generations according to the age and described key events occurring at the time, including cultural influences and work values for each. The author scrutinizes the similarity and difference between each generation accordingly.
This article is helpful in a way that it will help us, nurses, and other healthcare professionals identify what age group we are catering to and best way to approach such when providing care, teaching, communicating with patients of various ages. This article helps us learn advantages of each generation and the best way to approach each in the most favorable way whether it may be your patient or your co-worker.
Halfe, D., Saver, C., &Alfaro-LeFevre, R. (n.d.). Bridging the Generation Gaps. http://ce.nurse.com/RetailCourseView.aspx?CourseNum=ce478&page=1&IsA=1
Responsibility of Nursing Case Manager
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Job Responsibilities of Nursing Case Manager |
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Primary Care Model |
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Ilona Rizzo |
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NYCCT |
The consistent provisions of quality health care delivery and tremendous financial costs generated from such have been concerns for many. In the past, even though payers continued to seek methods for reducing costs while advancing quality and clearness of services rendered,clients were left to guide the system without resources, support, and education which are all the vital key points. Therefore, case management has emerged as an important intervention that fosters the watchful guiding of health care dollars while maintaining a primary and constant focus on quality of care, client’s self-determination, and self-care management. In today’s healthcare system, case managers are recognized as experts and vital participants of the care coordination team that empower patients to understand and access quality health care. As indicated in the study by Van Landeghem & Brach, Primary Care Case Management (PCCM) have shown to lower utilization of well-child and primary care visits while improving disease management effectively thus decreasing the costs of healthcare.
Primary Care Case Management model is a managed fee-for-service arrangement, utilizing a network of primary care physicians and other healthcare providers for Medicaid patients. Enrollees of this healthcare delivery model include pregnant women, children, low-income families, low-income individuals, and adult patients with disabilities.
A nurse case manager working in a primary care setting coordinates care needs for patients across healthcare delivery system continuously. He/she ensures that clients receive the most efficient and effective care according to the individual needs in the most sufficient way, enabling for improved patient outcome while containing costs. According to the 2010 guide of standards of practice, case management is “a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality cost effective outcomes”. Working in a primary care setting, nurse case manager carries several titles at the same time while addressing patients’ needs and collaborating with healthcare team. As a nurse case manager, one is able to see the picture of patients’ needs in a holistic way, and therefore, is able to assure that correct and sufficient resources and services are provided/utilized in a timely matter according to the unique needs of each client individually.
Successful patients’ outcomes cannot be established without specialized skills and knowledge of a nurse case manager in collaboration with other health care professionals such as doctors, OT, PT, social workers, and other providers as well as patients themselves. These skills include constructive relationships, effective communication, and negotiation, knowledge of risk arrangements, performing ongoing evaluations and critical analysis, and the ability to organize and plan accordingly to the patients’ specific needs.
It is essential that a case manager possess the knowledge of funding sources, insurances available/qualifying, health care services, healthcare delivery and financing systems, human dynamics, as well as clinical standards and outcomes. To carry out such effectively, nurse case manager encompasses numerous roles and responsibilities while functioning in a primary care setting and which should be prioritized based on what is required or is essential for specific client’s needs according to the practice established.
Initially, nurse case manager conducts a comprehensive assessment of the client’s medical health and psychosocial needs. Nurse case manager also assess patient’s health literacy status and deficits. He/she will then, based upon assessment conducted, develop a case management plan collaboratively with considerations of client and family or caregiver.
Planning/ coordination of care is another job responsibility of a nurse case manager. To maximize health care responses, quality, and cost-effective outcome, planning with the client, family, care providers, as well as payer and community takes place. The social problems of many clients can be overwhelming, therefore, coordinating care with social worker, knowledge of community resources and access to such plays a vital role in patient’s well-being and safe discharge and does require expert case manager and communication skills.
Case manager is also responsible for facilitating communication between members of healthcare team, insurance agents, and other beneficial resourceful foundations meanwhile involving the client and family in the decision making process in order to minimizemisunderstanding, gaps, and wastes in services.
Through comprehensive and clear communication with patient and family, case manager acts as an educator which is another important role of such. Nurse case manager serves as an educator to the client and family as well as to the health care team about treatment options, community resources available, insurance benefits, psychosocial concerns, and case management in order to achieve timely and informed decisions.
Achieving informed patient decisions can be established with the concept of advocacy. It is indeed one of the most important roles of a case manager and is, per say, one of the most challenging tasks as it pertains to every action and every decision made regardless patient care.
As a patient advocate, case manager is obligated to maintain and protect client’s privacy and confidentiality. By following such, the case manager is protecting the patient’s dignity and is practicing within the standards and scope of practice while assisting patients in the times of mental, medical, or emotional weakness. It is essential especially during the vulnerable and out of patient’s and families’ control times, while he or she may be unable to speak for or represent himself/herself or on the behalf of. One way to serve as the patient’s advocate for a case manager is to assist the patient to achieve autonomy and self-determination as well as to assist the client to become empowered, self-controlled, and self-determined. This can be achieved by allowing patient and family to express any concerns, views, desires, and choices and to make informed decisions thereafter. These decisions are finalized and determined based on patient’s and family’s personal wishes, beliefs, and values which should be acknowledged by the case manager in a sensitive, non-discriminatory, respectable, and non-judgmental way. This is why culture competency and sensitivity plays an excruciating role in patient care and must be addressed meticulously.
The rapidly evolving demographics and economics of a promptly growing multicultural world and the numerous disparities in the healthcare of patients from diverse ethnic and cultural backgrounds has challenged health care providers to consider cultural competence as one of the priorities.
Cultural competence is the essential ingredient for successful patient care and transition of healthcare through continuum. Serving such a broad variety of population, sufficient patient care cannot be achieved without it. Cultural competence is crucial to successful client-centered care. As article by Bearskin, R. L. B., states:”…nurses are required to incorporate culture into all domains of their nursing practice…cultural competency…” So what do we refer to when we address cultural competence? It is simply the process by which individuals and systems respond respectfully and efficiently to people of different cultures, ages, races, religions, and sexual orientations, ethnic and financial backgrounds.
Working with such a culturally diverse clientele, case management concept is influenced by cultural competence as it complements the values of self-determination, client-centered care, and individual dignity. Nurse case manager adheres to professional values, ethics, and standards of care. He/she recognizes how these values both conflict and accommodate the needs of a diverse multicultural clientele. It promotes respectful and effective communication, education, coordination of care between client and case manager as well as promotes positive and understanding relationships. Respectable relationships between patient/family and case manager have shown to improve compliance with individual’s plan of care and collaboration with healthcare team thus reducing the dollar costs. When working with patients, nurse case manager develops strategies to understanding one’s personal/cultural values and beliefs and how these influence practice while refraining from personal beliefs/biases as such do influence relationships with clients and families. Quality patient care cannot be achieved without addressing cultural competence and sensitivity.
Primary care case management model enables clear communication/ education with the patient and family as well as the addressing of any concerns/questions that client and family may have in a timely matter while ensuring that cultural sensitivity and competence even in the times of follow up. Case management in a primary care setting can particular be of interest as it shows to be one of the most effective in providing quality and cost effective care to thepatients of various cultural and ethnic backgrounds. It allows case manager to establish strong patient-client relationship which promotes positive bonding, trust, and compliance with plan of care. As indicated in the study by Elwyn, Williams, Roberts, Newcombe, and Vincent, besides the psychological benefits, it allows case manager time for assessment, review,implementation, coordination, and referrals of patient care services accordingly while ensuring that patient adheres to treatments and procedures as prescribed through.
In the conclusion, as a health care environment becomes more complex, nursing case managers become more important and vital members of the healthcare team that act as patients’ advocates, coordinators of care, educators, confidentiality protectors, and experts that empower clients to understand and access healthcare system in a sufficient and effective way while decreasing the healthcare dollars use.
References
Bearskin, R. L. B. (2011). A Critical Lens on Culture in Nursing Practice. Nursing Ethics,18(4),548-559.
Case Management Society of America. (2009). Mission and Vision. Assessed from Word WideWeb, November21, 2012 at http://www.cmsa.org
Elwyn, G., Williams, M., Roberts, C., Newcombe, R. G., & Vincent, J. (2008). Case Managementby Nurses in Primary Care: Analysis of 73 ‘success stories’. Quality of Primary Care, 16(2),75-82.
Leever, M.G. (2011). Cultural Competence: Reflections on Patient Autonomy and Patient Good.Nursing Ethics, 18(4), 560-570.
Van Landeghen, K., & Brach, C. (2009). Impact of Primary Care Case Management Implementation on Medicaid and SCHIP. The Child Health Insurance Research Initiative, 8.
