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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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Development of a Health Care Policy

Introduction

Development of a health care policy is one of the ways through which developing nations can be influenced to take actions that promote public health and reduce mortality rates, especially in countries where health inequality is a common problem. The Nature of health policy developed largely depends on specific health care problems that exist in a country at any given time.

Furthermore, one has to consider various social determinants of health in a country before developing and implementing a health policy (Kumar and Preetha, 2012). According to Kumar and Preetha (2012), social factors such as demographic patterns, political and economic changes, cultural issues, and learning environments are believed to influence health situations of many countries around the world.

A health policy that is aimed at reducing health inequality can be effective in promoting public health, and can greatly be supported by a country whose health is negatively impacted by disparities in health care. This paper explores the concept of health policy development and implementation about health inequality while giving special consideration to Malawi.

Health Care Policy: Rationale for Selecting Malawi

Malawi has been chosen for this case study because it is one of the world’s developing countries whose public health is negatively impacted by health inequality and lack of health policy to guide proper health care delivery. According to Daire and Khalil (2015), failure to access primary health care is one of the causes of high death rates among children aged below five years in Malawi.

Daire and Khalil (2015) further assert that health care for socio-economic barriers largely face Children in Malawi that policy makers in the health sector must address to promote positive child health in the country. Children who are born to low-income families in Malawi are highly likely to experience limited access to health care as compared to those who come from wealthy families. The main reason for the high infant mortality rates among low-income families in Malawi is a lack of primary health care policy.

According to Makaula, Bloch, and Muula et al., (2012) and Ustrup, Ngwira, and Fischer, et al., (2014), Malawi continues to experience low life expectancy because it currently lacks a primary health care policy to guide health care access among poor families with children aged below 5 years. Now, Malawi utilizes the Essential Health Package (EHP) program to implement primary health care.

This has impacted negatively on health care access among poor households and a significant reduction in life expectancy in the country. In this regard, Malawi is one of the developing countries that are experiencing high rates of infant deaths due to lack of primary health care policy and would; therefore, attract the attention of health policy makers (Daire and Khalil, 2015).

Social Determinants of Health in Malawi and Why they should be Addressed

There are two major social determinants of health in Malawi that need to be addressed. According to Kumar and Preetha, (2012), social determinants of health refer to factors in the social setting that influence the ability of a country’s population to obtain care at any given time. Examples of social determinants of health include socio-economic factors, family patterns, cultural beliefs and attitudes, learning environments, and demographic patterns.

In Malawi, the two social determinants of health that should concern policy makers are; economic affordability and geographic accessibility of health care facilities. These two social determinants are highly rampant among residents of rural Malawi. Rural populations in Malawi cannot access quality health care due to limited finances and high concentration of health care facilities in urban areas (Ustrup, Ngwira, and Fischer, et al., 2014).

In a study conducted by Ustrup, Ngwira, and Fischer, et al., (2014), the researchers have found that health care facilities are mainly located in urban Malawi, and this makes households based in rural Malawi to travel to the urban areas to seek for care. Ideally, rural Malawi does not only lack adequate health care facilities, but it also has poor roads that make it difficult for occupants to reach urban areas.

The long travel time coupled with high costs of transport prevent children from low-income families from receiving quality care, hence the observed high infant mortality rates in the country (Makaula, Bloch, and Muula, et al., 2012). Furthermore, variation in economic affordability among affluent and low-income families determines the nature of care that these two groups of populations can receive in Malawi.

Families in rural Malawi with either small or lack of basic income are faced with the challenge of obtaining care for their children as opposed to those in wealthy regions with high basic income. For this reason, limited economic affordability among residents of rural Malawi presents significant economic burden which prevents families from obtaining quality care for their children (Ustrup, Ngwira, and Fischer, et al., 2014; & Makaula, Bloch, and Muula, et al., 2012).

There is a great need to address social determinants of health about economic affordability and geographic accessibility of health care facilities to increase access to care for families in rural Malawi. As Daire and Khalil (2015) explain, one of the ways through which health inequality in Malawi can be solved is by addressing those factors that hinder citizens from accessing health care.

It is only by addressing these social determinants of health that Malawi will be able to reduce infant mortality and to achieve the Millennium Development Goals. Health care accessibility in Malawi will greatly be improved if the ability of low-income families to meet health care costs and to access health care facilities is enhanced (Daire and Khalil, 2015).

Potential Public Issues that might be encountered

Two major public issues may be faced in Malawi in an attempt to influence health policy development in the country. The possible general issues that may be encountered are related to the level of cultural awareness and health literacy among the country’s population. Health literacy refers to the ability of individuals to comprehend basic health information and their capacity to utilize it in decision-making.

High health literacy is directly related to improved health outcomes while limited health literacy is associated with poor public health. According to Smith-Greenway (2015), high infant mortality rates in Malawi are largely attributed to limited health literacy among low-income families in rural areas. Residents of rural Malawi rarely receive health education, and the public sector has not initiated any programs in those areas to keep citizens informed about health.

Also, the majority of households in rural Malawi can only speak their local language, and they do not understand any information presented to them in pure English (Smith-Greenway, 2015). Lack of public health education and proper communication of public health information are the primary causes of limited health literacy in Malawi. Consequently, limited health literacy may impede successful development and implementation of health policy in Malawi (Ustrup, Ngwira, and Fischer, et al., 2014).

The other public issue that may be encountered during health policy development and implementation in Malawi is the level of cultural awareness among the country’s population. According to Daire and Khalil (2015), cultural knowledge in a country determines the possibility with which a new policy can be developed and implemented. In this regard, it becomes difficult to implement a health policy that goes against the cultural beliefs and values of a country’s population.

As Reiney, Watkins, Ryman, Sandhu, Bo, and Benerjee, (2011) explain, low cultural awareness is a big problem in Malawi because it negatively affects health utilization among the country’s population. Specifically, cultural beliefs and values of the country’s population largely influence the patterns of health utilization in the country in the sense that, health underutilization is common in rural Malawi where occupants do not believe in care that is being offered by health care organizations. Ideally, low cultural awareness among rural populations in Malawi may prevent successful implementation of health policy in the country (Ustrup, Ngwira, and Fischer, et al., 2014).

Relationship Between Health Inequality and Life Expectancy in Malawi

There is an inverse relationship between health inequality and life expectancy in Malawi. In this regard, high disparities in health are associated with low life expectancy while low disparities in health are related to high life expectancy in Malawi. Life expectancy is low when infant mortality rate is high while life expectancy is high when infant mortality rate is low (Deurzen, Oorschot, and Ingen, 2014).

According to the World Health Organization report of 2017, health disparity in Malawi is significantly higher than that of Japan. Furthermore, an infant born in Malawi is highly likely to die at the age of 47 while a child born in Japan will probably die at the age of 87. Therefore, when health inequality is high in Malawi, life expectancy in the country is significantly low, especially among the rural populations (World Health Organization, 2012).

The inverse relationship between health inequality and life expectancy among poor populations is supported by research evidence. In a study conducted by Deurzen, Oorschot and Ingen (2014) the researchers have found that the rate of infant mortality is higher among the poor than among the rich populations. Therefore, a policy that can reduce health inequality will help to reduce infant mortality rate and eventually raise life expectancy (Deurzen, Oorschot, and Ingen, 2014).

Current Efforts in Malawi to Reduce Health Inequalities

The government of Malawi has worked hard to reduce health inequalities in the country with the aim of reducing infant mortality rates that occur among its rural populations. These efforts are geared towards addressing two major social determinants of health: economic affordability and geographic accessibility of health care facilities. As Ustrup, Ngwira, and Fischer, et. al., (2014) explain, governments can increase geographic accessibility of health care facilities by constructing additional organizations in rural areas.

Between 2003 and 2010, the Government of Malawi constructed a total of 39 health centers in the rural areas. This has helped its rural populations to access health care and to save time and money that could have been spent in traveling to the urban areas to seek for health care. Additionally, Malawi has taken appropriate actions to mitigate financial barrier among its rural populations by increasing their ability to meet health care cost.

In the year 2010, the Government of Malawi signed an agreement with facilities that operate under the Christian Health Association of Malawi (CHAM) to allow free health care services for mothers and children. With free access to child and maternal health care services, Malawi has been able to record a decrease in infant mortality rate with a slight increase in life expectancy (Ustrup, Ngwira, and Fischer, et. al., 2014).

Health Policy

The best health policy to address health inequality in Malawi would be that which will get the support of the country’s population, considering the fact that residents of rural Malawi have limited health literacy and do not have trust in the care offered by health care organizations (Makaula, Bloch, and Muula, et al., 2012).

An example of a policy that might be developed to reduce health inequality in Malawi is the creation of a National Development and Social Fund to support programs that facilitate construction of health care facilities in the rural areas, while at the same time meeting the health care costs of mothers and children who reside in rural Malawi.

The Government of Malawi should set aside funds to facilitate implementation of this policy to ensure that both rural and urban populations have equal access to health care. Successful implementation of this policy will result in a reduction in infant mortality rates among the poor populations in Malawi, which will eventually translate into high life expectancy in the country (Ustrup, Ngwira, and Fischer, et. al., 2014; Dairen and Khalil, 2015).

References

Daire, J. & Khalil, D. (2015). Analysis of maternal and child health policies in Malawi: The methodological perspective. Malawi Medical Journal, 27(4): 135-139.

Deurzen, I. V., Oorschot, W. V. & Ingen, E. (2014). The link between inequality and population health in low and middle-income countries: Policy myth or social reality? PLoS ONE, 9(12): e115109. https://doi.org/10.1371/journal.pone.0115109

Kumar, S. & Preetha, G. S. (2012). Health promotion: An effective tool for global health. Indian Journal of Community Medicine, 37(1): 5-12. doi: 10.4103/0970-0218.94009

Makaula, P., Bloch, P…..& Muula, A. S. (2012). Primary health care in rural Malawi: A qualitative assessment exploring the relevance of the community-directed interventions approach. BMC Health Services Research, 12: 328. doi: 10.1186/1472-6963-12-328

Reiney, J. J., Watkins, M., Ryman, T. K., Sandhu, P., Bo, A. & Benerjee, K. (2011). Reasons related to non-vaccination and under-vaccination of children in low and middle-income countries: Findings for a systematic review of the published literature, 1999-2009. Vaccine, 29(46): 8215-8221. doi: 10.1016/j.vaccine.2011.08.096

Smith-Greenway, E. (2015). Are literacy skills associated with young adults’ health in Africa: Evidence from Malawi. Social Science and Medicine, 127: 124-133. doi: 10.1016/j.socscimed.2014.07.036.

Ustrup, M., Ngwira, B…& Fischer, T. (2014). Potential barriers to healthcare in Malawi for under-five children with a cough and fever: A national household survey. Journal of Health Population and Nutrition, 32 (1): 68-78.

World Health Organization, (WHO). (2017). Fact file on health inequality. Retrieved from http://www.who.int/sdhconference/background/news/facts/en/

Reducing nursing alarm fatigue

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Reducing nursing alarm fatigue

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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Genetic Counseling and Testing

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Genetic Counseling

With the increase in knowledge around genetic issues, it is important that all healthcare providers are prepared to have thorough genetic-based discussions now with their patients. In this assignment, you will synthesize your knowledge into a client case with a real or potential genetic health-related illness.
• Use the Surgeon General’s Family History Tool at http://www.hhs.gov/familyhistory/portrait/index.html to complete this assignment.

Directions:

Write a 1,000 word paper addressing a client case that might benefit from the process of genetic counseling.

-Describe the reason for the genetic counseling based on the findings from your completion of the history tool.

-Discuss the possible reactions the patient may have to your counseling and how to avoid negative reactions.

Imagine this assignment as if you are giving this counseling to a patient. Discuss the following:

Health.
Prevention
Scr: eening
Diagnostics
Prognostics
Selection of treatment
Monitoring of treatment effectiveness

Genetic Counseling

Genetic Counseling: Introduction

Diabetes mellitus is considered a lifetime condition which inhibits the body’s capability to regulate metabolic glucose levels. Basically, it is divided into two categories that are; diabetes mellitus type 1 and type 2. Symptoms of type 1 occur after the destruction and damage of cells found within the pancreas leading to a deficit in the production of insulin. In diabetes mellitus type 2, insulin is produced, but it is either not enough or not effective at all (Hivert, Vassy, & Meigs, 2014). As an integral pillar of managing patients suffering from diabetes mellitus, genetic counseling is an aspect that should not be overlooked.

Reasons for Genetic Counseling

The patient is a 37-year-old African American male. The patient’s father passed away three years ago when he overdosed anti-diabetic medication. The patient’s mother was diagnosed with diabetes mellitus three years ago and has developed a diabetic foot complication. The client weighs 120.0 kilograms and his height is 1.4 meters. Diabetes mellitus is a disorder that has been associated with familial inheritance.

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The genetic factors responsible for causing diabetes mellitus are believed to be located from HLA regions within chromosome 6p21 (Hivert, Vassy, & Meigs, 2014). The protein sequences are inheritable factors. According to the family’s history, the patient is at risk of developing diabetes mellitus. A significant reason for genetic counseling is to create awareness. Through genetic counseling, the patient is expected to appreciate the fact that the condition can run across generations (Kaveeshwar & Cornwall, 2014).

Possible Reactions from the Patient

During the process of counseling, a patient’s reaction is either positive or negative. Positive feedback from the patient acts as a trajectory method to determine the cooperation of the client. The cooperation from the patient is determined by the patient’s mood and response (Anstee, Targher, & Day, 2013). In order to avoid negative reactions, a health worker is expected to first assess the patient’s mental well-being. For example, a depressed patient is most likely to respond negatively during genetic counseling (Anstee et al., 2013).

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The genetic counselor is expected to approach the client in a professional manner to avoid unnecessary predicament. Establishing rapport allays anxiety. In addition, the patient should be given time to present any ideas that might be necessary for the discussion. Appreciating any effort made by the patient to ask questions is also critical in managing negative feedback from the client.

Health

The ability of an individual to manage and adapt to mental, physical, psychological and spiritual well-being constitutes the health aspect of the individual (Anstee et al., 2013). A chronic illness like diabetes mellitus negatively affects the psychological status of any patient. Therefore, while providing counseling, mental, physical, psychological and spiritual well-being of the patient should be continuously assessed.

Prevention

The prevention of the occurrence and diabetes mellitus and the associated complications of diabetes will be undertaken in three stages including; primary, secondary and tertiary preventive measures. During primary prevention, the patient is educated on self-management and administration of insulin (American Diabetes Association, 2014). Secondary prevention is crucial for the patient diagnosed with diabetes mellitus.

Insulin administration and a change of lifestyle are two key pillars in improving the quality of life for diabetic patients. Dietary modification and engaging in physical activity for a specific period of time a day are crucial for prevention of complications arising from diabetes mellitus.

Screening

The process of screening involves coming up with a strategy to identify a condition which might have not manifested with signs and symptoms. The patient will be screened based on the presenting symptoms. The patient will be assessed on the level of blood glucose, the urinary functioning, the amount of water and food taken. The objective of the assessment is to identify the symptoms such as increased thirst, hunger, and the rate of urination.

The level of glycosylated hemoglobin is also part of the screening process in diabetes mellitus case. In the case scenario encountered, screening other family members is significant (American Diabetes Association, 2014). The unrecognized clinical manifestations among the siblings are identified through screening. In order to prepare in advance on dealing with the complications of diabetes mellitus, the process of screening is required.

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Diagnostics

Diagnosis is the process of coming up with the exact condition that the patient presents with. A patient is diagnosed with diabetes mellitus if the random blood glucose is 11.0 mili-moles per liter in cases with hyperglycemia, or oral glucose tolerance test of 11.0 mili-moles per liter or a fasting blood glucose level of 7.0 mill moles per liter. The management approaches for diabetes include self-insulin administration, physical activities, nutritional aspects and a general change in lifestyle (American Diabetes Association, 2014).

Prognostics

Aggressive management of the symptoms of diabetes mellitus includes prevention of complication like diabetes ketoacidosis. Control of the blood sugar results into control of micro-vascular complications of diabetes mellitus. Further, research studies have shown that the control of the level of glycosylated hemoglobin is associated with a reduction in the number of cases of mortality among diabetes mellitus patients. In order to prevent uncertainties, the patient needs to be advised to regularly administer insulin and monitor the glucose levels (Scirica, Bhatt, Braunwald, Steg, Davidson, Hirshberg, & Cavender, 2013).

The Selection of Treatment

Selecting the method of treatment will depend on the blood sugar levels of the patient. Other than insulin, other diabetic drugs like glibenclamide and metformin are prescribed based on the severity of presenting symptoms (American Diabetes Association, 2014). Administration of the drugs is preferred only in cases where the recommended lifestyle change fails to correct the blood sugar levels and associated symptoms. Furthermore, the dosage of drugs administered depends on the level of sugars present in circulation.

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Monitoring of Treatment Effectiveness

Monitoring involves making keen and observant follow up on the patient’s adherence to lifestyle modification, medication, participation in physical exercises and nutritional modification. The client will be educated and instructed to measure the glucose level by use of glucometer on a daily basis. The reduction of sugars in the blood will imply that the client positively responds to drugs, and other management approaches.

The medication dosage will be adjusted according to the level of glucose levels (American Diabetes Association, 2014). For example, an increase in the blood glucose level above 7.9 mili-moles per liter requires the use of high potency anti-diabetic medications.

In conclusion, diabetes mellitus is a lifelong condition which needs proper and well-structured management. A collaborative approach among the health workers, the patient and family members is necessary. As part of management on counseling, effective familial history is necessary.

The patient’s reaction expected during counseling is either of positive or negative feedback. The condition requires the combination of genetically oriented measures. The level of blood sugar in diabetes mellitus determines the screening, diagnosis, prognosis, treatment selection and measurement of treatment effectiveness.

Reference

American Diabetes Association. (2014). Diagnosis and classification of diabetes mellitus. Diabetes care, 37(Supplement 1), S81-S90.

Anstee, Q. M., Targher, G., & Day, C. P. (2013). Progression of NAFLD to diabetes mellitus, cardiovascular disease or cirrhosis. Nature Reviews Gastroenterology & Hepatology, 10(6), 330.

Hivert, M. F., Vassy, J. L., & Meigs, J. B. (2014). Susceptibility to type 2 diabetes mellitus—from genes to prevention. Nature Reviews Endocrinology, 10(4), 198.

Kaveeshwar, S. A., & Cornwall, J. (2014). The current state of diabetes mellitus in India. The Australasian medical journal, 7(1), 45.

Scirica, B. M., Bhatt, D. L., Braunwald, E., Steg, P. G., Davidson, J., Hirshberg, B., & Cavender, M. A. (2013). Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. New England Journal of Medicine, 369(14), 1317-1326.

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Neonatal Resuscitation Research Paper

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Neonatal Resuscitation

Introduction

Is there a thing that is as defenseless and precious as a baby who is newly born? I agree with the fact that thousands of babies in the United States are premature before their small bodies can sustain life. The normal time needed for a fetus to be fully developed in to a normal baby is usually thirty six to forty weeks. Premature infants therefore, are those born before the thirty sixth week.

Infants born before the twenty sixth gestation week have anatomically underdeveloped lungs and, they cannot physiologically support ventilation. I appreciate that there has been giant leaps forward within the last decades which has enabled us all but the most premature and smallest infants.

Currently, analyzing the Millennium Development Goals on Neonatal resuscitation in the developing world indicates that there is an impressive progress in child health. However, there is barely any notable achievement as far as neonatal health is concerned. Neonatal deaths’ proportion (death within the initial twenty eight days) is anticipated to increase as a result of the reduction in postneonatal deaths burden.

The World Health Statistics shows that the health-related MDGs indicate that approximately thirty seven percent of the under-five mortality is usually within the neonatal period. Most deaths occur during the first week (early neonatal period). More than one million neonates lose their life within the first twenty four hours as a result of poor quality care, globally and annually.

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Continuum of Care

The key principle in developing strategies aimed at addressing (NHC) Neonatal Health Care revolves within the continuum of care. Throughout the lifecycle, including childhood, childbirth, pregnancy and adolescence, the care need to be offered as a seamless continuum spanning the health center, community and home, globally and locally (Atkins and Murphy, 1994, 50). Therefore, decreasing child mortality depends entirely on managing neonatal mortality or otherwise, tackling Neonatal Health Care.

Personal Experience

I am a RRT (Registered Respiratory Therapist) and have worked in NICU (Neonatal Intensive Care Unit). Additionally, I have visited many other units as part of the duties as a Respiratory Care nurse. I have experienced the procedures and tests, the angst and waiting as well as the sensitive roller coaster of emotions that both parents and child endure. In case the infant is developed adequately and is strong enough for survival, there is anxiety concerning the quality of life for the child and the family that has to cater for the child’s specific needs.

Is the cost measurable in terms of real dollars and emotionally? Mezirow (1990) argues the mortality and morbidity rates in particularly low birth weight children is remarkably high; it is in fact, so high that the sole ethical choice is to leave them die a painless and natural death. Infants that are born before the twenty fourth gestation week need not be resuscitated for financial, medical and ethical reasons.

Medical ethic principles are justice, beneficence, non-maleficence and respect for autonomy. These principles act as the guideline for health care professionals when dealing with all their patients. There is no exception. Respect for autonomy recognizes “the patient has the capacity to act intentionally, with understanding, and without controlling influences that would mitigate against a free and voluntary act” (Lim et al, 2000, 492).

In the case of neonates, the biological parents have the responsibility of making the child’s health care decisions, as far as ethics in medicine is concerned. The non-maleficence principle implies that healthcare professionals should not create needless injury or harm intentionally to the patient, either with omission or commission acts. All procedures ad tests should have their benefits weighed. Beneficence can be defined as “the duty of health care providers to be of a benefit to the patient, as well as to take positive steps to prevent and to remove harm from the patient”.

In respect to the justice principle, each patient should be given what is rightfully theirs. Equal persons should be given equal treatment (Speck, 1985, 93). Moreover, patients need to be treated with honesty and dignity, and together with their families, the healthcare community’s total disclosure is necessary so that they are able to make informed decisions. Even if, a health care professional does not agree with the decision made, it is necessary to treat the patient with dignity; the choice should be respected.

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My Critical Experience

From my many years of practice as a nurse, I choose this critical experience since it was tremendously emotional and had a profound impact on me until today. Douglas was delivered at twenty five weeks of gestation with a weight of five hundred and fifty grams. He was born spontaneously preterm in vertex presentation. His primigravida single mother, Annette, had pre-eclampsia which led to the preterm birth.

Annette was given a dose of steroids thereby delivering Douglas within the next hour. Using antenatal steroids is considered as critical intervention in anticipation of prematurity which improves preterm babies outcome (Teasdale, 2000, 581).

At birth, Douglas’ condition was critical and therefore, the need for resuscitation. As mentioned earlier, surfactant treatment is administered to preterm infants having respiratory distress since they lack a protein referred to as surfactant which prevents the lung’s small air sacs from collapsing. Douglas was therefore given surfactant treatment together with a breathing mechanical ventilator aid so that his lungs could remain expanded.

The boy’s condition improved, and he was successfully transferred to CPAP (Continuous Positive Airway Pressure). This was aimed at delivering pressurized air to his lings via small tubes in the nose to help in breathing. Douglas developed bleeding in the brain (intracranial bleed) of grade III on the second day. Intracranial bleed is prevalent during the first 3 days of life and an ultrasound examination diagnoses it. Mild intracranial bleeds resolve themselves and no of few lasting problems (Miles, 1989, 71).

More severe bleeds cause the brain ventricles to expand rapidly, causing brain pressure which brings about permanent brain damage. The results are neuro developmental delay or cerebral palsy. Douglas also had PDA (Patent Ductus Arteriosus), a common heart problem in premature babies. This however did not need treatment as it was small.

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Irrespective of the boy’s critical condition during the first week in life, there was an improvement in his general condition. Naso-gastric tube feeds started being used, and intravenous fluids stopped (Shields-Poe and Pinelli, 1997, 32). While still an inpatient at the hospital, Annette visited Douglas for 2 days during which she was updated of his critical condition. Annette did not bond with her son comfortably, although the nurses encouraged her to.

She gave excuses so that she could not express milk and therefore Douglas was fed with donor breast milk. On the 3rd day, she was discharged, and she visited only once every week. However, she called nurses most of the times to enquire about his progress. Annette’s behavior was brought to the attention of a social worker, and it was reviewed. When I was delegated to look after Douglas, I met the mother once during which I spoke with her and encouraged her to hold and touch the baby which she did.

On the 22nd day after birth, the CPAP was working for Douglas; he could tolerate the feeds and was adding weight. For the six days I took care of him, his general condition was satisfactory. Annette called at nights to check on Douglas’ condition. I informed her he was stable with a 30 grams weight gain. She was enthralled and promised to come the following day.

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On my seventh night duty, on the twenty eight days after birth, I was surprised to meet Douglas re-intubated and on Nitric oxide high frequency mode ventilator. Douglas has developed PPHN (Persistent Pulmonary Hypertension), stopped breathing and was cyanotic. According to Wood (2009), preterm PPHN is linked to high risk adverse neurodevelopmental and health outcomes. To date, it is among the most complicated conditions experienced in NICU.

His critical condition made him be supported using various intravenous infusions, among them morphine to manage pain. Annette had visited at day time and cuddled her baby. She also has a social talk with the in-charge nurse and she was to come during the evening and stay overnight with her son. Unfortunately, Douglas succumbed to cyanotic attack after she left. She was updated of this on her way back to the hospital. On arrival, Annette and the friend she had come with were confused to see the extreme technical situation surrounding the boy.

I offered a drink and a chair to Annette. The serving consultant counseled her and recommended the life support to be withdrawn since Douglas IVH was at grade IV. Annette was unable to decide on the care withdrawal. She begged to leave and come back with her mother the following morning to discuss the situation further and come up with a decision. She immediately left.

At NICU, 4 nurses are delegated with the responsibility of receiving admissions from the theatre and labor ward and taking care of sick babies. We were 3 three nurses that night as a result of staff shortage. An emergency came from the clinical nurse manager from the labor room. One of the nurses rushed to the labor room and brought back twenty eight weeks preterm Mark who was intubated. He required medications and infusions and since his condition was grave, attention was focused to him.

After Mark settled, I was beside Douglas when I realized that his heart rate had gone down to 120 per minute from the usual 160 per minute. The consultant agreed with me that nothing more could be done. The morphine infusion had to be increased to manage pain (Reid, 1993, 307). I called Annette as they were driving home with the friend to inform her of the development. She confirmed that she would come back the following with her mother as earlier agreed.

I touched Douglas’s hand soothingly and wished Annette was there to console and hold him. Suddenly, the nurse attending to Mark called out for drugs as Mark had developed cardiac arrest. We worked to resuscitate Mark but I could see that Douglas was also going in to an arrest since there was continuous drop in the heart rate. Mark was the priority at the moment but I wished I could go over to Douglas and console him.

His monitor stopped indicating vital signs. Mark died shortly after Douglas. We did all we could have done to save the two lives but as with hundreds of other babies, we were unsuccessful. The social worker had to follow Annette to provide further care.

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The Care of Premature Newborns

“Good ethics begin with compelling facts” is a guiding principle when dealing with ethical care for premature newborns. So as to make a profound decision, the first thing is the qualified obstetrician to assess and gather all the necessary information utilizing all the available resources. Consequently, the parents need to be informed in a way that they can understand (respect for autonomy).

“It should be emphasized that there is some uncertainty with any predictive process, because every infant is unique. The prognosis for the fetus may change after birth, when a more accurate assessment of the gestational age and actual condition can be made” (Daly et al, 2004, 2).After the fetal weight and gestational age are determined; the parents should be presented with the facts and counseled on the child’s possible outcomes.

It is imperative that the health care team and physician address the process of decision making as a team, together with the parents. Moreover, the parent’s belief system and desires as well as the child’s needs should be kept at the forefront. The Journal Pediatrics have categorized the treatment decisions and summarized them on prognosis basis as:

1. In case there is a high likelihood of early death and survival would encompass high risk of morbidity that is unacceptably severe: intensive care not indicated.

2. In case there is a likelihood of survival and the risk of inadmissibly severe morbidity is small: indicate intensive care.

3. In cases that fall within the mentioned categories and there is uncertain prognosis and likely extraordinarily poor, and survival encompasses diminished child’s quality of life, parental desires determine the approach for treatment. (Carkhuff, 1996, 211).

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During the last few decades, there has been an improvement in the prognosis for tremendously premature infants. However, many of the exceptionally small and extremely premature infants die or possess a morbidity rate that is unacceptably high. In this population, the medical complications are usually profound and complicated. Some complications result from the birth event and others are congenital defects. Majority of the morbidities are linked to immature lung development.

Fetuses produce surfactant, an essential proper lung function protein, at the age of thirty two weeks. Surfactant deficiency is treated by medical science by refining and producing porcine and bovine surfactant. However, this is usually not as effective compared to native surfactant. There is the instantaneous complication of reduced delivery of oxygen to the brain, organs and blood. Besides this, the long term complication is anoxia, brain injury as a result of inadequate oxygen supply to the brain. High morbidity rates attract the greatest categories of complications.

Majority of the morbidities bring about profound and severe disabilities, and cause early demise (Murphy et al, 2003, 227). The mortality rate of neonates in this group is relatively high, and the severe to moderate morbidity rate is more than fifty percent. It is worth noting that the statistics for very small and very premature neonates indicate a one hundred percent mortality rate. These children possess physical limitations and abnormalities that they have to bear with for their entire lives and which their families need to provide care. The outstanding care is extremely expensive and emotionally exhausting.

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Reflect on the cost of offering care to late preterm vs a term infant. Late preterm have far much less complications as well as complicated medical needs as opposed to Extremely Low Birth Weight (ELBW) neonates, and yet the cost of caring for them during their 1st year of life is astoundingly vast. The cost for taking care of a premature infant who is late term is three times more the cost for term infants.

Extremely Low Birth Weight neonates’ cost is six times a term infant’s cost, if the infant survives. At a national level, the cost for ELBW’s care is staggering. United States spends 5.8 billion dollars annually (Raeside, 2000, 98). This represents forty seven percent of all infant hospitalization costs and twenty seven of all pediatric stays. 65, 600 dollars is the average cost, where the least viable consume most of the resources.

The figures refer to the initial hospital stay costs. This is the first care as far as caring for children with profound or severe disabilities are concerned. Is this burden fair to the society? These are some of the prevailing questions in the light of the discussion on medicine socialization and healthcare coverage. What is the belief of the society on the value of life? Can a baby’s existence be replaced with the dollar value?

Considering that resources are infinite, should they be used on the few neonates and leave the majority to share the smaller percentage? (Schmieding, 1999, 636). What if it is my child is among those that require disproportionate resources and care to survive? What if my child is among those being given a normal care level since there are few providers as majority of the providers are focused on ELBW who need the highest care level? The answer to these questions will vary depending on the role of a person; a parent, health care consumer or a provider.

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Figure 1: Grave Neonatal Morbidities in < 750 g Birth Weight Infants in the National Institute of Child Health and Human Development Neonatal Centers, 1995-1996

Condition	Frequency of Morbidities (%)	Range
Respiratory Distress Syndrome	78	54-97
Oxygen required at twenty eight days after birth	81	64-92
Chronic Lung Disease	52	8-86
Necrotizing Enterocolitis	14	9-38
Septicemia	48	30-64
Grade 3 intraventricular hemorrhage	13	6-29
Grade 4 intraventricular hemorrhage	13	3-26
Periventricular Leukomalacia	7	2-30
Growth failure	100	92-100

This data is for infants who are alive at twenty days (Cotton, 2001, 515).

Conclusion

Preterm neonates require extensive care to ensure their survival. Major challenges that make this goal ineffective include inadequate nurses and medication. More than often, care has to shift to neonates who require immediate attention. It is sue to these reasons that neonate mortality is still high although there has been an improvement in child care as per the MDGs. It takes a lot of courage to work as a nurse and especially when emphatic with the mother to the neonate infant.

Bibliography

Atkins, S. and Murphy, K. (1994) “Reflective Practice.” Journal of Nursing Standard, Vol. 8, iss. 39, 49-56.

Carkhuff, M. H. (1996) “Reflective learning: work groups as learning groups.” Journal of Continuing Education in Nursing, Vol. 27, iss. 5, 209–214.

Cotton, A. H. (2001) “Private thoughts in public spheres: issues in reflection and reflective practices in nursing.” Journal of Advanced Nursing, Vol. 364, iss. 4, 512-519.

Daly, J. Chang, E. and Jackson, D. (2004) “Quality of work life in nursing: Some issues and challenges.” Journal of the Royal College of Nursing, Vol. 13, iss. 4, 2.

Lim, J. J., Childs. J. and Gonsalves, K. (2000) “Critical incident stress management.” The Journal of American association of occupational health nursing, Vol. 48, iss. 10, 487–497.

Mezirow, J. (1990) Fostering critical reflection in adulthood: a guide to transformative and emancipatory learning. Jossey-Bass.

Miles, M. S. (1989) “Parents of chronically ill premature infants: sources of stress.”Journal of Critical Care Nursing Quarterly, Vol. 12, iss. 3, 69-74.

Murphy, F. C., Smith, I. N. and Lawrence, A. D. (2003) “Functional neuroanatomy of emotions: A meta-analysis.” The journal of Cognitive, Affective, & Behavioral Neuroscience, Vol. 3, iss. 3, 207-233.

Raeside, L (2000) “Caring for dying babies: perceptions of neonatal nurses.” Journal of Neonatal Nursing,Vol. 6, iss. 93-99.

Reid, B. (1993) “But we’re doing it already”, Exploring a response to the concept of reflective practice in order to improve its facilitation.” Journal of Nurse Education Today, Vol. 13, iss. 4, 305-309.

Schmieding, N. J. (1999) “Reflective inquiry framework for nurse administrators.” Journal of Advanced Nursing, Vol. 30, iss. 3, 631–639.

Shields-Poe, D. and Pinelli, J. (1997) “Variables associated with parental stress in neonatal intensive care units.”Journal of Neonatal Network, Vol. 16, iss. 1, 29-37.

Speck, P. (1985) “Counselling on death and dying.”British Journal of Guidance and Counselling, Vol. 13, iss. 1, 89-97.

Teasdale, K. (2000) “Practical approaches to clinical supervision.”The journal of Professional Nurse,Vol. 15, iss. 9, 579–582.

Wood, J. T. (2009) Interpersonal Communication: Everyday Encounters. Cengage learning.

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