Patient-Nurse Relationship: Alcohol Dependency Care

Patient-Nurse Relationship: Alcohol Dependency Care Diagnosis J.H was admitted to Unit 9 with a diagnosis of alcohol dependence causing induced mood disorder with depressive features. The diagnostic criteria outlined by the DSM-IV for substance dependence states that three or more of the following impairments must be seen in the patient, a tolerance for the specific substance, withdrawal symptoms if the substance stops being taken, persistent desire or unsuccessful efforts to cut back or control substance use, reduction or even cessation of important social, occupational, or recreational activities, and substance use in spite of knowledge of having a substance abuse problem (Austin Boyd, 2008). The etiology behind substance abuse is still being researched but the evidence suggests that there are both psychological and biological aspects to addictive personalities. It is also evident that substance abuse and dependence can lead to problems in all parts of the biopsychosocial well being. The interaction took place on unit 9 of the QEH hospital on September 24th at approximately 1530 hrs. The client and the student nurse had discussions in the pantry area of the unit as well as in the common area the conversation of focus took place in the common area. Preceding Critical Events The student nurse had met the client once before and had already started the orientation phases of the nurse-client relationship. The client was cleaning the pantry area of the unit while making himself a cup of coffee. This is when the student nurse approached the client and began a conversation which led to the discussion of focus. Phase of the Nurse-Client Relationship During the conversation of focus the student nurse and the client were in the working phase of the nurse-client relationship. They were in this phase because the client was beginning to outline areas of his illness that needed to be worked on in order to recover. Client and Nursing Partnership Goals Client Health Goals Short Term 1.) Client wants to get into an addiction center outside of PEI. The client has already tried the addiction center at Mt. Herberts and feels that the program does not work for him. This goal was identified by asking the client about the various treatments he has used in the past few years and he mentioned his application to a treatment center in Ontario. 2.) Client also wanted to go on a three hour pass that evening in order to complete some errands at his home. This goal was established after I asked the client what his plans were for the rest of the day. Long Term 1.) Client wants to gain control over his alcohol dependence by attending more AA meetings and getting the proper psychiatric treatment including medications and group work. 2.) Client wants to better his relationship with his two daughters but feels that he first needs to get control of his illness. 3.) Client wants to finalize his divorce, at the current time he is legally separated in order to complete the d ivorce the client must speak to his lawyer and finish some paperwork. Nursing Partnership Goals Short Term 1.) Establish a nurse-client relationship by defining boundaries, assuring confidentiality, and explaining the purpose of the relationship. 2.) Provide client with information regarding treatment center in Ontario. 3.) Gain enough trust with the client so that he feels comfortable to discuss his illness and his history with the student nurse. What I Observed Client was in the pantry area of the unit cleaning while making a cup of coffee. He seemed a little anxious and somewhat rushed (it was later observed that this is simply a part of the client personality.) When I entered the room J immediately greeted me saying Hello Greg, Im just making myself a cup of coffee. I like to try and do my part to keep the place clean his tone, volume, and rhythm were all within normal limits and he seemed to be in a pleasant mood. The client then said Oh, I dont clean up that often the other people here are pretty good at cleaning up after themselves I just like to keep busy. After the patient finished making his cup of coffee he moved to a couch in the common area. His mood was still pleasant and he was very talkative. After J was finished he said something that really caught my attention I know I have a problem but I only binge drink, its not like I drink all the time. Pause Well I shouldnt say that because it is bad enough to just binge drink and I ne ed to get better At this point the patient started to ask questions about me such as where I was from, what I thought of the nursing school, and a few other things. The client was now very relaxed in the couch with his feet up on the coffee table drinking his coffee. What I Thought and Felt When the client greeted me so quickly and in such a pleasant tone I felt that the nurse-client relationship was developing very well and that it was time to start the working phase of the relationship. By the way the client talked about his co-patients and the staff I could tell that he was quite comfortable on the unit. I felt that this would be a good time to start a conversation. I thought that now would be a good opportunity to ask J about what brought him to the unit and to explore his diagnosis. I felt a little nervous thinking of what to say I feared that I may be asking something to private this early in the relationship I was surprised at how easily J opened up about his history and I was slowly starting to feel more comfortable with asking questions about his illness. Again I felt that J was being very honest with me and I could sense that he trusted me as a nurse.

Ac555 Week 7 You Decide

Week 7 You Decide Course Project Keller Graduate School of Management Question 1 The Securities and Exchange Commission (SEC) would only have influence over Smackey Dog Foods, Inc. if they are a publicly listed company or if they register to become a publicly traded company. The SEC assists investors by providing reliable information to investors so they can make informed investment decisions. If Smackey Dog Foods, Inc. ecomes a public company, they would need to provide financial statements along with an opinion about the financial statements by an independent public accountant along with the registration statement and subsequent financial reports (Arens, Elder, and Beasley, 2010). Question 2 There are four things involved in the initial planning of an audit. According to Arens, Elder, and Beasley, 2010, they are: 1. â€Å"The auditor decided whether to accept a new client or continue serving an existing one, 2.The auditor identifies why the client wants or needs an audit, 3. To av oid misunderstandings, the auditor obtains an understanding with the client about the terms of the engagement, and 4. The auditor develops an overall strategy for the audit, including engagement staffing and any required audit specialists. † In relation to Smackey, Keller CPA’s need to make the decision as to whether or not they want to take Smackey on as a new client. Once that decision has been made, Keller needs to understand why Smackey wants or needs the audit.Smackey needs the audit in order for the bank to grant a new loan for expansion. Keller will now need to meet with Smackey’s managers to discuss and document what services they are going to be providing. Once that is determined, Keller will need to plan the audit strategy and determine if they are going to need to hire additional staff or any specialty staffing. Since they have no experience auditing a dog food company, Keller may need to bring in an auditor who has experience in this type of manufactu rer.Question 3 According to Ayers, et al, 2010 the four phases of the audit are â€Å"plan and design an audit approach, perform tests of controls and substantive tests of transactions, perform analytical procedures and tests of details of balances, and complete the audit and issue an audit report. † In the plan and design stage of the audit, the auditor needs to understand the business and its environment, understand internal controls and asses control risks and risk of material misstatement (Ayers, et al, 2010).The second stage of the audit is where the test of controls and substantive tests of transactions are completed. In the third stage, analytical procedures and tests of details of balances are accomplished. In the fourth and final stage, the audit has been completed and the auditor comes to an overall conclusion and issues the audit report (Ayers, et al, 2010). In the first phase of the audit, Keller is going to have to gain an understanding of Smackey.They can do thi s by researching dog food manufacturing businesses and the industry as a whole. If necessary, they can hire an auditor who has experience in the industry to assist with the audit. One of the internal controls Keller needs to look at is the adequate separation of duties. In the warehouse, one person monitors production and shipment of their regular line of dog foods and is also responsible for preparing and approving all inventory records. Another control that needs to be examined is independent checks on performance.Since the sales manager is afraid to fly and can’t really drive, there is nobody checking on the performance of the sales people. With no monitoring of the sales people and their commission being paid in advance based on projections, close monitoring of sales should be accomplished. In performing a test of controls, the physical control over assets and records will need to be done. How the waste and returned dog food is being handled should be reviewed. Seeing the employees taking bags of dog food that have been thrown away is a red flag for fraud by the employees.Examining documents related to the inventory will need to be done as all inventory records are prepared and approved by one person with little inventory left in the warehouse but a lot of returns left on the shipping dock. This can lead to an understatement of inventory, understatement of sales returns, and overstatement of accounts receivable which is the proposed collateral for the new loan. Analytical procedures should be applied to the determination of commission that is being paid to Smackey salespeople.The commissions on the average are off by 11 percent showing that they may not be reasonable. The auditors also need to perform the analytical procedures for inventory to determine if the inventory is being misstated. This would be a concern due to the amount of waste and returns. The test of details of balances will need to be done on the accounts receivables to determine if t hey are properly stated. Question 4 Keller needs to discuss the weaknesses in Smackey’s internal controls with Sarah as the president and manager of operations.The internal control issues that need to be pointed out are the lack of separation of duties in the inventory production and records, the improper classification of accounts receivables, and improper checks on performance of the sales personnel. As soon as Keller became aware of the significant deficiencies in the internal controls of Smackey, they are required to notify in writing to the governing bodies of Smackey. A management letter should also be written giving suggestions for ways to make improvements in the internal controls (Arens, et al, 2010).Question 5 There are several types of confirmation Keller can use to verify Smackey’s accounts receivables. They are positive confirmation which is some type of communication sent to the account holder requesting they directly confirm whether the balance on the re quest is correct or incorrect (Arens, et al, 2010). There are two types of positive confirmation, a blank confirmation form where the recipient is asked to fill in the balance of the account or an invoice confirmation which is where an individual invoice is confirmed instead of the entire account.There is also a negative confirmation where the recipient is only requested to respond if the balance is incorrect (Arens, et al, 2010). Due to the fact that Smackey’s accounts receivable is a large part of the assets and they aren’t writing off any bad debt, Keller should use the blank confirmation form to determine if the balances of the accounts are correct. Question 6 The major factors that affect the sample size for confirming accounts receivable are the weakness in internal controls within the sales department, and the improper statement of accounts receivable.With no control over the sales department, there is a higher risk of fraud by collusion between the salespeople and the companies that owe money to Smackey. With almost 20 percent of the receivables classified as 90 days or older, there is a higher risk of accounts receivable being overstated by uncollectable accounts leading to a possible material misstatement in the financial statements. Question 7 The concern about the possibility of legal encumbrances on verifying the ending balance in property, plant, and equipment comes from the lawsuit filed by the employee who was fired for not owning a dog.In order to determine the likelihood of the employee winning the suit, Keller will need to send a confirmation request to the lawyer handling the lawsuit for Smackey. The request will need to ask what is the probability of the ex employee winning the lawsuit. If there is a high probability, then the confirmation needs to include the possible amount of the award against Smackey. Question 8 With controls over inventory being deficient, Keller will be present at the year-end inventory. The auditors wi ll physically observe the counting of the inventory that is in the warehouse and on the shipping dock.The auditor will also observe to ensure the waste isn’t included in the physical inventory count. If the sales returns aren’t able to be resold, then the auditor needs to ensure they aren’t counted in the inventory. The observation is necessary to ensure the inventory isn’t overstated with what has been wasted or understated by not counting the sales returns that can be resold. Question 9 Inventory control weaknesses that exist in the inventory and warehousing cycle include controls over the physical count of inventory and pricing and compilation controls. Smackey should have documents that show the reporting f the inventory that is waste and the sales returns. There should also be a review of the inventory documentation but with Kim being busy with the Best Boy Gourmet line, she hasn’t been focusing on the regular product line. There should be doc umentation to show the sales returns being returned to inventory and there should be confirmation of the inventory documentation by Kim. Henry shouldn’t prepare and approve the documentation one of those functions should be done by someone else. Question 10 Pete is breaking Rule 301 Confidential Client Information by discussing some of the details of the audit with Alan over beer.Rule 301 states, â€Å"A member in public practice shall not disclose any confidential client information without the specific consent of the client (Arens, et al, 2010). † Smackey didn’t give Pete consent to discuss the audit with his friend who also happens to be working for the bank Smackey is trying to get the loan from. Because Pete isn’t aware of Alan’s relationship with the bank, he isn’t violating Rule 101 – Independence. If none of the auditors obtain adequate understanding of the industry or business, they will be in violation of Rule 201 – G eneral Standards, A. Professional Competence.Question 11 If Keller makes an intentional mistake, they can be held liable to Smackey or to the bank. If the intentional mistake results in Smackey not receiving the loan, they could sue Keller for negligence. The type of mistake would determine the degree of negligence. In an unintentional mistake, Keller could still be liable but could possibly defend themselves based on nonnegligent performance. Legal liability concerns regarding the Professional Rule violations are if the auditor doesn’t maintain independence, follow the requirements for technical standards, and doesn’t maintain confidentiality.

The First Year Of College - 1346 Words

The Merriam-Webster dictionary defines transformation as â€Å"a complete or major change in someone s or something s appearance, form, etc.†. From the time of birth to adulthood humans have many different experiences which help to shape their lives and I believe that some of the experiences I had in the first year of college caused major changes in my thoughts, actions and over all demeanour in my life. Entering college I was scared from the onset, I mean I was just a child, regardless of being 17 years old and technically a young adult I never thought of myself as growing up. Therefore venturing out into the big wide world, trying to get a higher education, especially living on my own for the first time, I did not realise it at the time†¦show more content†¦They shared their experiences and told me how they had to adjust as well. It was not until then I realised that I indeed had to start acting more maturely and become more independent while knowing that my family is always there to help me through anything rather than simply expecting them to fix and clean up my messes or handle my problems for me. My first step in doing this was to talk to my mother I told her that I loved and appreciated her very much but I would like her to help me become a strong, independent and mature woman just like her and that she can guide me through situations and not come to my rescue unless absolutely necessary. I thought she would be a little hurt but instead she smiled and gave me one of the biggest hug ever and said â€Å"my baby is growing up and I am so proud†. Then and there I knew I wanted that feeling forever and in order for people to respect and be proud of me I had to get my act together and work harder. According to Erik Erikson stage of Identity vs. Role Confusion, which ranges from the age of 12 to 18 years old; is when one is leaving childhood and now entering adulthood. McLeod (2013), states that Erikson determined that the individual is b ecoming more independent and starts to find his or her identity in society as it relates

Laser Tag Is A Team Or Individual Sport Or Recreational...

1. INTRODUCTION Laser tag is a team or individual sport or recreational activity where players attempt to score points by tagging targets, typically with a hand ­held infrared ­emitting targeting device. Infrared ­sensitive targets are commonly worn by each player and are sometimes integrated within the arena in which the game is played. Since its birth in 1979, with the release of the Star Trek Electronic Phasers toy manufactured by the South Bend Electronics brand of Milton Bradley, laser tag has evolved into both indoor and outdoor styles of play, and may include simulations of combat, role play ­style games, or competitive sporting events including tactical configurations and precise game goals. is a game which resembles paint ball, the only difference is that it is played using harmless laser guns. Indoor laser tag is typically played in a large arena (may be dark or may not) run by a commercial laser tag operator. The packs are tightly integrated with the devices inside the arena. The arena devices, and the packs themselves may be linked into a control computer for scoring and control over game parameters using radio equipment or infrared links. The game computer often serves to control other game effects and to manage player scores. Though the guns used in commercially played laser tags have lasers they are not used in actual mechanism of the game, they actually use infrared to register hits. Infrared has its own cool properties such as it gets scattered in very shortShow MoreRelatedAirheads Business Analysis Essay34215 Words   |  137 Pagesduring that time frame. Airheads’ focus on safety, via its protective gear and use of suspension cables to connect trampolines, provides a temporary competitive advantage according to the VRIO analysis. The firm’s focus on group socialization activities also acts as a strength for the firm. 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