Perioperative refers to the practice of surgical procedure where patients experience surgical intervention. Perioperative nurses are tasked with the responsibility of taking care of the patient before, during and after the surgical intervention (Banschbach, 2016). During this time of surgery intervention and care, many safety issues many arise. According to Ford (2012), many safety issues such as emotional, physiological, and socio-cultural safety issues may arise during the pre-operative, intra-operative, and post-operative phases of the surgical intervention because of the negligence of preoperative nurses.
Prior to the surgical procedure, perioperative nurses perform a patient assessment to evaluate the nursing care to be given in the operating room and after the patient returns to the nursing unit, or at home. This involves assessing the social, physical, and emotional needs of a patient. From the information obtained, the perioperative nurse can then predict the suitability of the surgical timing for the patient (Ford, 2012).
However, studies have shown that during this assessment period, perioperative nurses are bound to making social mistakes that result in social safety issues. According to Steelman et al. (2013) perioperative nurses, at the interaction level with the patients, may fail to actively engage the patient’s family members who can furnish important information about the patient that can help in assessing the social and physical needs of the patient and consequently help in determining the care to be provided.
In addition, Robinson (2016) states that sometimes the amount of and length of teaching recommended to a patient by the perioperative nurses is not sufficient enough to prepare the patient psychologically for the surgery type and procedure, leading to psychological safety issue during the intra-operative procedure where the patient can be more anxious and less cooperative.
According to the Nursing and Midwifery Board of Australia (2010), the information from pre-operative assessment helps in determining the surgery site and procedure for a patient. However, incorrect or insufficient information obtained from or about the patient can result in perioperative nurses recommending wrong site surgery for the patient, thereby resulting in physiological safety issue during the surgical intervention (Ford, 2012).
Besides, insufficient or inaccurate information from the pre-operative assessment can result in verification errors, scheduling errors, medication error, and patient time-out errors (from the surgical room and out of hospital) (Steelman & Graling, 2013). Thus, wrong or insufficient pre-operative assessment can be a strong basis for physical, emotional, and social safety issues on the part of the perioperative nurses.
Further, according to the Nursing and Midwifery Board of Australia (2010), the information from the pre-operative assessment can be used in settling professional and legal issues concerning the surgical treatment of the patient as it depicts proof of the medical care provided. According to Steelman & Graling (2013), any documents completed by healthcare practitioners during the pre-operative assessment are legal documents and can be demanded by the court during legal proceedings concerning the health care of a patient.
Thus, the pre-operative assessment should be undertaken with utmost care and keenness especially documentations such as pre-scribed medication, health care, and surgical areas. Ford (2012) adds that pre-operative assessment is part of the professional duty of perioperative nurses to the patients. And as such, accurate assessment and evaluation is a vital part of nursing practice as it forms the basis for efficient and safe care provided to patients.
References
Banschbach, K. S. (2016). Perioperative nurse leaders and their role in patient safety. AORN Journal, 104(2), 161-164
Ford, A. D. (2012). Advocating for perioperative nursing and patient nursing. Perioperative nursing clinics, 7(4), 425-432
Nursing and Midwifery Board of Australia (2010). Nursing and national competency standards for Registered nurse. Retrieved from: http://www.nursingmidwiferyboard.gov.au
Robinson, L. N. (2016). Promoting patient safety with perioperative hand-off communication. Journal of PeriAnesthesia Nursing, 31(3), 245-253
In recent times, scientific underpinnings to practice have become a major issue of concern where those performing roles in the nursing field are required to self-assess themselves for preparedness. Doctor of Nursing Degree was conceived with the objective of accelerating the translation of evidence and research into practices and also improvement of practices into expertise levels (Wysocki et al, 2015). It is essential to have a self-assessment as a DNP nurse so as to reflect on the experiences.
The reflection would entail the linkage of previous learning and the current experiences. The purpose of reflection is to gauge the extent of preparedness to advance in the nursing practice through exhibiting some advanced level skills and personal development. Through reflection, evaluation and synthesizing of information regarding the nursing practice contributes to one’s growth and development while also controlling an individual’s learning.
AACN approved the DNP for the advanced practice nurses who would be required to have sophisticated skills that would be implemented and used in the performance of their roles (Wysocki et al, 2015). The curricular competencies and essential elements in the DNP program are clearly outlined in the AACN. It is necessary to carry out a personal reflection to assess the compliance to these essentials and possession of competencies crucial for nursing practices.
Scientific underpinnings to practice are one of the essentials provided by the AACN which requires DNP graduates to have a reflection to evaluate the outcome competencies after completing the degree program (Wysocki et al, 2015). One of the competencies I would reflect on as per the scientific underpinnings to practice is the development of the care delivery approaches crucial during the performance of roles.
Assessment and reflection while considering the essentials for competencies in safety and quality patient care are another factor I would address where accountability is ensured (Kesten, 2015). The final competency is the ability to evaluate and develop effective strategies during management of the ethical dilemmas. The reflection would address these essentials of the scientific underpinnings to practice which informs the extent of preparedness.
To meet the pertinent DNP competencies, I would be required to possess some abilities, knowledge and vital skills essential for nursing practices. The DNP has been helpful in the integration of attitudes, informatics skills, and knowledge which culturally support evidence-based and culturally sensitive practices at high levels in the nursing field e.g. the leadership level (Kesten, 2015). My self-assessment after completion of the course, reflects on the competencies of the DNP as outlined by the AACN.
The learning outcomes and competencies outlined would form the basis of the self-evaluation. My increased sensitivity to different populations and diverse organizational cultures and improvement in communication skills are some of the skills identified after self-assessment which meet the pertinent competencies of the DNP (Hallas et al, 2012). These skills are essential learning outcomes for an accountable DNP graduate. The self-assessment also helped me evaluate my enhanced skills in leadership and also handling complex clinical issues that are increasing over time.
The enhanced knowledge to improve patient outcomes and nursing practice was also acquired. Through the self-assessment, I was able to evaluate the vital knowledge acquired after the DNP program. I was prepared to influence and design the best healthcare policy options with the focus on various factors such as quality, accessibility, and cost (Hallas et al, 2012). Other factors focused on are safety, equity, efficacy and proper regulations.
The acquisition of this knowledge and competencies is pertinent for a DNP graduate. After completion of the learning course in DNP, more insight on how to integrate theory and practices with the aim of ensuring quality care to all was gained. The self-assessment was important for me as it helped me evaluate my abilities in analyzing practice data and effective evaluation of outcomes in the nursing field.
The integrative abilities in implementing the nursing interventions based on science are pertinent to the DNP competencies which are an indicator of the benefits of learning the course (Hallas et al, 2012). The massive benefits in the form of skills, knowledge, and abilities gained after learning the course as identified through the self-assessment are pertinent to the DNP competencies (Terhaar et al, 2016).
The orientation program for new students is essential in impacting success positively. Having gone through the orientation program as a new student, I would gain more insight and a lot of information essential in enhancing my success at Chamberlain (Price et al, 2015). The orientation is important for me as I can acquire fundamental information needed to connect with people that would influence my success in Chamberlain.
Through the orientations, insight and a better understanding of skills and belief essential for progressing well thus influencing success while in Chamberlain is efficiently gained. Crucial information on the survival tactics and handling complex issues enhance personal growth and academic success (Price et al, 2015).
In a nutshell, it is important for everyone who undergoes the DNP degree program to ensure the best skills, abilities and knowledge is acquired after completion of the course. Such efforts would ensure the competencies gained impact the nursing practice positively.
The pertinent DNP competencies are essential due to the impacts it has brought to the nursing field by enhancing the development of both effective strategies during management of the ethical dilemmas and care delivery approaches crucial during the performance of roles (Price et al, 2015). The adoption and integration of these competencies into practice would revolutionize the nursing field for the better.
References
Hallas, D., Biesecker, B., Brennan, M., Newland, J. A., & Haber, J. (2012). Evaluation of the clinical hour requirement and attainment of core clinical competencies by nurse practitioner students. Journal Of The American Academy Of Nurse Practitioners, 24(9), 544-553. doi:10.1111/j.1745-7599.2012.00730.x
Kesten, K. S. (2015). Assessment of APRN Student Competency Using Simulation: A Pilot Study. Nursing Education Perspectives, 36(5), 332-334. doi:10.5480/15-1649
Price, D. M., Buch, C. L., & Hagerty, B. M. (2015). Measuring Confidence in Nursing Graduates Within the Framework of the AACN Essentials. Nursing Education Perspectives, 36(2), 116-117. doi:10.5480/13-1162.1
Terhaar, M. F., Taylor, L. A., & Sylvia, M. L. (2016). The Doctor of Nursing Practice: From Start-Up to Impact. Nursing Education Perspectives, 37(1), 3-9. doi:10.5480/14-1519
Wysocki, Kenneth, Patricia C. Underwood, and Susan Kelly-Weeder. 2015. “An essential piece of nursing’s future: The continued development of the nurse practitioner as expert clinician and scientist.” Journal of the American Association of Nurse Practitioners, April. 178-180. Academic Search Premier, EBSCOhost (accessed September 2, 2016).
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Diagnosis (es): DSM 5 Code Diagnostic Classification 309.81 (F43.10) Posttraumatic stress disorder (PSTD) Medications: Prazosin and sertiline Supports/Strengths: Prazosin would be appropriate for this patient because it has been shown to reduce insomnia and nightmares. Sertiline is also necessary since it is an anti-depressant hence will help in management of anxiety and depression. This agent also aids in improving the patient’s concentration and sleeping problems. Presenting Problems: Leah presents with flashbacks and nightmares to an extent that she fear sleeping alone. She has disturbing thoughts, dreams as well as feelings related to the terror attack that occur at her school. Moreover, Leah develops distressing and repetitive images of the attack. The event has made it difficult for her to concentrate in class or even remember what was taught in previous classes. Treatment Recommendations: a) Psychotherapy is the primary treatment for patients suffering from PSTD. Leah should therefore be subjected to exposure therapy, a form of psychotherapy, which helps a patient to safely face what they find frightening so that she can learn to cope with the negative thoughts that she has. This technique uses virtual reality programs that would help Leah to re-enter the setting similar to that of the attack. Cognitive therapy should also be used to help Leah change her ways of thinking.
b) Medications such as diazepam an anxiolytic agent or sertraline an anti-depressant can be used to manage Leah’s symptoms.
Desired Goals of Tx: The psychotherapy treatment will help Leah learn ways of coping with the symptoms of the attack that she witnessed. They drugs can help in relieving symptoms of fear, depression, and anxiety that Leah is going through. This will in turn improve Leah’s sleeping problems and concentration in class. Additionally, Leah is expected to start socializing with her classmates just like she used to. Frequency of Tx: Treatment should be initiated immediately and maintained and the patient is stable enough. The initial dose of sertiline should be 10mg once daily and increased to 20 mg after one week. Adjustments should be made weekly based on patient presentation. However, the patient should be monitored since administered agents, that is, sertraline and diazepam are associated with severe side effects.
Project Length of Treatment: Approximately 2- 3months Supportive Background Documentation for Diagnoses and Meds:
PSTD is the primary diagnosis in the case study presented. This is because the disorder occurs as a result traumatic events such as traffic collisions, sexual assault, or terror attacks. Patients suffering from PSTD present with nightmares, flashbacks as well as distressing and repetitive images (Williams et al., 2013). These findings are consistent to those presented in the case study, hence proving that the Leah has PSTD. TREATMENT GOALS/INTERVENTIONS CLINICIAN NAME: LEAH CLIENT NAME: GINA S. Long Term Goals:
– Exercise proper sleeping patterns
– Patient should demonstrate proper control and relaxation techniques Short Term Goals:
– Patient should manage her feelings and fear.
– Improved social interaction
-Improved concentration
TREATMENT GOALS/PROBLEMS, STRENGTHS, BARRIERS, PERSON RESPONSIBLE
Goal #1: Leah should demonstrate control and relaxation techniques OBJECTIVES: Distinguish between present and memory. She should also recognize environmental triggers and react to them appropriately. INTERVENTIONS: Evaluate the patient’s symptoms, encourage her to identify terrors, use de-escalation techniques in her management, and use virtual programs to boost Leah’s courage. Target Date: December 20th, 2016 |Review Date: |Completed ?yes, ?no | New Target Date: |Review Date: |Completed ?yes, ?no TREATMENT GOALS/PROBLEMS STRENGTHS BARRIERS PERSON RESPONSIBLE Goal #2: Improved social interaction OBJECTIVES: Patient will interact effectively with her peers. Her concentration in class should also improve. Leah should also use proper skills when initiating and maintaining an interaction. INTERVENTIONS: Enquire which symptoms she experiences when she starts feeling anxious. Leah should be trained on how to briefly remove herself when she feels agitated and engage in exercises that relief anxiety such as deep breathing. This will aid in improving her sense of control in public.
Target Date: January 7th, 2017 |Review Date: |Completed ?yes, ?no | New Target Date: |Review Date: |Completed ?yes, ?no
Signature of Client/Date Signature of Therapist/Date
Old age is associated with different aging problems such as diseases, depression, loneliness, ego-integrity among others. However, leading to a successful old age is a dream of each person, but still, some factors affect older adults’ health. Thus, the primary objective of this report is to evaluate factors that influence health of aged people.
The influencers of the health problems in old age will be analyzed to determine the factors that are highly associated. This will lay a foundation on what can be done to improve the life of aged people, increase the longevity and successful life.
A sample of adults aged 50 years and above will be randomly selected, and given the questionnaire to fill. Collected data will be analyzed to determine the correlation of different variables that might be attributed to the health of old aged people.
More specific, the participation on leisure, life satisfaction, attending social clubs/events, positivity about their health, among others. The dependent variable is the number of times a person visits the doctors (only when sick). The research will be designed to answer the following question: What are the main factors affecting old age health?
Literature Review
Aging is a process that is inevitable. Aging makes people susceptible to illness and other disabilities. Although this process is inevitable, measures can be taken to reduce the effects of the aging, as well as maintaining good health. This is because most of the old people are prone to risk factors that increase the chances of getting sick. These factors need to be addressed amicably, which will reduce the likelihood of old age problems. This is in agreement with Risk factors of ill health among older people(2016), health practitioners need to address the following factors adequately to risk factors.
First, old people need to be protected from injuries, like falling. Most of the old people become wearisome, making their bodies weak, which increases chances of injuries. Also, they should be protected from noncommunicable diseases, which may cause premature death. Most of the harmful behavior in early life may cause premature death.
Poor nutrition and becoming physically inactive as well as taking alcohol or smoking may contribute to chronic diseases (Strollo et al., 2015). Among other factors that need to be kept in check to avoid old age illness are like; poverty which can be tackled through encouraging social security saving. Avoiding social isolation, or exclusion and ensuring that people at old.
(Han et al., 2015) Stipulates that aging is a psychological, physical, social and wellness of a person in the later age. Just like a chain of reaction, the previous stage of life affect the subsequent in one way or the other. Therefore, people should prepare well in preparation for the next stage of their life. It is imperative to understand how to prepare at early age so that they can prepare for a healthy life in future. That’s why (Han et al., 2015) carried out research to determine some of the vital factors that are associated with old age illness and disability.
Such preparations are critical in ensuring that one has a quality of life, as well as improving other health-related attitudes. In an attempt to improve the quality of life, different scientific research have been conducted, utilizing biological means. Biological research has been done to understand healthy aging. These investigations aim at finding a combination of factors that optimize opportunities that retain the mental wellness, the excellent transition at old age stage.
Different biological explorations have been conducted to revolutionize the perspective of healthy aging. For instance, molecular, genetic, and cellular factors, which affect the aging processes. This, has revealed different environmental factors, social attributes, behavioral factors, co-existing conditions, among other factors that pose risks to successful aging. Biologists are aiming at improving and maintaining physical and psychological wellness. Different terms have been used to mean healthy aging, such as successive aging, productive aging, positive aging, and active aging.
These terms can be used interchangeably without losing the meaning. Paramedics have done different tasks in identifying cellular and molecular factors that highly influence the aging process; that may fasten the aging pace. This includes monitoring various stress, immune system, and the science behind the deterioration of cells (commonly referred as senescence). Thus, recent researches have been carried to isolate and identify some additional factors that increase the aging, and more importantly strategies of eluding those effects.
Also, deeper analysis has been conducted to understand how cellular, and molecular structure changes with aging. That is, using therapeutic approach has been used in determining the underlying aspect of what causes the decreasing function of the cells as well as the increased cases of illness among the aged people. Studies have been conducted to ensure that even after aging the physiological processes are maintained. In fact, most studies have pointed that increased number of chronic diseases are associated with the weakening of the molecular and cells in animals and the human body.
As earlier stated, life is a cycle, and people have to pass through different stages to become mature and become of age. Importantly, the researcher can understand whether developmental, early life and prenatal life is associated with the success old age. Consumption of harmful substances can have a detrimental effect on the human body, and when stem cell is affected, it is not good news.
This is because stem cells are responsible for replenishing cells and tissues throughout and organism’s life. Thus, epidemiology has explored, to identify factors that may affect earlier stages of life that may contribute to reduces life longevity. Through these studies, they are able to point out some measures that can be adopted to minimize these factors effect during the old age.
It is with great concern investigations have been performed to determine the underlying association between obesity and metabolic status especially on old age. Most of the chronic diseases such as diabetes, hypertension, cardiovascular diseases, insulin signal, thus, studies have assessed the association between these factors and old age. Different studies have been completed on how to maintain quality life, at the same time have a nutritional, and cognitive practices that improve the successive old age.
In this way, it has been pointed that physical exercise is highly associated with overweight, which increases risks of old age. Thus, as people emphasize on eating responsibly, people should have ample time sleeping, taking physical exercise classes, increasing social events attendances. This will act as a method used to mitigate chances of getting cancer, diabetes, digestive diseases, musculoskeletal disorders among the aged people.
Life satisfaction has nowadays been considered as a basic necessity for healthy life. This includes a desire to maintain a good leading life, live a good lifestyle with physical and social participation. That is, successful life is beyond disease free living, rather it extends to the mental wellness of an individual, physical participations, and social wellness. The state of mind plays a significant role in helping the positive health, which reduces the stress that may maybe a root cause of chronic diseases, depression, and self-pity (Singh, 2015).
This has paved the way for significant research to be conducted on different factors attributed to the mental ill-health. The mind is thought to be connected to psychological which impacts on the body making it weak and thus may lead to falling sick. Thus, the state of mind is associated with disease intervention and prevention on old people (Singh, 2015). Thus, it is important to determine the psychological factors associated with the mental ill-health, which helps in reducing cases of depression, loneliness, self-efficacy, and self-esteem.
In that light, different research has been carried out to examine the how factors such as self-esteem, ego-integrity, leisure participation (as a physical as well as a social activity), loneliness, depression as the leading factors associated with healthy old age. Thus, mitigations need to be adopted to curb these problems. In accordance with (Luo et al., 2012), the mentality of aged people about their health plays a vital role in their wellbeing and at the same time their mortality. Therefore, this needs to be checked to improve the psychological problem the old aged people might be undergoing.
All these factors have a close relationship with old age health, and they play a vital role in the wellbeing of the elderly. However, this paper will exclusively use five factors to determine whether they are associated with the dependent variable. These number of variables makes the paper have a wider scope since most of the study assess one or two independent variables.
Ethical consideration
A number of issues will be considered to protect the participants, where questions will be design to ensure that they will not evoke psychological torment. Also, the participants will be made aware on the importance of the research, and they will be informed that they can discontinue anytime they wish. The information shared will not be disclosed to anyone, and will be treated with great confidentiality.
The data will be enough in answering the research question. Also, hypothesis test will be executed successfully since the data used will be in nominal scale, which will use non-parametric tests like chi-square to infer whether there is any association. This is because the non-parametric tests can also be performed using small sample sizes.
Conclusion
Based on the literature review obtained, there is great need to understand old age health, improve their condition to ensure that they live a successful and longevity life. The variable selected will show the nature of association as well as the magnitude. Also, using simple random sampling technique, sufficient information can be collected to make inference about the influences of the old age.
The researcher will make a recommendation on the best practices that can yield productive/healthy old age, which interns if adopted can lead to improving the quality of life the aged people live. In achieving this, the researcher would have met the desired goal of the research.
References
Han, K., Lee, Y., Gu, J., Oh, H., Han, J., & Kim, K. (2015). Psychosocial factors for influencing healthy aging in adults in Korea. Retrieved 9 December 2016, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4367838/
Strollo, S. E., Caserotti, P., Ward, R. E., Glynn, N. W., Goodpaster, B. H., & Strotmeyer, E. S. (2015). A review of the relationship between leg power and selected chronic disease in older adults. The journal of nutrition, health & aging, 19(2), 240-248. From http://link.springer.com/article/10.1007/s12603-014-0528-y
Tchkonia, T., Zhu, Y., Van Deursen, J., Campisi, J., & Kirkland, J. L. (2013). Cellular senescence and the senescent secretory phenotype: therapeutic opportunities. The Journal of clinical investigation, 123(3), 966-972. From http://www.jmir.org/article/view/2439/1
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HOURLY ROUNDING IN IMPROVING PATIENT SAFETY IN GERIATRIC POPULATION
Aim: Unintentional patient fall clinical economic burden cannot be contested. The increased incidences of geriatric patient falls combined with the impacts of nurse shortages results to increased staff workloads. In turn, the increased workloads are associated with noncompliance with patient safety interventions and basic falls preventive measures. The shortage of nurses, increased of patient acuity, and time constraints increase the probability of creating a stressful environments with low compliance of fall prevention protocol, leading to fatal fall related injuries and mortality.
Methodology: This mixed research paper explores on the evidence based practice for fall prevention strategies are significant to nurse profession because they will significantly reduce unintentional patient fall incidences, and lower workloads that cause increased nurse burnout.
Results: Evidence based study indicates that hourly rounding promote patient safety, quality of care and patient satisfaction. The evidence based practice outcome have been documented in systematic reviews that it results into reduction of patient falls by 52%, use of call lights and bells by 37%, pressure ulcers by 14% and increases patient satisfaction by 12%.
Conclusion: The proposed recommendation is to initiate hourly nurse rounding program in geriatric population ward. Hourly rounding is a systematic nursing intervention that is designed to address the needs of hospitalized geriatric population using an approach that reduced patient falls and related complication.
Introduction
Patient falls are strong indicators of quality of care that is often used to monitor quality performance within departments, local and national level. The physical injuries include bruising, pain, scratches, lacerations, fractures and intracranial bleeding. Patient falls and related injuries not only affect patient safety, but also damages hospitals reputation. Hourly rounding has positive impact on healthcare facility in four major variables namely a) reduction of patient fall, b) low emergency care due to fall related injuries, c) reduce hospitalization days and d) increase patient outcomes (Lee et al. 2013).
Therefore, this paper explores whether “In geriatric patients admitted in the orthopedic ward, is use hourly rounding’s (I) or call light use (C) more effective in improving patient safety, in six months (T)?” (Bennett, Ockerby, Stinson, Willcocks, & Chalmers, 2014).
Proposed solution
Patient falls and injury prevention still remains a considerable challenge across the care continuum. Hourly rounding is an effective and wining strategy. Once approval and training is done, the nurses will be expected to make purposeful rounds after every hour between the A shift (0600hrs-2200hrs) and after every two hours during the B shift (2200hrs-0600hrs).
The proposed solution of hourly rounding in the orthopedic ward is expected to reduce patient falls by 50%, reduce skin breakdowns by 14% and increase patient satisfaction by 12%. The solution is also expected to contribute to increased teamwork and efficiency in addressing patient safety matters (Dunne, Gaboury, & Ashe, 2014).
Incorporated theory
Initiating change in any organization is a complex process. Introducing hourly rounding within a healthcare facility is a potential solution to patient safety problems such as patient falls and pressure ulcers. Although research on effectiveness of hourly rounding fall-prevention programs has proliferated in the recent past, it is still unclear if most organizations are willing or have the capacity to adopt and use this evidence based practice. This calls for an effective change model that will facilitate unfreezing old practices, introduce new ones and facilitate the process of refreezing the new evidence based practice (Neumeier, 2013).
SIGNIFICANCE OF HOURLY ROUNDING IN IMPROVING PATIENT SAFETY IN GERIATRIC POPULATION
Aim: Unintentional patient fall clinical economic burden cannot be contested. The increased incidences of geriatric patient falls combined with the impacts of nurse shortages results to increased staff workloads. In turn, the increased workloads are associated with noncompliance with patient safety interventions and basic falls preventive measures. The shortage of nurses, increased of patient acuity, and time constraints increase the probability of creating a stressful environments with low compliance of fall prevention protocol, leading to fatal fall related injuries and mortality.
Methodology: This mixed research paper explores on the evidence based practice for fall prevention strategies are significant to nurse profession because they will significantly reduce unintentional patient fall incidences, and lower workloads that cause increased nurse burnout.
Results: Evidence based study indicates that hourly rounding promote patient safety, quality of care and patient satisfaction. The evidence based practice outcome have been documented in systematic reviews that it results into reduction of patient falls by 52%, use of call lights and bells by 37%, pressure ulcers by 14% and increases patient satisfaction by 12%.
Conclusion: The proposed recommendation is to initiate hourly nurse rounding program in geriatric population ward. Hourly rounding is a systematic nursing intervention that is designed to address the needs of hospitalized geriatric population using an approach that reduced patient falls and related complication.
Introduction
Patient falls are strong indicators of quality of care that is often used to monitor quality performance within departments, local and national level. The physical injuries include bruising, pain, scratches, lacerations, fractures and intracranial bleeding. Patient falls and related injuries not only affect patient safety, but also damages hospitals reputation. Hourly rounding has positive impact on healthcare facility in four major variables namely a) reduction of patient fall, b) low emergency care due to fall related injuries, c) reduce hospitalization days and d) increase patient outcomes (Lee et al. 2013).
Therefore, this paper explores whether “In geriatric patients admitted in the orthopedic ward, is use hourly rounding’s (I) or call light use (C) more effective in improving patient safety, in six months (T)?” (Bennett, Ockerby, Stinson, Willcocks, & Chalmers, 2014).
Nature of the problem
Research indicates that the most common etiology for nonfatal injuries in geriatric population is unintentional falls. Approximately, 25-32% of geriatric patients experience falls each year, where females experience frequent falls as compared to males(Iaboni et al. 2015). In addition, unintentional fall-related injuries are the major cause for accidental deaths among the geriatric patients, which results to approximately 41 deaths related to unintentional falls per 100,000 people annually.
Injury and mortality rates continue to rise dramatically for geriatric populations across the ethnic populations. Research indicates that the increased unintentional fall rates among the geriatric population continues to drift away from the Healthy people fall-prevention goal, indicating that unintentional fall is a growing public health concern that needs to be addressed adequately ( Iaboni et al. 2015).
Reference
Neumeier, M. (2013). Using Kotter’s change management theory and innovation diffusion theory in implementing an electronic medical record. Canadian Journal of nursing informatics Vol.8 (2). Retrieved from http://cjni.net/journal/?p=2880
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1: In order of priority, identify which tasks you yourself will undertake and which tasks you will delegate with critical thinking and decision making skills.
2: Document your rationales in detail.
Parham, (2012) states that Registered Nurses (RNs) are charged with the key responsibility of prioritising care whereby they ensure that patients receive safe and quality care within clinical settings. Care prioritization should be based on the condition of a patient as well as the severity of the disease. Critical thinking and decision making skills are some of the important parameters that nurses need for them to prioritize care (Levvet-Jones, 2013). From the scenario, I would first give priority to the elderly woman who has collapsed on the floor.
Usually, an unconscious condition can predispose an individual to situations that are life threatening when urgent medical interventions are not provided (Parham, 2012). I will employ the primary survey technique DRABCDE so that I can optimize the condition of the patient quickly and initiate met call or code blue if necessary (Thim et al, 2012). Usually, post-operative individuals are predisposed to the risk of clinical deterioration.
In managing the elderly woman my primary concern would be to stabilize her airway. This is because the analgesic and anaesthetics used during the operation depress the respiratory system and this can worsen her condition if not well managed (Farrell & Dempsey, 2014). Moreover, I will maintain contact with the met call teams for documentation and medication.
Similarly, I would assign tasks to the enrolled nurses (EEN) as well as assistants in nursing (AINs) to evaluate and offer support to the individual that fainted in the living room to reduce the potential risk. The delegation of these tasks will be done according to the scope of practice of an individual. I will frequently supervise them to ensure there is patient safety and legal requirements are observed (Eager, Cowin, Gregory & Firtko, 2010).
I would also give priority to Mr Esposito who is meant to leave the ward for cardiac catheterization and requires perioperative medication. I will therefore ask an EEN to administer the medication to reduce the risk and complications encountered after surgery (Farrell & Dempsey, 2014). Moreover, I will double check the patient’s perioperative check list and consent to avoid any legal or ethical issues (Nursing and Midwifery Board of Australia, 2015). I would then request the AIN to help in transferring Mr Esposito to have cardiac catheterization.
Thereafter, I would call the ward clerk and inform him about the toilet overflow; this is a code yellow criteria due to crisis and mechanical damage (Government of Western Australia, 2013). The overflow may increase chances of infections spreading and smell in the hospital environment, and therefore, proper and timely intervention should be put in place by the members responsible (Government of Western Australia, 2013).
In the patient that is due for antibiotic, I will check the IV cannula site to determine whether there is any sign of infiltration or inflammation. Any sign of inflammation will prompt me to remove the cannula and I will inform the doctor on the need for the patient’s recannulation. I would also notify the EEN to prepare antibiotics for Mrs Chew and I will supervise the EEN closely when she is preparing the antibiotics.
According to the Nursing and Midwifery Board of Australia (2015), enrolled nurses can administer most medications but they are not competent enough to administer IV antibiotics without completion of the IV medication competency. I will lastly discuss with the VMO about medication error that were recorded the previous week. I will then convey the information to the next shift staff to offer clarification of this discussion to avoid similar risks to patient and clinicians.
References
Eager, S. C., Cowin, L. S., Gregory, L., & Firtko, A. (2010). Scope of practice conflict in nursing: A new war or just the same battle? Contemporary Nurse: A Journal for the Australian Nursing Profession, 36(1/2), 86-95. Retrived from http://search.informit.com.au/browseJournalTitle;res=IELHEA;issn=1037-6178
Farrell, M., & Dempsey, J. (2014). Text book of medical surgical nursing (3rd ed.). Philadephia PA
Levvet-Jones, T. (2013). Clinical reasoning: Learning to thinking like a nurse. Pearson, Melbourne Australia,
Nursing and Midwifery Board of Australia. (2015). Enrolled nurses and Medication Administration Fact Sheet. Retrieved from:file:///C:/Users/Owner/Downloads/Nursing-and-Midwifery-Board—Fact-Sheet—Enrolled-nurses-and-medicine-administration.PDF.
Parham, G. (2012). Recognition and response to the clinically deteriorating patient. Australian Medical Student Journal, 3(1), 18-22. Retrieved from: www.amsj.org/ Thim, T., Krarup, Grove, Rohde, & Lofgren,. (2012). Initial assessment and treatment with the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach. International Journal of General Medicine,117. http://dx.doi.org/10.2147/ijgm.s28478
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Identify and explain any legal implications that exist for failure to adhere to a standard of care
Standard of care in nursing refer to the general guiding frameworks on how a nurse /he should do or not do during delivery of care in their professional capacity. Deviating from nursing standards can results into serious legal implications. For instance, Ivan a newborn baby developed brain injury due to complications during delivery that led to spastic quadriplegic cerebral palsy. The mother labor was induced and they were discharged without monitoring their progress.
In this case, medical negligence claim can be made against obstetrician for failing to adhere with the recommended nursing care standards of monitoring them for at least 48 hours before discharge. The legal implications of violating the standard of care, the nurse will be suspended as his case is investigated. If the investigations indicate that he is guilty, then his practice license can be revoked or judgment awards hefty fines and penalties to be given to the patient directly affected (American Nurses Association, 2013).
Identify and explain the key elements of malpractice
The four key elements of malpractice include duty, breach of duty, damages and causation. Duty refers to what patient is owed. This includes safe environments and quality care. Breach of duty refers to scenarios where duties owed to the patient is neglected (Legal Information Institute, n.d.). In this context, the obstetrician did not monitor the child’s health status as required by the facility nursing standards.
Damages are the consequences due to breach of duties. In this context, patient brain injuries due to medical negligence are the damages that should be claimed. Causation generally refers to what led to the series of events. This is the most difficult element to prove in malpractice lawsuit (Buppert, 2014). In this case, causation was lack of patient monitoring soon after delivery.
Compare the differences in malpractice policy options
Health policy is a trade-off among three dimensions of cost, quality and access. There are 3 general categories of medical malpractice including claims – made coverage, claims paid coverage and occurrence coverage. Claims made coverage are the most common because their premiums are based on healthcare provider past and current experiences. Therefore, the premiums paid are lower. Claims paid policy and occurrence coverage premiums are higher and are not flexible enough to allow a healthcare provider increase liability limits like claims made coverage policy (Reising, 2012).
References
American Nurses Association. (2013). nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD: Author.
Buppert,C.(2014). Nurses practitioner business practice and legal guide. Jones and Barlett publishers. Burlington
Legal Information Institute. (n.d.). Requirements for and assuring quality of care in skilled nursing facilities, 42 U.S.C. § 1395i–3. Cornell University Law School. Retrieved from http://www.law.cornell.edu/uscode/text/42/1395i-3
Reising, D. L. (2012). Make your nursing care malpractice-proof. American Nurse Today, 7(1), 24–28.
Want help to write your Essay or Assignments? Click here
Identify and explain any legal implications that exist for failure to adhere to a standard of care
Standards of care in nursing refer to the general guiding frameworks on how a nurse /he should do or not do during delivery of care in their professional capacity. Deviating from nursing standards can results into serious legal implications. For instance, Ivan a newborn baby developed brain injury due to complications during delivery that led to spastic quadriplegic cerebral palsy. The mother labor was induced and they were discharged without monitoring their progress.
In this case, medical negligence claim can be made against obstetrician for failing to adhere with the recommended nursing care standards of monitoring them for at least 48 hours before discharge. The legal implications of violating the standard of care, the nurse will be suspended as his case is investigated. If the investigations indicate that he is guilty, then his practice license can be revoked or judgment awards hefty fines and penalties to be given to the patient directly affected (American Nurses Association, 2013).
Identify and explain the key elements of malpractice
The four key elements of malpractice include duty, breach of duty, damages and causation. Duty refers to what patient is owed. This includes safe environments and quality care. Breach of duty refers to scenarios where duties owed to the patient is neglected (Legal Information Institute, n.d.). In this context, the obstetrician did not monitor the child’s health status as required by the facility nursing standards.
Damages are the consequences due to breach of duties. In this context, patient brain injuries due to medical negligence are the damages that should be claimed. Causation generally refers to what led to the series of events. This is the most difficult element to prove in malpractice lawsuit (Buppert, 2014). In this case, causation was lack of patient monitoring soon after delivery.
Compare the differences in malpractice policy options
Health policy is a trade-off among three dimensions of cost, quality and access. There are 3 general categories of medical malpractice including claims – made coverage, claims paid coverage and occurrence coverage. Claims made coverage are the most common because their premiums are based on healthcare provider past and current experiences. Therefore, the premiums paid are lower. Claims paid policy and occurrence coverage premiums are higher and are not flexible enough to allow a healthcare provider increase liability limits like claims made coverage policy (Reising, 2012).
References
American Nurses Association. (2013). nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD: Author.
Buppert,C.(2014). Nurses practitioner business practice and legal guide. Jones and Barlett publishers. Burlington
Legal Information Institute. (n.d.). Requirements for and assuring quality of care in skilled nursing facilities, 42 U.S.C. § 1395i–3. Cornell University Law School. Retrieved from http://www.law.cornell.edu/uscode/text/42/1395i-3
Reising, D. L. (2012). Make your nursing care malpractice-proof. American Nurse Today, 7(1), 24–28.
Want help to write your Essay or Assignments? Click here
