Category: Nursing essay

Geriatric Dermatology Diagnosis Essay

Geriatric Dermatology
Geriatric Dermatology

Geriatric Dermatology

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Introduction

There is an increased focus on geriatric dermatology due to the growing trend towards aging populations in several countries across the globe. Elderly individuals are predisposed to many dermatological conditions as a result of senile changes in their skin. Although sometimes skin problems seem to be minor compared to major chronic diseases frequently seen in elderly patients, proper diagnosis and management aids in reducing the morbidity and influences positively their quality of life.

How to Properly Diagnose Skin Wounds in Frail Elders

Diagnosis is based on patient history. It is also founded on physical examination whereby a physician inspects the appearance of the condition, mode of distribution, arrangement and configuration, size of individual lesion, color. Surface characteristics such as rough, smooth, waxy or warty, and shape which can either be oval, round, or linear. Diagnostic tests can also be carried our such as skin scrapings that are important in detecting fungal infections, skin prick tests for allergies, and skin biopsies.

In an infection, germs are present in the body and are responsible for signs and symptoms such as pus from wounds, fever, and increased leukocyte count. Conversely, in colonization germs are present in the body but the patients do not present any signs and symptoms.

Type of Skin Wound

I selected herpes. This is an infection caused by the herpes simplex virus. Individuals with this infection have sores anywhere on their skin. Usually, it occurs around the nose, mouth, genitals, and buttocks. The infection is a painful experience, embarrassing and recurs time after time. Herpes is generally associated with genital herpes. However, herpes is actually a term referring to a family of viruses ranging from Epstein-Barr virus (causes infectious mononucleosis), varicella zoster virus (causes shingles), herpes virus 1/HSV-1, to herpes virus 2 HVS-2. Under a microscope, HSV-1 and HSV-2 look identical. Either type can infect the genitals and the mouth.

Herpes simplex has been ranked as one of the most common infections with approximately one out every five individuals in US having HSV-2 and about half to three quarter of all adults having a positive test for HSV-1. However, just ten percent of exposed persons get visible sores.

During the infection, the viruses, HSV-1 and HSV-2, traverse into the nerves where they blend with the DNA forcing the body to make copies of them so that they can be spread easily to other people. However, the body’s immune system attacks the viruses and the products overcoming them. In individuals with a weakened immune system, the virus traverses to the skin where it leaks out in tiny blisters that are painful, burning or unusually tender.

Herpes infection is severe in individuals whose immune system is weak such as children and the elderly. Often, it is a mild infection in that it goes unnoticed in majority of the people who are infected. The infected persons perceive the infections as normal skin irritation or chaffing. However, HSV can recur years later and be mistaken as an initial attack resulting in unfair accusations of infidelity between partners.

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Treatment

Anti-viral pills such as acyclovir, famyclovir, and valacyclovir are used in treatment herpes. Topical application ointments also help in reducing the healing time as well as the duration of symptoms. Some of the topical applications that are prescribed include penciclovir, acyclovir, and docosanol cream.

There are several risk factors in geriatric dermatology that can predispose one to developing herpes. Some of these factors include, a history of a prior sexually transmitted infection, engaging in sexual intercourse at an early age, having several sexual partners, and poor socioeconomic status. Research by Bernstein et al., (2013) indicated that HSV-2 is transmitted easily from men to women than vice versa.  This explains why females have a high likelihood of developing HSV-2 infection than men. Individuals whose immunity is compromised such as patients with HIV are also at a high risk of acquiring herpes infection.

Prevention

Herpes is a contagious infection whose prevention before and after an outbreak is of great significance. If signs of recurrence such as itching, tingling, burning or tenderness are felt at any area of the body, then that area should be kept away from other people. Patients that have mouth lesions should avoid sharing cups, lip makeup, or kissing. Sharing of towels and clothing should be avoided strictly.

Avoidance of sexual activity among patients with genital herpes is an important intervention. Sharing of sexual toys should also be avoided highly as they may promote transmission of herpes. Use of condoms is the most effective intervention of preventing herpes transmission. Partners should also go for medical check-ups in case one of them experiences herpes symptoms.

Conclusion

Individuals who have had the infection should maintain general good health and keep stress as low as possible to lit chances of having recurrences which fortunately are milder than the initial attack. Infected patients should take care of the affected skin area by keeping it dry and clean during outbreaks to facilitate healing. Physical contact should be avoided until all skin sores heal completely, not just scabbed-over.

If one touches a sore he/she should wash hands thoroughly with soap and water failure to which the hands can transmit the virus to other body parts such as eyes causing herpes keratitis a condition that causes pain and sensitivity to light and is accompanied with discharge. Geriatric dermatology practice has to be by professional who have studied and understand their geriatric patients.

Reference

 Bernstein, D. I., Bellamy, A. R., Hook, E. W., Levin, M. J., Wald, A., Ewell, M. G., & Belshe, R. B. (2013). Epidemiology, clinical presentation, and antibody response to primary infection with herpes simplex virus type 1 and type 2 in young women. Clinical Infectious Diseases, 56(3), 344-351.

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Pressure Ulcer: Nursing Home Case Study

Pressure Ulcer
Pressure Ulcer

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Pressure Ulcer

Immaculate Mart Home has an occupancy rate of 99% with 293 patients occupying its total of 296 beds. The facility is a non-profit home and is not part of a multiple nursing home ownership. It has a below average RN per resident per day of approximately 43 minutes compared to that of the state of Pennsylvania of 55 minutes.

It has a Long Term Pressure Ulcer Percentage (LTPUP) of 2.4% and a short term pressure percentage (STPUP) of 2.1%.  In September 24th 2015, PA was awarded a rating of 5 out 5 by the CMS of the Dept. Health for Human Services. This rating means that the nursing home is way above average based on quality measures, staffing, and health inspections.

Chapel Manner Nursing Home has a 95% occupancy rate with 229 patients using its total of 240 beds. It is part of a multiple nursing home ownership and it is a for profit organization. Its RN Hours/Resident/ Day is 57 minutes with an average of 2.29 minutes of Physical Therapy Staff. It has a LTPUP of 2.3% and a STPUP of 1.4%. It received a 2 out 5 overall rating. A score that implies that the facility is rated below average based on staffing, quality measures, and health inspections.

Fair View Care Center is a for profit nursing home that accepts Medicaid. It has a capacity of 36 beds. Its RN Hours/Resident/Day is averaged at 44 minutes and that of physical therapy staff is less than one minute. Moreover, it has 0.0% of its long staying patients as well as short staying patients with pressure ulcers.

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Baptist Health Care Center: This is a non-profit nursing home that has a total of 140 beds, all fully sprinkled with 138 beds occupied. It has an occupancy rate of 99%. It accepts both Medicaid and Medicare and it is not located within a hospital. It has a LTPUP of 2.8% and a STPUP of 1.6%

Its reported physical therapy hours are 0.03 per day and the total nurse staffing hours per patient daily is 4.47.  In addition, it has a quality rating of 3 and a RN staffing rating of 4.

Some of the risk factors that predispose an individual to developing pressure ulcers include immobility, inactivity, smoking, poor nutrition, use of corticosteroids, and urinary or fecal incontinence.

Some of the strategies that can be used to prevent pressure ulcers include frequent weight shifting, using cushions or specialized mattresses that relieve pressure, protect and clean affected skin, maintaining a balanced diet, and proper health standards such as avoidance of smoking (Coleman et al., 2013).

Awareness can be increased by first laying out facts to the nursing home staff about the consequences of pressure ulcers, how they develop, and how easily they can be prevented. For instance, the staff should be aware that in 2013, the condition caused a totally of 29, 000 deaths up from 14, 000 in 1990 (Lachenbruch et al., 2016).  This therefore, begs the nursing staff to implement urgent interventions against pressure ulcers.

References

Coleman, S., Gorecki, C., Nelson, E. A., Closs, S. J., Defloor, T., Halfens, R., & Nixon, J. (2013). Patient risk factors for pressure ulcer development: systematic review. International journal of nursing studies, 50 (7), 974-1003.

Lachenbruch, C., Ribble, D., Emmons, K., & VanGilder, C. (2016). Pressure Ulcer Risk in the Incontinent Patient: Analysis of Incontinence and Hospital-Acquired Pressure Ulcers from the International Pressure Ulcer Prevalence (TM) Survey. Journal of Wound Ostomy & Continence Nursing.

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Polypharmacy: Health Journal

Polypharmacy
Polypharmacy

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Polypharmacy: Health Journal

In my practicum setting a patient visited for a follow up check on several complex medical conditions. During the process, patient history was conducted whereby a variety of clinical and statistical data was captured. The history examined the past medical account of the patient whereby a review was conducted on the conditions that the patient was suffering from.

The history was also geared towards determining the past surgical history of the patient, his family history, current medication, possible allergies, and the systems review. Murphy et al., (2014) highlights that follow ups are vital since they enable practitioners to assess patient’s needs and implement proper interventions to avoid readmitting of patients. 

Researchers have well-established that polypharmacy is associated with an increase in the risk of adverse reactions, such as falls, poor vision, memory and hearing loss, decline in renal function, cognitive, functional impairment, as well as changes in metabolic rates (Maher et al., 2014; Jeffery & Kruse, 2014). However, from this patient it can be deduced that the adverse effects commonly linked to polypharmacy do not usually occur in all patients.

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This evidenced through the findings obtained in the patient history especially under the review of systems section whereby the patient denies having any adverse effects in most of her body system except for musculoskeletal system where the patient reports of experiencing back pain, joint pain, and shoulder pain.

For this patient, my plan will be to carry out diagnostic tests to identify the potential causes of the musculoskeletal signs and symptoms that the patient reports about. Moreover, examine the whether the patient is experiencing any progress from the treatment plan that she is undertaking.

My goal will be to ensure that the musculoskeletal signs and symptoms that the patient is complaining about are well controlled. Health care providers are charged with the responsibility of ensuring that patients receive the quality care delivery at all times (Martin-Misener & Bryant-Lukosius, 2014). Therefore, it will be my responsibility to ensure that the patient receives quality care delivery with improved outcomes.

References

Jeffery, L., & Kruse, M. G. (2014). CP-084 Pharmacist identification of potential side effects in patients with multimorbidity and polypharmacy. European Journal of Hospital Pharmacy: Science and Practice, 21(Suppl 1), A34-A34.

Maher, R. L., Hanlon, J., & Hajjar, E. R. (2014). Clinical consequences of polypharmacy in elderly. Expert opinion on drug safety, 13(1), 57-65.

Martin-Misener, R., & Bryant-Lukosius, D. (2014). Optimizing the Role of Nurses in Primary Care in Canada. Consulté sur http://www.cfpna.ca/cms-assets/documents/184147-364851.cna-report-2014.pdf.

Murphy, R., Bartlett, L., Pace, D., Boone, D., Smith, C., Lester, K., & Twells, L. (2015). Providing Obesity Treatment Information, Assessment and Follow-up: Improving Patient Access through Technology in One Province of Canada. Canadian Journal of Diabetes, 39, S50.

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Teenage Psychotherapy Application

psychotherapy
Psychotherapy

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Teenage Psychotherapy Application

Discussing about underage alcohol consumption can be tough. It is important for the healthcare provider to have a discussion plan as most of the teens are likely to dodge the discussion. To obtain a meaningful discussion, in psychotherapy the first step is to find out the teens perception about alcohol. This will help the healthcare providers debunk the myths that alcohol consumptions gives one pleasure and share the facts that alcohol is a depressant, normally associated with aggressiveness and sadness.

This will help the health care provider appeal the teenager self-respect and empower them with strategies to manage peer pressure.  The CDC alcohol consumption statistics is accurate. Most of the adolescents take alcohol without their parent knowledge. Most of these incidences are attributable to peer-pressure (Tanner-Smith and Risser, 2016).

The Neuman Systems Model of psychotherapy is used to give theoretical framework for developing Anorexia. The Neuman Systems Model of psychotherapy helps establish a mutual partnership between patients and their care givers, which helps in understanding the patient environment and in designing appropriate preventive, rehabilitative and corrective measures that will ensure that the desired outcomes are met. 

When managing patient diagnosed with Anorexia, the model is used to assess the patient profile, identify stressors perceived by the patients, developmental factors, psycho-social, cultural and spiritual factors, learn the patient’s lifestyle patterns and interventions needed by the client to meet the desired outcome. This is helpful as it helps one deliver care in a comprehensive manner using the primary, secondary intervention as well as the tertiary interventions to promote the client’s health (Neuman and Fawcett, 2012).

 The Imogene theory of goal attainment focuses in achieving the set life goals. According to this theory, nurse and patient relationship is important as it facilitates effective communication that will enable then set goals and together design action plan that will enable them achieve the set goals. Anorexia eating disorder results due to a sequence of behaviours which revolve around mental and physical action. According to this theory, to help the patient maintain their health and functionality, the nurse is expected to interact during assessment.

This will help the nurses gather data on patient perceived stressors, cultural and social cultural goals. The theory helps during nursing diagnosis in that through the interaction with the patient, problems and disturbances are identified. This helps in designing an effective care plan that will be used to solve the challenge identified is made. This phase involves making of decision and setting of goals. The continuation of transaction is reflected by implementation phase. This theory guides during the evaluation phase to determine if the goals have been achieved (Alligood, 2010).

 Nurses play an integral role in facilitating recovery in patient diagnosed with eating disorders. For this reason, it is important for a healthcare provider understand the helpful strategies that will help the patient restore their health. A comprehensive assessment should be done using the following questions (CDC, 2013);

a)  Are you happy with eating pattern?

b) Do you eat in secret?

c) How do you feel about your weight?

 During this treatment, the patient should be advised on the effective dietary which will help them achieve the desired weight range. This exercise should be complemented using psychotherapy. The counselling section should involve education on body weight, impacts of starvation and clarification of myths on dietary misconceptions. This will help the patient regain self-esteem and self-control (Moy et al., 2013).

References

Alligood, M. (2010). Family Healthcare with King’s Theory of Goal Attainment. Nursing Science Quarterly.

Centers for Disease Control and Prevention. (2013). Youth risk behavior surveillance system (YRBSS). Retrieved from http://www.cdc.gov/healthyyouth/data/yrbs/index.htm

Moy, J., Petrie, T., Dockendorff, S., Greenleaf, C. and Martin, S. (2013). Dieting, exercise, and intuitive eating among early adolescents. Eating Behaviors, 14(4), pp.529-532.

Neuman, B. and Fawcett, J. (2012). Thoughts about the Neuman Systems Model: A Dialogue. Nursing Science Quarterly, 25(4), pp.374-376.

Tanner-Smith, E. and Risser, M. (2016). A meta-analysis of brief alcohol interventions for adolescents and young adults: variability in effects across alcohol measures. The American Journal of Drug and Alcohol Abuse, 42(2), pp.140-151.

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Critical patient care Case Study

Critical patient care
Critical patient care

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Critical patient care

Within the case provided, critical patient care coordination especially communication between medical providers and the patient including his family remains essential. As a NP, having been asked by Mr. Wiggin’s wife to make a decision in regards to progressive, critical patient care for the husband, I would consider the state of the patient, his unsuitability for dialysis. This factor has attributed to the general decline of his functionality resulting to complications that include organ failure (Cowan, 2016). The condition of this patient will deteriorate if other conventional treatment methods are not introduced.

I would incorporate a symptoms management approach in this stage in order to ensure t the patient gets opportunity to discuss his wishes in considering other conventional treatment options(‘Hare, Rodriguez,& Bowling, 2016). Before arriving at the decision, there will be a need to conduct consultations with other practitioners and engage the patient in the treatment discussion. In this instance it would be essential to also include the entire family especially in this state, thus providing the patient with support that encourages him to arrive at the decision of choosing another conventional treatment option.

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In facilitating critical patient care to this patient, it is essential to meet the patient’s needs, a factor that would require a shift from the tradition methods that focused on the disease to a more patient-centered approach where quality of live is considered as key (Garcin, 2015). Considering that this patient’s health condition is deteriorating, it is essential to encourage the patient through support in reviewing other treatment options that may be of benefit.

In addressing the need of the patients and their families, it is essential to consider including good communication with the aim of facilitating an informed decision (Thirsk, Moore, & Keyko, 2014). This would require an explanation of the results and progression of the disease and its prognosis are including the consideration of managing the patient within a home setting.

References

Cowan, D. 2016. Understanding The Journey Travelled By Patients And Carers Living With End Stage Kidney Disease And Haemodialysis. Australian Nursing & Midwifery Journal, 23(8), 27-29.Available from: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=113232640&site=ehost-live. (25th April 2016)

Garcin, A. 2015. Care of the Patient with Chronic Kidney Disease. MEDSURG Nursing, 4-7.Retrived From: Available From: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=113313826&site=ehost-live (25th April 2016)

‘Hare, A. M., Rodriguez, R. A., & Bowling, C. B. 2016. Caring for patients with kidney disease: shifting the paradigm from evidence-based medicine to patient-centered care. Nephrology Dialysis Transplantation, 31(3), 368-375. doi:10.1093/ndt/gfv003. Available From: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=113310258&site=ehost-live (25th April 2016)

Thirsk, L. M., Moore, S. G., & Keyko, K. 2014. Influences on clinical reasoning in family and psychosocial interventions in nursing practice with patients and their families living with chronic kidney disease. Journal Of Advanced Nursing, 70(9), 2117-2127. doi:10.1111/jan.12370. Available From: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=97431961&site=ehost-live (25th April 2016)

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A Social Issue or Governmental Concern

A Social Issue or Governmental Concern
A Social Issue or Governmental Concern

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A Social Issue or Governmental Concern

Introduction

            Obesity is currently a serious social issue that is increasing rapidly. Whoever considered both woman and children to have different perceptions about their body index, the knowledge in surgical and medical issues that are connected to this disease (Li, et.al.2015). It is important to establish that the US is considerably experiencing a larger growth of obese generation, a factor that needs address.

Thesis:

            Obesity is a fast growing epidemic due to several factors such as poor diet, lack of physical activity and stress and has become a serious social issue requiring greater government involvement through nutritional content regulation and increased physical education in schools.

Obesity as a Governmental Concern

It is essential to determine that obesity as a health problem has had a considerable amount of economic impact within the health care system of the United States of America. This can be attributed to the increasing prevalence of overweight individuals that are directly associated with costs for a nations. These costs are incurred by the government in the development of preventive, diagnostic and treatment approaches that are connected to this disease (Li, et.al.2015).

On the other hand, the indirect costs that nations are bound to experience includes the wages that are lost by individuals who do not have the capacity to work since they are diagnosed with this ailment including the value of the future costs that a state is bound to encounter as a result of this ailment, a factor that makes it more of a governments concern as well. Additionally, it is imperative to determine that nations divert resources with the aim of dealing with the challenges that these issues present in a nation thus affecting the economic state of a nation.

Governments are additionally pushed in the acquisition of healthy foods that are more available, with the aim of reducing the supply chain and the promotion of other foods. The government is also obligated to develop awareness programs that encourage the population of healthy feeding in order to mitigate the effects of this disease, encourage physical activity and make the changing of policies easier for individuals who preset such illnesses. In other words, the government is forced to use its potentials in changing the social causatives of obesity

Obesity has been found to affect the health, economy, and social status of different individuals including the economic nation. This can be depicted as individuals who present this illness spend on medication including the government’s efforts aimed at managing this disease. The government in handling this situation is forced to pool several resources aimed at training the healthcare professionals on how to help in managing obesity (Li, et.al.2015).

The health professionals help patients on decreasing their weight stigma and encouraging patients on the need of being sensitive through an approach that involves education. The healthcare professionals are then trained and equipped with appropriate skills in managing this disease. This has seen the development of an obesity management approach that teaches the patients on how to diet and manage the disease. These approaches remain effective in managing obesity in a nation, a factor that requires a joint effort of both the health and government sectors. This determines the fact that obesity remains a health concern in a state.

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Obesity as a Social Issue

            Obesity is characterized as a condition that allows the accumulation of excess fats in the body. However, when people accumulate unnecessary weight as a result of this disease, it results into a social factor since it develops several implications within the society, legal, economic, religious and political elements (Li, et.al.2015). In determining the social aspects of obesity in Americans, it is essential to consider that Americans have turned out to be conscious about obesity currently than they did in the past, with many considering it as a societal issue that is viewed to be serious as compared to smoking or drinking.

The rates of Obesity has immensely grown, thus resulting in other nutritional related chronic diseases including the significant burdens that families, healthcare systems and the community encounter in caring for patients with this disease.

It is additionally important to consider the fact that individuals who are obese are viewed differently in the society. The society is more likely to consider them as suffering from unwanted illnesses, a factor that depicts the fact that these individuals are prone to suffer from discrimination and prejudice in different societies (Li, et.al.2015). On the other hand, obese people are considered to also have few friends, lower employment and education opportunities.

Following sources, we considered the perceptions of women especially those who suffer from obesity and their levels of knowledge on the medical and surgical elements as related to this disease as social (Li, et.al.2015). This has seen many of overweight women grow in large numbers, a factor that has caused them to underrate their body mass index (BMI). Since a majority of women that are obese are faced with the challenge of underrating their body mass index.

This can be depicted in the less educated women who we considered whom as having issues that result in the underestimation of their BMI. As depicted in the research, several of these women do not consider knowing their BMI status (Li, et.al.2015).Women are more likely to suffer from obesity without considering to it. It is now essential to call for support systems among the medical fraternity in administering advice to this population.

It is essential to consider that there are some misconceptions that have been developed and that have dominated policy initiatives directed towards combating and managing obesity. Several schools of thought believe that diet restrictions and the element of weight stigmatization may be ineffective in the fight against obesity (Li, et.al.2015).

However, it is important to consider applying psychological science in enacting new regulative approaches that aid in weight management in the local and national level. This essentially discourages individual’s willpower that is in strategies developed to fight obesity and encourage the initiation of policies that support environmental changes that nurture health for the populace.

In managing diabetes, it is vital to consider that there have been misconceptions dominating the policy initiatives in mitigating this disease. This determines the fact that the misconceptions dwelt on diet restrictions and weight stigmatization as not effective in mitigating this disease. In addressing this health concern, there is a need of inclusively incorporating psychological science in helping patients with weight management.

Studies have discovered that there is a need of employing scientific policies in improving the health of patients who suffer from this disease (Li, et.al.2015). This encourages the patients to develop a willpower approach in fighting obesity, whereas there is a need of encouraging policies that support environmental changes in nurturing a healthy society for all. Working conditions require that employees develop a healthy lifestyle that entails eating healthy foods, exercise and inclusion of education.

As determined in this paper, Obesity has turned out to be a health concern since it affects the economic, health, and social lives of individuals in a nation. In a nut shell, obesity is a social concern that has grown rapidly over the years. This a major cause for concern in the long list of issues that obesity can lead to.

Many people do not realize just how damaging obesity can be to their body and their overall health. It is in our hands to put an end to obesity and the extra toll that it is taking on the lives of US citizens conclusively. Let’s change the trend of obesity by making the initiative to live better lifestyles so that we can build towards a healthier America.

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  • Conclusion

As determined in this study, Obesity remains a fast growing epidemic due to several factors such as poor diet, lack of physical activity and stress and has become a serious social issue requiring greater government involvement through nutritional content regulation and increased physical education in schools. Obesity has been found to affect the health, economy, and social status of different individuals including the economic nation (Li, et.al.2015).

This can be depicted as individuals who present this illness spend on medication including the government’s efforts aimed at managing this disease. However, it is important to consider applying psychological science in enacting new regulative approaches that aid in weight management in the local and national level.

This essentially discourages individual’s willpower that is in strategies developed to fight obesity and encourage the initiation of policies that support environmental changes that nurture health for the populace. This therefore determines the rationale behind this ailment being a social issue and a governmental concern that is widely affecting several nations both socially, economically, religiously and politically.

References

Li, W., Buszkiewicz, J. H., Leibowitz, R. B., Gapinski, M. A., Nasuti, L. J., & Land, T. G. (2015). Declining Trends and Widening Disparities in Overweight and Obesity Prevalence among Massachusetts Public School Districts, Retrieved from http://www.medscape.com/medline/abstract/26270317

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What is nursing theory? Essay Paper

nursing theory
nursing theory

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What is nursing theory?

1. What is nursing theory? What is the relationship and importance of nursing theory to the discipline of nursing?:

Nursing theory is the concept that aims to establish a creative and rigorous idea reconstruction to explain the theorem or phenomena being applied in health care. This is a routine concept that supports the ideas and reference of ideas that is pointing towards nursing practice in both clinical and community setting.

The relationship and importance of nursing theory towards nursing is about the systematic organization of knowledge and skills towards health care. This is applicable towards patient advocacy by being able to provide patient care, which seeks to promote relevant health care practice in both hospital and community setting.

2. Grant theory is the process wherein there is a sociological imagination that is similar with other concept to form an abstract theory. The difference is that it is conceptualizing about the probable outcome that can be associated with its planning activity. Middle range theory is an approach that is aiming to establish collaboration, which seeks to promote social construction of practices.

In nursing perspective, the difference is about the intervention applied when the nurse is now going to apply plan into action. As for the practice theories, this how social beings uses their diverse intentions in order to accomplish certain tasks. The difference is that they always take to create a critical analysis such as evaluating the outcome of each practice.

3. Dorothy Johnson’s theory is applied for the advocating of effective and efficient behavioral functioning, which is similar with other theories that utilize emotions. The difference is about the application of psychological issues that affects nursing practice. The theory of goal attainment aims to direct nurses with the efficient application of health care between nurses and patients. The difference is about the application on interaction, perception, and communication that seeks to improve growth and development.

Estrine Levine’s theory is about the process of conservation principles in nursing, in which nursing is a continuous practice of enhancing skills and knowledge to be progressive. The difference is the concept of keeping together, which means that nursing process should be always intact regardless of what situation that the nurse and client are currently experiencing.

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4. Jean Watson applies caring theory being applied in both clinical and community practice. In contrast, it is all about the science of caring theory focusing on humanitarian caring process. Leininger’s transcultural theory is about the application of interpersonal relationship. The difference is about the cultural aspect that the nurse applies when providing care. Boykin & Schoenhofer‘s grand caring theory is a major application of clinical practice that seeks to promote nursing skills by guiding nurses. The difference is about the application of framework in nursing practice to improve client patient relationship.

5. Newman’s theory of health as expanding consciousness is the chosen theory. This supports the view of nursing profession by indicating that nursing is a continuous process. Nursing values becomes competent when nursing practice will be supported by additional insights and applications. This can be processed through trainings and seminar workshops to transform nursing practice competitive and reliable.

6. As an understanding of SDS, this is about the concept that focuses on the evolution of stress due to environmental stimuli. As a scenario in clinical setting, patients in distress who are seeking for health care service are suffering from psychological and physiological stress. Applying this model can be applied during physical assessment procedure and intervention, which enables to assess the problems and then address patient’s health care problems to prevent further injury and promotes health as related by Chinn & Kramer (2010).

Reference

Chinn, Peggy &Kramer, Maeona (2010). Integrated Theory & Knowledge Development in Nursing (8 ed.). St. Louis: Mosby. ISBN 0323077188.\

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Dissemination of Evidence in Nursing

Dissemination of Evidence
Dissemination of Evidence

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Dissemination of Evidence

Effective dissemination of evidence means that the right audience gets the correct information on the right time, format, and manner. The general aim of communicating information is to encourage all stakeholders to understand the progress and achievements of the project so that they can take part in it (McCormack et al, 2013; Beidas et al., 2012).

The pioneer nurses who will have gone through the teaching program will be posted in different units where they will reach out to other nurses in these units about the initiative. They will be allowed to use posters outside the unit, post reminders outside the unit, or post important updates on the hospitals’ website. The nurses will also be expected to explain to fellow colleagues in other units about the CAUTI prevention program through the hospital newsletter, tweets, blogs or even during hospital-wide nursing meetings. This will be a sure way of ascertaining that equal protection is met for all patients in the hospital (Edmunds et al., 2012).

To further facilitate spread of information, the trained health care providers will be encouraged to meet with interested hospitals within the region where they will share what they will have learned and communicate the achievements they have made in reducing the rates of CAUTI within this hospital. During this activity, they will be expected to start with units with higher rates of CAUTI, share the prevention program manual and other essential resources available in the website, and avail themselves whenever they are requested to train more members.

Project leaders will also be requested to attend monthly regional coaching and monthly national content webinars where they will share crucial information about “why and what” the implementation program is all about. The project leaders will be encouraged to attend the webinar calls with at least two or three nurses who will help further in dissemination of information.

Reference

McCormack, L., Sheridan, S., Lewis, M., Boudewyns, V., Melvin, C. L., Kistler, C., … & Lohr, K. N. (2013). Communication and dissemination strategies to facilitate the use of health-related evidence.

Edmunds, J. M., Beidas, R. S., & Kendall, P. C. (2013). Dissemination and implementation of evidence–based practices: training and consultation as implementation strategies. Clinical Psychology: Science and Practice, 20(2), 152-165.

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Reducing nursing alarm fatigue

Reducing nursing alarm fatigue
Reducing nursing alarm fatigue

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Reducing nursing alarm fatigue

  1. Introduction

In the healthcare setting, clinical alarm fatigue management failure is often as a result of nursing mistakes relating to complexity of the system. Telemetry technicians as well as nurses are occasionally affected by clinical alarm fatigue which hinders their capability to respond to the clinical alerts in the monitors (Sowan et al, 2015). Often, these practitioners are inundated with a significant number of visual and audio alerts which makes them ignore or fail to see the pertinent clinical alarm.

According to a qualitative research done by Dressler et al (2014), fatigue alarms rate from about 187 alarms per day in a single bed, 88.8% of which are false positives. This high rate has been a nuisance and a distraction in the healthcare setting as they can lead to increased number of mistakes in patient care. They are also a cause of panic and stress to patients who may be trying to rest as well as recover from illnesses and surgeries. Therefore reducing nursing alarm fatigue is much needed in the healthcare setting.

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Problem statement 

The rate at which false alarm fatigue go off has remained to be a huge problem for telemetry technicians and nurses in charge of monitoring alarm signals in the telemetry room. These nurses and technicians are faced by a barrage of alarms and alerts during their shifts which makes them ignore the alerts at times. As a result, these practitioners may ignore a true positive alarm that needs immediate action leading to detrimental safety complications on the patient (Sowan et al, 2016).

Purpose of this study

The main aim for this study is to investigate whether healthcare organizations can minimize the amount of fatigue alerts in the telemetry rooms by applying the Plan Do Study Act (PDSA) method.  Failure to respond to true actionable alarms has led to serious patient injuries and even deaths in the healthcare setting (Christensen, Dodds, Sauer, & Watts, 2018). 

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Significance of the study

This research is important because it informs the healthcare practitioners on how to minimize the severity of non-actionable alerts that nurses and other clinicians face during their shifts. Reducing the number of false positive alarms will create an environment that can improve the practitioner’s awareness of the alarms thus decreasing alarm fatigue (Cho, Kim, Lee, & Cho, 2016)

Research Questions (PICO)

How does an organization’s infrastructure, culture, technology, and practices influence a strong alarm management plan?

How can the elimination of false alarms such as premature ventricular contraction (PVC) and low amplitude GCG complexes lower the number of non-actionable alerts in the telemetry room? 

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Key words

Alarm fatigue, false positive alarms, premature ventricular contraction, and telemetry room 

  • Methods

This qualitative research investigates how the healthcare system can minimize the number of alerts that cause fatigue among nurses as well as telemetry technicians to enhance patient safety. This paper uses peer reviewed papers from credible sources retrieved from databases such as PubMed, CINAHL, MEDLINE/EBSCO, Proquest, and HEALTH SOURCE/NURSING/ACADEMIC EBSCO.

The key terms that were used in this research includes clinical alarms, alarm fatigue, and physiologic monitor alarms. The timeline for this research was publications that dated from 2012 to 2019. The inclusion criteria for this research study included qualitative and quantitative studies that discussed how to reduce false positives in the telemetry room. A total of 46 research articles were reviewed though only 10 were used as the rest were duplicates or did not include detailed information.  

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Reducing nursing alarm fatigue

  • Results

Srinivasa et al. (2017) and De Vaux et al. (2017) carried out quality improvement projects using the PDSA methodology in an effort of minimizing the severity of false alarms that nurses and technicians are exposed to in a single shift by revisiting the alarm alert typology. While De Vaux et al. (2017) used direct observations based on the alarm codes to develop concepts, Srinivasa et al. (2017) captured data using electronic software tools to capture data.

The two research studies investigated the PVC alarms and asserted that these alarms go off when physiologic monitor peaks irregularities in cardiac rhythms. During the beginning of physiological monitoring, most healthcare practitioners treated PVCs using various interventions or medications. However, recent research shows that cardiac irregularities are basically benign and are not treated.

Nonetheless, even after this discovery the PVCs alarms were not removed from the physiologic monitoring system. These two researchers concluded that PVC alarms should be removed from the physiologic monitoring system to reduce alarm fatigue among the practitioners. 

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In their research, Walsh-Irwin and Jurgens (2015) also investigated how the healthcare system can reduce false alarms by adopting better cultures and patient care systems. These researchers carried a research that involved monitoring physiologic alarms before interventions and after the application of certain physiologic monitor leads following improved skin preparation.  

Walsh-Irwin and Jurgens (2015) analyzed the collected data before and after the skin care intervention in an effort of determining whether the number of alarms reduced or accelerated. The statistical data that was collected in this research showed that proper skin preparation results to a reduced number of false positive alarms. The healthcare system should therefore adopt cultures that ensure proper skin preparation in patients to reduce the number of false alarms in the telemetry room. 

Paine et al. (2016) also carried out a quasi-experimental research to investigate how healthcare organizations can reduce the number of false positive alarms among patients. This research examined topics such as the relationship between nurse response time and alarms exposure, non-actionable and actionable alarm propositions, and important interventions that help in the reduction of false alarms frequency.

This research established that the actionable alarms raged between <1% and 36% across many healthcare organizations in the United States. This research also found that there is a considerable correlation between alert exposures and the time that nurses take to respond to the alarm. 

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In another experiment, Pelter, Fidler, and Hu (2016) investigated the probable impacts of a low-amplitude QRA complexes on asystole alarms that are false positives. Low-amplitude QRS complexes occur when limb complexes lead to less than 5-10 millimeters in the precordial leads. This qualitative study involved 82 patients who were observed in a period of 31 days.

The research suggested that there was no significant statistical data to having a false positive asystole alarm when a 12-lead ECG measured QRS complexes that were low amplitude. This experiment demonstrated that the low amplitude QRS complex alarm can be eliminate from the physiologic monitor. 

  • Discussion

The themes that are evident in the above research studies provide insight to the healthcare’s struggles to apply PSDA methods that can manage alarm alerts. The studies establish that most alarms are not actionable and are a source of disruption and fatigue among nurse and therefore there should be active efforts to minimize the number of false positive alarms because they result to alarm desensitization and important alerts can be ignored as a result (Model for Improvement, 2018).

The research studies also establish that modifying alarms to ensure that only actionable physiological changes are recorded is a good of reducing alarm fatigue. Pelter, Fidler, and Hu (2016) clearly show that interventions are also a safe way of reducing the number of non-actionable alarms. 

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  • Conclusion

In essence, alarm fatigue is a huge problem that puts patients in grave danger and a practitioner can ignore an actionable alarm thinking that it is a false positive. As such, adopting a PSDA methodology to reduce the number of false alarms will enhance the opportunities for practitioners to respond to the actionable alarms as well as reduce alarm fatigue. The healthcare organizations should create an environment that provides meaningful information to telemetry room monitors.    

Reducing nursing alarm fatigue

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 References

Cho, O. M., Kim, H., Lee, Y. W., & Cho, I. (2016). Clinical alarms in intensive care units: Perceived obstacles of alarm management and alarm fatigue in nurses. Healthcare informatics research, 22(1), 46-53.

Christensen, M., Dodds, A., Sauer, J., & Watts, N. (2018). Alarm setting for the critically ill patient: a descriptive pilot survey of nurses’ perceptions of current practice in an Australian regional critical care unit. Intensive and Critical Care Nursing, 30(4), 204-210.

De Vaux, L., Cooper, D., Knudson, K., Gasperini, M., Rodgerson, K., & Funk, M. (2017). Reduction of nonactionable alarms in medical intensive care. Biomedical Instrumentation & Technology, 51(s2), 58-61.

Dressler, R., Dryer, M. M., Coletti, C., Mahoney, D., & Doorey, A. J. (2014). Altering overuse of cardiac telemetry in non–intensive care unit settings by hardwiring the use of American Heart Association guidelines. JAMA internal medicine, 174(11), 1852-1854.

Model for Improvement: Plan-Do-Study-Act (PDSA) Cycles. (2018). Retrieved April 29, 2018, from http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementTestingChang es.aspx

Paine, C. W., Goel, V. V., Ely, E., Stave, C. D., Stemler, S., Zander, M., & Bonafide, C. P. (2016). Systematic review of physiologic monitor alarm characteristics and pragmatic interventions to reduce alarm frequency. Journal of Hospital Medicine, 11(2), 136-144.

Pelter, M. M., Fidler, R., & Hu, X. (2016). Research: Association of low-amplitude QRSs with false-positive asystole alarms. Biomedical Instrumentation & Technology, 50(5), 329- 335. Srinivasa, E., Mankoo, J., & Kerr, C. (2017). An evidence‐based approach to reducing cardiac telemetry alarm fatigue. Worldviews on Evidence‐Based Nursing, 14(4), 265-273.

Walsh-Irwin, C., & Jurgens, C. Y. (2015). Proper skin preparation and electrode placement decreases alarms on a telemetry unit. Dimensions of Critical Care Nursing, 34(3), 134- 139.

Sowan, A. K., Gomez, T. M., Tarriela, A. F., & Reed, C. C. (2016). Changes in default alarm settings and standard in-service are insufficient to improve alarm fatigue in an intensive care unit: a pilot project. JMIR human factors, 3(1), e1.

Sowan, A. K., Tarriela, A. F., Gomez, T. M., Reed, C. C., & Rapp, K. M. (2015). Nurses’ perceptions and practices toward clinical alarms in a transplant cardiac intensive care unit: Exploring key issues leading to alarm fatigue. JMIR human factors, 2(1), e3.

Walsh-Irwin, C., & Jurgens, C. Y. (2015). Proper skin preparation and electrode placement decreases alarms on a telemetry unit. Dimensions of Critical Care Nursing, 34(3), 134- 139.

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