Category: Nursing

Nurse staffing: Article Critique

Nurse staffing
Nurse staffing

Nurse Staffing Article Critique Questions

Question 1: Introduction

            The authors of this article have various nursing qualifications that make them competent to carry out an investigation on the given topic. Sung-Hyun Choo is a registered nurse with a doctoral degree in nursing. Barbara A. Mark is a registered nurse with a doctoral degree in nursing, and he also possesses the Fellows of the American Academy of Nursing (FAAN) qualifications. George Knafl has a doctoral degree in nursing, Hyoung Eun Chang is a registered nurse with a Masters degree in Public Health, and Hyo-Jeong Yoon is a registered nurse.

            The current study is an empirical quantitative research that examines how nurse staffing and experiences of patients are related as well as how missed nursing care affects this relationship. The variables in the study therefore are; nurse staffing, experiences of patients, and missed care by nurses. The study population comprises of patients, nurses, and nurse managers.

            The purpose of the study is to assess the relationship between experiences of patients and nurse staffing and to find out the mediating impact that missed care has on this relationship. The researchers have used a correlational study design to carry out their research. The study is based in South Korea. A total of 208 patients and 362 nurses have been sampled from 23 treatment units in six health care facilities in the region.

Nurse staffing has been measured based on the manner in which patients and nurses perceive nursing adequacy as well as on patient-to-nurse ratios. Experiences of patients has been measured using the occurrence of adverse events, the way patients communicate with nurses, and on how patients rate the health facilities. The researchers have used the MISSCARE Survey-Patient that contains three domains to measure missed care as reported by patients.

            There are two key findings in this study. First, the researchers have found that there is a significant relationship between patients’ perceptions of nurse staffing adequacy and patients’ experiences as well as missed care as reported by patients. Second, missed nursing care as reported by patients mediates the relationship between experiences of patients and nurse staffing.

Question 2: Research Problem and Purpose

            The problem statement for this study states that, “In light of the increasing emphasis on patients’ perceptions and experiences, research on the relationships among nurse staffing as assessed using empirical and perceptual measures, patient-reported missed care, and patients’ experiences is expected to enhance our understanding of how nurses and nursing care contribute to patients’ experiences (p. 348).”

The purpose statement of the study states that, “The purposes of this study were (a) to examine the relationship of nurse staffing, as measured by nurse-perceived and patient-perceived staffing adequacy as well as by the patient-to-nurse-ratio, with patient experiences, and (b) to determine the mediating effects of patient-reported missed care on the relationship between nurse staffing and patients’ experiences (p. 348).”

This study is significant in the sense that, it will help the health facilities in South Korea to understand how patients perceive nurse staffing as well as the main factor that contributes to missed nursing care. This study is relevant to nursing because its findings will help health care organizations to learn that patients’ experiences can be improved and missed care can be reduced by providing appropriate nurse staffing.

The study is feasible to conduct because the researchers possess the right expertise to carry out the research. In addition, the subjects that the researchers can use in the study are readily available, and the health care facilities from where the study participants can be obtained are easily accessible.

Question 3: Review of the Literature

            The three major topics listed in the review of literature include; the relationship between nurse staffing and patient outcomes, the effect of missed care on nursing quality and patients’ outcomes, as well as the measurement of nurse staffing.

 Two models have been identified in the review of the literature. The first theoretical model assumes that negative patient outcomes and high rates of missed nursing care are attributed to inadequate nurse staffing. The second model states that patient’s experiences, as well as the way patients perceive missed care, are directly affected by nurse staffing.

            The review of literature perfectly describes current knowledge of the research problem because it describes what other researchers have written about the study topic as well as the gaps that new studies should fill. In addition, the review if literature has mainly focused on articles published between 2008 and 2016.

            The studies reviewed in the review of literature have been summarized based on the way they address the relationship between nurse staffing and patient outcomes, as well as in the way they describe the association between missed care and nursing quality. The studies have also been summarized based on the way they describe how nurse staffing should be measured.

Question 4: Study Framework

            The authors have explicitly described the study’s framework and their description leaves no doubt to the reader. This description can easily be followed by someone else who did not conduct the study.

 The important concepts found in the study’s framework include the samples used in the study and how they have been obtained, the measures that have been used to study the performance of variables, the methodology used to collect data, as well as how the collected data has been analyzed.

            The framework presents the relationship among the major concepts of the study. For instance, the data collection process indicates how information has been obtained from nurse managers, nurses, and patients that were selected at the sampling stage.

Question 5: Research Objectives, Questions, or Hypotheses

            This article has clearly stated the study objective which also serves as the study purpose. However, the researchers have not pointed out clearly whether there are specific research questions or hypotheses being addressed.

The article’s objective states that, “The aims of this study were to examine the relationships between nurse staffing and patients’ experiences, and to determine the mediating effects of patient-reported missed care on the relationship between nurse staffing and patients’ experiences (p. 347).”

Question 6: Variables

            The major study variables are nurse staffing, experiences of patients, and missed care as reported by patients. Out of the three variables, one of them is an independent variable and two of them are dependent variables. The independent variable is nurse staffing while the dependent variables are experiences of patients and missed care as reported by patients. The performance of the dependent variables is determined by the nature of nurse staffing.

The conceptual definitions of the major variables have been provided in the study. Nurse staffing has been defined by the number of nurses, patients’ experiences have been defined by patient outcomes, while missed care has been defined by the timely responses to care that patients receive from nurses.

            The operational definitions of major variables are explained in the methods section. Nurse staffing has been defined by patients’ perception of staffing adequacy. Patients’ experience has been defined by hospital rating, adverse events, and communication. While missed care as perceived by patients has been defined by basic care and communication.

            The author has not identified any extraneous variables used in the study. Demographic variables such as age, gender, and sex of participants have not been specified in the study.

Question 7: Research Design

            The research design used in the study is correlational design. This is because the researchers are trying to investigate the relationship between dependent and independent variables as well as how that relationship is affected by one of the dependent variables.

 The correlational study design perfectly matches the study objective because it allows the researcher to examine how nurse staffing and experiences of patients are related as well as how missed nursing care affects this relationship. Its effectiveness is answering the research questions and hypotheses have not been explained because the researchers have not clearly stated the questions and hypotheses that are being addressed by the study. Since the study purpose in this research is the one that acts as the study objective, it can be concluded that correlational research design provides a means to examine the study purpose.

            The study includes interventions and this is evidenced by the use of a number of specific measures to examine the performance of variables. For instance, missed care as reported by patients has been examined by using domains such as basic care and communication between nurses and patients. Pilot study findings have been used to design the major study because the researchers have relied on previous study findings to organize their study framework.

Question 8: Strengths and Weaknesses

            One of the strengths of the study lies in the use of a large sample size that helps the researchers to minimize bias. The other strength of the study lies in the manner in which the researchers have used a correlational study design that helps them to examine the relationship among variables.

 The main weakness of the study is that the findings may not be generalized because the researchers have focused their study in health facilities in Korean context alone without integrating what might happen in other countries. In addition, other patient characteristics which have not been adjusted in the study might have contributed to the observed patient experiences.

Reference

Cho, S., Mark, B. A., Knafl, G., Chang, H. E. & Yoon, H. (2017). Relationships between nurse staffing and patients’ experiences, and the mediating effects of missed nursing care. Journal of Nursing Scholarship, 49(3): 347-355.

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Nursing Practice Reflection Paper

Nursing Practice
Nursing Practice

Nursing Practice Reflection Paper

Part 1

Since the Future of Nursing recommendations was released by the Institute of Medicine (IOM), nurses have worked hard to ensure that they fit into each one of them. For instance, nurses strive to obtain the right academic qualifications from institutions of higher learning to enable them to perform their roles effectively (Reinhard and Hassmiller, 2015). Personally, I see myself fitting into recommendation 4, recommendation 5, and recommendation 6 documented by the Institute of Medicine.

The IOM recommends that nursing practice in the United States can be transformed by increasing the number of nurses who graduate with baccalaureate degrees to 80 percent by the year 2020. According to the IOM, relevant accrediting bodies should work in collaboration with academic nurse leaders, employers, as well as public and private funders to ensure that student nurses obtain the right academic qualifications that can enable them to deliver quality care to diverse populations.

This means that the number of student nurses who are enrolled in baccalaureate degrees should increase for the fourth IOM recommendation to be implemented successfully (The Institute of Medicine, 2010). Since I am preparing to graduate with a Bachelor of Science in Nursing (BSN) degree in a few years to come, I am confident that I perfectly fit into the IOM Future of Nursing recommendation four.

I will effectively apply the knowledge and skills that I will acquire from my baccalaureate degree to deliver quality healthcare to diverse populations. In this manner, I believe that I will form part of nurses who graduate with baccalaureate degrees by the year 2020 as I continue to deliver care that is intended to improve nursing practice in the United States.

The IOM also gives a recommendation that the number of nurses who possess doctorate degrees should double by 2020 for nursing practice in the United States to be improved. Under recommendation five, the IOM directs academic nurses to collaborate with both public and private funders as well as with accrediting bodies to increase the number of student nurses who are enrolled into and who graduate with doctorate degrees (AnneMarie, 2016; & The Institute of Medicine, 2010).

Since I am planning to be enrolled in a Master’s program once I complete my undergraduate degree, and into a doctorate degree program thereafter, I believe that I will fit into the IOM Future of Nursing recommendation five. From the doctorate degree program, I will acquire advanced nursing knowledge that I will apply to carry out nursing research for an improved nursing practice. I, therefore, believe that I will form part of nurses who possess doctorate qualifications by 2020.

The IOM recommends that nursing institutions should engage in long-term learning for nursing practice in the United States to be improved. Under recommendation six, healthcare organizations, accrediting bodies, and educators are required to join hands in ensuring that student nurses, as well as graduate nurses, engage in prolonged learning with the aim of acquiring competencies that will enable them to deliver quality care to patients from different backgrounds (The Institute of Medicine, 2010; & AnneMarie, 2016).

Personally, I undertake numerous training that is related to nursing care even as I strive to achieve higher academic qualifications. For this reason, I have been able to obtain relevant knowledge and skills that I intend to apply in delivering quality care to patients in future. Since I currently engage in lifelong learning, I perfectly see myself fitting into the IOM Future of Nursing recommendation six.

Part 2

Increasing my level of education will positively affect how I compete in the current job market. According to McHugh and Lake (2011), today’s health care organizations are keen to hire nurses who possess relevant clinical nursing expertise because this is critical to health care quality. For this reason, only nurses who possess relevant nursing knowledge and skills can effectively compete in the current job market.

Individual nurse education has been identified as one of the factors that help to increase clinical nursing expertise (McHugh and Lake, 2011). In this regard, nurses who obtain high levels of education are believed to be in a better position to compete in the job market than those who do not.  By increasing my level of education, I believe that I will possess the right clinical expertise that will enable me to compete favorably in the current job market.

Increasing my level of education will greatly change my role in the future of nursing. As Black, Balneaves, Garossino, Puyat, and Qian (2015) explain, future nurses are expected to engage in nursing research in order to generate data that can be used to promote evidence-based practice. Knowledge of how nursing research should be conducted is best acquired through nursing education.

This is because instructors normally teach nurses on how they can use evidence obtained from research to inform evidence-based practice. In addition, through nursing education, nurses are able to learn the best approaches to research that will generate important information that can be used to improve health care delivery (Ketefian and Redman, 2015). Therefore, increasing my level of education will enable me to perform both nursing practice roles as well as research roles.

References

AnneMarie, P. (2016). The future of nursing: Leading change, advancing health…how are we doing? Nursing Critical Care, 11(3):4.

Black, A. T., Balneaves, L. G. Garossino, C., Puyat, J. H. & Qian, H. (2015). Promoting evidence-based practice through a research training program for point-of-care clinicians. The Journal of Nursing Administration, 45(1): 14-20.

Ketefian, S. & Redman, R. W. (2015). A critical examination of the developments in nursing doctoral education in the United States. Revista Latino-American de Enfermagem, 23(3): 363-371.

McHugh, M. D. & Lake, E. (2011). Understanding clinical expertise: Nurse Education, experience, and the hospital context. Research in Nursing & Health, 33(4): 276-287.

Reinhard, S. & Hassmiller, S. (2015). The future of nursing: Transforming health care. The AARP International Journal, retrieved from https://www.journal.aarpinternational.org/

The Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Washington, DC: The National Academies Press.

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Health care cost: Burden to low income earners

health care cost
health care cost

Financial Management

Health care cost

Patient care financial problem is one of the reasons why today’s populations are unable to receive high quality care that they need to achieve improved health outcomes. The problem of huge health care cost is a big burden to low income earners who always lack adequate finances to purchase drugs and to pay for hospital bills (Kelley, McGarry, Georges, and Skinner, 2015). It becomes even worse for patients who are suffering from chronic health conditions such as diabetes and cancer.

According to Kelley et al., (2015), dementia is one of the chronic diseases that are attracting large social costs for patients in the United State. For this reason, being a fatal health condition, many dementia patients in the United States are dying due to patient care financial problem. Patient care financial problem has an impact on federal and national budgets. Nurses play a very big role in ensuring that patient care financial problems are integrated into the national and federal budgets by analyzing information that may be required for budget development (Luga & McGuire, 2014)

Health care cost: Heath insurance

Lack of health care insurance and high costs of prescription drugs are the most common patient care financial problems in today’s society. According to Saksena, Hsu and Evans (2014), health care coverage helps to protect patients from financial risks, and lack of it becomes a big burden for many populations. In addition, paying for health care through out-of-pocket payments prevents many people around the world from accessing care.

Although lack of health care insurance is a financial problem for patients, it is always associated with both non-financial and financial health-related impacts to public health. For instance, limited access to quality health care as a result of lack of health care coverage, results into negative health outcomes for the population. This is a good example of a non-financial impact associated with lack of health insurance (Luga & McGuire, 2014).

With regard to financial-related impact, an increase in disease burden among populations is of great financial impact to the public health sector, which must allocate additional funds to clear disease from the society (Saksena, Hsu and Evans, 2014).

The other financial problem that is related to patient care is high costs of prescription drugs. Many patients and their families really have to struggle in order to meet health care costs, especially medication costs. According to Walkom, Loxton, and Robertson, (2013) in a study conducted with the aim of assessing the impact of high medication costs on patients’ ability to adhere to prescription drugs, it has been discovered that 27 percent of participants from Australia and 36 percent of subjects from the United States tend to skip their drug doses because they are unable to purchase drugs which are charged at extremely high prices.

In addition, the need to purchase prescription drugs through out-of-pocket payments is one of the contributing factors to poor health among populations in today’s society (Luga & McGuire, 2014).

Lack of insurance as well as high costs of prescription drugs have an impact on federal and national budgets. This is because the government has to integrate health care costs into its budget to help low income earners to access care and to achieve improved health outcomes (Saksena, Hsu and Evans, 2014). According to Saksena, Hsu and Evans (2014), the number of uninsured citizens is on the rise in the United States because many people are reluctant to join available Medicare and Medicaid programs following increased uncertainties that continue to surround their use.

If the current trend persists, the federal government will be compelled to integrate patients’ health care costs into its budget in order to increase the percentage of United States citizens who receive quality care. As Kelley et al., (2015) explain, there is great need for the federal government to increase budget that it allocates for helping the society to manage chronic illnesses, considering the fact that chronic health conditions become more severe among the uninsured patients than among patients with health care coverage.

Similarly, high costs of prescription drugs have an impact on federal and national budget because the government has to increase its spending on these drugs to promote positive health among its population, especially the low income earners (Luga & McGuire, 2014).  

Nurses play a very crucial role in solving patient care financial problems because they are charged with the responsibility of analyzing public health information that is needed for budget development. The federal government depends on information collected by nurses regarding health care costs to make a decision on the most appropriate funds that should be allocated for patient care (Salmond and Echevarria, 2017).

In order to ensure that the right information is used for budget development, nurses must be sure to collect accurate and specific information as this will help the government to distinguish between funds that are allocated for health care coverage from those that are designated for prescription drugs. The staff nurse plays the role of collecting data directly from the community and presents it to the nurse manager.

The nurse manager analyzes the presented information and evaluates its relevance before passing it to the chief nurse. The chief nurse analyzes the information and forwards it to the agencies responsible for budget development, stating the reasons why it should be included in the budget (Salmond and Echevarria, 2017).

References

Kelley, A. S., McGarry, K., Georges, R. & Skinner, J. S. (2015). The burden of health care costs for patients with dementia in the last 5 years of life. Annals of International Medicine, 163(10): 729-736. doi: 10.7326/M15-0381.

Luga, A. O. & McGuire, M. J. (2014). Adherence and health care costs. Risk Management and Healthcare Policy, 7: 35-44. doi:  10.2147/RMHP.S19801

Salmond, S. W. & Echevarria, M. (2017). Healthcare transformation and changing roles for nursing. Orthopedic Nursing, 36(1): 12-25.  doi:  10.1097/NOR.0000000000000308

Saksena, P., Hsu, J. & Evans, D. B. (2014). Financial risk protection and universal health coverage: Evidence and measurement challenges. PLoS Med, 11(9): e1001701. https://doi.org/10.1371/journal.pmed.1001701

Walkom, E., J., Loxton, D. & Robertson, J. (2013). Costs of medicine and health care: A concern for Australian women across the ages. BMC Health Services Research, 13: 484. doi:  10.1186/1472-6963-13-484

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Gerontological Nursing: Case Analysis

Gerontological Nursing: Case Analysis

Gerontological Nursing: Case Analysis

Gerontological Nursing: Identification and Description of the Interviewed Individual

            The interviewee is a male individual aged 80 years, and who currently stays with his wife and their son in the city. This client is a retired accountant who has been out of work for the past five years. Also, he is married with three children; two sons aged 25 and 36, and one daughter aged 40.  Furthermore, the patient participates in three major health promotion activities including walking regularly, limiting consumption of salt and sugary foods, and participation in community’s social support groups.

The interviewee believes that increased consumption of fruits and foods rich in sorghum and millet help people to live long. Being 80 years old, the interviewee is considered to be the oldest family member who has ever reached such age. Furthermore, the interviewee is on insulin medication to help with management of diabetes clinical problem. He visits the doctor at least twice a week for a general medical check-up and to obtain clinical guidance on how to effectively manage diabetes symptoms.

Gerontological Nursing: Identification and Description of the Cultural Implications for the Individual

            Personal values and beliefs about old age and health have a great implication to the care of the interviewee. For instance, the interviewee’s philosophy on living a long life may make it difficult for him to appreciate the fact that aging is a normal process. He believes that living long is God’s blessings while deaths that occur when people are still young are associated with curses.

Also, the interviewee has unique thoughts about people who are considered to be of old age. He feels that for a person to qualify to be of old age, lack the capacity to perform daily physical activities, be unable to maintain an upright posture, and must put on glasses to assist with vision. These cultural beliefs may impact negatively on the care of this client because the clinician will find it difficult to change the interviewee’s perceptions and replace them with new ones that can promote positive health outcomes (Shrack et al., 2016).

Additional cultural implication related to the interviewed person include; his or her beliefs regarding health and illness and his values about health status and treatment of older adults. The most appropriate way of eliminating the impact of the person’s cultural values and beliefs is through maintenance of cultural competence throughout the interview and when giving interventions.

Gerontological Nursing: Comprehensive Functional Assessment

To establish what the interviewee can accomplish as well as those that he cannot do properly at his age, a comprehensive functional assessment has been performed using four tools namely; Tinetti Balance and Gait Evaluation, Katz Index of Activities of Daily Living, Assessment of Home Safety, and The Barthel Index. The person’s movement ability has been assessed using the Tinetti Balance and Gait Evaluation.

The client’s ability to perform various activities independently has been evaluated using the Katz Index of Activities of Daily Living. The most appropriate tool that has been used to measure the safety of the patient’s environment is the Assessment of Home Safety, while that which has been used to examine whether the identified individual can accomplish some daily tasks independently is The Barthel Index.

A duly filled Tinetti Balance and Gait Evaluation, Katz Index of Activities of Daily Living, Assessment of Home Safety, and The Barthel Index tools used during the interview have been provided in the Appendix section of this paper.

Gerontological Nursing: Comparison of Age-Related Changes

There are similarities and differences between the expected age-related changes and those observed in the interviewee. Older adults are expected to present with some physiological, physical, pathological, sensory, and motor changes, which significantly affect their ability to perform their activities of daily living and to make various physiological controls. According to Shrack et al. (2016), older adults aged 65 years and above have problems with maintaining gait and balance.

Similarly, the interviewee experiences problems with maintaining gait and balance, both while he is seated and whenever he is standing. Also, Tkatch, Musich, MacLeod, Alsgaard, Hawkins, and Yeh, (2016) point out that older adults often need assistance with various activities of daily living such as dressing, cooking, washing, and toileting. Although the interviewee is 80 years old, he needs assistance only in certain activities of daily living such as rising from a chair.

However, he is still strong enough to feed alone once the food is made available for him. Older adults are at high risk of falls, and there is therefore great need to keep their home environment free from objects that may increase the possibility of falling (Phelan, Mahoney, Voit, and Stevens, 2015). Similarly, the interviewee is at a high risk of falling considering the fact he has a problem controlling balance and gait.

For this reason, his home environment is often kept free from equipment that may increase the risk of falling. Again, as it happens in older adults, the interviewee occasionally finds it difficult to control his bladder and bowel and therefore may always want people to stay around to assist.

Gerontological Nursing: Preliminary Issues Assessed from the Interview

 Four major preliminary issues have been assessed from the interview. The four issues include; age-related changes that are taking place or that have taken place in the interviewee, health promotion activities that the interviewee is currently involved, the interviewee’s cultural values over old age and living longer, as well as actions that have been taken to promote safety at the interviewee’s home environment.

As Tkatch et al. (2016) explain, nurses who are providing care to older adults must be able to understand the impacts that their age-related changes have on their abilities to perform daily activities. Using this information, these nurses must recommend relevant health promotion activities for their clients, including how they can keep their home environment safe for living. The nature of care given as well as the nature of health promotion strategies recommended will depend on the client’s cultural values and beliefs over old age and long life (Tkatch et al., 2016).

From the current assessment, the interviewer has discovered that the interviewee has undergone various physiological, physical, pathological, sensory and motor-related changes as a result of old age that greatly affect his ability to perform daily activities. Furthermore, the interviewer has found that the client engages in a few health promotion activities such as frequently walking to keep fit and consuming fruits.

Through current assessment, it has also been established that some actions have been taken to keep the interviewee’s home environment safe by eliminating objects that may increase the risk of falls. Most importantly, the interviewer has found out that the interviewee believes that God helps people to survive through old age, that the society is less concerned about assisting the aging population, and that God promotes healing and recovery.

Based on results obtained from this assessment, the interviewer understands health problems that majorly occur in older adult as well as factors that must be taken into consideration when establishing the most appropriate health promotion strategies of the elderly (Shrack et al., 2016).

Gerontological Nursing: Alterations in Health

            The interviewee has alterations in health in three major functional areas namely; physiological functions, motor functions, and physical functions. Concerning physiological functions, the interviewee is struggling to manage diabetes, which is a common chronic health problem among older adults. Due to old age, the interviewer’s body cannot control blood sugar levels as required, and hence the observed onset of diabetes (Kezerle, Shaley, and Barski, 2014).

As far as motor functions are concerned, the interviewee has a problem with bladder and bowel control, which makes him have short call accidentally and long call at any time. This problem occurs mainly because of reduced motor function, which is greatly influenced by old age (Westra, Savik, Oancea, Choromanski, Holmes, and Bliss, 2011).

Furthermore, the interviewee experiences physical problems related to balance and gait maintenance, which put him at high risk of falls. He has reported that he needs support when rising from a chair and when moving upstairs. This means that his physical movement has been limited by old age. Therefore, the nature of intervention that would be recommended for the interviewee must target physical, physiological, and motor functional areas described in this section (Tkatch et al., 2016).

Gerontological Nursing: Interventions for Identified Problems

            Interventions should be implemented based on individual health problems that the interviewee is currently suffering from. The most appropriate interventions for diabetes include nutrition counseling, exercise training, and drug adherence training. The interviewee should be guided on those foods that he should avoid keeping his blood glucose level low. Also, he should be trained on the importance of exercise in managing weight, and his family members should be guided on how to offer the right support.

Again, the interviewee should be reminded of the importance of drug adherence in reducing diabetes symptoms (Kezerle, Shaley, and Barski, 2014; & Tkatch et. al., 2016). Three different interventions can be implemented to help the interviewee to reduce risks of falls. First, the interviewee should be guided on how to perform simple exercises that will help him to improve balance and gait.

Second, his family members should be taught on strategies for reducing hazards in the interviewee’s environment to maximize safety. Third, risks of falls can be eliminated if the patient is trained in safety-related behaviors and skills (Phelan et al., 2015). The best interventions for bowel and urinary incontinence include training the interviewee on how to perform pelvic floor muscle exercise, offering nutritional counseling, and educating him on usage and side effects of anticholinergic for the bladder that is overactive.

Frequent pelvic muscle exercise will help to avoid incontinence actions of the urinary bladder and the bowel. Again, the interviewee should be taught to limit fluid intake and to avoid foods that cause bladder irritation. Furthermore, correct use and adherence to anticholinergic can help the interviewee to effectively manage bladder and bowel incontinences (Westra et al., 2011).

References

Kezerle, L., Shaley, L. & Barski, L. (2014). Treating the elderly diabetic patient: Special considerations. Diabetes, Metabolic Syndrome, and Obesity: Targets and Therapy, 7: 391-400. doi:  10.2147/DMSO.S48898

Phelan, E. A., Mahoney, J., Voit, J. C. & Stevens, J. A. (2015). Assessment and management of fall risk in primary care settings. Medical Clinics of North America, 99(2): 281-293. doi:  10.1016/j.mcna.2014.11.004

Shrack, J. A., Cooper, R.,…& Harris, T. R. (2016). Assessing daily physical activity in older adults: Unraveling the complexity of monitors, measures, and methods.  Journals of Gerontology-Series A Biological Sciences and Medical Science, 71(8): 1039-1048. 10.1093/gerona/glw026

Tkatch, R., Musich, S., MacLeod, S., Alsgaard, K., Hawkins, K. & Yeh, C. S. (2016). Population health management for older adults: Review of interventions for promoting successful aging across the health continuum. Gerontology and Geriatric Medicine, 2 (1): DOI: https://doi.org/10.1177/2333721416667877

Westra, B. L., Savik, K., Oancea, C., Choromanski, L., Holmes, J. H. & Bliss, D. (2011). Predicting improvement in urinary and bowel incontinence for home health patients using electronic health record data. Journal of Wound Ostomy & Continence Nursing, 38(1): 77-87.

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Case Study Report: Patient Care Action Plan

Patient Care Action plan
Case Study Report: Patient Care Action Plan

Case Study report: Patient Care Action Plan

Case Study Report

Name

Institution

Case Study Report

Patient Care Action Plan for: William

Main Contact: Gladys

Main Contact’s Relation to Client: Wife

Council area where client lives:  London

Client Address: 49 Featherstone Street, London, United Kingdom

Background This patient care action plan is for William. William currently has liver cancer and he is very much worried about his condition and how his wife Gladys will cope with the situation. When William was growing up, he thought that he would live to reach ninety years old, like his parents, without any serious illness. His dream of living longer has just been shattered after he recently discovered the presence of blood in his stool. On visiting the hospital, William has received a confirmation from Dr. Maxwell that he has liver cancer. William’s immediate carer is his wife, Gladys, who provides assistance with daily living activities as well as with social support. Since William’s kids have their own families and they are mostly committed to work, he has limited access to family support. His living setting is the home environment, and he frequently visits the hospital from where he is cared for by Dr. Maxwell and nurse Linda. Dr. Maxwell has involved other physicians in William’s care. The doctor is working together with other highly qualified healthcare professionals to ensure that William receives the support that he needs for the longest period possible. William’s health condition is not that severe, and his recent health care trajectory indicates that he has a positive progress. His positive health progress is mainly attributed to good communication and a positive relationship with his healthcare providers, including the social worker. At the moment, William largely depends on services obtained from only one GP healthcare resource.
Needs Assessment From the PCC4U Needs Assessment, it is evident that some of Williams needs have been met while there are others, which have not been effectively addressed.
Needs that are currently met  The positive progress that is being observed in the patient is attributed to primary health care services that he is now receiving from the doctors and nurse Linda (Llobera, Sanso, and Leiva, 2017). Through support obtained from the doctors, William has learned and can apply various health promotion options that are available to him. Also, William has been informed about the right people he should approach in case his health condition gets worse. Immediate needs that should be met It is important to prioritize patients’ unmet needs to plan effectively on how to help them manage their health conditions (Khosla, Patel, and Sharma, 2012). There are two major immediate needs that William should be assisted to meet. During his interaction with nurse Linda, William explains that he is in a bit of pain and that he still has a lousy appetite. These conditions are common among older people with terminal illnesses (Goodman, Dening, and Zubair, et al., 2016). In this regard, William should be taught how he can solve his appetite problems and how he can effectively manage pain. Potential needs that might arise William’s healthcare providers should be prepared to address potential needs that might arise in the course of care. It is important to identify possible emotional and physical health problems that may arise to formulate strategies that can be used to prevent them early (Clarke, Bourn, Skoufalos, Beck, and Castillo, 2017). To meet William’s physical and emotional needs, the healthcare providers should engage specialists in palliative medicine and palliative nursing, as well as family members, to provide necessary care as early as possible (Llobera, Sanso, and Leiva, 2017).

Local Resources and Services Scan

Service name and brief descriptionAddress/contact details and website URL (if available)Opening hours/contact hoursHow to access (e.g. is a referral required?)What needs can this service help to meet?Healthcare team member responsible for referral/actionAdditional Comments
Companions of London110 Gloucester Ave, London NW1 8HX, +44 020 3519 8001 www.companionsoflondon.com/palliative-careEvery day: 9.00 am to 5.00 pm. Closed on Saturday and SundayNo referral requiredPrimary care, including emotional and social support.Palliative nurses are available even with short notice.This is a useful back up for William’s primary care and emotional and social support needs.
St. Joseph’s HospiceMare St, London E8 4SA, + 44 020 8525 6000 https://www.stjh.org.uk/contact-us8.30 am to 5.00 pm every day
Referrals are necessary. From 8.00 am to 6.00 pm every day by calling 0300 30 30 400.  Provides all primary care services needed by patients with serious illnesses.Sharon Finn offers social services support and can connect patients with palliative care specialists in the facility.This facility provides hospice care that William may need shortly.
Meadow House HospiceUxbridge Road, Middlesex, UB1 3HW +44 020 8967 5179 http://www.meadowhousehospice.org.uk/Open Monday to Friday from 8.30 am to 5.00 pm, Saturday from 12 pm to 2.30 pm, Closed on Sunday.Referrals are required. From Friday 8.30 am – 16.00 pm by calling 020 8967 5758Psychiatric and primary care services.Jane Cowap is the lead clinician who specializes in psychiatric care for geriatric patients.This facility will be appropriate for William in future when he will be in need of psychiatric support.
Pembridge Palliative Care UnitExmoor St, London W10 6DZ, UK +44 20 8102 5000 http://www.cqc.org.uk/location/RYXY2    Open 24 hours dailyNo referral requiredPsychological and physical support.Doctor Louise Ashley specializes in the treatment of psychological problems, especially for patients with physical disabilities.A useful facility for screening and diagnostic procedures.
Marie Curie Hospice, Hampstead11 Lyndhurst Gardens, Hampstead, London NW3 5NS, UK. +44 20 7853 3400 https://www.mariecurie.org.uk/help/hospice-care/hospices/hampsteadOpen Monday to Friday from 8.00 am to 6.00 pm, Saturday 11.00 am to 6.00 pm, and Closed on SundayNo referrals are necessaryOffers emotional and social support for patients with terminal illness and their families.Lead nurse Angel and Marilyn can assist patients with making appointments and follow-up.William can get necessary emotional and social support from this facility.
Hospice UK34-44 Britannia St, Kings Cross, London WC1X 9JG +44 20 7520 8200 http://www.hospiceuk.org/Open Monday to Friday from 9.00 am to 5.00 pm, Closed on Saturday and SundayNo referrals are necessaryProvides all types of home-based care needed by patients with serious illness.Carol Warlford is the Chief Clinical Officer in charge of all forms of palliative care in the facility.This facility is appropriate for meeting William’s physical, social, physiological, and emotional needs both now and in future.
St. Christopher’s Personal CareSydenham, UK +44 20 8768 4500 http://www.stcpersonalcare.org.uk/    Open every day from 9.00 am to 5.00 pm.No referrals are requiredOffers support with all forms of care including medication, nutrition, activities of daily living, social support, and emotional support.Denise, Maxine, Tony, and Sandra are highly trained to offer palliative care to all patients with various needs.The facility is a useful back up for William’s palliative care needs.

Action Plan

Medication: The nurse should plan a visit to the physician to provide the right prescription for William to enable him to manage pain effectively (Ramanayake, Dilanka, and Premasiri, 2016; & Al-Mahrezi, and Al-Mandhari, 2016).  This arrangement should be made as soon as possible.

Nutrition: The nurse should contact a nutritionist to help with the development of a feeding plan for William and his wife. Since appetite is one of William’s problems that should be solved urgently, this action should be started as soon as possible (Forbat, Haraldsdottir, Lewis, and Hepburn, 2016; & Caccaialanza, Pedrazzoli, and Zagonel, et al., 2016).

Physical Activity: William’s wife should contact a trainer to help William with physical exercise (Lowe, Tan, Faily, Watanabe, and Courneya, 2016; & Chandrasekar, Tribett, and Ramchandran, 2016). This arrangement should be made before William’s next meeting with the GP.

Counselling: The nurse should plan a visit to a professional psychologist to plan counselling sessions for William and his family (Pino, Parry, Land, Faull, Feathers, and Seymour, 2016). This plan should be ready before William’s next meeting with the GP.

Referral to Hospice: The nurse should contact a social worker to provide William and his wife with detailed legal information related to the procedures he should follow when he will be required to relocate from home-based care to the hospice (Hui and Bruera, 2016). This arrangement should be made when William will no longer be in a position to make decisions by himself.

Reference List

Al-Mahrezi, A. & Al-Mandhari, Z. (2016). Palliative care: Time for action. Oman Medical Journal, 31(3): 161-163. doi:  10.5001/omj.2016.32

Caccaialanza, R., Pedrazzoli, P…& Zagonel, V. (2016). Nutritional support in cancer patients: A position paper from the Italian Society of Medical Oncology (AIOM) and the Italian Society of Artificial Nutrition and Metabolism (SINPE). Journal of Cancer, 7(2): 131-135. doi:  10.7150/jca.13818

Chandrasekar, D., Tribett, E. & Ramchandran, K. (2016). Integrated palliative care and oncologic care in non-small-cell lung cancer. Current Treatment Options in Oncology, 17: 23. doi:  10.1007/s11864-016-0397-1

Clarke, J., Bourn, S., Skoufalos, A., Beck, E. & Castillo, D. J. (2017). An innovative approach to health care delivery for patients with chronic conditions. Population Health Management, 20(1): 23-30. doi:  10.1089/pop.2016.0076

Forbat, L., Haraldsdottir, E., Lewis, M. & Hepburn, K. (2016). Supporting the provision of palliative care in the home environment: A proof-of-concept single-arm trial of a palliative carers education package (PrECEPt). BMJ Open, 6(10): e012681. doi:  10.1136/bmjopen-2016-012681

Goodman, C., Dening, T…& Zubair, M. (2016). Effective health care for older people living and dying in care homes: A realist review. BMC Health Services Research, 16: 269. doi:  10.1186/s12913-016-1493-4

Hui, D. & Bruera, E. (2016). Integrating palliative care into the trajectory of cancer care. Nature Reviews Clinical Oncology, 13(3): 158-171. doi:  10.1038/nrclinonc.2015.201

Khosla, D., Patel, F. D. & Sharma, S. C. (2012). Palliative care in India: Current progress and future needs. Indian Journal of Palliative Care, 18(3): 149-154. doi:  10.4103/0973-1075.105683

Llobera, J., Sanso, N….& Leiva, A. (2017). Strengthening primary health care teams with palliative care leaders: Protocol for a cluster randomized clinical trial. BMC Palliative Care, 17: 4. doi:  10.1186/s12904-017-0217-9

Lowe, S., Tan, M., Faily, J., Watanabe, S. & Courneya, K. (2016). Physical activity in advanced cancer patients: A systematic review protocol. Systematic Reviews, 5: 43. doi:  10.1186/s13643-016-0220-x

Pino, M., Parry, R., Land, V., Faull, C., Feathers, L., & Seymour, J. (2016). Engaging terminally ill patients in end of life talk: How experienced palliative medicine doctors navigate the dilemma of promoting discussions about dying. PLoS ONE 11(5): e0156174. https://doi.org/10.1371/journal.pone.0156174

Ramanayake, R., Dilanka, G. & Premasiri, L. (2016). Palliative care: Role of family physicians. Journal of Family Medicine and Primary Care, 5(2): 234-237. doi:  10.4103/2249-4863.192356

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Patient Care: Nursing Entrance Essay

Patient Care
Patient Care

Question One: Patient care

            The patient care that I have provided has greatly influenced my career and my decision to advance my nursing education. Although I am a licensed practical nurse (LPN), the nature of patient care that I have provided is far much above my professional level. Most of the care services I offer perfectly match those that should be performed by a registered nurse. For instance, I have been able to obtain a specialty in allergies just like a registered nurse.

Due to my commitment to patient care, I have been promoted to head the sub-acute unit of the hospital where I currently work. I have frequently had the privilege to train registered nurses who are deployed at my unit despite the fact that I belong to a lower rank than them. Surprisingly, a large percentage of registered nurses whom I have interacted with have succeeded in their careers, not only in my current hospital but also in other facilities.

            These achievements have influenced me to continue my nursing education. As Farinaz (2016) explains, there is always a limit of the nature of patient care that an LPN can provide. Being an LPN, there is a limit of what I can do to my patients and my fellow nurses. In this regard, I feel that by advancing my education, I will acquire additional nursing knowledge and skills that will enable me to possess competencies that resemble those of a registered nurse.

With these academic qualifications, I will be in a position to perform more advanced caring roles than the ones that I can offer at the moment. Furthermore, I believe that advancing my nursing education will increase the salary that I shall be able to earn. Being a single mother of three, I honestly think that I should be compensated well to motivate me to work hard because most of the tasks that are delegated to me should be performed by a registered nurse.

Question Two

            With the nursing knowledge and skills that are currently possessed, together with those that are yet to be acquired, I see myself contributing positively to the nursing profession. According to Arabi, Rafii, Cheraghi, and Ghiyasvandian, (2014), nurses make an enormous contribution to the nursing profession by protecting the quality of health care. I believe that the goal of a successful nurse is always to make a meaningful contribution to his or her profession.

I am highly committed to achieving this goal, and I increasingly utilize my work experience to make a significant change to nursing. With seven years of professional experience, I stand out as a nurse who can deliver quality patient care. Furthermore, I always strive to provide care by my educational training to protect my licensure. I work hard every day to become part of highly qualified nurses who can deliver the highest quality care as recommended by the Institute of Medicine (The Institute of Medicine, 2010).

            Furthermore, I will contribute to the nursing profession by utilizing my skills and knowledge to assist my supervisors as well as my fellow nurses. As I continue to deliver extraordinary care to patients, I extensively interact with my supervisors because this helps me to evaluate my strengths and weaknesses.

I am eager to learn to fill my knowledge gaps and to fit to work in the rapidly changing medical and nursing fields. In this manner, I will be in a position to make meaningful reforms to the nursing profession and to take patient care to a higher level. The contribution that I can make to nursing encompasses both patient advocacy and change implementation (Arabi et al., 2014).

Reference List

Arabi, A., Rafii, F., Cheraghi, M. A. & Ghiyasvandian, S. (2014). Nurses’ policy influence: A concept analysis. Iranian Journal of Nursing and Midwifery Research, 19(3): 315-322.

Farinaz, H. (2016). The effect of mode of nursing care delivery and skill mix on quality and patient safety outcomes. Retrieved from https://open.library.ubc.ca/cIRcle/collections/ubctheses/24/items/1.0340283

The Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Washington, DC: The National Academies Press.

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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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Nurse to Patient Ratios Essay Paper

Nurse to Patient Ratios
Nurse to Patient Ratios

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Nurse to Patient Ratios

One of the major difficulties in the healthcare sector is the unbalanced nurse to patient ratios. (Cornwall, 2018)recently performed a study to better understand the changing environment and growing problems of the nursing profession. Respondents from around the country offered their thoughts on topics such as workload, the national nurse shortage, the nursing profession in general, and workplace respect.

The results showed that the growing national nursing shortage exacerbates all of the challenges confronting today’s nurses. According to the Bureau of Labor Statistics, there will be 1.2 million registered nursing openings between 2014 and 2022, with the consequences of this growing gap becoming severe. Respondents to a poll supported this perspective, with 91 percent believing their hospital was understaffed (Cornwall, 2018).

Burnout Syndrome has been a serious concern in the workplace, contributed by the nurse to patient ratios with its prevalence increasing by 60% – 70% over the last few decades (Gutsan, Patton, Willis, & Coustasse, 2018). One of the most frequent definitions of Nurse Burnout is a persistent response to work-related stress that includes three components or dimensions: emotional fatigue, depersonalization, and personal achievement. 

Burnout Syndrome has been more commonly observed in nurses due to the emotional aspect of their occupation, particularly in hospitals and psychiatric wards where common exposure to stress, inflexible policies, improper work assignments, poor training, inadequate remuneration, employee conflict, and complex or unknown patient needs occur (Gutsan, Patton, Willis, & Coustasse, 2018).

The minimum nurse-to-patient ratio in hospitals and ambulatory units has been recommended as 1:6 in medical-surgical units and behavioral units, 1:4 in step-down, telemetry, or intermediate care units and non-critical emergency rooms, 1:2 for Intensive Care Unit or trauma patients and post-anesthesia units, and 1:1 for every patient under anesthesia (Gutsan, Patton, Willis, & Coustasse, 2018).A high nurse-patient ratio has dangerous effects, including increased stress levels and mental weariness among nurses, as well as an increase in errors and accidents, which has resulted in a rise in malpractice cases.

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Most nurses don’t have a lot of spare time. According to the research, 40% of nurses said they had less free time (Cornwall, 2018). Eighty percent of respondents feel there is a nurse shortage at their facility, and 76 percent say the shortfall has directly harmed them. Because there are fewer nurses in the business, 88% of nurses’ workloads have increased (Cornwall, 2018).

Nurses believe they don’t have enough time to give enough comfort and emotional support to their patients and their family members, and 86% say they can’t devote as much time to patient education as they would want (Heath, 2018). Mandatory nurse staffing ratios would have a detrimental financial impact on hospitals while restricting patient access to treatment.

Poor resource allocation leads to more disparity in care delivery, less local access to healthcare, and fewer patient options. Furthermore, hospitals may be obliged to recruit less experienced and trained RNs, which would certainly cancel out any quality or safety improvements (Heath, 2018).

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According to study (Michaud, 2020), people in long-term care institutions with lower nurse staffing levels, worse quality scores, and larger percentages of disadvantaged individuals have higher rates of confirmed COVID-19 infections and fatalities. Data analysis revealed that long-term care facilities with a larger number of disadvantaged people, such as Medicaid recipients and racial and ethnic minorities, and lower nurse staffing levels had higher rates of confirmed COVID-19 cases and fatalities.

Higher nurse staffing ratios in the nurse to patient ratios, in particular, were substantially linked to fewer cases and fatalities (Michaud, 2020). Greater staffing numbers are consistently associated with higher levels of care quality, (Harrington & Edelman, 2018). Increased registered nurse and certified nursing assistant employment has been linked to better quality indicators such as physical restraints, catheter usage, pain management, and pressure sores.

Larger employment numbers and professional staff mix, as well as reduced turnover and usage of agency employees, were found to be linked with improved quality. Higher staffing levels have been found to have the strongest association with fewer defects (violations of rules) issued by state surveyors (Harrington & Edelman, 2018).

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Regardless of such a nurse to patient ratios situation, all nurses are expected to maintain professionalism when interacting with their patients. (Curtin, 2016) used the Gricean Maxims to elaborate on the ethics that all nurses should have with the first Gricean Conversation Supermaxim which is to attempt to make your contribution truthful, which naturally means that you do not say anything you think to be untrue or anything for which you lack proof. 

According to the following Gricean Supermaxim, everything you say must be well articulated and readily comprehended. This necessitates that all parties avoid ambiguity, confusion, and excessive verbosity, and deliver their contributions in an impassionate and organized manner (Curtin, 2016). The first rule in healthcare ethics is to do no damage. People usually take precedence over objects in ethics.

Making money, saving money, or even losing money is not an ethical justification for harming others. By virtue of who they are and what they do, health professionals and those who earn a living by employing, organizing, and facilitating their practice bear extra responsibilities (Curtin, 2016). Nurses are responsible for examining patients and choosing how to effectively share the priceless resource that is themselves or themselves.

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In terms of relationship quality, it appears to be a component that affects the professional to support patient-centered care. This relationship quality has a direct impact on the quality of care delivered and is critical for the efficacy of nursing practice (Molina & Estrada, 2020). The health-care system has devised initiatives aimed at humanizing care and enhancing care quality. A positive nurse-patient connection shortens hospital stays and enhances the quality and happiness of both parties.

In contrast, while the patient’s involvement in choices is higher, the positive relationship is conditioned by the patient’s subservient role (Molina & Estrada, 2020). A poor or negative nurse-patient relationship reduces the quality of treatment and the patient’s autonomy. A poor patient is one who demands a lot of information, who wants to make his or her own decisions, often against those suggested by specialists, and who does not maintain a good connection with professionals (Molina & Estrada, 2020).

Nursing leadership has an influence on the whole health system as well as on the nurses’ direct life (Little, Wagner, & Boal, 2018). A nurse manager is in charge of the day-to-day operations of the workplace. This involves, among other things, personnel recruitment, employment, orientation, staff development and assessment, resource allocation and management, risk management, patient safety, and financial responsibility (Little, Wagner, & Boal, 2018).

Nurse managers are also required to offer nurses and other health care professionals with inspiration, advice, and direction and especially in a situation where the nurse-to-patient ratio is imbalanced. As a result, nurse supervisors have the best chance to establish professional nursing standards in the nursing staff. The connection between nurses and their leaders is important because it contributes to Magnet status, which results in better nurse satisfaction and high-performing work environments with excellent patient outcomes (Little, Wagner, & Boal, 2018). 

Nurse managers are skilled knowledge brokers as well. They transform organizational policy instructions into action at the frontline of health care while also providing information to top management about health care delivery and practice requirements to shape organizational policy. Nurse managers have an important intermediate function in this position (Little, Wagner, & Boal, 2018). The knowledge translation of organizational directions would not be possible without nurse managers.

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In a situation where the nurse-to-patient ratio is imbalanced, nursing leaders should employ autocratic leadership.Concentrating decision-making power at the top of the chain of command can be an effective method for completing simple tasks; rather than becoming bogged down by competing viewpoints, autocratic leaders can ensure that quality care is delivered safely and efficiently, with little time wasted on deliberation (Norwich University, 2017).

Autocratic leaders are effective at making important choices in time-sensitive situations when soliciting employee opinion may only help to confuse issues and hence represent a risk to the patient. As a result, autocratic clinical nurse leaders must be precise, succinct, and direct while organizing staff and ensuring that they follow the established protocols of their particular hospitals (Norwich University, 2017). 

In health-care environments with tight procedures, authoritarian leadership is quite successful. It can also be useful in typical medical institutions with high patient numbers. Because an unbalanced ratio of patients to health care professionals restricts how many resources may be committed, such institutions thrive when an authoritarian leader supplies them with commands broken down into fundamental stages (Norwich University, 2017).

Autocratic leadership in nursing does not foster trust or communication among team members, but rather promotes a culture in which team members’ important thoughts and knowledge go untapped. This type of leader discourages collaborative decision-making and transparency, both of which impede an organization’s journey to high reliability (Cornell, 2020).

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References

Cornwall, L. (2018, December 12). RNnetwork 2018 Portrait of a Modern Nurse Survey. From RNnetwork : https://rnnetwork.com/blog/rnnetwork-2018-portrait-of-a-modern-nurse-survey/

Heath, S. (2018, August 14). How Nurse Staffing Ratios Impact Patient Safety, Access to Care. From Xtelligent Healthcare Media: https://patientengagementhit.com/news/how-nurse-staffing-ratios-impact-patient-safety-access-to-care

Michaud, M. (2020, June 18). COVID-19 Toll in Nursing Homes Linked to Staffing Levels and Quality. From University of Rochester Medical Center : https://www.urmc.rochester.edu/news/story/covid-19-toll-in-nursing-homes-linked-to-staffing-levels-and-quality

Harrington, C., & Edelman, T. S. (2018, July 20). Failure to Meet Nurse Staffing Standards: A Litigation Case Study of a Large US Nursing Home Chain. From NCBI: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6055099/#bibr19-0046958018788686

Gutsan, E., Patton, J., Willis, W. K., & Coustasse, A. (2018). Burnout syndrome and nurse-to-patient ratio in the workplace. Chicago: Marshall University.

Curtin, L. (2016, April 7). A conversation about the ethics of staffing. From AMERICAN NURSE: https://www.myamericannurse.com/conversation-ethics-staffing/

Molina, M. J., & Estrada, J. G. (2020). Impact of Nurse-Patient Relationship on Quality of Care and Patient Autonomy in Decision-Making. International Journal of Environmental Research and Public Health, 2-3.

Little, L., Wagner, J., & Boal, A. S. (2018). Responsibility and Authority of Nurse Leaders. From Pressbooks: https://leadershipandinfluencingchangeinnursing.pressbooks.com/chapter/chapter-12-responsibility-and-authority-of-nurse-leaders/

Norwich University. (2017, December 4). 5 Leadership Styles for Clinical Nurse Leaders. From Norwich University: https://online.norwich.edu/academic-programs/resources/5-leadership-styles-for-clinical-nurse-leaders

Cornell, A. (2020, April 13). 5 LEADERSHIP STYLES IN NURSING. From Relias LLC: https://www.relias.com/blog/5-leadership-styles-in-nursing

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Health Record Policies

Health Record Policies
Health Record Policies

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Health Record Policies

Evaluate the two policies in the attached “Health Record Policies” by doing the following:
 
Discuss what information should be included in an addendum pertaining to a shadow chart.

Generally, an addendum includes amendments or corrections in the primary medical records.This must bear the client’s signature, the amendment date and the amendments themselves. This avails the information that was missing at time of original entry.

Discuss how information technology staff can help decrease incidents of security breaches.

Security breaches especially related to data cause negative consequences for healthcare institutions, their clients and employees. The information technology staff should take preventive measures to avoid this. Encrypting confidential data is essential. All computers in the organization must have password protection. Also a backup of all data must be kept to avoid loss of data in case of data loss.

Thirdly, controls must be placed on data access and storage to avoid unauthorized access. Disposal of outdated data and equipment should be done carefully, and there should be regulation on use of laptops and other portable storage media and devices (Pendrak & Ericson, 1998).

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Discuss one situation from Montana Code 41-1-402 (2a through 2d) that may result in criminal liability to the organization if not followed.

A situation that may result in criminal liability for a healthcare institution is if for example an abortion is procured on a minor from a stable family and under the care of her parents without the parent’s consent.

Summarize how HIPAA defines criminal liability.

HIPAA has put a penalty for any unauthorized access to a patient’s medical records with or without knowledge of this law. Employees in healthcare institutions can also be charged with breaching the confidentiality of patients without authority to do so. 
Explain which part of 2a through 2d of Montana Code 41-1-402 would directly impact actions of clinical staff.
            Part 2 (d) would impact actions of the clinician. If a minor needs treatment for STDs, drug and substance abuse, then if the clinician accepts to offer treatment, they are also mandated to offer counseling the minor or refer them to a counselor.

Health Record Policies

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 Discuss one situation from Montana Code 50-16-603x (1 through 7) specific to health record identification that may result in a legal claim against the organization if not followed.

 If a healthcare institution uses pictures of their former patients for its advertisement on the media without written consent from the former clients.
Develop a confidentiality policy statement (suggested length of 1–2 sentences) using either Montana Code 41-1-402 or Montana Code 50-16-603.

Disclosure of a patient’s presence: This should not be disclosed to unauthorized parties, even in a manner that would reveal nature of disease without the consent of the patient as it will be a breach of confidentiality. 

Compare three points in the Montana codes to HIPAA laws as they refer to release of information.

50-16-542. 1(a) Release of information will be denied if the healthcare provider thinks it will cause negative effects on the recipient. 50-16-542. 1(c) if the information will cause danger to the recipient’s safety and 50-16-542. 2(a) if the minor has a mental condition. All these show that information can only be released if it will not cause any adverse effects on the patient.

Health Record Policies

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Develop a release of information policy statement (suggested length of 1–2 sentences) using either Montana Code 50-16-541 or Montana Code 50-16-542 for a policy book.

Releasing information of patient over the phone of fax: This is not encouraged as the there is no evidence provided to show that the caller or fax destination are eligible recipients of the patient information.

References

Pendrak, R. F., & Ericson, R. P. (1998). Information technologies need to protect patient confidentiality.Healthcare Financial Management, 52(10), 66-8. Retrieved from http://search.proquest.com/docview/196382179?accountid=45049;

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