Developing a Culturally Competent Teaching Plan for a Patient with Peptic Ulcer Disease

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Developing a Culturally Competent Teaching Plan for a Patient with Peptic Ulcer Disease
Scenario:
The RN is developing a teaching plan for a male patient with a new diagnosis of peptic ulcer disease related to an H. pylori infection.
The patient immigrated to the United States from Vietnam two years ago with his extended family.  He denies any current use of alcohol but has smoked one pack of cigarettes per day for the last 20 years.  He reports increased fatigue during exercise, uses Chinese medicine to manage frequent muscle pain and has noted an occasional black bowel movement.
Initial Discussion Post:
1. Identify three (3) items related to the medical diagnosis that the RN needs to include in the teaching plan for this patient.
2. How will the RN incorporate cultural considerations into the teaching plan for this patient?
3. Identify one (1) member of the interprofessional health care team that should be included in this education plan.  What is the role of this member?

What does the story of the Chilean miners rescue suggest to you about the variety of ways that project management can be used in the modern world?

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Rescue of Chilean Miners On October 13, 2010, Foreman Luiz Urzua stepped out of the rescue capsule to thunderous applause and cries of “Viva, Chile!”; he was the last of 33 miners rescued after spending 70 days trapped beneath 2,000 feet of earth and rock. Following a catastrophic collapse, the miners were trapped in the lower shafts of the mine, initially without contact with the surface, leaving the world in suspense as to their fate. Their discovery and ultimate rescue are a story of courage, resourcefulness, and ultimately, one of the most successful projects in recent times. The work crew of the San Jose copper and gold mine near Copiapo, in northern Chile, were in the middle of their shift when suddenly, on August 5, 2010, the earth shook and large portions of the mine tunnels collapsed, trapping 33 miners in a “workshop” in a lower gallery of the mine. Though they were temporarily safe, they were nearly a half mile below the surface, with no power and food for two days. Worse, they had no means of communicating with the surface, so their fate remained a mystery to the company and their families. Under these conditions, their main goal was simple survival, conserving and stretching out meager food supplies for 17 days, until the first drilling probe arrived, punching a hole in the ceiling of the shaft where they were trapped. Once they had established contact with the surface and provided details of their condition, a massive rescue operation was conceived and undertaken. The first challenge was simply keeping the miners alive. The earliest supply deliveries down the narrow communication shaft included quantities of food and water, oxygen, medicine, clothing, and necessities for survival as well as materials to help the miners pass their time. While groups worked to keep up the miners’ spirits, communicating daily and passing along messages from families, other project teams were formed to begin developing a plan to rescue the men. The challenges were severe. Among the significant questions that demanded practical and immediate answers were: 1. How do we locate the miners? 2. How quickly can we drill relief shafts to their location? 3. How do we bring them up safely? The mine tunnels had experienced such damage in the collapse that simply digging the miners out would have taken several months. A full-scale rescue operation was conceived to extract the miners as quickly as possible. The U.S.-Chilean company Geotec Boyles Brothers, a subsidiary of Layne Christensen Company, assembled the critical resources from around the world. In western Pennsylvania, two companies that were experienced in mine collapses in the South American region were brought into the project. They had UPS ship a specialty drill, capable of creating wide-diameter shafts, large enough to fit men without collapsing. The drill arrived within 48 hours, free of charge. In all, UPS shipped more than 50,000 pounds of specialty equipment to the drilling and rescue site. The design of the rescue pod was the work of a NASA engineer, Clinton Cragg, who drew on his experience as a former submarine captain in the Navy and directed a team of 20 to conceive of and develop a means to carry the miners one at a time to the surface. Doctors from NASA and U.S. submarine experts arrived at the mine site in mid-August, to assess the psychological state of the miners. Using their expertise in the physical and mental pressures of dealing with extended isolation, they worked with local officials to develop an exercise regimen and a set of chores for the workers in order to give them a sense of structure and responsibilities. The miners knew that help was being assembled, but they had no notion of the technical challenges of making each element in the rescue succeed. Nevertheless, with contact firmly established with the surface through the original contact drill shaft, the miners now began receiving news, updates from the surface, and a variety of gifts to ease the tedium of waiting. The United States also provided an expert driller, Jeff Hart, who was called from Afghanistan, where he was helping American forces find water at forward operating bases, to man the specialty drilling machine. The 40-year-old drilled for 33 straight days, through tough conditions, to reach the men trapped at the mine floor. A total of three drilling rigs were erected and began drilling relief shafts from different directions. By September 17, Hart’s drill (referred to as “Plan B”) reached the miners, though the diameter of the shaft was only 5 inches. It would take a few weeks to ream the shaft with progressively wider drill bits to the final 25-inch diameter necessary to support the rescue capsules being constructed. Nevertheless, the rescue team was exuberant over the speed with which the shaft reached the trapped miners. Because of the special skills of the mining professionals, it is estimated that they cut more than two months off the time that experts expected this phase of the operation to take. The first rescue capsule, named Phoenix, arrived at the site on September 23, with two more under construction and due to be shipped in two weeks. The Phoenix capsule resembled a specially designed cylindrical tube. It was 13 feet long and weighed 924 pounds with an interior width of 22 inches. It was equipped with oxygen and a harness to keep occupants upright, communication equipment, and retractable wheels. The idea was for the capsule to be narrow enough to be lowered into the rescue shaft but wide enough for one person at a time to be fitted inside and brought back to the surface. To ensure that all 33 miners would fit into the Phoenix, they were put on special liquid diets and given an exercise regimen to follow while waiting for the final preparations to be made. Finally, after extensive tests, the surface team decided that the shaft was safe enough to support the rescue efforts and lowered the first Phoenix capsule into the hole. In two successive trips, the capsule carried down a paramedic and rescue expert who volunteered to descend into the mine to coordinate the removal of the miners. The first rescued miner broke the surface just after midnight on October 13 following a 15-minute ride in the capsule. A little more than 22 hours later, the shift manager, Urzua, was brought out of the mine, ending a tense and stressful rescue project. The rescue operation of the Chilean miners was one of the most successful emergency projects in recent memory. It highlighted the ability of people to work together, marshal resources, gather support, and use innovative technologies in a humanitarian effort that truly captured the imagination of the world. The challenges that had to be overcome were significant: first, the technical problems associated with simply finding and making contact with survivors; second, devising a means to recover the men safely; third, undertaking special steps to ensure the miners’ mental and physical health remained strong; and finally, requiring all parties to develop and rely on radical technologies that had never been used before. In all these challenges, the rescue team performed wonders, recovering and restoring to their families all 33 trapped miners. On November 7, just one month after the rescue, one of the miners, Edison Pena, realized his own personal dream: running in and completing the New York City marathon. Quite an achievement for a man who had just spent more than two months buried a half mile below the surface of the earth!35 Questions 1. What does the story of the Chilean miners rescue suggest to you about the variety of ways that project management can be used in the modern world? 2. Successful project management requires clear organization, careful planning, and good execution. How were each of these traits shown in this rescue example?

Do you think integrity, responsibility, forgiveness, and compassion have a moral nature?

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Answer these queastions according to this article …
here is the queastions
1/Did the results from Kiel’s study surprise you? Do you think
conversations of character have a place in the workforce?
2/Do you think integrity, responsibility, forgiveness, and
compassion have a moral nature?
3/How do you define the difference between morality and
judgment?
4/Charles Sorenson suggested that pursuit of excellence and
courage should be added to the above four principles… do you think
there is anything else?
Article >> Measuring the Return on
Character
When we hear about unethical executives whose careers and
companies have gone down in flames, it’s sadly unsurprising. Hubris
and greed have a way of catching up with people, who then lose the
power and wealth they’ve so fervently pursued. But is the opposite
also true? Do highly principled leaders and their organizations
perform especially well?
They do, according to a new study by KRW International, a
Minneapolis-based leadership consultancy. The researchers found
that CEOs whose employees gave them high marks for character had an
average return on assets of 9.35{0e601fc7fe3603dc36f9ca2f49ef4cd268b5950ef1bbcf1f795cc00e94cdd119} over a two-year period. That’s
nearly five times as much as what those with low character ratings
had; their ROA averaged only 1.93{0e601fc7fe3603dc36f9ca2f49ef4cd268b5950ef1bbcf1f795cc00e94cdd119}.
Character is a subjective trait that might seem to defy
quantification. To measure it, KRW cofounder Fred Kiel and his
colleagues began by sifting through the anthropologist Donald
Brown’s classic inventory of about 500 behaviors and
characteristics that are recognized and displayed in all human
societies. Drawing on that list, they identified four moral
principles—integrity, responsibility, forgiveness, and
compassion—as universal. Then they sent anonymous surveys to
employees at 84 U.S. companies and nonprofits, asking, among other
things, how consistently their CEOs and management teams embodied
the four principles. They also interviewed many of the executives
and analyzed the organizations’ financial results. When financial
data was unavailable, leaders’ results were excluded.
At one end of the spectrum are the 10 executives Kiel calls
“virtuoso CEOs”—those whose employees gave them and their
management teams high ratings on all four principles. People
reported that these leaders frequently engaged in behaviors that
reveal strong character—for instance, standing up for what’s right,
expressing concern for the common good, letting go of mistakes
(their own and others’), and showing empathy. Examples include Dale
Larson, who took over his family’s storm door business decades ago
after his father died of cancer, growing it from about 30 employees
to more than 1,500 and gaining a market share of 55{0e601fc7fe3603dc36f9ca2f49ef4cd268b5950ef1bbcf1f795cc00e94cdd119}; Sally Jewell,
a former CEO of REI, America’s largest outdoor retailer; and
Charles Sorenson, a surgeon who moved into management at
Intermountain Healthcare when the company began to grow and
eventually took on the top job.
“I’m Suspicious If a Report Card Is Too
Good”
Charles Sorenson, the president and CEO of Intermountain
Healthcare, was one of the highest-scoring leaders in KRW’s study
on character. He spoke with HBR about what he learned from the
results. Edited excerpts follow:
Do you think KRW measured the right
principles—integrity, responsibility, forgiveness, and
compassion?
There are two I might add. One is the pursuit of excellence.
That’s partly included in the definition of responsibility—the
desire to leave the world a better place. It’s especially important
in health care. The other is the courage to do the right thing even
when it’s difficult or painful. To make changes in a field as
deeply entrenched as health care, you need to stick your neck
out.
How have you incorporated the feedback?
We’ve made some changes in leadership—put in people who model
these values. In medicine and surgery, most of us just remember the
last five episodes of patient care and extrapolate incorrectly from
them. So it’s wonderful to have an objective measure of culture and
behavior.
What struck you most about the responses?
We had some room for improvement—but that’s OK. I’m suspicious
if a report card is too good. One person wrote that it doesn’t
always feel safe to disagree with management. We’ve made progress
there, so I was a little disappointed. There was also a comment
about conservative attitudes toward women. That’s an oucher for me.
We have a lot of terrific women in senior positions.
At the other end of the spectrum, the 10 lowest scorers—Kiel
calls them “self-focused CEOs”—were often described as warping the
truth for personal gain and caring mostly about themselves and
their own financial security, no matter the cost to others. This
group includes the CEO of a public high-tech manufacturing firm,
the CEO of a global NGO, and an entrepreneur who heads a
professional services firm. (All study participants were guaranteed
anonymity from the beginning. Only a third later gave permission to
use their names.) Employees said that the self-focused CEOs told
the truth “slightly more than half the time,” couldn’t be trusted
to keep promises, often passed off blame to others, frequently
punished well-intentioned people for making mistakes, and were
especially bad at caring for people.

Examine the application of your selected pain management technique in relation to the same situation within a different culture

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Examine the application of your selected pain management technique in relation to the same situation within a different culture. Explain the role of the perception of pain and the impact of culture on perception of pain, identifying and usage trends of applied behavioral science unique to different groups.
All cultures are different, we all look to healing within our own beliefs. Many different cultures believe in more natural ways of healing. A study done on, American Indians and Alaska natives showed,”specific activities mentioned including drumming, traditional crafts such as beating and pottery, Gathering and using traditional herbs, prayer and working with a medicine person or traditional Indian medicine practitioner.”( Haozous; Doorenbos; Ardith; Stoner,2016. Pg. 238, par.1). With Indians believing in natural herbs for healing, and the love of outdoors, I believe Mindfulness- based stress Reduction would be a pain management technique they use as well.

References-
Haozousus Emily A.; Doorenbos, Ardith Z.; Stoner, Susan;( 2016)Pain Management Experiences and the Acceptability of Cognitive Behavioral Strategies among American Indians and Alaska Natives Journal of Transcultural Nursing , Vol 27(3), May, 2016 pp. 233-240. Publisher: Sage Publications; [Journal Article] Database: PsycINFO
McCarthy, C. J., DeLisi, M., Getzfeld, A. R., McCarthy, C. J., Moss-King, D. A., Mossler, R., Privitera, G. J., Spence, C., Walker, J. D., Weinberg, R. S., & Youssef-Morgan, C. M. (2016). Introduction to applied behavioral science[Electronic version]. Retrieved from https://content.ashford.edu/

#2Kristine Hunt
YesterdayJan 10 at 10:51pm
Manage Discussion Entry

· Identify the type of pain your client is experiencing for which applications of applied behavioral science are appropriate (e.g., arthritis, bone or joint pain, muscle pain, fibromyalgia, migraine headaches, cancer pain, post-surgery, etc.).

My client is a 20 year old white female who suffered from multiple myeloma. She was hospitalized on and off for the last 5 years and initially not expected to survive. She did survive, however, but had to use a wheelchair and crutches during those 5 years. She was treated successfully in the hospital with medications and recently underwent a couple surgeries at the Mayo clinic in Chicago, where she had a bone graft from her hip to her thigh. She is now in full recovery with no lingering illness but she is struggling to regain her physical, as well as mental strength.

· Describe any psychological factors and emotional states of your client which appear to impact her or his mental and physical health (e.g., depression, anxiety, general level of satisfaction with life).