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Healthcare Quality Management
Mcleod Medical Centre is an acute centre hospital located in Florida. The hospital is ranked higher among the others which provide acute care. The hospital provides emergency treatment, receives its tests electronically, can track the patient’s progress electronically and provides both outpatient and inpatient services (“Medicare Hospital Comparison”, 2016). As shown above, the hospital has invested in both resources and professionals. The ratio of nurses to patients is high meaning that more patients can receive more attention.
Additionally, the hospital has an internal quality control system the monitors the quality levels of different practices. Examples of some of the practices monitored include the wait time and response level of the medical practitioners (“Medicare Hospital Comparison”, 2016). The second hospital should introduce a quality management section that will introduce standards for different practices. Additionally, it should invest more in resources and medical professionals to reduce the nurse to patient ratio.
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The value of services in the different hospitals can be increased by focusing on both medical and non-medical aspects of quality (Hibbard & Greene, 2013). Access to medical care and physicians should be increased in the different hospitals. Additionally, the waiting time should be reduced to minimal levels. Responses should be collected from different patients on the effects of waiting times.
Additionally, the hospital should invest in providing patients with enough information regarding different conditions (Taylor et al., 2014). Well, trained counsellors will be used to create a link between the hospital and the patients. Check-in and check-out procedures should also be friendly to patients (Aiken et al., 2013). The hospital should also provide ancillary services to all patients (Dixon-Woods, McNicol & Martin, 2012). Medical aspects include having trained professionals, use of modern equipment and new technologies as well as proper medications and instruments.
References
Aiken, L. H., Sermeus, W., Van den Heede, K., Sloane, D. M., Busse, R., McKee, M., … & Tishelman, C. (2012). Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ, 344, e1717.
Dixon-Woods, M., McNicol, S., & Martin, G. (2012). Ten challenges in improving quality in healthcare: lessons from the Health Foundation’s programme evaluations and relevant literature. BMJ quality & safety, bmjqs-2011.
Hibbard, J. H., & Greene, J. (2013). What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs. Health Affairs, 32(2), 207 214.
Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic review of the application of the plan–do–study–act method to improve quality inhealthcare. BMJ quality & safety, 23(4), 290-298.
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Cholera Outbreak
Introduction
Cholera is a diarrheic condition that is caused by bacteria known as Vibrio cholerae. The bacterium is an enterotoxin that affects the ileum. Patients with this disease present with a sudden onset of rapid watery stool that is painless (Sekar, 2012). Early stages of cholera are manifested by rapid vomiting and nausea. When cholera is not treated, it can results into hypoglycemia in children, circulatory collapse, dehydration, renal failure and acidosis.
The infection is transmitted by asymptomatic carriers. Cholera is mostly asymptomatic or occasionally causes moderate diarrhea particularly with EI T micro-organisms or biotype. Death occurs within a few hours in severely dehydrated cases where by the rate of case-fatality may go beyond the 50% mark. However, timely and effective rehydration reduces the death rate to 1%.
Background
A cholera outbreak was first detected in The Central African Republic (CAR) in the early months of 1997 and hit the country for the second time in 1999.
The affected regions within the country included the sub-prefecture of Ngaoundaye. This is located along river Oubangui which is located near the border with Chad(Dworkin, 2010). Sékia moté village had the very first few reported cases and within a short period, the outbreak had spread to the prefecture of Lobaye and its environs and to the city of Bangui. Ombella Mpoko district and seven other villages where the Oubangui River passed later became part of the tragedy.
The outbreak was primarily discovered after the chief’s son of Sékia mote village became sick and passed away after showing signs of profuse diarrhea, abdominal pains and fever. The chief of Sékia mote village reported the case to the district’s governor on the very same day it occurred, who then alerted the Ministry of Health immediately later that day.
Both private and public health facilities in the Central African Republic (CAR) recorded extraordinary cases of watery diarrhea from Sékia moté village and several other villages to the Ministry of Health (Kamradt, 2015).
On the 25th of September 2011, a stool sample was obtained from a patient that had been transferred and got admitted at the community clinic in Bangui by two of the laboratory technicians from the Central African Field Epidemiology and Laboratory training Program (CAFELTP)(Nair, 2014).
After three days of thorough testing, the National Laboratory in Bangui (NLB) isolated Vibrio cholera sero group 131 from the earlier submitted specimen of stool with the help of a laboratory expert, from the NCIRD/GID.
This fostered the drive of Global Immunization Division, Immunization Systems, and Centers for Disease Control and prevention (CDC) since they were certainly convinced that the disease was cholera. On September 30th, cholera outbreak was declared officially in CAR. Rapid response team was put in place by the Minister of Health (MOH). The team comprised of CAFELTP residents, WHO, MSF staff, UNICEF, MOH staff, and others. The team established a series of control and preventative guidelines that would curb the spread of the outbreak.
The first measure entailed enhancing treatment capacity and cholera surveillance at the already existing health facilities. Secondly, the city of Bangui and affected villages had to have cholera treatment facilities. Thirdly, endorsing practices such as improved sanitation, proper food preparation, proper funerals and burial. The fourth measure was on affected people were to be advised on usage of oral rehydration solution and encouraged to seek medical attention at the onset of watery diarrhea. Finally, there were to be provision of chlorine for treatment of drinking water.
The rapid response team had a report of the case as by October 23rd. The record indicated that there were a total of 172 individuals who were suffering from acute watery diarrhea and also recorded 16 cholera deaths. This study was carried out with the goal of identifying risk factors associated with cholera outbreak. Moreover it also focused on assessing how prepared the affected districts were in controlling the outbreak.
Cholera Investigation
Environmental investigation
Many households were constructed along river Oubangui. The distance between the river and these households was approximately 20 meters. Generally, there was poor hygiene in the village characterized by mud and stagnant water (Kurjak, 2015). The children in the village were playing and walking bare feet in the mud and at times not fully dressed. Villagers were commonly using pit latrines whose maintenance was poor. Oubangui river was has many uses which include a source of drinking water, fishing, swimming and defecation.
Epidemiological investigation
The Ministry of Health requested CAFELTP resident advisors to assist in investigation and control of cholera outbreak in Central Africa Republic. The CAFELTP officials formed a rapid response team that worked in the affected areas. The team members were assigned different duties. For instance, one of the epidemiological officials was charged with the responsibility of reporting and collecting data on cholera outbreak where as two other lab technicians had the responsibility of collecting and analyzing samples.
Moreover, the advisors of these officials arrived in Bangui after two weeks. Upon arrival, they were taken through the events in Bangui by the CAFELTP staff and the officials from the MOH on the matter at hand and evolution of cholera. A data collection instruments and a protocol were developed by the residents and RAs. The main risk factors were highlighted as follows, lack of infrastructure for sanitation, drinking untreated water, and attending a cholera case funeral. Cholera Treatment Facility in Mbobo and Bangui district held arena for questionnaires pre-testing. In-country procedures such as mission orders, submission of terms of reference were followed before going to the field.
Coincidentally, during the outbreak investigation several campaigns on cholera awareness were underway in different areas of the country. The awareness involved sessions of community education and use of mobile Information Education Communication (IEC) resources presented on posters, TV, radio, cars, and mobile phones prevention messages.
Confirmation of the outbreak
The term outbreak is simply defined as a sudden increase or start of disease of fighting. It can also be defined as a sudden increase in numbers of a harmful organisms particularly the insects within a specific area. A disease outbreak is the occurrence of diseases in excess beyond the normal expectations in a specific geographical area, season or community.
An outbreak may emerge in a restricted geographical area or even spread to several countries. Its duration may be a few days, weeks or several years(Sekar, 2012). Definition of an outbreak enables those responsible for managing an outbreak occurrence to report the condition in its early stages to the responsible authorities.
The director of disease control conducted training sessions on cholera management in the hospitals as well as the community. The training was done to the health personnel in the affected districts. Weekly review notification records under joint custodian of the (WHO) and MOH, found 172 individuals diagnosed with suspected cholera. In the CAR from September 20th to October 26th, national case fatality rate was 9.3%.
Data on the number of individuals infected with cholera was sourced from the WHO Bangui office, cholera treatment centers and health centers in the affected areas. Medecins Sans Frontiers (MSF) were responsible for collection of the data on infected individuals. These information was used by the investigators in performing a comprehensive analysis of cholera outbreak.
Assessment on the level of epidemic readiness and response was carried out in each district using a checklist. General hygiene in the affected areas termed environmental investigation was also assessed. Stool and water samples were taken to the lab to be examined for Vibrio cholerae.
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Epidemic preparedness and response (surveillance)
None of the visited districts had either an epidemic readiness plan or a committee in place prior to the outbreak. There was provision of IV fluids and protective materials after the event of the outbreak. Some of the health centers such as Kamba had a radio system that was functional for communication, the health centers in Ngazi and Mogo had no means of communication. Unfortunately they had to travel for about 35 Km by bicycle or foot to the health facility (Shah, 2016).
Epidemic management funds were not available in the country before the occurrence of the outbreak. However, there were disinfectants in the entire health district that was visited. Chlorine used for water treatment was distributed by ministry of health to the two villages. Centers for chlorine treatment were planted at Bangui hospital, Ngazi and Mbombo health facilities. At the time of visit, these centers were functional although each had at least one cholera patient.
One personnel in Ngazi and Mongo village managed the public health surveillance system. The system was exempted prior to the occurrence of the epidemic.
Case definition
Case definition entails a standard criterion that categorizes an individual as a case. It includes criteria for person, time, clinical features and place. The criteria should be specific to the outbreak under investigation (Madoraba, 2010).
Place
Most houses were constructed along the Oubangui River. The distance between the river and the houses was less than 20 meters. There was generally poor hygiene in the village (Dale 2013). Mud and stagnant water were everywhere. Children played and walked in the mud bare feet and at times not fully dressed. There was common use of pit latrines; however, the latrines were poorly maintained. The Oubangui River served as a source of drinking water and swimming, fishing and defecation.
Person
Diarrhea: Diarrhea as a result of cholera usually has a milky, pale appearance that resembles water that has been used to rinse rice, hence the name rice-water stool.
Dehydration: dehydration develops within hours after the commencement of the symptoms of cholera. The ranges of dehydration vary from mild to severe depending on the amount of fluid lost. Severe dehydration is characterized by a loss of 10% or more of total body weight.
Nausea and vomiting: occurs during the early phase of cholera. Sometime vomiting may occur for hours.
Other signs and symptoms of cholera include lethargy, irritability, dry mouth, and sunken eyes, dry skin that bounces back slowly after it has been pinched into a fold, extreme thirst, little urine output, irregular heartbeat (arrhythmia) and low blood pressure
The people of Bangui expressed symptoms that are consistent with the case definition of cholera outbreak. The environment in Bangui also had conditions that are likely to predispose people to developing cholera
Cases
Cases are categorized into three types; confirmed, possible and probable cases. Confirmed cases are the laboratory confirmed cases such as the cholera victims who had their stool tested for Vibrio cholerae. However probable cases have characteristics clinical features of the disease but they lack laboratory confirmations (Ramamurthy, 2011). For example, there were residents of Mbaika district who had bloody diarrhea but without laboratory testing. Finally, possible cases are those with some clinical features such as abdominal cramps and diarrhea such as three stools in a 24-hour period.
Cholera is a point source epidemic. It arises due to common sources such as contaminated food or an infected food handler. The period for incubation ranges from a few hours to 5 days after infection. Suspected cholera case was defined as any individual of any age that presented with acute watery diarrhea. The most affected individuals were the women living in villages along Bangui River.
Hypothesis
The cholera outbreak in Mbaika district, Central Africa Republic where 170 patients and 16 cholera deaths reported, were related with risk factors that were food borne. There is a substantive association between cholera and eating cold cassava leaves. Epidemiological studies from Zambia indicated that the major transmission vehicle of cholera outbreak is contaminated food.
Vibrio cholerae could be inoculated into cooked food during preparation by an asymptomatic but infected person (Howard, 2011). However, the cause of contamination of cassava leaves may vary and the study did not determine its course. This hypothesis is true because earlier studies indicate that soiled kitchen ware can contaminate food and the Vibrio cholerae live for up to 2 days.
Discussion
Cholera outbreak caused many deaths in the region. The death rate rose up to 24.2% in Matuu which is higher than the countrywide rate of 9%. MOH in collaboration with various partners assisted in the management of cholera. The investigation produced important results. The outbreak of cholera in Kamba district, Central African Republic where by more than 170 cases and 16 deaths reported, was as a result of risk factors that were food borne.
The case control investigation associated cholera with consumption cold leaves of cassava. Epidemiological study from Zambia indicated that during an outbreak, the major transmission vehicle of cholera is contaminated food. When food is prepared, Vibrio cholerae could be inoculated by asymptomatic but affected person. The source of contamination varies in cassava leaves. The study did not determine its course. According to previous studies, soiled kitchen ware can contaminate food where the Vibrio cholerae persists for 1-2 days.
There was lack of association between the outbreak and water-related risk factors. Cholera transmission through direct waterborne ways was not very evident in these areas. Other previous investigations have reported that drinking water sold in the streets was responsible for the outbreak of cholera in Latin America.
The study ruled out the link between cholera and drinking contaminated water, poor sanitation and attending burials that are cholera related in the district. Households in the two villages are built along the river which makes the area vulnerable especially during floods. Consumption of untreated water from Oubangui River was not proven risky but it should be avoided.
Delay in the analysis of stool samples should be discouraged. It leads to delayed confirmation of an outbreak as well as delayed implementation measures. According to this case, the delay occurred because the outbreak emanated outside Bangui. On the other hand, Bangui National Laboratory (NLB) did not have a means of transport for collecting stool samples from outside Bangui. It is very vital to have all the appropriate resources during an outbreak. Availability of epidemic readiness plan and a committee present in a district results in effective and timely management of the outbreak. Public health surveillance system management by only one individual in the entire district may not be effective in handling all the threats in public health.
Conclusion
The outbreaks of cholera in Central Africa are still ongoing but in a slow rate compared to the past three week. Considerable association between cholera and eating cold cassava leaves was identified. First and seventh regions were the only ones affected by the outbreak (Lewenson, 2013). Women and children living along the Oubangui River were the most affected by the outbreak. Lack of transport of samples to the National Laboratory delayed outbreak confirmation. Effective measures in cholera treatment there were to be implemented include; establishment of cholera treatment center, treatment of drinking water, health education on good food and general hygiene.
Lessons learnt
The study provided epidemiological information that leads to cholera. They include consuming untreated water, poor sanitation and attending cholera areas.
The major transmission vehicle of cholera is contaminated food.
Consumption of water sold in the street can also result into cholera outbreak.
Lack of laboratory materials transport and communication causes delay in analysis of an outbreak
There is need for a stand by epidemic readiness plan and committee in the district that ensures well-timed management of the outbreak.
Recommendations
Health education and social sensitization on habits of eating, community hygiene and personal, sanitation and burial practice.
System for public health surveillance should be strengthened by the administration.
Encouragement of eating food when still hot.
Each region should be supported in development of a functional epidemic readiness plan and response committee and a definite epidemic readiness control plan as soon as possible.
Ministry of health in conjunction with that of water should ensure that the communities have access to clean water.
Laboratories should have basic resources to avoid delaying in laboratory confirmations.
The surveillance system should be able to identify outbreaks and report in time.
Bibliography
SEKAR, R., & MYTHREYEE, M. (2012). Microbiological Investigation of Diarrheal Outbreak in South India Cholera Outbreak – Microbiological Investigation. Saarbrücken, LAP LAMBERT Academic Publishing. http://nbn-resolving.de/urn:nbn:de:101:1-20121026248.
DWORKIN, M. S. (2010). Outbreak investigations around the world: case studies in infectious disease field epidemiology. Sudbury, Mass, Jones and Bartlett Publishers.
TRUGLIO-LONDRIGAN, M., & LEWENSON, S. (2013). Public health nursing: practicing population-based care. Burlington, Mass, Jones & Bartlett Learning.
KURJAK, ASIM. (2015). Textbook of Perinatal Medicine. Jaypee Brothers Medical Pub.
CARNEIRO, I., & HOWARD, N. (2011). Introduction to epidemiology. Maidenhead, Berkshire, Open University Press. http://public.eblib.com/choice/publicfullrecord.aspx?p=863803.
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Evaluation Plan
Introduction
An evaluation plan refers to a summary that guides one on what requires being evaluated for effectiveness after the implementation. The evaluation plan effectively identifies the objectives and the manner in which data will be collected and analyzed (Grol et al, 2013). There are several benefits or having the evaluation plan. The plan is essential in giving a roadmap of what when and how to go about with a certain activity.
The plan enhances delivery of the best services and programs leading to the success of a given project. Through the evaluation plan for the project, the assessment practices, and data collection is refined so that the information acquired is helpful in advancing the objectives and mission of the project.
The delivery of quality Medicare to the patient by the nurses and other medical practitioners is an issue of concern in the health sector. The provision of substandard healthcare by the medical practitioners leads to many negative effects that mainly affect the patients who are the main recipient of the Medicare. The issue has prompted me to give a proposal for the project that aims at ensuring the issues is handled and managed in the most efficient manner (Grol et al, 2013).
The enhancement of the patient-centered Medicare in the health care sector is the proposal of the project that would efficiently solve the problem and provide a viable solution. The adherence to the patient-centered Medicare by all health care providers is intended to improve the quality of healthcare by reducing the readmission, long hospitalization duration and also the high mortality rates among the patients in the healthcare centers.
The patient-centered Medicare ensures the healthcare system revolves around the patients. The enhancement of the patient-centered Medicare with strict observance by the heads of all the centers to ensure full adherence impacts the healthcare quality positively to the satisfaction of the patients and their family members.
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Various methods were adopted to assess the effectiveness of the solution proposed depending on the factors of interest. The readmission rates are one issue that would be solved through the implementation of the proposed solution for the poor Medicare provided to the patients. The high rate of uncontrolled infections among the patients and the disorders have contributed to the lengthy hospitalization of the patients due to the poor medical care where the system of healthcare is physician centered (Grol et al,2013).
The readmission and lengthy hospitalization of the patients before the implementation of the project led to the high costs of Medicare. The readmissions are potentially harmful cause the patients to incur high medical costs. The poor quality healthcare before initiating the change indicated the high cases of readmissions within twenty days of discharge with 30% of readmission cases reported in the healthcare centers.
The patient-centered Medicare will enhance the provision of medication on discharge and also lengthen the handoff process. The readmission rates have dropped significantly to 20% which indicates the importance of the solutions. The patterns of admission among the patients have changed for the better. Strict adherence to the patient-centered care enhances the reduction of high costs of health care incurred by patients.
The poor medication is a major factor that leads to the high mortality rates among the patients. The errors in medication and failure to fully involve the patients in their Medicare is a problem that requires quick intervention due to the negative impacts it has in the healthcare sector(Grol et al,2013). The communication barriers and lack of involvement in the treatment decision-making process have affected the delivery of quality care among the patients.
The patients do not get the appropriate information regarding their medication which affects their recovery from their illnesses. There are several cases where the poor medication leads to severe outcomes such as death among patients. The mortality cases are as a result of the medical practitioners failing to adhere to the patient-centered Medicare requirements.
Research indicates that the high mortality rates are attributed to the provision of quality healthcare which is associated with the failure to adhere to the patient-centered Medicare. The reduction of mortality cases by 5% after initiating change and enhancing strict measures to ensure the effectiveness of the solution is an efficient method of assessing the project’s outcomes. The involvement of the patients in the medication process has also raised the satisfaction levels by over 50% after initiating the change.
There are several variables used in the assessment of the effectiveness of the proposed solution and its viability after implementation. The mortality rates among the patients in the healthcare centers are one of the variables used for assessing my project. The rate of deaths is a variable and vital indicator for the type of healthcare quality offered to the patients in the health centers.
The significant reduction in the death rates and the reduced cases of injuries indicates the success of implementing the proposed solution to remedy the challenges in the healthcare sector (Grol et al, 2013). The rates of readmission in the hospitals is a variable of interest while identifying the effectiveness of the solutions. The lower rates of readmissions in the hospitals imply that there is quality Medicare offered by the practitioners.
The variable thus helps in assessing effectiveness as the quality of Medicare is closely related to the patient centered type of Medicare. The patient-centered Medicare is a wide aspect of providing health care to the patients that even shortens their stay and enhances their quick recovery. The positive impact indicated by the low rates of readmission is useful while evaluating the project. The patient satisfaction and their perception regarding the type of Medicare they receive are other variables for evaluation of the project.
The variances in the attitude of the various patients that receive the healthcare before initiating the changes and after is essential in assessing whether the project has had a positive impact. The reduced number of complaints and positive recommendation by the patients and their families gives credit to the project while the low levels of satisfaction indicate poor delivery of quality Medicare (Grol et al, 2013).
The cost of Medicare is a variable of interest during the evaluation of the project and its outcomes. The compliance to the patient-centered Medicare results in delivery of quality healthcare thus lower readmissions rates and consequently lower medication costs and insurance. In this case, the variances in the costs incurred by the patients are good in gauging the effectiveness of the project.
There are various tools used in the education of the project participant and also in evaluating the project outcomes. The questionnaire is an essential tool to be used in evaluating the project outcomes. The questions designed to assess the perception of the patients and their families depending on the type of Medicare and the way practitioners engage them during treatment are effective in the evaluation.
The nurses and healthcare practitioners should also fill the questionnaires related to how the implementation of the project has influenced their delivery of services whether positively or negatively. The surveys involving the collection of data about the different rates used as assessment methods for the project is used in the evaluation of the project. The survey shall be conducted in different hospitals where the changes have been initiated. The health practitioners who are the main participants in the implementation of the project require education to ensure they comply in the most efficient manner (Grol et al, 2013).
The use of seminars and training sessions for the health practitioners is aimed at creating awareness on the importance of patient-centered care. The training and seminars also help in the provision of guidelines on the effective ways to deliver quality services to the patients. The pamphlets are also distributed as teaching materials to educate them on the compliance and adherence to the project requirements to yield positive impacts.
Conclusion
In a nutshell, the enhancement of the patient-centered Medicare in the health care sector is the proposal of the project that would efficiently solve the problem and provide a viable solution. Through the evaluation plan for the project, the assessment practices, and data collection is refined so that the information acquired is helpful in advancing the objectives and mission of the project. Compliance to the patient-centered Medicare leads to a revolutionized health sector with the massive improvement in the delivery of services (Grol et al, 2013).
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CHRONIC BACK PAIN
Chronic back pain is identified as a common problem in healthcare which calls for the careful examination to identify the particular type of back pain. These types include back pain due to the spinal cause, due to the nonspinal source, nonspecific low back pain, and spinal stenosis. Evaluation of the patient experiencing chronic pain is necessary so as to commence the appropriate treatment to manage the situation (Buttaro et al, 2013).
The evaluation of chronic of back pain entails the physical and history examination of the patient. There are various factors that I would put into consideration while carrying out the assessment. Differential diagnosis includes evaluation for congenital disease, lumbar strain, the traumatic fracture and presumed instability (Buttaro et al, 2013).The description of how the pain started and also the intensity, duration or pattern of the pain by the patient would help in evaluating the symptoms and sites of pain.
Assessment of the chronic back pain related symptoms such as numbness, weakness, or bladder problems is essential in the evaluation. Previous episodes of back pain and the type of treatment adopted are essential in tracing the history and the experiences of the patient and the effectiveness of the management strategies used.
The working history about the patient is important so as to get a link between the back pain and work. Assessment of the sensory and muscular problems would be performed through a series of movements performed by the patient (Buttaro et al, 2013). The assessment factors would help in the evaluation of the patient who presents with chronic back pain.
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There are various warning signs that indicate that the patient is abusing the drugs prescribed by the healthcare profession. Finishing the prescription earlier than recommended raises a red flag that treatment schedule has not been properly followed (Buttaro et al, 2013). Requesting for specific dosages and medication is an indicator of poor pain management. Borrowing of medication from other people is a warning sign of abusing medication. Using medication prescribed for others or stealing drugs raises a red flag.
Losing the prescription provided as medication for pain management is a warning sign of drug abuse. In cases where the patient rates pain as ten on a numerical scale. Such rates create suspicion of whether the prescription is of help to the patient or is abused so as to get more falsely. Visiting the emergency rooms without the conscience of the doctor so as to get additional medication raises a red flag (Buttaro et al, 2013).
There are several implications that should be considered when giving prescriptions for narcotic pain. Ethical implications arise when the providers prescribe narcotic drugs as per their self-serving reasons or to have some financial gain (Buttaro et al, 2013). The drug-seeking reasons that are illegitimate in nature can lead to an ethical implication when the medication is provided to the patient. The providers have high pressure to prescribe controlled substances such as narcotics. In this case, the providers are faced with the dilemma of whether to serve the patients as per their interests or to do what is indicated as ethically appropriate.
Narcotic dependence and addiction by the patient make it cumbersome for the care provider to prescribe the medication as per clinical standards (Buttaro et al, 2013). Considering the modified treatment strategies e.g. deep tissue massage to manage pain instead using narcotic that pose some problems in making clinical decisions resulting to ethical implications is crucial during treatment (Buttaro et al, 2013). Due to the arising ethical implications, health professionals should advocate the use of narcotics as indicated medically.
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Quality and Safety in Healthcare
Constant improvement of quality and safety is an important aspect in healthcare. Nurses play an important role in improving quality and safety in healthcare. Be as it may, nurses are always in contact with patients during the entire treatment. Their actions, professionalism, and observation of ethical principles determine the level of quality of service and safety within the healthcare system (Simon et al., 2013).
Nurses need to be committed to offering quality services including offering grief support. Emphasis on good care plans to ensure protocol is followed when offering support to patient can improve the quality of care.
I learned that nursing ethics play an important role in improvement of quality and safety of patients. Nurses are guided by professional principles and ethical framework that ensure that patients are treated according to standard protocol put in place. Nurses are required to be caring to patients and communicate effectively to ensure that patient is comfortable throughout while in the hospital. Respecting other healthcare practitioners and building strong and professional relation could also help improve quality of healthcare (Elwyn et al., 2014).
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Nurses can also ensure that healthcare goals of registering desirable patient outcomes is achieved by ensuring that each individual and family takes part in the care process. By engaging patients and families in the process of care, nurses are able to improve patient outcomes and rates of satisfaction. This is achieved through enhancement of the quality of the associations between the patient, the physician as well as the utilization of diagnostic testing, hospitalizations, and referrals.
Improvement of quality of healthcare can be achieved through observing its structure, processes, and outcomes. Structures essentially validates the availability, accessibility and quality of resources such as number of nurses, bed capacity among others. Nurses can help in improving quality of nursing through observing nursing principles and ethics, working through teamwork and involving family in provision of healthcare services.
Elwyn, G. et al (2014). Shared decision making and motivational interviewing: achieving patient-centered care across the spectrum of health care problems. The Annals of Family Medicine, 12(3), 270-275.
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Health Promotion to Pregnant Women
Introduction
All expectant women should ensure that they stay healthy during pregnancy since most of what they consume is shared with the foetus. Some of the things women take are good for the baby while others can be harmful. To educate a group of first-time teenage mothers, I will use posters to inform them about the following important information.
First, I will emphasize on the need for pregnant women to maintain a balanced diet. Most meals should include starch –based foods such as cereals, rice, fruits as well as vegetables. Women should also eat a lot of fiber and proteins. Weight monitoring is also of great importance although it has been found out that a weight increase of between 11 to 16kg during pregnancy is normal.
Pregnant women also need an extra 200 calories especially in their last month of pregnancy. Rauh et al. (2013) support the idea that folic acid supplements are ideal during pregnancy and should be taken up to the end of the 12th week of pregnancy since they aid in avoiding anemia, a common condition among pregnant women.
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Tobacco smoke contains harmful chemicals that pass through our bloodstream and goes into the growing foetus’ blood. Therefore, the pregnant woman should be counseled to stop smoking and avoid risks such as ectopic pregnancy, miscarriage, and premature labor (Piano & Phillips, 2013).
Additionally, during pregnancy women should avoid drinking alcohol because it slows down growth and causes serious problems in future. Pregnant women should also avoid pets which at times may carry germs that can be passed to the unborn baby. For instance, toxoplasma is bacteria commonly found in cats, therefore, I will educate women to wash their hands after handling cats.
This will aid in minimizing the effects of these germs. Using any illicit drugs when pregnant can have a detrimental effect on the unborn baby. Illicit drugs in most cases cause birth defects or miscarriage. Drug use can also affect the baby central nervous system according to Simkin et al. (2016).
Conclusion
Pregnant women should seek advice to get more information on how to stay healthy during pregnancy and after giving birth. Lifestyle adjustments will enable both the mother and the baby to stay healthy.
Rauh, K., Gabriel, E., Kerschbaum, E., Schuster, T., von Kries, R., Amann-Gassner, U., & Hauner, H. (2013). Safety and efficacy of a lifestyle intervention for pregnant women to prevent excessive maternal weight gain: a cluster-randomized controlled trial. BMCpregnancy and childbirth, 13(1), 1.
Simkin, P., Whalley, J., Keppler, A., Durham, J., & Bolding, A. (2016). Pregnancy, childbirthand the newborn: The complete guide. Simon and Schuster.
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Mammary duct ectasis
Case study overview
A 60-year-old Latina female is concerned about the thick green discharge on her left breast, a situation she has experienced for the past month. The discharge happens spontaneously causing pain and burning around the breast. She reported to have breastfed all her children; she was not on any medication. However, occasionally she used Tylenol for treating arthritis.
The mammogram test done 14 months ago is within the normal limits. Physical examination indicates that there are slight redded and edematous around the left breast. A greenish-black is seen when palpation is done; there is an ovoid which is smooth, very mob that is not tender at 1cm nodule in the RUIQ at 11.00 5cm from the nipple. The patient is worried that she might be at risk of developing breast cancer.
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Diagnosis
Women over 50 years are likely to suffer from mammary duct ectasis; this is a condition that occurs when the breast dust becomes wider making its walls thicken causing fluid build-up around the breast (Stanford School of Medicine, 2016). Sticky and thick black or green discharge is an indication of mammary duct ectasis. In addition, the nearby tissues around the breast and the nipple will become tender and red. The hard lump caused by this condition is often confused with breast cancer (Patel, et al, 2015).
Treatment and management plan
The patient needs antibiotics for 10 to 14 days to treat the infection; pain medication includes acetaminophen or, ibuprofen, other drugs are Advil, Motrin IB among others. Acetaminophen is commonly prescribed to reduce the pain ,an adult dosage includes is 2 regular strength 325 mg after every four hours or 2 extra-strength of 500mg after every six hours but the maximum dosage should not exceed 4,000 mg in a day.
In mild cases, patients are advised to conduct warm compresses to help to manage the disease, however in severe cases, surgery will be recommended whereby an incision will be made at the edge of the colored tissue to release the built up fluids (Chougule et al, 2015).
Mammary duct ectasis is often confused with breast cancer, therefore women especially those that are above 50 years need to be educated about the differences in the presentation between the two conditions and urged to seek urgent medical attention whenever they have sysmptoms related to mammary duct ectasis.
References
Chougule ,A., Bal A, Das, A., Singh, G ( 2015). IgG4 related sclerosing mastitis: expanding the morphological spectrum of IgG4 related diseases. Pathology 47 (1): 27–33
Patel, B. K., Falcon, S., & Drukteinis, J. (2015). Management of nipple discharge and the associated imaging findings. The American journal of medicine, 128(4), 353-360.
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Breast Abscess Patient Diagnosis and Treatment
Journal Entry
In my 4th week clinic I have learned more about patient diagnosis and treatment. Breast abscess can be caused by several different factors. To begin with, it can develop as a defensive reaction against infections and similarly, due to presence of foreign objects which causes accumulation of pus in the breast tissue. In this case the effect manifested itself in form of a greenish drainage.
Abscess can occur anywhere in the body. However, most breast abscess develops in women who are lactating and breast feeding. Breast abscess occurring in non lactating women are a bit unusual and initially can be a sign and symptom for breast cancer. A woman who has undergone breast cancer treatment is likely to have the abscess (Bosma, Morden, Klein, Neal, Knoepp & Patterson, 2016).
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The abscess is normally accompanied with pain and breast tenderness. However, not all abscesses are accompanied by inflammation making their diagnosing a difficult matter. My patient’s pus in this case the greenish drainage will be collected and tested to know the type of infection. The type of bacteria causing the abscess should be examined so as to give the best treatment since same bacteria are prone to some kind of treatment (Bosma, Morden, Klein, Neal, Knoepp & Patterson, 2016).
Blood test and ultrasound can also be done to check the patents immune and determine what structures of the skin are being affected by the infection. The above information is more likely to relate to an individual living with breast cancer. My patient is likely suffering from breast cancer. Breast cancer does not only show itself through inflammations but also breast abscess especially in non-lactating women.
The collection of fluids in the breast that is the greenish fluid commonly turns out to be an invasive cancer. The complains of the abscess in breast cancer normally associate itself with non-healing breast abscess despite use of antibiotics; through the previous weeks, patients not lactating, elderly patents and breast abscess associated with hard lumps in the breast (Bosma, Morden, Klein, Neal, Knoepp & Patterson, 2016).
Health care professionals and practitioners use theory in practice and apply it in rendering or conducting patient care and as leaders determining and promoting system change. A health behavior change I would choose is the integrated theory of behavioral change which is a new mid-range descriptive theory. I believe that an individual’s health is influenced by their behavior and such improvement in health can be achieved by managing chronic conditions or employing health promotion practices (Ryan, 2009).
Health promotion, requires individuals to come up with healthy behavior variations which positively influence health. These practices include activity and exercise, management of stress, moderate alcohol consumption, proper nutrition, and cessation of smoking. Prevention behaviors such as cancer screening and immunization are also vital. Therefore, for primary health promotion, healthy lifestyles must be incorporated to improve and maintain people’s health status.
This assumption goes hand in hand with health models such as the health belief model. For example, a person’s perceived susceptibility, a severity of an illness and the benefits of taking action will influence the person’s health-related behavior. Therefore, he/she will address any health concern by changing the behavior. For instance, an individual would abstain from sexual behavior to avoid the possibility of contracting HIV/AIDS.
The trans-theoretical model also advocates for behavioral change through some stages for modification of lifestyle. This will help clients adopt new positive changes in lifestyle which is important in their health promotion and maintenance (Ryan, 2009). The theory of planned behavior also assists in understanding the various ways we can change people’s behavior through a prediction of deliberate conduct. This behavior influences a person’s lifestyle; therefore, the knowledge and beliefs stated in the theory help understand health behavior.
Reference
Ryan, P. (2009). An integrated theory of health behavior change: background and intervention development. Clinical nurse specialist CNS, 23(3), 161. http://dx.doi.org/10.1097/nur.0b013e3181a42373
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