Want help to write your Essay or Assignments? Click here
Dissemination of Evidence
Effective dissemination of evidence means that the right audience gets the correct information on the right time, format, and manner. The general aim of communicating information is to encourage all stakeholders to understand the progress and achievements of the project so that they can take part in it (McCormack et al, 2013; Beidas et al., 2012).
The pioneer nurses who will have gone through the teaching program will be posted in different units where they will reach out to other nurses in these units about the initiative. They will be allowed to use posters outside the unit, post reminders outside the unit, or post important updates on the hospitals’ website. The nurses will also be expected to explain to fellow colleagues in other units about the CAUTI prevention program through the hospital newsletter, tweets, blogs or even during hospital-wide nursing meetings. This will be a sure way of ascertaining that equal protection is met for all patients in the hospital (Edmunds et al., 2012).
To further facilitate spread of information, the trained health care providers will be encouraged to meet with interested hospitals within the region where they will share what they will have learned and communicate the achievements they have made in reducing the rates of CAUTI within this hospital. During this activity, they will be expected to start with units with higher rates of CAUTI, share the prevention program manual and other essential resources available in the website, and avail themselves whenever they are requested to train more members.
Project leaders will also be requested to attend monthly regional coaching and monthly national content webinars where they will share crucial information about “why and what” the implementation program is all about. The project leaders will be encouraged to attend the webinar calls with at least two or three nurses who will help further in dissemination of information.
Reference
McCormack, L., Sheridan, S., Lewis, M., Boudewyns, V., Melvin, C. L., Kistler, C., … & Lohr, K. N. (2013). Communication and dissemination strategies to facilitate the use of health-related evidence.
Edmunds, J. M., Beidas, R. S., & Kendall, P. C. (2013). Dissemination and implementation of evidence–based practices: training and consultation as implementation strategies. Clinical Psychology: Science and Practice, 20(2), 152-165.
Want help to write your Essay or Assignments? Click here
Catheter Associated Urinary Infection (CAUTI): Evidence Based Practice
Abstract
After selecting the topic of study, a team will be responsible for implementation and evaluation of the project will be formed. The selection of the team members will be directed by the topic and involve all responsible stakeholders. Thereafter, a brainstorming session will be held to determine the available sources and the key terms that will be used as guide in the research. Electronic databases such as Proquest, Cinhahl, and Cochrane will be used as a source of evidence.
The obtained evidence will be graded, an EBP standard developed and implemented and later an evaluation of the project outcomes will be done. The aim of this project is to reduce incidences of Catheter Associated Urinary Infections (CAUTIs). CAUTIs are ranked as the most common nosocomial infections. Surveys indicate that CAUTIs account up to 40% of all infections acquired in hospitals per year. Approximately 80% of these infections worldwide have been associated with insertions of indwelling urethra catheters.
In the US alone, hospital related infections account for about 5 to 10% of all hospitalized patients every year. The risk of developing CAUTI increases proportionately with the duration of catheterization. CAUTI pose a huge economic burden in the health care sector. It has been estimated that about 45 billion dollars are spent in the US for maintaining direct health costs and account for over 100, 000 deaths each year. CAUTIs also cause several complications such as gram –ve bacteremia, epididymitis, and orchitis in males, cystitis, and pyelonephritis, endocarditis, meningitis, prostatis, and septic arthritis in all patients.
These complications cause discomfort among patients, increased care cost, prolonged hospital stay, and high mortality Researchers report that there is need for re-education of clinicians about insertion of catheters to ascertain that best practice is maintained. Therefore, the project will be geared towards using this evidence-based intervention in promoting patient outcomes.
Project Proposal
Problem Description
Hospital acquired infections in the urinary tract are classified as the most common infections acquired in nursing homes as well as hospitals. Research has indicated that these infections are caused by insertion of indwelling catheters. It has been projected that these infections would be more worse were it not for the current modifications that have been done on the catheter itself (Gordon, 2015). CAUTIs reduce the quality of life of patients by subjecting them to discomfort, prolonged hospital stay, increased health costs as well as high mortality.
Solution Description
Management and care of an IUC patient is within the scope of nursing practice. One of the most effective ways that will be used to prevent CAUTI will be through re-education of nurses on placement, early removal, and management catheters. According to Meddings, (2014), improved care processes and care outcomes can be achieved through examination of best evidence serve as a guide in nursing practice and developing support systems that offer education and enhanced product accessibility to attain maximum care.
Although challenging, online learning programs will be created to serve as a guide for registered nurses. The intervention will also aim at updating clinical policy in a manner that it provides consistent, factual, and succinct content that will be an essential vessel for improving current practice (Scanlon et al., 2012). More importantly, clinicians will be re-instructed on how to best insert catheters and how to appropriately locate the drainage bag to minimize occurrence of reflux and CAUTI risks.
However, it has been documented that the most important strategy for preventing CAUTI is to maintain awareness on the existence of a catheter (Sutherland et al., 2015). It is for this reason that practitioners will be educated about how to use catheter reminder interventions such as daily checklists, electronic reminders, and sticker reminders.
Implementation Plan
The first step during implementation of this project will be to request for approval. It will be crucial for the entire organization to understand the necessity of reducing CAUTI. Project leaders will shed light to the leaders in the top management regarding the prevalence of catheter use, the risk that CAUTI predisposes to patients, and the health care costs related to management of CAUTI.
The project leaders will also engage fellow staff/colleagues by first making the problem real. This will be done through narrating a story of a patient who is suffering from CAUTI in the clinical area. Additionally, it will be illustrated that hospital acquired infections occur in 25% of the patients with indwelling catheters which in turn increases the cost of care (Bartlomé et al., 2015; Clarke et al., 2013).
The members will then be urged to join the fight against CAUTI, which is ranked as one of the conditions that can be easily controlled. The clinicians will be notified that the Centers for Medicare & Medicaid Services has stopped reimbursing costs associated with CAUTI since it can be prevented (Parry et al., 2013). Therefore, it is the duty of health care providers to come up with effective strategies for maintaining CAUTI.
Want help to write your Essay or Assignments? Click here
Evaluation Plan
After implementation, some of the variables that will be evaluated include;
Clinical outcomes
The evaluation team will identify the number of patients with symptomatic CAUTIs in the clinical setting monthly. Data from National Health Safety Network (NHSN) will be used to benchmark the progress. The data is essential because it provides the limitations on the number of CAUTI cases that an institution should record (Stacy, 2015). Comparison will also be done between the rates of ICU occurrence in the clinical setting and compared to the occurrences in other clinical settings in the hospitals with similar conditions.
Process Evaluation
Under process evaluation, some of the factors that will be monitored include indications for catheter placement, maintenance of aseptic conditions during catheter use, and the proper removal of catheters that are no longer useful to the patient. The daily prevalence rate will also be collected by dividing the number of patients that are catheterized in the ICU by the total number of patients admitted in the ICU (Zhou et al., 2015; Calfee, 2013). If the survey notes that the rate of CAUTI has spiked, an in-depth investigation will be conducted to identify the causes of the occurrence.
Patient Safety Culture
A survey will be conducted to assess this variable. The survey will be done after every three months annually. The results obtained will be used in the identification of improvement opportunities and allow project managers in designing specific strategic plans that will be used in addressing areas that indicate that staff perception is not as desired (Bell, et al., 2015; Andreessen et al., 2012). Some of the tools that will be used in accomplishing the evaluation process include brochures, Power Point presentation, and handouts.
Dissemination of Evidence
Nurses who will have gone through the education program will be posted in the various units in the hospital where they will serve as important vessels for teaching fellow colleagues about how the project is vital and why they should embrace it. Trained practitioners will also be encouraged to visit neighboring hospitals and help on spreading the message. The progress will be posted in blogs and hospital website where health care providers across the globe can easily access.
Review of Literature
Various scholars ascertain that UTI infections due to indwelling catheters are the most common hospital acquired infections. For instance, according to Giles et al., (2015), the major determinant of CAUTI development is the catheterization duration. Marra et al., (2011) propose that the most significant intervention to prevent these conditions is to discontinue the use of catheters the moment they are feasible and to limit the indwelling use of catheters.
Bartlomé, N., Conen, A., Bucheli, E., Schirlo, S., & Fux, C. A. (2015). Change management with empowerment of nursing staff to reduce urinary catheter use. Antimicrobial Resistance and Infection Control, 4(Suppl 1), P217.
Bell, N., Eagan, J., Warren, M., Graham, J., Kamboj, M., & Sepkowitz, K. (2015). Catheter Associated Urinary Tract Infection (CAUTI) Surveillance: Less Charts, More Prevention. American Journal of Infection Control, 43(6), S35.
Calfee, D. P. (2013). Catheter-Associated Bloodstream Infections. InEssentials of Hospital Medicine: A Practical Guide for Clinicians (pp. 703-716).
Clarke, K., Tong, D., Pan, Y., Easley, K. A., Norrick, B., Ko, C., & Stein, J. (2013). Reduction in catheter-associated urinary tract infections by bundling interventions. International journal for quality in health care, 25(1), 43-49.
Giles, M., Watts, W., O’Brien, A., Berenger, S., Paul, M., McNeil, K., & Bantawa, K. (2015). Does our bundle stack up! Innovative nurse-led changes for preventing catheter-associated urinary tract infection (CAUTI). Healthcare Infection, 20(2), 62-71.
Gordon, P. R. (2015). The Effects of Nursing Education on Decreasing Catheter Associated Urinary Tract Infection Rates.
Marra, A. R., Camargo, T. Z. S., Gonçalves, P., Sogayar, A. M. C. B., Moura, D. F., Guastelli, L. R., & Edmond, M. B. (2011). Preventing catheter-associated urinary tract infection in the zero-tolerance era.American journal of infection control, 39(10), 817-822.
Meddings, J. (2014, October). Systematic Review of Interventions to Reduce Catheter-Associated Urinary Tract Infection in the Long-Term Care Setting. In ID Week 2014. Idsa.
Oman, K. S., Makic, M. B. F., Fink, R., Schraeder, N., Hulett, T., Keech, T., & Wald, H. (2012). Nurse-directed interventions to reduce catheter-associated urinary tract infections. American journal of infection control, 40(6), 548-553.
Parry, M. F., Grant, B., & Sestovic, M. (2013). Successful reduction in catheter-associated urinary tract infections: focus on nurse-directed catheter removal. American journal of infection control, 41(12), 1178-1181.
Scanlon, M. K., Deluca, G., & Bono-Snell, B. (2012). Reducing Catheter-Associated Urinary Tract Infections in Home Care: A Performance Improvement Project. Home Healthcare Now, 30(7), 408-417.
Stacy, K. M. (2015). Challenges in Hospital-Associated Infection Management: A Unit Perspective. AACN advanced critical care, 26(3), 252-261.
Sutherland, T., Beloff, J., McGrath, C., Liu, X., Pimentel, M. T., Kachalia, A., & Urman, R. D. (2015). A Single-Center Multidisciplinary Initiative to Reduce Catheter-Associated Urinary Tract Infection Rates: Quality and Financial Implications. The health care manager, 34(3), 218-224.
Zhou, Q., Lee, S. K., Hu, X. J., Jiang, S. Y., Chen, C., Wang, C. Q., & Cao, Y. (2015). Successful reduction in central line–associated bloodstream infections in a Chinese neonatal intensive care unit. American journal of infection control, 43(3), 275-279.
Appendix A
Credible Sources
Author(s)(Formatted as in-text citation)
Database(CINAHL, EBSCO, Cochrane, Pro-Quest)
Peer-Reviewed(Yes/No)
Applicability(Yes/No)
Evidence Grade(Strength/ Hierarchy)
Appraisal(Briefsummary of findings; how findings inform your project?)
Inclusion(Yes/No)
Meddings, 2014)
Cochrane
Yes
Yes
4/Cross-Sectional
Systematic Review of Interventions to Reduce Catheter-Associated Urinary Tract Infection in the Long-Term Care Setting
Yes
Gordon, 2015).
Cochrane
Yes
Yes
4/Cross-Sectional
The Effects of Nursing Education on Decreasing Catheter Associated Urinary Tract Infection Rates
Yes
Stacy, 2015).
Pro-Quest
Yes
Yes
4/Cross-Sectional
Challenges in Hospital-Associated Infection Management
Yes
Clarke et al., (2013)
Pro-Quest
Yes
Yes
4/Cross-Sectional
Reduction in catheter-associated urinary tract infections by bundling interventions
Yes
Andreessen et al., (2012)
Pro-Quest
Yes
Yes
4/Cross-Sectional
Preventing catheter-associated urinary tract infections in acute care: the bundle approach
Yes
Want help to write your Essay or Assignments? Click here
Want help to write your Essay or Assignments? Click here
Medication Errors
Introduction
This study basically analyzes the perception of nurses with regards to errors in medication. It has been pointed out that different nurses have diverse perceptions in relation to the causes of medication errors. Some of the major causes include indecipherable handwritings by physicians, distractions, exhaustion, and tiredness. A few nurses believe that many cases of medication errors have been reported and those that have not been reported are often as a result of peer pressure or fear of the managers. The results of this study can be essential in the programs intended to encourage detection of medication errors and the elimination of the obstacles that prevent people from reporting such incidences.
Medication Error among Nurses
Medication errors can be described as failure to follow the physicians’ prescription. Medication errors in hospitals are extremely common and are realized almost each and every day. The most common sources of these errors include provision errors, calculation errors, administration errors, and monitoring errors (Feleke, Mulatu, & Yesmaw, 2015). All the staff in the medication department including pharmacists, nurses, unit clerks and physicians can cause the occurrence of a medication error.
When it comes to drug administration errors, nurses are ranked at the fore front since they are responsible for administering those drugs to the patients. These errors have adverse negative impacts on the nurses such that they are often victims of psychological effects since most nurses who get involved in medication errors face trauma while others end up being devastated.
First and foremost, nurses care about their patients; hence, those errors can cause guilt and some of them feel extremely terrified and upset (Oshikoya, Oreagba, Ogunleye, Senbanjo, MacEbong, & Olayemi, 2013).In addition, they lose confidence in their professional abilities. Also, they get angry at themselves and end up criticizing their own selves. Any nurse is capable of committing medication errors regardless of their years of practice, education or age.
Application of Evidence-Based Literature
Most medical institutions rely on the nurses to identify and report any medication errors regardless of the cause of the errors. Researchers have pointed out that most nurses do not report such incidences (Feleke, Mulatu, & Yesmaw, 2015).In order for the prevalence medication errors to be reduced, the nurses have to take the initiative of accurately reporting such cases so as to help in establishing appropriate remedies that would help to deal with the crisis. In case an incident of medication error is not reported, it conceals the defective systems which can lead to more damages.
It is important to consider the fact that the medical institutions that rely on reports of such incidences to provide information often tend to overlook issues to do with date errors. Reports are provided by the nurses who recognize the errors which are then forwarded to the administration, department of risk management, or quality department. The systems of reporting primarily depends on the conviction of the nurse that he or she has committed the mistake, ability to identify the occurrence of an error, accepting that there is a probability that the nurse in question might be dismissed , and the belief that the error needs to be reported (Russo, Buonocore, & Ferrara, 2015).
The most underreported incidences in medical institutions concern administration of medicine. This occurs mainly because the nurses believe that this does not have adverse effects on the patient’s health. On the other hand, the most often reported cases involve overmedication. Nurses intentionally choose not to report medication errors due to fear of punishment that may often lead to termination of their services. They also fear that they might be mistaken to have committed the medication errors intentionally.
Want help to write your Essay or Assignments? Click here
Analysis of Literature
In healthcare institutions, drug interventions are intended to accomplish positive results for different patients as well as preventing the occurrence of undesirable drug reactions. It has been pointed out that most cases of deaths occur due to medication errors hence creating a significant need to research more on these errors; thus, placing high attention on the nurses (Russo, Buonocore, & Ferrara, 2015). The management of medication is acknowledged as an elemental aspect of the role of nurses since it is mostly connected with extensive risks.
Continuous observation should be maintained so as to evade the possibility for medication errors. Nurses have been assigned with the task of administering medicines to all the patients; hence, they should be at a position to report any incident of medication errors. Medication errors can be stated as failure of completing planned action or using a wrong method to achieve a medical based objective (Ammouri et al, 2015). Most events that have been realized are often as a result of dispensing, distribution, errors in professional practices and wrong prescription. Hospitals which lack disciplinary actions are likely to report a rise in the occurrence of medication errors amongst their staff especially the nurses.
Conclusion
All the staff in the medication sector including nurses, pharmacists, unit clerks and physicians can lead to the occurrence of a medication error. Whenever medication error is identified, and no action is taken, this can lead to an increase in costs. It is essential to note that any nurse is capable of committing medication errors regardless oftheir years of practice, education or age. In medical institutions where disciplinary action is not considered important as such, there is a likelihood of an increase in the number of incidences to do with medication errors.
Want help to write your Essay or Assignments? Click here
Promoting Awareness on Heart Disease through Evidence-Based Practice
In investigating the impact of promotion awareness on preventing heart disease in women, the following PICOT question will be used to guide the research:
In women with cardiovascular diseases (P), does health promotions using evidence-based strategies to achieve optimal health of the heart (I), as compared to women receiving standard cardiovascular care (C) show better improvement in the cardiovascular disease (O) within six months? (T).
Using terms in the PICOT statement was not effective in finding useful studies. Most of the studies found by using such terms addressed broader concepts or did not relate all the ideas that the PICOT question needed to address. Some of them talked about one aspect of cardiovascular diseases alone without giving any hint about women, outcomes or interventions made towards controlling the condition.
Want help to write your Essay or Assignments? Click here
MESH terms such as cardiovascular, women, health promotion and others limited the number of studies that were listed on the databases compared to when those terms were not used. Therefore, this is an implication that the utilization of the MESH terms delimited the search as it filtered out some of the search results that did not have most components of the PICOT question.
Most of the research findings were not relevant to the study. To improve the relevance of the of the materials obtained, I applied limiters such as age, studies, EBP, women, years so as to only have articles that had a direct link to the various components of the Picot statement. The use of limiters was helpful because most of the items obtained in this case gave relevant information about aspects of the study. Reviewing this articles provided adequate information on the association between evidence-based practice in health promotion and improvement of cardiovascular diseases in women.
The study used for the study on preventing heart disease in women the following databases: AHRQ, guidelines.gov, joannabriggslibrary.org, EBCO, PubMed, and Ovid to gather evidence. All of them provided valid pieces of evidence. The study provided level I evidence as most of the articles were systematic reviews of randomized control trials.
Vandvik, P. O., Lincoff, A. M., Gore, J. M., Gutterman, D. D., Sonnenberg, F. A., Alonso-Coello, P., … & Spencer, F. A. (2012). Primary and secondary prevention of cardiovascular disease: antithrombotic therapy and prevention of thrombosis: American College of Chest Physicians evidence-based clinical practice guidelines. CHEST Journal, 141(2_suppl), e637S-e668S. Retrieved from https://www.guideline.gov/summaries/summary/35273?.
Want help to write your Essay or Assignments? Click here
Want help to write your Essay or Assignments? Click here
Preventing Heart Disease in Women by Promoting Awareness through Evidence-Based Practice
In investigating the impact of promotion awareness on preventing heart disease in women, the following PICOT question will be used to guide the research:
In women with cardiovascular diseases (P), does health promotions using evidence-based strategies to achieve optimal health of the heart (I), as compared to women receiving standard cardiovascular care (C) show better improvement in the cardiovascular disease (O) within six months? (T).
Using terms in the PICOT statement was not effective in finding useful studies. Most of the studies found by using such terms addressed broader concepts or did not relate all the ideas that the PICOT question needed to address. Some of them talked about one aspect of cardiovascular diseases alone without giving any hint about women, outcomes or interventions made towards controlling the condition.
Want help to write your Essay or Assignments? Click here
MESH terms such as cardiovascular, women, health promotion and others limited the number of studies that were listed on the databases compared to when those terms were not used. Therefore, this is an implication that the utilization of the MESH terms delimited the search as it filtered out some of the search results that did not have most components of the PICOT question.
Most of the research findings were not relevant to the study. To improve the relevance of the of the materials obtained, I applied limiters such as age, studies, EBP, women, years so as to only have articles that had a direct link to the various components of the Picot statement. The use of limiters was helpful because most of the items obtained in this case gave relevant information about aspects of the study. Reviewing this articles provided adequate information on the association between evidence-based practice in health promotion and improvement of cardiovascular diseases in women.
The study used for the study on preventing heart disease in women the following databases: AHRQ, guidelines.gov, joannabriggslibrary.org, EBCO, PubMed, and Ovid to gather evidence. All of them provided valid pieces of evidence. The study provided level I evidence as most of the articles were systematic reviews of randomized control trials.
Vandvik, P. O., Lincoff, A. M., Gore, J. M., Gutterman, D. D., Sonnenberg, F. A., Alonso-Coello, P., … & Spencer, F. A. (2012). Primary and secondary prevention of cardiovascular disease: antithrombotic therapy and prevention of thrombosis: American College of Chest Physicians evidence-based clinical practice guidelines. CHEST Journal, 141(2_suppl), e637S-e668S. Retrieved from https://www.guideline.gov/summaries/summary/35273?.
Want help to write your Essay or Assignments? Click here
Want help to write your Essay or Assignments? Click here
Use of Chlorhexidine Bath to Reduce Central-Line Associated Bloodline Infections (CLABSI)
The study on the impact of daily use of chlorhexidine bath on the outcomes of ICU adult patients with central-line associated bloodstream infection guided by the PICOT question: In adult patients in Intensive care units (P), does daily use of chlorhexidine bath (I) compared to the use of ordinary soap and water (C), decrease the central-line associated bloodline infections (O), in a period of six months?
An understanding of the effect that chlorhexidine bath can have on improving patients’ outcome is an impact to nursing care and can serve as evidence to nursing practices. Poor nursing practices have adverse effects on patient’s outcomes and results to long hospital stay duration, which is associated with more other risks and complications. Investigation of the best practices on CLABSI, a condition whose outcomes is greatly dependent care is an important thing as it will better the care practices.
Findings
The results of the inquiry are in tandem with the proposition of implementation of chlorhexidine bath as a means in washing intravenous ports to control CLABSI. Results of the study undertaken indicate a decline in rates of infections due to the use of chlorhexidine bath are significant evidence for its adoptions. In investigating the outcomes of the impacts of chlorhexidine, some studies were used, all of which gave valid evidence that indicated a positive result in adult CLABSI patients.
From the systematic reviews and other studies, it was reported that the use chlorhexidine bath in the management of infections is one of the most essential intervention. Systematic reviews linked the application of chlorhexidine bath as an approach of minimizing the level of HA-CLABSI as well as association health care and medication costs.
A systematic review (Karki, & Cheng, 2012), realized that use of non-rinse CHG application has a positive impact as it substantially lowers the risk of CLABSI, SSI, and colonization with VRE or MRSA. Another study (Kim et al., 2016), which was conducted to investigate the effect the effects chlorhexidine bathing in CLABSI also gave a similarly positive conclusion. Kim et al. carried out peer reviews and meta-analyses, which indicated that use of chlorhexidine on a daily basis reduced the incidences of CLABSI, MRSA, and VRE to a great extent (2016).
In addition, Kim et al. found out that the extended use of the approach improved patient outcomes. While conducting investigations using the same variables, a randomized controlled study on the effects of chlorhexidine bath interventions hospital-acquired infections, (Wong et al., 2013) gave positive findings linking the two. Wong et al., states that a daily use of washcloths impregnated with chlorhexidine protected patients from acquiring MDROs and central-line associated bloodstream infections.
Many other studies (Cullen et al., 2016; Denny 2016) reviewed gave additional evidence that supported the use of the intervention in reducing chances of the concurrence of hospital-based conditions and other conditions. The meta-analysis study conducted by (Cullen et al., 2016) found out that using 2 % chlorhexidine lowered the incidences of central-line associated bloodline infections. Moreover, by this mediation, this study reports that related costs of care are decreased by 10% as compared when there are no such interventions.
Want help to write your Essay or Assignments? Click here
Impact
The research will have positive results in the sense that it will provide pieces of evidence that will be used to trigger changes in health care practices. Findings from this study will be used to disprove poor practices which affect patients’ outcomes. As seen from some of the studies, besides improvement of patient’s outcomes, it is also evident that the intervention can improve the whole healthcare system as some of the unnecessary costs due to complex conditions, and increased hospital stay will be dealt with.
The effect of this intervention will imply that there will be decreased cases of CLABSI, BCC among other conditions. If this intervention is not practiced, then hospital stay duration for patients may be increased and an ultimate increase in the cost of their medication. Generally speaking, without the evidence-based practice, then CLABSI incidences will continue being high as well poor patient outcomes.
Strategy: Implementation and Challenges
The model can be used in the implementation is the Stetler model which is made up of five stages (Stetler et al., 2007; Aarons, Hurlburt, & Horwitz, 2011), all the parts in this model are designed to allow for critical thinking on the issue of implementation. The model is also a vital tool in minimizing errors in practice. Use of Stetler model in executing chlorhexidine bath will involve the following phases which will be crucial as a requirement of the design.
Phase 1 (preparation for implementation of Evidence Based Intervention): The aim of this approach could be sited as use of chlorhexidine bath in patients in various patient care settings with the aim of decreasing the rates of CLABSI. In this stage, activities that will be used in support of this evidence-based practice will involve the systematic review randomized studies, the quasi-experimental intervention study, and the prospective multivariate study. In the preparation stage, factors that have the ability of affecting the implementation process such as nurse commitment are needed for best practice.
Phase two (validation):All the evidence and studies chosen to support evidence will be analyzed individually to confirm their suitability and credibility to use in enhancing the use of disinfection caps in the management of CLABSI. This process will be essential for determining the strength of the evidence and will be used in finding whether or not to use evidence from such sources for the preparation of the evidence-based practice.
Phase Three (Comparative evaluation): From in depth study of the various articles chosen for this research, it was noted that they have a great index of resemblance, considering the contents of PICO question. Though different designs were used, they managed to measure the impact of chlorhexidine bath on the incidences of CLABSI. Moreover, study population addressed was the adults. At this juncture, the possibility of the intervention will be chosen by use of triple ‘r’ Stetler’s concept in which provision of necessary resources, risks and willingness of other stakeholders such as nurses and doctors will be considered before launching on the evidence-based intervention.
Phase Four (Translation): This will involve a process that is written down on how the implementation process of using chlorhexidine bath will be used to promote the control of CLABSI.
Phase Five (Evaluation):The results of the evidence-based practice will be assessed in various ways. In most cases, this will be achieved by records or a realization of a decreased number of CLABSI and associated conditions.
The preferences and values of other persons including nurses and patients may accelerate or hinder the process. It is as indicated in the Stetler’s model of EBP in third phase where r’ r’ r’ concept is applied. The Evidence-based practice will not be achieved if the resources (R). Also, if other stakeholders are not ready(R) to adopt the approach, then it will not be easy for it to take root.
Lack of enthusiasm from both nurses and patients may pose as a challenge to the project in that clinicians are required to aid in executing it, so that when they object, they will adhere to their standard practice. Some patients have autonomy rights that prompt them to decline some forms of medical procedures. Therefore, the best way of overcoming implementation challenges will include convincing other healthcare workers and ensure that the practice is well funded and supported by stakeholders.
Project Summary
This research entails collection of evidence that will be used to guide practices in nursing and healthcare as a whole. It focuses on investigating the impact of using chlorhexidine baths to reduce incidences central-line associated bloodstream infections and others conditions that are hospital-based. The project examines different types of researches, be it single-quantitative researches, systematic reviews, meta-analyses and other types of evidence.
To complete this project, research will be limited to the PICOT research question: In adult patients in Intensive care units (P), does daily use of chlorhexidine bath (I) compared to the use of ordinary soap and water (C), decrease the central-line associated bloodline infections (O), in a period of six months?.
Others studies carried on CLABSI, which will not address all these components will not be used as evidence to validate or disprove the intended intervention. Evidence will be gathered from studies that involve adult patients under intensive care or other high risks levels of care. In carrying out this inquiry, outcomes will be compared against that of patients who will not be under intervention programs.
Carrying out this survey is an important thing to healthcare practices in the sense that it will collect enough evidence that will be used to guide care practices so that there is an ultimate improvement in patient outcomes. Further, this research intends to find valid information that will be used to reduce the standard practices such as the use of water and soap, which have proved hurtful to patients’ outcomes.
References
Aarons, G. A., Hurlburt, M., & Horwitz, S. M. (2011). Advancing a conceptual model of evidence-based practice implementation in public service sectors. Administration and Policy in Mental Health and Mental Health Services Research, 38(1), 4-23. Retrieved from http://link.springer.com/article/10.1007/s10488-010-0327-7.
Climo, M. W., Yokoe, D. S., Warren, D. K., Perl, T. M., Bolon, M., Herwaldt, L. A., & … Wong, E. S. (2013). Effect of daily chlorhexidine bathing on hospital-acquired infection. The New England Journal of Medicine, 368(6), 533-542. doi:10.1056/NEJMoa1113849
Denny, J. (2016). Chlorhexidine Bathing Effects on Health-Care-Associated Infections. Biological Research for Nursing.
Karki, S., & Cheng, A. C. (2012). The impact of non-rinse skin cleansing with chlorhexidine gluconate on prevention of healthcare-associated infections and colonization with multi-resistant organisms: a systematic review. The Journal of Hospital Infection, 82(2), 71-84. doi:10.1016/j.jhin.2012.07.005
Kim, H. Y., Lee, W. K., Na, S., Roh, Y. H., Shin, C. S., & Kim, J. (2016). The effects of chlorhexidine gluconate bathing on health care-associated infection in intensive care units: A meta-analysis. Journal of Critical Care, 32126-137. doi:10.1016/j.jcrc.2015.11.011.
Shah, H. N., Schwartz, J. L., Luna, G., & Cullen, D. L. (2016). Bathing With 2% Chlorhexidine Gluconate: Evidence and Costs Associated With Central Line-Associated Bloodstream Infections. Critical Care Nursing Quarterly, 39(1), 42-50. doi:10.1097/CNQ.0000000000000096
Stetler, C. B., Ritchie, J., Rycroft-Malone, J., Schultz, A., & Charns, M. (2007). Improving the quality of care through routine, successful implementation of evidence-based practice at the bedside: an organizational case study protocol using the Pettigrew and Whipp model of strategic change. Implementation Science, 2(1), 1. Retrieved from https://implementationscience.biomedcentral.com/articles/10.1186/1748-5908-2-3.
Want help to write your Essay or Assignments? Click here
Want help to write your Essay or Assignments? Click here
Interview
I interviewed LD who is the Nurse in charge at St. Monica Hospital. The interview took place on 27th July, 2016. According to LD, there are many career pathways in nursing. Typically, all nurses are required to have at least two year training in areas such as psychology, anatomy, pharmacology and patient care practice. In her case she started as a Licensed Practical Nurse (LPN).
Nurses at this level are permitted to conduct simple medical procedures under the guidance of a registered nurse. Her common tasks at this level included measuring blood pressure, dressing wounds and keeping patient records. After two years of LPN, she acquired a nursing degree and became a Resisted Nurse (RN). At this level, she was able to supervise the work of LPNs and was responsible for the overall safety of the patients under her care.
LD indicates that one of the most important pillars of modern nursing is evidence-based care. This method of care is based on the need of improving patient outcomes through the delivery of high-quality care. Studies have indicated that when best evidence is used in care, the patient outcomes improve (Ginter, 2013). At St. Monica Hospital where the interviewee works, there are various best evidence practices at play.
For example, she indicates that they use oxygen therapy for patients with chronic obstructive pulmonary disease. They also use infection control practices to prevent infections and use non-invasive techniques to measure blood pressure in children.
There are various technologies that have been adopted in the healthcare systems. One of the most important electronic systems from a nursing perspective is the Electronic Health Records (EHR). EHR allows nurse to electronically store data and information about patients past and present health status allowing for better diagnosis, treatment and management of diseases. However, there are various safeguards that must be observed in using electronic health records.
One of the most important safeguards is the observance of privacy and confidentiality of the patients (Malaker, 2013). To this end, nursing professionals must know their limits with regards to, how to handle patient information. One requirement is the need to seek approval of the patients with regards to sharing of private and confidential data.
This means nurses must be conversant with laws such as the HIPAA which governs how confidentially can be achieved within the health sector (Malaker, 2013). Nonetheless, occasionally the need to offer quality care and improve patient outcomes can outweigh the need for confidentiality, and this is the main basis of electronic health systems.
With regards to electronic records, garbage in, garbage out is used to make decisions regarding patient care. It is important for all information acquired from the patients to be accurate in order for the improved patient outcomes to be achieved. Remarkably, if wrong information is fed into the electronic systems, then wrong diagnosis and hence treatment might occur. Thus, nurses must work very hard to ensure that only the most appropriate and reliable patient’s data is used.
Reflection
This interview has modified my career expectations as a BSN-prepared nurse. I now understand the competency levels that are expected of me and the career path that I’m likely to take. For example, given that I will be entering the nursing field is a relatively high level of qualification, one of my roles will be to work with and supervise Licensed Practical Nurses. I will also be required to maintain patient privacy and confidentially, especially with regards to the electronic data of patients.
Malaker, K (2013). Personal medical record: Dominica’s low-tech, low-cost solution for a high-tech, high-cost problem. International Journal of Medicine and Medical Sciences, 3: 419-427.
Want help to write your Essay or Assignments? Click here
Want help to write your Essay or Assignments? Click here
Differential Diagnosis
The patient has presented with various symptoms and sign that prompt the need for a unique and proper differential diagnosis. The differential diagnosis is meant to enhance the better treatment and management strategies after identification of the main disorder. A differential diagnosis of endometriosis disorder which is also associated with musculoskeletal pain would be carried on the patient (Nelson et al, 2012).
The symptoms for endometriosis include heavy bleeding and irregular periods, dyspareunia problems, painful urination. E.g. during menstruation and pelvic pain especially in the lower abdomen. Some of the differential diagnosis include tests for generalized pelvic pain, pelvic adhesions and levators spasm. caused by musculoskeletal causes and also primary and secondary dysmenorrhea. Dyspareunia evaluation would be carried by assessment of pelvic vascular congestion. The patients only had irregular periods and dyspareunia problems as the main symptoms reported.
Primary Diagnosis
The primary diagnosis for primary and secondary dysmenorrhea caused by musculoskeletal pain is essential for the patient which is carried out through physical examination (Nelson et al, 2012). Primary phases is due to pain causes while secondary is due to organic diseases. Biochemical tests can also be used during clinical assessment. The patient reports pain in various parts of the body which necessitates the tests such as DNA probe testing and abdominal ultrasonography (Nelson et al, 2012).
Want help to write your Essay or Assignments? Click here
Treatment and Management
Medical treatment for endometriosis includes the use of medication such as danazol to relieve symptoms of the disorder. Use of agents such as goserelin and leuprolide is vital medication for relieving pain. Treatment for the musculoskeletal pain includes taking dosages like norepinephrine, serotonin, eszopiclone and ramelteon. Surgical treatment is recommended for the advances in endometriosis disorder (Apte et al, 2012).
Other pharmacological treatment measures include taking vaginal estrogens, local anesthetics, corticosteroids as management for dyspareunia. Clinical guidelines such as the emphasis on exercises, therapeutic massage, and osteopathic manipulations are essential for management of her condition (Lier et al, 2016).
Education would be provided to the patient regarding the importance of following the right prescription provided. Education on the necessity for modification of sexual positions during intercourse and offering psychological treatments would be vital in treatment and management of the condition suffered by the patient (Nelson et al, 2012).
The multidisciplinary approach would be adopted by incorporating effective pain management sessions for the patient, clinical psychology, physiotherapy as well as psychosocial drugs (Lier et al, 2016). The adoption of these strategies is effective in the management of the medical problems facing the patient.
Lier, R., Mork, P. J., Holtermann, A., & Nilsen, T. L. (2016). Familial Risk of Chronic Musculoskeletal Pain and the Importance of Physical Activity and Body Mass Index: Prospective Data from the HUNT Study, Norway. Plos ONE, 11(4), 1-13. doi:10.1371/journal.pone.0153828
Nelson, P., Apte, G., Justiz, R., Brismeé, J., Dedrick, G., & Sizer, P. S. (2012). Chronic Female Pelvic Pain-Part 2: Differential Diagnosis and Management. Pain Practice, 12(2), 111-141. doi:10.1111/j.1533-2500.2011.00492.x
Want help to write your Essay or Assignments? Click here
Want help to write your Essay or Assignments? Click here
Handling a Patient who Constantly Complains about Pain
As nursing students, we are trained on how to care for patients (Grace, 2013). In health care, pain is one of the symptoms that is primarily managed. The pain is of different kinds, various degrees and some of the patients might experience recurring pain or a onetime pain. We as nursing students come across all these patients and are tasked to care for them. As different diseases have different kinds of pains, they are dealt with differently. A migraine is a disease which has severe pain as the primary symptom (Hale & Paauw, 2014).This paper aims to discuss the ways a nursing student can handle a patient who frequently complains about pain.
Event
I recently encountered a patient who complained of severe headaches. He said that his headaches began just after a nasty bout of vomiting, which he attributed to spoilt milk. As with most headaches, he bought a painkiller to help him relieve the pain. However, the pain did not recede but became more specific to one-half of the head. This migraine was pulsing and throbbing, and every time he moved it became even more painful. After a day of pain, he decided not to go to work, as his job involved moving around a lot.
In addition to the ache, he experienced sharp sensitivity to light. He, therefore, had to resort to staying in places that are relatively darker. He also vomited twice, within twenty-four hours of the migraine, thus eating less as a result. He also learned to predict his headaches, just before the headaches, he would have a visual disturbance and then the severe migraine on one side of the head would start.
His chief complaint, however, was the throbbing headache. I asked him about how frequently he had severe headaches. He informed me that it was a regular thing, and would occur at least once a fortnight. He further told me that the headaches had started while he was quite young, and he had not attributed it to anything other than regular headaches. The reason why he never took his headaches into serious consideration was that he would feel quite well after taking the painkillers.
He further told me that the pain, for him, would last up to a maximum of twelve hours. The recent attack, however, lasted for twenty-four hours and in this case, the pain was throbbing. He noted that even though the previous headaches lasting for less than twelve hours were less painful, they all began just after a bout of vomiting. The regularity and severity of his pain indicated that he was suffering from a migraine (Rolan, 2014).
Want help to write your Essay or Assignments? Click here
Action: Diagnosis and Treatment of the Migraine
As I was asking him about his symptoms, I took note of everything he told me to the detail. My diagnosis of the patient was a migraine. I came up with the diagnosis after observing that the headaches were a recurring symptom and that they were unilateral, specific to one side of the head (Stark et al.,).Furthermore, he experienced a bout of vomiting just before the headaches began, and they lasted for between twelve to twenty-four hours. To confirm my diagnosis, I consulted the doctor, who reviewed the patient and asserted the diagnosis.
There are two types of treatment plans for migraine: abortive prescriptions and preventive antibiotics (Lau &Nissen, 2015). Both medications were prescribed to the patient. The abortive prescriptions would aid to reduce the head pain he was experiencing, and get rid of the accompanying symptoms.
The preventive medications would be to reduce the severity and frequency of future migraines. I also warned that the preventive antibiotics might be accompanied by a few side effects. These side effects included nausea, sleepiness, fatigue and a bit of physical weakness (Martin et al., 2014). However, I assured him that the cases of people experiencing these side effects were few.
Result: The Patient after Treatment
The patient before treatment was experiencing difficulty with movement and had stayed home from work as his job included a lot of movement. After treatment, he was able to move comfortably without experiencing debilitating ache. His sensitivity to light reduced and he became once more comfortable enough to stay in a well-lit room.
He was more relieved by the fact that he no longer felt the excruciating throbbing pain to one side of the head. The preventive drugs that were given to him reduced the occurrence of the headaches he felt were normal, and the severity of pain during one of the attacks was also reduced.
Lau, E., &Nissen, L. (2015). Nausea associated with migraines. Australian Journal of Pharmacy
Martin, P. R., Reece, J., Callan, M., MacLeod, C., Kaur, A., Gregg, K., &Goadsby, P. J. (2014). Behavioral management of the triggers of recurrent headache: a randomized controlled trial. Behaviour research and therapy, 61, 1-11.Silberstein, S. D. (2016). Considerations for management of migraine symptoms in the primary care setting. Postgraduate medicine, 128(5), 523-537.
Rolan, P. E. (2014). Understanding the pharmacology of headache. Current opinion in pharmacology, 14, 30-33.
Stark, R. J., Ravishankar, K., Siow, H. C., Lee, K. S., Pepperle,R., & Wang, S. J. (2013). Chronic migraine and chronic dailheadache in the Asia-Pacific region: a systematic review. Cephalalgia, 33(4), 266-283.
Want help to write your Essay or Assignments? Click here
