The main objective of the empirical study was to measure the effects of Dorothea Orem’s self-care model on fatigue and its self-management in patients with multiple sclerosis (MS). As such, fatigue is defined as a subjective MS symptom yet it is one of the most prevalent in patients with this disease. The term refers to a sense of reduced psychological and/or physical functionality and, therefore, adversely affects individuals’ performance of various activities.
A decisive evidence-based treatment for this problem currently does not exist, but the researchers argued that Orem’s self-care model provides opportunities for the improvement of patients’ quality of life by enabling them to decrease fatigue.
As the authors of the study indicate, the main purpose of Orem’s theory is to empower patients and endow them with the necessary resources to engage in self-care independently. The major concepts used in the article are self-care, self-care needs, self-care agency, self-care deficit, and nursing system design. The researchers did not provide an explicit description of these concepts yet utilized them during the design of research measures and tools in their original meanings.
In the article, the term “self-care” refers to individuals’ behaviors aimed at the promotion and maintenance of their own health and well-being. Self-care needs imply basic necessities that a person must satisfy and the resources they need to get to ensure their good health. These needs include rest/physical activity, food, air, medical assistance, adherence to recommended healthcare interventions, and so forth.
As for the concept of self-care agency, it is used in the study as one’s overall capability to engage in self-care behaviors. This ability is defined not only by the skills and healthcare status of a patient but also their access to essential resources, including finances and knowledge. At the same time, when one is incapable of performing self-care tasks or lacks certain resources, it means they have a self-care deficit.
Lastly, the authors of the study developed their own concept of nursing system design based on Orem’s theoretical principle of methods of helping that clarifies which particular tools and techniques nurses should implement in order to help patients to enhance their self-care agency. A few of the examples of those methods include guiding and teaching, providing an environment, and support. Some of the ways through which these methods can be implemented are education about the disease and non-medical treatment principles, assistance in the planning of daily activities, and so forth.
The described concepts are applied in the study to assess self-care agency and deficit levels in a sample of 32 MS patients and 31 control group members. The researchers developed an evaluation tool to measure their universal and disease-specific self-care needs, including water, food, and learning to live with the negative impacts of MS. In addition, they analyzed participants’ ability to meet those needs by marking their self-care agency levels as either adequate or inadequate. Besides, the researchers identified specific self-care deficits of each patient, such as grooming, drug complications, and so forth, and linked them to particular methods of helping and interventions.
The study findings revealed that by implementing self-care interventions, which were prescribed to patients with MS-related fatigue based on the outcomes of the abovementioned assessment, it was possible to reduce this symptom in them. The results showed that those interventions allowed to improve individuals’ self-concepts, as well as their perceptions of health status and quality of life. It means that the use of Orem’s model in order to develop persons’ self-care agency and reduce their self-care deficits, it is possible to attain more favorable health outcomes and gain more opportunities for the overall success of chronic disease treatment.
Afrasiabifar, A., Mehri, Z., Javad Sadat, S., & Ghaffarian Shirazi, H. R. (2016). The effect of Orem’s self-care model on fatigue in patients with multiple sclerosis: A single blind randomized clinical trial study. Iranian Red Crescent Medical Journal, 18(8), e31955.
Steps In The Process Of Risk Management In Healthcare
Risk management is essential for any enterprise, but for healthcare organizations, it has even greater significance because, frequently, people’s lives are at stake. Risk is defined as “a probability or threat of damage, injury, liability loss that is caused by vulnerabilities and that may be avoided through pre-emptive actions” (Alam, 2016, p. 118). The essence of risk management consists in identifying, assessing, and reducing possible threats to patients, visitors, personnel, and resources of the organization (Alam, 2016).
This paper will analyze a risk management plan of Jackson Health System (JHS), a net of medical centers and hospitals in Miami. The analysis shows that the organization’s plan complies with the standards established by the superior regulatory agencies.
Summary of the Risk Management Plan
The type of risk management plan elaborated by JHS is community-focused and centered on patient safety. The rationale for selecting this example is that it is a large set of hospitals, some of them being considered the best in the country. Therefore, this organization is sure to manage risks successfully to guarantee the safety of a great number of patients, visitors, and employed healthcare professionals.
The purpose of JHS is to provide citizens of Miami with high-quality healthcare regardless of their income levels. It has a wide range of medical services to offer to its patients, such as urgent and primary care, rehabilitation and behavioral health centers, as well as outpatient services. Risk management plays a significant role in these settings since there is always a possibility of a medical error, equipment malfunction, and patients’ deaths (Jackson Health System [JHS], 2016). Consequently, the organization should assess the probability of these risks and develop a strategy of preventing or addressing them.
Standard Administrative Processes
While preparing a risk management plan, a healthcare organization relies on standards accepted by the regulatory agencies. There are five basic stages of the risk management process: establishing the context, identifying risks, analyzing them, evaluating, and managing them (Alam, 2016). While establishing the context, risk managers should pay primary attention to intensive care units, operation and emergency rooms, as well as blood transfusion services and medication management (Alam, 2016).
Communication with personnel and patients, as well as various reports and survey results, are used to identify risks (Alam, 2016). Analyzing levels of risks and their underlying causes are required to prioritize them and assess which of them should be managed in the first place (Alam, 2016). The final step requires defining the necessary actions, resources, responsible persons, and timeframes (Alam, 2016). The risk management plan of JHS follows all five steps.
Florida Statutes provide a more specific list of requirements for a healthcare organization’s risk management plan. According to Florida Statute 395.0197, healthcare organizations should educate their nonphysician personnel about risk prevention annually (Jones & Slosburg, n.d.). However, it is unknown whether JHS provides such training for its staff since there is no information about it in the risk management plan.
Florida Statutes also prohibit unauthorized personnel from attending patients alone and require healthcare employees to reports all the adverse incidents to the risk manager (Jones & Slosburg, n.d.). The risk management plan of JHS conforms to these rules since it includes these requirements and provides a detailed explanation of the process of reporting incidents.
Key Regulatory Organizations
The major organization regulating the administration of safe healthcare in Miami is the Joint Commission. It is a federal agency that gives accreditation to other healthcare organizations. Being accredited by the Joint Commission means that a hospital or a medical center meets the standards of medical care, patient safety, and healthcare professionals’ competence. Another organization that oversees the risk management process is the Florida Department of Health.
It passes legislation as to the procedures of risk management, which all the healthcare organizations in the state should follow. The Florida Agency for Health Care Administration (AHCA) is the third agency that supervises healthcare organizations. Its aim is to license and regulate medical care providers, as well as inform citizens of the quality of healthcare services.
Compliance with the Standards of the Joint Commission
The corresponding MIPPA-approved accrediting body of JHS is the Joint Commission. According to its standard relevant to privacy, healthcare organizations must maintain the confidentiality of patients’ information (The Joint Commission, 2016). It requires employees working with patients’ personal data to sign a confidentiality statement and to keep records out of sight of unauthorized individuals (The Joint Commission, 2016).
The JHS risk management plan claims that incident reports are confidential, but it does not provide any information about the privacy of other patients’ documents (JHS, 2016). As for worker safety, the Joint Commission’s standards expect employees to wear gowns to avoid contamination and require them to undergo health screenings (The Joint Commission, 2016).
The risk management plan of JHS does not contain any information about worker safety; rather, it is focused on patient safety and reporting incidents. As for patient safety, the Joint Commission requires healthcare organizations to place emergency call buttons in hospital rooms and be aware of who enters the buildings (The Joint Commission, 2016). JHS meets the requirement as to the emergency call button but does not contain information about admitting strangers to hospitals.
To sum up, the risk management plan of JHS complies with the majority of standards established by the regulatory organizations. However, some recommendations may be given to improve the risk management program. For example, the organization could develop a set of rules to ensure worker safety since the current plan does not contain any requirements as to this issue. It could also state in the plan the necessity of risk management training for employees to conform to the requirement of Florida Statutes.
Alam, A. Y. (2016). Steps in the process of risk management in healthcare. Journal of Epidemiology and Preventive Medicine, 2(2), 118-122.
Jackson Health System. (2016). JHS – Risk management. Web.
The Joint Commission. (2016). Standards interpretation frequently asked questions. Web.
Jones, S., & Slosburg, D. (n.d.). Florida risk management and related regulations (3rd ed.). Web.
Jackson Health System: Description And Analysis Of The Medical System
Jackson Health System (JHS) is a medical system, which is regulated and managed by Public Health Trust. It is a non-profits organization that aims to provide high-quality medical service to all people, including those who cannot afford such services. JHS is comprised of a number of hospitals and care centers, among which are Jackson Memorial Hospital and Jackson North Medical Center. The given organization strives to become both nationally and globally recognized top medical system that provides a high-quality service.
JHS possesses a wide range of accreditation, which ensures that the institution’s services are properly evaluated and accredited. The main role of JHS’s MIPPA-approved accreditation body in the evaluation of the organization is to conduct annual checks, comprehensive sampling, audit checks, policy guidance, and technical evaluation (“MAP–MIPPA Accreditation Program,” 2019). Holtz Children’s Hospital, which is a part of JHS, is accredited by a national accreditation program called Foundation for the Accreditation of Cellular Therapy (FACT).
In addition, Jackson North Medical Center is fully accredited by the American College of Radiology (ACR) in the organization’s mammography department (“Accreditation,” 2019). American College of Surgeons (ACS) gave a complete verification and accreditation to Jackson Memorial Hospital in regards to a trauma center (“Accreditation,” 2019). Thus, the role of JHS’s accreditation body plays an essential role in ensuring that each department complies and adheres to the latest standards of medical care provision and risk management.
Different levels of administrative personnel play a major role in defining and implementing healthcare ethics and maintaining a critical focus of risk management based on employers and employees. Risk is considered as a situation associated with the presence of a choice of the proposed alternatives by assessing the likelihood of the occurrence of a risk-containing event, entailing both positive and negative consequences. Organizational risk management aims to manage risks and opportunities that affect the creation or maintenance of value (Suprin et al., 2019). The corresponding personnel is involved in the process of making and implementing management decisions that minimize the adverse impact on the organization of losses caused by random events.
The personnel responsible for procedures and controls in place should ensure an effective and timely response to risk. Throughout the organization’s risk management process, it is monitored as part of the current management activities or through periodic evaluations.
The organization’s risk management is not a linear process, and the stages considered are not necessarily implemented sequentially. That is, the relevant activities can be carried out in parallel, and a return to the previous steps is possible. This is a multidirectional, cyclical process in which almost all components can and do affect each other, and it is controlled by top managers of the department (Suprin et al., 2019). Under various external and internal risk factors, multiple methods of risk reduction can be used that affect one or another aspect of JHS.
Ethics and Patient Rights
JHS’s risk management and compliance programs are strictly adherent to ethical standards and patient rights. JHS’s risk management program, first of all, defines the limits of its competence. When it comes to the human right to protection of health, then at the same time, there are problems of other branches of legislation related to laws in the field of education, culture, and labor. When seeking medical help for a patient, the result of treatment is important first of all, as well as the duties of medical workers and his or her personal rights in the treatment process in accordance with patient consent standards (Lunshof & Birnbaum, 2017).
For medical workers, a clear definition of their rights and obligations in relation to the patient and responsibility to the patient and the law for the results of their activities. This also includes adhering to outlined ethical standards and legal protection in case of unreasonable and unlawful claims by patients.
The legal responsibilities of the personnel and program are defined by the regulations of bioethics. Society stably and steadily develops only when ethical and legal knowledge and practice correspond to human interests and needs. An important role in affirming the moral foundations of the patient’s rights is played by bioethics. Bioethics educates people in the ability to combine personal and public interests in the process of resolving contradictions, conflicts, guided by the principle of priority of human rights.
Bioethics, mediated by the idea of human rights, makes it possible to understand the relationship between law and morality as social regulators of the moral foundations (Lunshof & Birnbaum, 2017). The dialectic of law and morality in bioethics is that law should be ethical, but morality should not replace the law.
JHS’s risk management understands that its activities cover the area of action in relation to the body, which, firstly, puts the human body at risk. Secondly, the subject of which, that is, the doctor, personally makes this or that decision. The slightest mistake of a doctor can lead to serious suffering and even death. In the program, the medical worker has an extremely narrow field of action. Faced with destruction, the subject is morally obligated to justify this as a means to achieve a certain good. The main principle of medical ethics in the JHS, according to which everything that relates to the field of medicine, should not go beyond morality (Lunshof & Birnbaum, 2017). Being associated with a risk to life, the actions of physicians cannot be regarded as neutral concerning the truth.
The success of any organization, including medical ones, depends on consumers, both external and internal. JHS’s risk management fully understands their current needs and predicts future ones. Without satisfying the needs of the consumer of medical services, the meaning of the functioning of the healthcare system as such is lost. Therefore, the new standards of the risk management system of quality are aimed at satisfying not only the end-user of medical services but also all interested parties and society as a whole.
JHS’s quality improvement procedures are mostly based on the concept of customer or patient satisfaction. Monitoring customer satisfaction in JHS is a systematic and regular comprehensive procedure focused on solving the main task of a medical organization to ensure and improve the quality of medical procedures through a system of interaction between a medical organization and a consumer.
Currently, JHS has not developed a unified approach to assessing the satisfaction of external consumers with medical care. The indicated problem is solved by researchers, practitioners of public health, and employees of other interesting structures by various methods (Suprin et al., 2019). JHS actions can also include assessing the quality of medical care according to the structure and results of its provision, standards, and expert characteristics. Thus, JHS analyzes a number of critical factors in order to increase its quality of service.
In conclusion, JHS is a medical system with a wide range of accredited compartments that adhere to the latest standards in the medical industry. Mandatory healthcare ethics are commonly practiced in the given organization due to the strict management from the administrative personnel. Risk management regulations are also compliant with patient rights and ethical standards in order to protect their patient from malpractice. In addition, JHS fully understands its legal responsibilities, thus, it integrates bioethics in the organization’s procedures. The overall quality improvement is accomplished by focusing on patient satisfaction.
Accreditation. (2019). Web.
MAP–MIPPA Accreditation Program. (2019).
Lunshof, J. E., & Birnbaum, A. (2017). Adaptive risk management of gene drive experiments: Biosafety, biosecurity, and ethics. Applied Biosafety, 22(3), 97-103.
Suprin, M., Chow, A., Pillwein, M., Rowe, J., Ryan, M., Rygiel-Zbikowska, B., … Tomlin, I. (2019). Quality risk management framework: Guidance for successful implementation of risk management in clinical development. Therapeutic Innovation & Regulatory Science, 53(1), 36-44.