Understanding of Health Care Organization - Report Example

Running Head: HEALTH CARE ORGANIZATION Health Care Organization Health Care Organization Understanding the organization structure as well as the medical, psychological and ethical issues facing the population of an Adult Care facility will greatly enhance the efficacy of treatment to that population. This facility, and in particular the fourth floor nursing unit, which specializes in the care and treatment of the geriatric population with a variety of issues. However, they all have one thing in common: the inability to care for themselves, temporarily or permanently, by having suffered damage to their cognitive abilities, their physical capabilities or a combination of both. Brighton Gardens of Salt Lake City, a Sunrise Senior Living center, serves many different functions. The accommodations range from suites with all the amenities of apartment living for those seniors who are capable of independent living, to full scale skilled nursing facilities for those in more severe need of medical, psychological as well as assisted living attention. Three meals per day are provided for all residents as well as monthly wellness checkup and a variety of other social and medical services. Prior to moving into the facility an initial assessment is conducted with the potential resident and his or her family. This helps to determining the level of need and placement in the correct accommodation in the facility. After the assessment is completed, an evaluation team which includes the Executive Director, Assisted Living or Reminiscence Coordinator, Health Care Coordinator, and a Care Manager creates an initial Individual Service Plan (ISP), which is monitored and adjusted on an ongoing basis. The parent company is a publicly traded company, Sunrise Senior Living, and thus by financial nature a for-profit organization. However, while here are certainly strict protocols in place regarding care by staff, the overall organization is structure more towards non-profit. The reason I say this is because the real concern by staff is not focused on making more money for the company, but by giving the best care that they can while respecting the rights and dignity of the patients on their floor. I was unable to secure a copy of the mission statement of this particular living facility. However I was able to locate a statement of the philosophy of Sunrise Senior Living, the parent company of this facility: Since the first Sunrise community opened in 1981, the Sunrise operating philosophy has been to provide services and care to seniors following Sunrises Principles of Service: encouraging independence, enabling freedom of choice, preserving dignity, celebrating individuality, nurturing the spirit and involving family and friends. All Sunrise team members are trained to provide services and care in a manner that supports these principles and furthers Sunrises mission. (Sunrise, 2007) While the staff members I interviewed were not able to quote the mission statement they did respond with ideas that were very similar to the statement of Philosophy above. “We try to promote and encourage as much independence as possible while doing what is best medically for the patient,” LPN #1 4th floor “We always strive to help keep the dignity of our residence, both independent and assisted living, intact while caring for them,” RN #1 charge nurse 4th floor In general all of the floor staff, both nurses as well as the CNA’s (Certified Nurses Assistants), cafeteria staff and janitorial staff, all had excellent positive attitudes in regards to their work and their co-workers. They also seemed to have great respect and camaraderie with those in their care. The final product of both the unit and the organization as a whole is to promote the health, both mentally and physically, of the senior patient to the point of maximum independence and enjoyment of life. To that end the nursing staff on the 4th floor delivere skilled nursing care to not only alleviate the patient’s current suffering but to also, by the use of therapeutic methods, give the patient coping skills to help them improve the quality of their life. This floor deal with a wide variety of acute problems such as advanced Alzheimer’s, many physical impairments, like paralysis, as well as hospice care. For the majority of patients on this floor their level of independence is often severely impeded and some form of assistance for their care may always be required. IN some ways this goes against the grain of the philosophy of the organization and may send mixed messages through the care staff. Obviously a patient in hospice care is not going to recover and treating them as if they are is often counterproductive and can be insulting to the intelligence of both the patient and his or her family. All floors that utilized skilled nursing follow the requirement of any hospital in regards to reporting and audits of patient records. In order to provide the patient with consistent quality of care all progress, lack of progress, changes in diet, medication, bowel movement, eating and sleeping habits are meticulously charted and dated. The chart audit assures that each and every person that has had contact with the patient’s care has charted the outcomes or changes of that encounter. Social services conducts and patient satisfaction survey with in the first month of the patient’s stay and then usually every three months thereafter. This is done with all residents of the facility. Speaking further with the director of Social Services I was informed that they use different models for quality improvement for different section of the facility. Here on the 4th floor they us the Chronic Care model, since most patient here are experiencing long term conditions. This models utilizes a great deal of emphasis on patient’s being informed and given as much information about their condition as they can have. This helps them to make more informed choices about their care and gives them more of a sense of independence under the circumstances. The delivery of patient care and clinical information is carefully scrutinized and monitored. The organization of health care both in the facility and in the surrounding community is also evaluated. For the most part it seems that this process works well and gives the patients a great deal of power over their condition. However, one must remember that there are limitations to this power. The issue of informed consent has several dimensions when dealing with the population in a nursing facility. The first, and probably the most important, is the attempt to ascertain the cognitive capacity of the resident in determining his or her own care and treatment. The nature of the facility is to deal with Adults that, for one reason or another, not only have physical disabilities, but accompanying cognitive impairments that may make their judgment suspect and require the need for further investigation. In that regard both nursing staff and the social workers perform a Mini-Metal State Examination (MMSE). It is a very quick assessment of the level of cognition in the resident and is a very blunt and general device. It is composed of a series of questions that evaluate two major levels of cognition: Memory and Attentions; Language and Praxis. The chief purpose of this instrument is to perform an assessment the cognitive abilities of the patient to make informed decisions and to discuss any advance directives. If the score goes below a certain level than a psychiatric consultant must be brought in to further evaluate the patient. If the patient scores above a certain level than the process of informed consent can continue. The pecking order of supervision seems to be laid out as follows. The medical director of the facility is responsible of the overall care programs in all the units. The director conducts regular reviews with the nursing supervisors/ charge nurses in all the units. On the 4th floor there is a Nurse Practitioner and an RN supervisor who are both responsible for that management of that unit. There are Doctors and Clinical Supervisors that also rotate throughout the facility and are on call as needed. From my conversation with the RN charge nurse the duties of the various levels of staff certainly have some interchangeable features. The RN says that she will perform any job from the administering meds. to helping a patient with their bedpan. However, the actual delineation of duties she laid out is that the RN charge nurse supervises and schedules the floor, substitutes for LPN’s as necessary. She is qualified to do a higher level of medical care and treatment than most of the staff are and oversees all new staff in the performance of their duties. She also has extensive background in PT (Physical Therapy) as OT (Occupational Therapy) and is licensed to perform those duties on the floor. LPN’s are assigned to perform the daily routine of medical treatment, administering and setting up medication trays, IV and injection medication as well. They are also usually the first line in detecting any problems or concerns the patient may have and raising those problems to the charge nurse or other appropriate authority as well as marking their observations in the patients chart. Here is another instance of overlap, the authority of the RN is usually whom the LPN would defer to but she also has the duty to act more immediately in case of an emergency condition or something that need more immediate care. In such case he or she may go directly to one of the Doctors on call or the Nurse Practitioner on Duty, who both have the authority to change and modify the treatment of the patient. This is where the ultimate authority of the care of the patient resides. However, the RN informs me that she also has some authority in modifying patient care under certain conditions. Here is where some potential conflict may occur in the gray areas regarding who is responsible to whom. While the RN states that there has not been any serious problems arising from this, it would seem that the immediate care of the patient is the top priority, as long as sound medical judgement from the appropriate sources is consulted. References Sunrise Senior Living (2007) Brighton Gardens of Salt Lake City. Sunrise Senior Living Retrieved from http://www.sunriseseniorliving.com/community/CommunityHome.do?from_search=1&commid=233 on 4 February 2007 Read More