Hlt33115 Health Services Assistance Of Assessment Answers

1. Why is it important to identify and report on variations in the quality of products and services provided?

 

2. Research and list the various competencies and professional development needs for your job role. Why is it important that you should have these competencies?

 

3. List what are the personal skills and competencies you have identified that you need to develop in order to work effectively in the health industry and how can you achieve it?

4. Identify three people or positions or roles that are part of your work place structure for reporting and taking direction from?

 

5. List other job roles which form part of your working environment?

 

6. Write a note to your supervisor regarding the following matter :

7. Explain about below conflicts and how you would deal with them:

8. Provide three examples of actions that could be taken to ensure that you transport individuals on time?

 

9. What checks should you complete to ensure that the equipment is attached safely prior to transporting a client?

 

10. If you are transporting individuals in a wheel chair that has no seat belts, What actions can you take to ensure the safety of the client during the journey?

 

11. What documentation exists within health care organizations that outline information about how you should transport individuals? Provide some examples of specific policies that must be followed?

 

12. Discuss as a group the types of conflicts that you would have to report to your organization or other agencies if they take place during transportation?

 

13. List the potential barriers that may affect the communication between you and the client that may prevent you from identifying what you need to assist with transportation?

 

14. What extra considerations are needed for clients with disabilities during transportation?

15. Your client needs to be transported to endoscopy department for a procedure. Hehas and MRSA infection and has a wound that is covered on his lower left leg. He is also on oxygen, has IV fluids, and an Indwelling Catheter (IDC).

16. A client named Tom is under Jasper’s care and has fallen in the bath room. He is conscious but unable to stand by himself. The bathroom is very small and the space is limited. There is no room for hoist. Jasper decides to use a slide sheet to move Tom to a place that will allow enough room for a hoist to be used. There are no other workers around so he decides to do this alone. He rolls Tom onto his side and puts the slide sheet against his spine. He then rolls Tom onto his other side and unrolls the rest of the sheet. He notices that the slide sheet is slightly smaller than the person he is moving but decides to carry on using it. He stands at the bottom of the sheet and grabs the slide sheet without bending his knees. He hasn’t tucked Tom’s elbows in and, as he pulls Tom through the doorway quickly, he bumps Tom’s left elbow.

17. List the common medical check-ups people should have (Including gender specific, age and frequency)?

 

18. You are working in an acute care environment and taking out IV Cannulas as instructed by your RN’s What would be the Personal Protective Equipment that you need to use and the body mechanism you need to maintain to follow work health and safety policy and procedures? Give reasons for your response.

 

19. If a staff member feels that Joe who is a new staff is being bullied by another colleague. Does this issue fall under work health and safety? If Yes what should be the right steps to be taken by the staff member.

 

20. Sophie, who is a staff member of the house keeping department, has slipped and fallen in the staffroom as she was mopping. She cannot get up from the floor and she is in a lot of pain. You are the only person in the staff room, what should you do to follow WHS policy and procedure.

 

21. How are staff in the healthcare environment expected to respond to situations that they have identified as a risk of infection? Give an example of what should be the response of a staff member who suspects that the client has wound infection?  

 

22. Explain how would you do Risk categorisation and the level of risk for the following:

a. The client has vomiting and diarrhoea and you suspect that its gastroenteritis

b. The client has redness around his wound on his back

c. The client has a history of urinary tract infection and he looks confused and agitated now.

 

23. Explain the importance of documenting the details of what is your observation of a client’s wound that he got on his leg due to a fall a week ago.

 

24. What information do you need to include in an incident report form?

 

25. Identify a crisis plan or other planned responses to behaviours of concern that may be implemented within a health care facility. Give a summary of what might be included in this plan and when it would apply (e.g. duress alarm).

 

26. Why is it important to address behaviours of concern promptly?

 

27. Tom’s mother Mary is a resident in the facility that you work. Tom comes to the nurse’s desk and slams his fist on the table and is verbally abusive. He shouts “My mother is in so much pain and you all seem to be relaxing here!” Explain what you would do to deescalate this matter as well as provide quality care.

 

28. Mary has chronic pain and suffers from severe hallucinations, which means she often gets agitated and confused. When the care worker Sophia was assisting Mary in the shower, Mary pushed Sophia and this resulted in Sophia having a fall and a very painful left arm.

Answers

1. Causes of change need to be identified and eliminated to reduce and improve the product quality indefinitely (Orel & Kara, 2014). It is essential because it is a critical factor in quality control and continuous improvement which can be used to determine how changes should be made (Orel & Kara, 2014). Process feedback data should be examined to determine the causes of variation, identify and process its significant problems and fix the subset of processes. If the changes are monitored, then they can be kept at minimum and customers can acquire whatever they want hence consistency (Orel & Kara, 2014).

2.` The competencies include service delivery, communication, teamwork, problem solving and leadership. Service delivery is a competence which covers the provision of help and assistance to high standards which may include reacting to requests for advice or information, actively promoting or offering services of the company to others along with setting the overall standards of service offered (Plomp et al., 2016). Communication covers through electronic, oral, visual and written communication which may involve the need to convey basic factual information clearly and accurately, communicating information in the correct format along with explaining detailed or complex specialists’ information.

Teamwork competency is crucial for careers and objectives as it gives direction to our life to a higher stage of fulfilling our interests, money concern, and the future growth recognition along with social recognition (Plomp et al., 2016). Furthermore, it directs the path of the team and their career objective where they want to go by continuously learning. Leadership competencies assist an organization to determine which level of management needs a particular skill. When selecting and developing management professionals organizations should consider a candidate’s competencies and compare these with the skills that need further development to succeed within a leadership role. Approaching leadership competencies in this manner assist firms to make correct decisions on recruiting, developing and promoting the highest quality candidates (Plomp et al., 2016).

Problem-solving is a fundamental skill which could range from something simple like addressing a staff shortage to something more technical like overcoming a major stumbling block during a project. It is important in identifying or developing options and choosing solutions to problems which happen within the job role.

3. Communication skills are essential in working effectively in the health industry. It is achieved by developing active listening skills that are, making an effort to hear and understand what other individuals are saying without being distracted by anything around. Furthermore, communication skills can be developed by improving writing skills (Walczak, Butow, Bu & Clayton, 2016). How to communicate well in writing for instance, when writing emails of which numerous of them are written every day can improve communication skills. There are many approaches that can be utilized to ensure that the emails are written expertly and get read.

Computer skills are important for utilizing computers and related technology efficiently. These skills can be achieved by identify what one needs to learn, starting with the basics and ensure how to use a computer, familiarizing with an understanding of how computer works, taking a free online or-in person computer courses along with applying the knowledge and getting hands-on practice (Walczak, Butow, Bu & Clayton, 2016). Self-confidence is crucial in a health industry since no one wants to think that they are being cared for by a novice, so one needs to project confidence in his or her abilities no matter how experienced they are. Self-confidence is achieved through positive thought. Believing that it is possible to accomplish something, acknowledging the strengths and weaknesses, accepting compliments and complementing oneself along with using criticism as a learning experience (Walczak, Butow, Bu & Clayton, 2016).

4. The people include Clinical nurse manager, staff nurses, and pharmacists. Health services assistants report to the clinical nurse manager under the direction of a medical provider they perform a variety of tasks which include nursing and medical support roles for registered nurses, physicians, nurse practitioners along with physician assistants (Coyne, Comiskey, Lalor, Higgins, Elliott & Begley, 2016). They assist the nursing staff in the delivery of patient care and maintaining hygiene standards within the ward under the supervision of clinical nurse managers along with staff nurses. The nursing staff decides which task the health service assistant will perform in respect of each patient.

5. Health care assistants work within a hospital setting alongside nurses, clinicians, doctors and other medical professionals across a huge variety of tasks to assist with the treatment of patients and the running of wards (Coyne, Comiskey, Lalor, Higgins, Elliott & Begley, 2016). They address the physical needs of patients like helping with baths and showers, changing bed sheets along with emptying bedpans. They clean and tidy the hospital environment and maintain equipment in departments and wards together with helping patients move about the wards and interacting with family. Furthermore, they help with particular procedures like recording medical observations, blood pressure along with temperature measurements.

6. Dear Supervisor

Am writing this note regarding the patient I have here. The patient has signs of stress and agitation, and there needs immediate attention. The patient seems to be restless and gains anger easily. Under those circumstances, he might be dangerous in particular situations since some people are more likely to resort to violence. Accordingly, he seems to be moving from one place to the other and hence cannot concentrate at one place.

He also shows an inability to focus, which also indicates erratic and forgetful behavior. In that case, he is unable to complete any task assigned to him. He also seems to lack the thinking ability and also his physical health is not good. Furthermore, he is not comfortable and would like to see a doctor with immediate effect. Kindly accord him permission.

Thank you for your consideration

Best Regards

7. Mistrust and conflict

This conflict can be dealt with through defining of responsibilities in which if every individual knows exactly what he or she should be doing at all times miscommunication amidst management and workers is reduced hence generating a lack of mistrust (Kalra, Unnikrishnan & Baruah, 2017). Addressing the issue by watching the employees interact with each other and identify some signs of mistrust and schedule a meeting to address the issue immediately.

Interpersonal conflict

Interpersonal conflict occurs when a team of individuals or a person frustrates or interferes with another individual’s effort at achieving a goal. Stress as a result of this conflict might be influenced by support on the effective coping procedures to be employed to deal with it. Also, it can be dealt with by just walking up to the person and talk to them in a mature way and sort out the problem (Liu, Wang, Chang, Shi, Zhou & Shao, 2015). Also, one could pretend there is no conflict or stop interacting with the person causing problems and consciously avoiding all contact. Frustrations in the conflict can be handled through channeling the negative energy into something positive.

8. The unnecessary delays caused by transfer personnel carrying out further procedures should be avoided (Lindholm & Blinge, 2014). Secondly, the easiest and the shortest route should be followed as planned. Here, elevators should be available and secured to prevent any delays along with crowds. Finally, the fastest mode of transport should be utilized such as the air transport so that the minimum time possible can be taken to make sure the patient is safe (Vercruysse et al., 2015) The use of air ambulances are useful in overcoming time together with geographical barriers to access to medical care.

9. Checks like routine maintenance of the equipment by the manufacturers’ recommendations such as the brakes of a car or items on a hoist such as actuators, straps, and batteries should be completed. Also, the LOLER examination that is the Lifting Operations and Lifting Equipment Regulations should be certified that during testing all elements that has a bearing on safety has formally been inspected and evaluated as being in a safe state. For the case of wheelchairs the brakes should be locked before getting in power turned off for the example of power wheelchairs (Boschin, Brusque, Carvalho, Galle & Smith, 2015). For the elevator, the battery should be fully charged and fitted correctly, the emergency stop button should be set correctly, the lifting tape should be intact and not frayed, and there should be no fluid leaks. All stitching of slings must be kept intact and ensure that it is compatible with the client and the elevator. Moreover, checks on the slings must be completed on all the labels to make sure they are legible and indicate safe working load along with a unique identifier.

10. The action to be taken is to avoid hard turns, avoid sudden stops or acceleration, avoid driving over curbs or through potholes and most of all being involved in a collision. Accordingly, you should let the patient hold your hands to avoid falling (Erickson et al., 2016).

11. Documentation is the critical vehicle which is used to convey essential clinical information concerning each patient diagnosis, treatment together with the outcomes. In that case, the complete documentation of the encounter has to be made available to the referring provider. Some of the specific policies which have to be followed are that patients should be receiving treatments from the Trust and its clinics (Fritz, Slowther & Perkins, 2017). It's also vital for the transport provider to be notified of any contagious illness on the request form.

12. Some of the conflicts which can be reported to an organization during transportation are as highlighted below. The first one is prioritizing Key tasks (Lippi & Mattiuzzi, 2016). As an illustration, one nurse might think of helping a patient in the middle of a draining emotional display. The other conflict can be between the nurses together with the spouse of her patient. They might has a misunderstanding on what needs to be done during transportation.

13. Physiological barriers are as a result of the client's physical state. If the client has a reduced hearing, he or she many not wholly grasp the content of a spoken conversation more so if there is significant background noise. Attitudinal barriers are perceptions or behaviors that prevent people from communicating effectively and are as a result of personality conflicts. Language is another potential barrier which may occur when terminologies used are not understood by the client although they are using the same language (Bee, Price, Baker & Lovell, 2015). If the communication includes too much of specialist jargon and abbreviations the client might not understand and his or her transportation needs may not be met. Finally, psychological barriers such as low self-esteem anger and stress prevent effective communication. If the client is not feeling comfortable when communicating his or her transportation needs may not be known and hence not met.

14. For the hearing impaired clients, the transportation team should use the patient's preferred method like lip reading or pen and a paper and look at the patient while speaking and listening. Also, they should face the patient in good light especially for the lip readers and speak clearly but not too slowly and should not exaggerate their speech or shout (Jalongo, M. R., & Breece, L. (2018). On the other hand,  when transporting visually impaired clients, the transporting staff should use verbal responses and avoid nods, and head shakes, gain the client’s attention by speaking first or by a gentle touch on the arm along with talking to the person directly instead of facing their sighted companion.  Moreover, the transportation staff should verbalize their actions and ask if support or guidance is needed.

15. The precaution that should be taken is to ensure the tubes along with the attachments are properly placed before the procedure to prevent any accidental removal. Accordingly, the slider board together with the full-size sheet or the friction reducing sheet needs to be used during the transfer. The patient privacy and dignity also needs to be ensured. On the other hand, some of the steps are that the number of staff which is required to safely transfer the patient needs to be predetermined (Singh, Lancioni, Karazsia, Chan & Winton, 2016).

The patient has to roll over and then places the slider board halfway under the patient thus forming a bridge between the bed and the stretcher taking care of the wound on the left leg and the oxygen tubes. The patient is then returned to the supine position. The designated leader has to count one two three and then start the move. The pillow has to be replaced under the head to ensure the patient is comfortable and be covered with the sheet.

16. At least two carers should be present to perform patient transfer but in this case, although there were no other workers around Jasper ignores looking for another person but decides to do it alone. It is required that the carer should ask the patient before being moved the kind of help he or she might want to give. Although Tom was unable to stand by himself he was conscious and Jasper should have talked to him about the assistance he would offer, but he didn't (Kales, Gitlin & Lyketsos, 2015). Moreover, Jasper used only one slide sheet to roll Tom instead of folding it or using two of them such that he could use the top slide sheet to move the patient which slides against the bottom slide sheet hence creating a smooth and easy transfer for both Tom and Jasper.

 Furthermore, when Jasper found out that the sliding sheet was smaller than Tom, he decided to continue using it instead of using a small tubular sheet under Tom's calves and heels. This would prevent damage of skin because of shearing forces. Before rolling the slide sheet Jasper should have put Tom’s arms across his chest and bend his far knee, and because of his ignorance, he failed to tuck Tom’s elbows in the sheet resulting to bumping his left elbow. Jasper did a mistake in grabbing the slide sheet without bending his knees. He should have stood with one foot in front of the other foot on opposite sides.

17. Medical check-ups identify any signs of health issues. Bowel cancer is tested for men and women who are aged between 50 and 74 years and those at increased risk should start screening earlier and are tested at a frequency of every two years which may be different for those at an increased risk. High blood pressure is tested for men and women aged 18 years and older at a frequency of at least two years. Moreover, a check-up of high cholesterol is on men and women at the age of 45 and above and 35 years and above for the Aboriginal and Torres Strait Islander people at least every five years (Kales, Gitlin & Lyketsos, 2015).

Cervical cancer screening tests for all women between 25 and 74 years after every five years and women at increased risk of cervical cancer may require more frequent testing. A cardiovascular disease like heart attack and disease is tested for women and men of 45 years and Aboriginal and Torres Strait Islander adults of 35 years. Its frequency depends on initial risk assessment, and if the risk is low it is tested after every two years, 6 to 12 months for moderate risk and regular review for high risk (Kales, Gitlin & Lyketsos, 2015). Men at average risk of prostate cancer who decide to have a prostate-specific (PSA) screening can be offered testing between 50 and 69 years and for those with a family history of prostate cancer and decide to have a PSA screening tests should be offered to test from the age of 40 to 45 depending on how many close family members have been diagnosed with prostate cancer until 69 years. The testing is offered after every two years.

18. A piece of dry sterile gauze should be held over the insertion site, and as the cannula is removed immediately, a firm pressure is applied to the site approximately 2 to 3 minutes or long enough to make sure that there is no subcutaneous leakage of blood. A suitable dressing is applied to the site where the cannula is removed but before the application patient is checked whether he has any allergies to any of the materials to be used (Singh, Lancioni, Karazsia, Chan & Winton, 2016). The intravenous cannula is then inspected and removed and checked that it is complete and undamaged. At the end of the procedure, all the equipment is disposed safely in the correct sharps bin and disposable plastic bags and a record of the procedure in all relevant documentations.

19. This issue falls under work health and safety, and the staff should have created a code of conduct addressing bullying. This involves having a particular policy in place to deal with workplace bullying including the type of conduct that is unacceptable and the consequences for them. Also, the staff should hold a regular training session where the staff should be periodically coached on the proper way to communicate (Singh, Lancioni, Karazsia, Chan & Winton, 2016). This will be an opportunity to remind them about the best ways to interact with one another emphasizing the relevance of respect. Finally, the staff should be encouraged to speak out creating a surrounding where the individual feels comfortable enough to report the behavior. Furthermore, staff members knowing whom they can talk to about bullying and what steps they should take to resolve the situation.

20. The WHS policy and procedure involves taking care of their health and safety and that of others within the workplace. Under those circumstances, I would ensure the floor is safe by removing any soapy water before I proceed to help Sofia get some treatments (Singh, Lancioni, Karazsia, Chan & Winton, 2016). This is because if I don't take care of the floor, then we might find ourselves in the same situation.

21. Staff members are responsible for making sure that they comply with all infection control procedures that are implemented to help minimize the risk of exposure and the possibility of transmission of infection. This involves identifying, assessing along with controlling all risks. The risk of infection can never be eliminated and some, individuals have a higher risk of obtaining an infection than others. Strict hospital infection control procedures and policies along with the cautious use of antibiotic medication (Liu, Wang, Chang, Shi, Zhou & Shao, 2015). The staff should implement an appropriate response within their role and responsibility by identifying a hazard, accessing the risk associated with each hazard to determine how it can be eliminated, identify the control measures which should not impose another risk and monitoring the control measures.

Moreover, staff should document and report tasks and activities that put the client at risk. In reporting the incident, the staff should indicate the time and date of exposure, how the incident occurred, name of the source client and the site of the injury (Liu, Wang, Chang, Shi, Zhou & Shao, 2015). The staff should respond appropriately to situations that pose an infection risk in accordance with the procedures and policies of the organization. Also, they should follow procedures for risk control and risk containment for particular risks together with following protocols for care following exposure to blood or other body fluids as expected.

22. a. Gastroenteritis is an illness triggered by the infection and inflammation of the digestive system and is extremely contagious and therefore its level of risk is extreme (Ahmed et al., 2014). Categorization of risk will be done via identifying the high-risk food handlers along with the health facility that contain direct contact or clients where an intestinal disease would have specifically serious repercussions. Also, risk categorization would consider children or older clients who are unable to implement good standards of personal hygiene.

b. Redness around a wound is normal and therefore its level of risk is low (Wardi, Schneir & Medak, 2015)

c. Urinary tract infection become more and more severe the further they spread, and if they spread to the upper urinary tract it is much difficult to treat, and it is more likely to spread into the blood causing sepsis (Flores-Mireles, Walker, Caparon & Hultgren, 2015). This is a life-threatening situation, and therefore its level of risk is extreme.

23. The observations are recorded to identify any changes that are observed in the wound from the admission date throughout treatment. Furthermore, it is used to plan and evaluate the patient’s treatment (Donaldson et al., 2015). The observations are used to evaluate the state of the wound whether it is severe or not and also to identify any other complications which might have occurred. Documenting patient’s observations helps practitioners monitor what is being done and reduces the peril of errors creeping into the treatment process. It ensures continuity of care as it serves as a communication tool among healthcare professionals.

24. The incident report needs to cover all the important information about the incident or near misses. It should include the circumstance of the incident, date, time and location and during which shift and on what unit the incident occurred, witnesses, staff members and resident’s accounts of the incident along with interventions taken to care for the resident immediately after the incident (Kakinohana, Toita, Heianna & Murayama, 2015). Also, notifications made as a result of the incident, resident symptoms before the incident, vital signs and observations made after the event, resident operation during the incident, medical issues or injuries related to the incident together with the environmental hazards or faulty equipment contributing to the conflict. Finally, the presence of any new incident risk factor along with the corrective measures taken to minimize the likelihood of another incident is included (Kakinohana, Toita, Heianna & Murayama, 2015).

25. Positive Behaviour Support (PBS) plan may be implemented to guide caregivers along with health professionals within natural contexts that result in a reduction in the challenging behaviour and leads to the acquisition of new skills and lifestyle changes for the person with expressions of concern (Singh, Lancioni, Karazsia, Chan & Winton, 2016). Positive behavior support is a philosophy of practice, and it denotes a range of individual together with multisystemic interventions that aim to impact change in a person's behavior and ultimately their quality of life. It applies to all individuals and has been used to support children, adults, individuals with and without disability and individuals in a range of settings. It acknowledges that all individuals regardless of their behavior are endowed with fundamental human rights and any evaluation, intervention or support must be respectful of those rights (Singh, Lancioni, Karazsia, Chan & Winton, 2016). Moreover, it acknowledges that all human behavior serves a purpose including the practices which are deemed to be challenging behaviors.

Values, theory and evidence base along with processes are included in the plan. Values incorporate of prevention and reduction of challenging behaviors within the context of increased quality of life and support of valued social roles and stakeholder involvement in informing, implementing and validating evaluation along with intervention practices. Also, it involves constructional techniques to intervention design which builds opportunities and skills of stakeholders (Singh, Lancioni, Karazsia, Chan & Winton, 2016). Theory and evidence base includes an understanding that challenging behaviors develop to serve vital functions for people, the primary use of applied behavior analysis to evaluate and support behavior along with the secondary use of other complementary techniques to support behavior change. Finally, processes involve a data-driven method to decision making, functional evaluation, multi-component interventions along with implementation support, monitoring and assessment of responses.

26. Expressions of concern are any behavior that causes worry, stress, risk or actual harm to an individual, their carers, family members and staff (Holle, Halek, Holle & Pinkert, 2017). When these challenging behaviors are addressed proactive strategies are put in place, and they contribute much to the maintenance of long-term behavior change. Also, it is important to immediately address the behaviors of concern so that when the environment is changed the person's behavior also changes (Koegel, Koegel, Ashbaugh & Bradshaw, 2014). It is vital to address the challenging behaviors and the reason why they happen so that the best help can be acquired from the appropriate therapists.

Moreover, if the behaviors are addressed a positive behavior plan or intervention will be implemented and will be used consistently across all settings including school, home along with respite and this will help in practising new skills and coping strategies and people around them will respond to their behaviours in the same manner (Koegel, Koegel, Ashbaugh & Bradshaw, 2014). Since every behavior serves a function, when the behaviors are addressed people are taught on skills that replace their problem behavior regarding the purpose it serves and by doing this they will be able to meet their requirements in a socially acceptable way.

27. One has to understand that it is not easy to be a patient or a family with a patient who has stuck in the hospital for long. If nurses tend to get cranky under stress so are they. The responsibility of a nurse is to let patients feel that they understand and care for them and thus should show empathy by focussing their attention on patient’s surrounding along with their actions, feelings, and expressions (Cottingham, 2015).  They should also demonstrate their interest, and that patient are important. Tom should have been allowed to blow off some steam and let him calm down not to worsen the situation and proceed with explanations. It is good to remember that they are not happy that they are ill and therefore it’s good to keep cool while waiting for them to calm down.

Ensuring that the patient’s personal space is not invaded by not getting too close or too far from them they might feel that they still have their own space and that they are safe there. Furthermore, being sensitive if a family to a patient gets mad is better by thinking about how one would feel if they were in their shoes which mean embracing and respecting them no matter what happens (Cottingham, 2015). A nurse should be gentle and remain calm so that if they have to respond to something they make the situation better and try to avoid negativity but concentrate on the thing that can be done to assist the patient. Trying not to argue and apologizing for the inconvenience to restore the health of the patient will suit the situation. Here, the nurse can settle the problem amicably, keep her promises, set boundaries, communicate, recognize the projected feelings of the patient, listen and ask open-ended questions (Cottingham, 2015).

28. Severe hallucinations results to agitation and depression which is a biological symptom of schizophrenia and which can be compounded by extra burden of stress carried by a person living with chronic pain (Kales, Gitlin & Lyketsos, 2015). Depression might be a side effect of antipsychotic medication, and also a co-diagnosis along with schizophrenia and some of the same neurotransmitter imbalances which are implicated in schizophrenia may also contribute to the development of depression hence agitation. Individuals experiencing agitation and hallucinations tend to have a characteristically negative tone (Stanghellini & Raballo, 2015) and this could have resulted in Mary's behavior of pushing Sophia resulting in her left arm pain. Mary might have heard voices and sounds and become confused thus pushing Sophia.         

References

Ahmed, S. M., Hall, A. J., Robinson, A. E., Verhoef, L., Premkumar, P., Parashar, U. D., ... & Lopman, B. A. (2014). Global prevalence of norovirus in cases of gastroenteritis: a systematic review and meta-analysis. The Lancet infectious diseases, 14(8), 725-730.

Bee, P., Price, O., Baker, J., & Lovell, K. (2015). Systematic synthesis of barriers and facilitators to service user-led care planning. The British Journal of Psychiatry, 207(2), 104-114.

Boschin, F., Brusque, J. P. D. C., Carvalho, M. D. F., Galle, L. R., & Smith, R. S. (2015). U.S. Patent No. 9,114,954. Washington, DC: U.S. Patent and Trademark Office.

Cottingham, M. D. (2015). Learning to “Deal” and “De?escalate”: How Men in Nursing Manage Self and Patient Emotions. Sociological Inquiry, 85(1), 75-99.

Coyne, I., Comiskey, C. M., Lalor, J. G., Higgins, A., Elliott, N., & Begley, C. (2016). An exploration of clinical practice in sites with and without a clinical nurse or midwife specialists or advanced nurse practitioners, in Ireland. BMC health services research, 16(1), 151.

Donaldson, I. A., Alonzi, R., Barratt, D., Barret, E., Berge, V., Bott, S., ... & Hindley, R. (2015). Focal therapy: patients, interventions, and outcomes—a report from a consensus meeting. European Urology, 67(4), 771-777.

Erickson, B., Hosseini, M. A., Mudhar, P. S., Soleimani, M., Aboonabi, A., Arzanpour, S., & Sparrey, C. J. (2016). The dynamics of electric powered wheelchair sideways tips and falls: experimental and computational analysis of impact forces and injury. Journal of neuroengineering and rehabilitation, 13(1), 20.

Flores-Mireles, A. L., Walker, J. N., Caparon, M., & Hultgren, S. J. (2015). Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nature reviews microbiology, 13(5), 269.

Fritz, Z., Slowther, A. M., & Perkins, G. D. (2017). Resuscitation policy should focus on the patient, not the decision. BMJ, 356, j813.

Holle, D., Halek, M., Holle, B., & Pinkert, C. (2017). Individualized formulation-led interventions for analyzing and managing the challenging behavior of people with dementia–an integrative review. Aging & mental health, 21(12), 1229-1247.

Jalongo, M. R., & Breece, L. (2018). Mitigating Physical and Psychological Disabilities: Service Dogs for Children. In Children, Dogs and Education (pp. 229-249). Springer, Cham.

Kakinohana, Y., Toita, T., Heianna, J., & Murayama, S. (2015). SU?E?P?07: Retrospective Analysis of Incident Reports at a Radiology Department: Feedback From Incident Reporting System. Medical physics, 42(6Part4), 3227-3228.

Kales, H. C., Gitlin, L. N., & Lyketsos, C. G. (2015). Assessment and management of behavioral and psychological symptoms of dementia. bmj, 350, h369.

Kalra, S., Unnikrishnan, A. G., & Baruah, M. P. (2017). Interaction, information, involvement (The 3I strategy): Rebuilding trust in the medical profession. Indian journal of endocrinology and metabolism, 21(2), 268.

Koegel, L. K., Koegel, R. L., Ashbaugh, K., & Bradshaw, J. (2014). The importance of early identification and intervention for children with or at risk for autism spectrum disorders. International journal of speech-language pathology, 16(1), 50-56.

Lindholm, M. E., & Blinge, M. (2014). Assessing knowledge and awareness of the sustainable urban freight transport among Swedish local authority policy planners. Transport policy, 32, 124-131.

Lippi, G., & Mattiuzzi, C. (2016). Biological samples transportation by drones: ready for prime time?. Annals of translational medicine, 4(5).

Liu, Y., Wang, M., Chang, C. H., Shi, J., Zhou, L., & Shao, R. (2015). Work-family conflict, emotional exhaustion, and displaced aggression toward others: The moderating roles of workplace interpersonal conflict and perceived managerial family support. Journal of Applied Psychology, 100(3), 793.

Loveday, H. P., Wilson, J., Pratt, R. J., Golsorkhi, M., Tingle, A., Bak, A., ... & Wilcox, M. (2014). epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. Journal of Hospital Infection, 86, S1-S70.

Orel, F. D., & Kara, A. (2014). Supermarket self-checkout service quality, customer satisfaction, and loyalty: Empirical evidence from an emerging market. Journal of Retailing and Consumer Services, 21(2), 118-129.

Plomp, J., Tims, M., Akkermans, J., Khapova, S. N., Jansen, P. G., & Bakker, A. B. (2016). Career competencies and job crafting: How proactive employees influence their well-being. Career Development International, 21(6), 587-602.

Singh, N. N., Lancioni, G. E., Karazsia, B. T., Chan, J., & Winton, A. S. (2016). The effectiveness of caregiver training in mindfulness-based positive behavior support (MBPBS) vs. training-as-usual (TAU): A randomized controlled trial. Frontiers in psychology, 7, 1549.

Stanghellini, G., & Raballo, A. (2015). Differential typology of delusions in major depression and schizophrenia. A critique to the unitary concept of ‘psychosis’. Journal of affective disorders, 171, 171-178.

Vercruysse, G. A., Friese, R. S., Khalil, M., Ibrahim-Zada, I., Zangbar, B., Hashmi, A., ... & Gries, L. (2015). Overuse of helicopter transport in the minimally injured: a health care system problem that should be corrected. Journal of Trauma and Acute Care Surgery, 78(3), 510-515.

Walczak, A., Butow, P. N., Bu, S., & Clayton, J. M. (2016). A systematic review of evidence for end-of-life communication interventions: who do they target, how are they structured and do they work?. Patient education and counseling, 99(1), 3-16.

Wardi, G., Schneir, A. B., & Medak, A. J. (2015). Posttraumatic subcutaneous emphysema: in need of immediate surgical debridement or a careful history?. Journal of Emergency Medicine, 48(4), 468-469.