Tag: Health care

Quality of care: Article Review

Quality of care
Quality of care

Quality of care Article Review

Introduction

 The international agencies and national nursing associations acknowledge the fact that unhealthy working conditions affect the quality of care, employee’s health, and are associated with nurse sensitive patient outcomes. In their article “Hospital magnet status, unit work environment and pressure ulcers,” Ma and Park explored the relationship between the RN environment nurse outcomes (job satisfaction, turnover rates and intent to stay) and patient safety outcomes (pressure ulcers, falls, and quality of care).

The article suggests that the hospital administration  and  nurse leaders should understand the importance of nurse work environments, as it sets  the stage for quality care and provides competitive advantage in current’s  value driven healthcare system (Ma &Park, 2015).

This essay is a critical analysis of Ma & Park article’s that aims to assess if the information improves nursing practice, increases nursing knowledge and understanding on patient safety. The main topics that will be critically analyzed include the article’s research design, data collection, data analysis, findings, discussion and nursing implication.

The research problem and its significance

 Creswell   states that a study’s research problem should be described using an approach that orientates the reader to the research subject (Creswell, 2014; Jaul, 2014).  The article states that better nurse work environments are associated with lower hospital acquired pressure ulcers. Pressure ulcers are critical patient issue because they are associated with prolonged hospital stays, increases patient risks for adverse events and increased consumption of the healthcare costs (Cai, Rahman, & Intrator, 2013; Buttaro et al., 2013, p. 304).

The research problem in this study is the organization’s factors or nurse work environment that negatively influence patient’s outcome, such as increasing HAPU incidence. “The unit-level work environments have major impact on the nurse work environment” (Ma & Sharks, 2015, p.65). The research problem is a focal point of research. It is well stated in this article and generates questions in which the research study aims to address (Stafford & Brower, 2012, p. 11; Suttipong & Sindhu, 2011, p. 373).

The study hypothesizes that nurses play crucial role in preventing pressure ulcers. However, the degree of patient safety is determined by the nurse work place environment, “The organizational factors in work-environments facilitate or constrain the professional nursing practice” (Ma & Parks, 2015, p. 566).  The article evaluates the nursing factors at both the hospital and unit level associated with Hospital acquired pressure ulcers (HAPU).

On the other hand, the significance of a study is the rationale of the study.  The researcher proves to the audience that the research is vital and worth doing it.  For instance, the study indicates that the need to reduce hospital acquired pressure ulcers has gained national attention. “There are approximately 2.5 million pressure ulcers that occur in the USA, and coasts $9.1-11.6 billion (Ma &Sharks, 2015, p. 65).”

 The research design and methods

Richardson-Tench and colleagues state that research design is the overall strategy chosen by the researcher to integrate different components of the study. It should be constructed in a logical manner to ensure that the researcher effectively address the research problem using the appropriate data collection and analysis approach (Melnyk & Fineout-Overholt, 2014; Richardson-Tench et al., 2014).

 The research method is used in this article is qualitative. The research design used in this article is the Cross-sectional observational study of data collected from the National Database of Nursing Quality Indicators (NDNQI). This research design is appropriate for this study because it examines the relationship of exposure and outcome in a defined population at one point in time.

In addition, the research design is inexpensive, less time consuming and provides a good but quick picture of prevalence of the research problem and its outcome. Although appropriate for this study, the main issue with this research design lacks time element making it difficult to determine the temporal relationship between the research problem and the outcome of the proposed intervention (Ma & Sharks, 2015, p.567).

 Data used in this article was collected from NDNQI. The data collected was supplemented with the NDNQI RN survey.  The total participants for RN survey was 33, 845 from 1,381 units in 373 healthcare facilities in 44 States. The inclusion criteria for this survey were nurses who had spent 50% of their time in general units in the hospital within the last three months. The researcher also established measures to ensure reliability of the data collected (Ma & Sharks, 2015, p.566).

Data analysis of the collected data was analyzed using t tests to compare the nurse work environments, staffing levels, HAPU rates and the RN skill mix of the NDQI member hospitals.  Three multilevel logistic regression models were used to estimate the effect of nurse work environment and healthcare facilities management of HAPU. The data analysis used is appropriate for this nature of the study as it provides conclusive comparative analysis (Ma & Sharks, 2015, p.568).

 Findings and their relevance to contemporary nursing policy and practice

 The study findings indicate that improving working environments both at hospital level and unit level results to lower HAPU rates. The data findings presentation in this article  is concise and appropriately used non-textual elements such as table summaries and figures to present data findings effectively.  The data provided is critical in answering the research question. For instance, Magnet hospital units had 21% low odds of having HAPU as compared to the non-magnet hospital.  

There are several limitations noted in this study. To start with, participation of hospitals in NDNQI is voluntary, which indicates overrepresentation or underrepresentation of hospitals with certain characteristics. Secondly, the study omitted some specific information such as ethnicity, socioeconomic status and other co-morbidities that could introduce residual confounding effects. In addition, patient level information in most of quality indicators is limited.

Despite the limitations, the study findings are consistent with the previous studies that better nurse work environments is associated with lower hospital acquired pressure ulcers, lower readmission rated and a higher overall rating.  The nursing implication of this study is that it improves the understanding of work environments in relation to patient’s outcomes (Guihan et al., 2016, Matsuo, Oie, & Furukawa, 2013).

The quality of care is influenced by the nurse work environment characteristics such as the administrative support, nurse-physician relations and nurse resource adequacy.  Effective nurse work environments are established through better communication, team work between the healthcare providers and higher autonomy/practice control.

Nurses in such types of environments are less likely to suffer from burnout or express intent to quit their jobs, but are likely to function efficiently, deliver superior quality of care that ultimately improves patient’s overall outcome (Demarre et al., 2014, p. 392; Singh et al., 2015, p.7; Neilson et al., 2014, p. 21).

Conclusion

Critical appraisal is important process as if facilitates a thorough understanding of the research study in order to establish the study strengths and weaknesses and to evaluate the quality, and if the study’s strength is effective and appropriate for its use in the reader’s practice. This study generates new ideas that will help improve the quality of care and patient safety and quality of care in nursing practice. The study findings in this study facilitate the understanding the link between organizational environments and the patient outcomes. This study highlights the effectiveness of unit-specific quality improvement initiatives in today’s highly specialized care.

References

Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2013). Primary care: A collaborative practice (4th ed.). St. Louis, MO: Mosby.

Cai, S., Rahman, M., & Intrator, O. (2013). Obesity and Pressure Ulcers Among Nursing Home Residents. Medical Care, 1. http://dx.doi.org/10.1097/mlr.0b013e3182881cb0

Creswell, J. W. (2014). A concise introduction to mixed methods research. Sage Publications.

Demarre, L., Verhaeghe, S., Van Hecke, A., Clays, E., Grypdonck, M., & Beeckman, D. (2014). Factors predicting the development of pressure ulcers in an at-risk population who receive standardized preventive care: secondary analyses of a multicentre randomised controlled trial. J Adv Nurs, 71(2), 391-403. http://dx.doi.org/10.1111/jan.12497

Guihan, M., Murphy, D., Rogers, T., Parachuri, R., SAE Richardson, M., Lee, K., & Bates-Jensen, B. (2016). Documentation of preventive care for pressure ulcers initiated during annual evaluations in SCI. The Journal Of Spinal Cord Medicine, 160204031040002. http://dx.doi.org/10.1080/10790268.2015.1114225

Jaul, E. (2014). Multidisciplinary and comprehensive approaches to optimal management of chronic pressure ulcers in the elderly. Chronic Wound Care Management And Research, 3. http://dx.doi.org/10.2147/cwcmr.s44809

Matsuo, M., Oie, S., & Furukawa, H. (2013). Contamination of blood pressure cuffs by methicillin-resistant Staphylococcus aureus and preventive measures. Irish Journal Of Medical Science, 182(4), 707-709. http://dx.doi.org/10.1007/s11845-013-0961-7

Ma, C., & Park, S. H. (2015). Hospital Magnet status, unit work environment, and pressure ulcers. Journal of Nursing Scholarship, 47(6), 565-573. 

Melnyk, B., & Fineout-Overholt, E. (2014).Evidence-based practice in nursing & healthcare: A guide to best practice, 3rd Edition. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins

Neilson, J., Avital, L., Willock, J., & Broad, N. (2014). Using a national guideline to prevent and manage pressure ulcers. Nursing Management – UK, 21(2), 18-21

Richardson-Tench, M., Taylor, B., Kermode, S., & Roberts, K. (2014). Research in nursing: Evidence for best practice (5th ed.). Cengage Learning Australia: South Melbourne.

Singh, R., Dhayal, R., Sehgal, P., & Rohilla, R. (2015). To Evaluate Antimicrobial Properties of Platelet Rich Plasma and Source of Colonization in Pressure Ulcers in Spinal Injury Patients. Ulcers, 2015, 1-7. http://dx.doi.org/10.1155/2015/749585

Stafford, A., & Brower, J. (2012). Letʼs get comfortable. Nursing Management (Springhouse), 43(9), 10-12. http://dx.doi.org/10.1097/01.numa.0000418777.69056.f7

Suttipong, C., & Sindhu, S. (2011). Predicting factors of pressure ulcers in older Thai stroke patients living in urban communities. Journal Of Clinical Nursing, 21(3-4), 372-379. http://dx.doi.org/10.1111/j.1365-2702.2011.03889.x

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Diabetes mellitus: Web based intervention

Diabetes mellitus
Diabetes mellitus

Diabetes mellitus: Web based intervention

Introduction

Diabetes mellitus is one of the most prevalent non-communicable diseases in the world. The disease is associated with societal and economic burden particularly among patients from low and middle income countries.  Particularly, Diabetes is an important public health concern in the USA as it affects about 29.2 million people (Centers for Disease Control and Prevention, 2014).  

The burden of morbidity and mortality caused by diabetes mellitus is evident among the Americans as more than 4% of people diagnosed with Type 2 diabetes mellitus are diagnosed with diabetes related health complications. The management strategies are complex processes as they entail controlling multiple risk factors that cause complications. There is emerging evidence on effective socio- behavioral interventions that are effective in diabetes management and prevention of chronic diseases such as diabetes but most effective strategy is self management practices (Ramadas et al., 2015).

 Web based media have improved patient knowledge, lifestyle modifications and clinical outcomes for a range of health conditions. Web-based interventions have the potential to close the gaps in diabetes self care and self management intervention on the clinical (glycemic control, blood pressure and weight) and psychological (self care and quality of life) outcomes (Kalsen et al., 2016). However, previous web- based interventions have focused on the principles of effective education behavioral modification in diabetic patients and very few have emphasized on diet.

The proposed study is unique as it puts into consideration the ethnic and cultural background of diabetic patients to tailor the dietary change based on individual needs and preferences. Therefore, the proposed study will explore a web-based dietary intervention program (myDIDeA) for people diagnosed with Type 2 Diabetes Mellitus to evaluate the interventions feasibility and acceptability by the population. 

Proposed PICOT

 Despite the extensive actions to educate the diabetic population on effective management strategies for diabetes mellitus, there are still several issues that hinder this goal. One of the obstacles that have not been explored adequately is educating the patients about the most effective dietary changes. 

Health care providers use the strategy of ‘one size fits all’ strategy, ignoring the fact that dietary needs and preferences are unique for each patient. Consequently, most of the patients diagnosed with diabetes report poor control associated with inappropriate diabetes management and preventive measures (Plaete et al., 2016).

There is need to narrow the gap between nursing knowledge regarding diabetes management and preventive processes (Kalsen et al., 2016). The purpose of this evidence based project is to develop a web- based intervention that incorporates diabetic dietary management practices in patient’s diagnosed with diabetes mellitus with the aim of reducing HbA1c levels within a period of nine weeks. 

In this context, the PICOT statement is: In patients diagnosed with diabetes Mellitus (P), web-based dietary intervention program (myDIDeA) (I) is more effective than the standard care (C) in maintaining the Hb1Ac within normal range, (O) within a period of nine weeks (T).

 The primary aim of this study is to evaluate the effect of web based diet intervention on patient’s knowledge, attitude and behavior in patients diagnosed with diabetes mellitus. The study aims to determine the impact of the intervention on blood biomarkers and nutrient intake.  The eligible participants will be randomly allocated to the control group and the web based diet intervention.

The control group will receive standard treatment to patients with diabetes mellitus. The web-based dietary intervention program (myDIDeA) is borrowed from Ramadas and colleagues. The dietary plans developed based on the Nutrition Recommendations and Interventions for diabetic patients by American Diabetes Association (Kalsen et al., 2016).

The content of each lesson plan will be studied for its relevance to local community and fine tuned to suit each patient. Each lesson plan will have five Likert scale items that start from strongly agree =5 to strongly disagree =1).  The participants will be assigned to the dietary recommendations will be based on scores generated. The recommendations aims at addressing the dietary barriers in order to motivate the participants based in the lesson plans.

The participants will be briefed on web-based dietary intervention program (myDIDeA) and will be given unique username and password   through e-mail and SMS after randomization. Login reminders will be emailed each time the website is updated with new lesson plan. Participants will be also encouraged to send their questions to nutritionist through the email.

Reflection

Given the fact that diabetic patient control their health, self management training is an important strategy to improve the quality of care. Patient self management interventions have been indicated to be beneficial in both glycemic control and quality of life, but its participation is low and its effectiveness wanes over time. In addition, accessing professional support for self management is limited. This calls for strategic interventions that are promising and those that offer ease of access for patients who are computer literate or illiterate as they can be scaled up at a little cost (Kalsen et al., 2016).

Health care limited to clinic visit is not meeting the demands of the patients diagnosed with diabetes.  Healthcare systems that use Web-based communication offer a great opportunity to shift focus from office based healthcare towards daily lives at home. This health information technology is important because it improves the interaction between the service user and the healthcare providers which enhance effectiveness of chronic illness (Yu et al., 2014).

However, there is little research on the impact of web based interventions and shared electronic records in primary care for patients diagnosed with diabetes. The internet has emerged as an effective medium for exchange of information. The healthcare industry has recognized the internet’s potential and web- based education programs and is slowly being integrated in nursing prevention and management of chronic care in diabetes management. They have demonstrated some favorable outcomes thereby bridging gaps in diabetes self care and management (Pal et al., 2013).

Conclusion

Diabetes has become a very important health issue in the world. There is urgent need to improve the overall self management education on best strategies for diabetes self management.  Increasing use of web based interventions by consumer for promoting health information is an ongoing revolution in the health information technology, and it implies that the service users are accepting the new era of health information technology.

However, the full potential of this technology is yet to be achieved due to high attrition rates as well as limited uptake. This study aims to shed light in these limitations by identifying the characteristics related to web base interventions and attrition and in suggesting effective strategies that will help optimize these clinical outcomes.

References

Centers for Disease Control and Prevention. (2014). National diabetes statistics report: estimates of diabetes and its burden in the United States, 2014. Atlanta, GA: US Department of Health and Human Services, 2014. Retrieved from https://www.cdc.gov/diabetes/pdfs/data/2014-report-estimates-of-diabetes-and-its-burden-in-the-united-states.pdf

Karlsen, B., Oftedal, B., Lie, S. S., Rokne, B., Peyrot, M., Zoffmann, V., & Graue, M. (2016). Assessment of a web-based Guided Self-Determination intervention for adults with type 2 diabetes in general practice: a study protocol. BMJ open, 6(12), e013026.

Ramadas, A., Chan, C. K. Y., Oldenburg, B., Hussien, Z., & Quek, K. F. (2015). A Web-Based Dietary Intervention for People with Type 2 Diabetes: Development, Implementation, and Evaluation. International Journal of Behavioral Medicine, 22(3), 365–373. http://doi.org/10.1007/s12529-014-9445-z

Pal, K., Eastwood, S. V., Michie, S., Farmer, A. J., Barnard, M. L., Peacock, R., … & Murray, E. (2013). Computer‐based diabetes self‐management interventions for adults with type 2 diabetes mellitus. The Cochrane Library.

Plaete, J., Crombez, G., Van der Mispel, C., Verloigne, M., Van Stappen, V., & De Bourdeaudhuij, I. (2016). Effect of the Web-Based Intervention MyPlan 1.0 on Self-Reported Fruit and Vegetable Intake in Adults Who Visit General Practice: A Quasi-Experimental Trial. Journal of medical Internet research, 18(2).

Yu, C. H., Parsons, J. A., Mamdani, M., Lebovic, G., Hall, S., Newton, D., … Straus, S. E. (2014). A web-based intervention to support self-management of patients with type 2 diabetes mellitus: effect on self-efficacy, self-care and diabetes distress. BMC Medical Informatics and Decision Making, 14, 117. http://doi.org/10.1186/s12911-014-0117-3

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Primary Health Care Organizations in Georgia

primary health care
Primary Health Care

Primary Health Care Organizations in Georgia

Organizations that deliver primary health care here include Georgia’s Voice to end Breast Cancer, Georgia Public Health Association, Georgia Advocacy Office and Georgia Charitable Care Network among others.

Georgia’s Voice to end Breast Cancer is an organization founded by breast cancer survivors. Their focus is helping the people of Georgia put to an end the devastating disease cancer. They want to make a difference to about eight thousand Georgians who are yearly diagnosed with breast cancer (Kohler et al., 2015). They receive funding from collaborations with National Breast Cancer Coalition and individuals who were willing.

Georgia Public Health Association is a non-profit organization started in the role of promoting the public and personal health of the people of Georgia. It provides training, technical help and strategies to expand Federally Qualified Health Centers. Joining this organization gives one access to other health professionals, scholarships, recognition awards and opportunities for continuing education. Georgia Public Health Association receives most of its funding from government grants (Murray et al., 2013). This organization has for sure improved the environmental and personal health conditions of Georgia.

Georgia Advocacy Office is yet another organization that delivers primary health care in Georgia. They provide an array of services to people with disabilities in Georgia (Livermore, 2015). Examples are Investigation of an allegation of abuse, neglect, or violation of rights, assistance in negotiation on behalf of individuals and multicultural outreach to underserved or unserved persons with disabilities. Donations and grants from individuals and corporations fund this organization’s activities.

Finally, Georgia Charitable Care Network was founded in 2003 as a clinic network to offer free medical services to the people of Georgia. It consisted of a network of compassionate caregivers. They work with communities interested in starting clinics and solicit funds to distribute to members. This care network gets its primary funds from individuals and private foundations. This organization has been of great value Georgians for providing easier access to medical facilities.

References

Kohler, B. A., Sherman, R. L., Howlader, N., Jemal, A., Ryerson, A. B., Henry, K. A., … & Henley, S. J. (2015). Annual report to the nation on the status of cancer, 1975-2011, featuring incidence of breast cancer subtypes by race/ethnicity, poverty, and state. Journal of the National Cancer Institute, 107(6), djv048.

Livermore, G. A., & Honeycutt, T. C. (2015). Employment and economic well-being of people with and without disabilities before and after the great recession. Journal of Disability Policy Studies, 26(2), 70-79.

Murray, C. J., Abraham, J., Ali, M. K., Alvarado, M., Atkinson, C., Baddour, L. M., … & Bolliger, I. (2013). The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. Jama, 310(6), 591-606.

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Morbidity

Morbidity
Morbidity

Morbidity

Introduction

“Morbidity refers to the prevalence or the frequency of a particular disease in a specific region or population. Medically it can be used to describe the medical complications that arise due to a special treatment” (Cancer Research UK, 2017). Mortality, on the other hand, involves the figure of deaths reported among a population within a set duration of time. Simply put, it is the state of being destined to pass away.

“Report on mortality can be based on people living in a specific area or country, people deceased from a particular illness, and deaths of a certain age or gender or ethnic population” (Cancer Research UK, 2017). The cause of both mortality and morbidity lies in several factors found within the surroundings, and this may include technological factors, pollution of the environment among others. However, the purpose of this study is to mainly look at the environmental, economic and social factors that impact the morbidity and mortality rate of the UK population.

Social factors

It is evident from past studies done in the policy paper, Healthy Lives, Healthy People: our strategy for public health in England – GOV.UK., by the UK government reveal that citizens of the UK are living longer and healthier than people from other nations (Bennett et al., 2015). The positive aspect brought by the decline in mortality and morbidity is associated with several primary enhancement in the social dimension of their lives such as they achieved high ratings for overall life satisfaction, the economy and personal finances.

“The decrease in the death rate of both infants and adults has attributed innovations within the public health that comprises of mass immunization initiatives, enhanced sewerage services alongside water quality that significantly minimized cases of infectious ailments” (Policy Paper-GOV.UK, 2017). The impact has been positive as social factors such as healthy living have prolonged life, therefore, reducing both morbidity and mortality rates. “For instance, 501, 424 deaths were recorded in Wales and England which is a 1.1% decrease compared to the 506, 790 deaths that were recorded in 2013” (Policy Paper-GOV.UK, 2017).

Economic Factors

People have put the interest of their health first, and as a result, they have invested heavily in it by increasing the spending to 8.9% in a report by OECD in 2015 (Devaux, 2015). Some opt for insurance and health schemes to ensure their health gets taken care of in the event of an illness. Investment in health helps in ensuring that the people can consume more and at the same time reduce the occurrence of illness. “The inequalities witnessed in the UK population reveal high levels of health inequalities, and the result of this is economic status” (Balia & Jones, 2008).

A person’s socioeconomic status directly correlates with the health care they receive. Therefore, based on the statistics of deaths reported and registered by the Office for National Statistics in the UK in 2017 indicated that the mortality rate rises from the highest social class as it goes down to the lowest social classes (McLaren, 2017). In some lower social classes, the death rate doubled the rate in the highest social class.

The same observation was also made in the morbidity rate as those in the lower social class had challenges in accessing proper care and healthy living due to their economic status. The table below provides statistics on the important findings on mortality rate based on socio-economic factors such as social classes, education, and gender.

Table 1. Percentage death rate in different socio-economic groups 2014-2015

Source: (“Death registrations summary tables – England and Wales- Office for National Statistics”, 2017)

The statistics on the table provides a clear picture of the number of deaths over the ten-year period. The data reveals that there are high death rates among the older generation compared with the younger population. However, there is a considerable general decline in the number of deaths reported in the ten-year period. A good example is the number of deaths reported among the age bracket of 10-14 whose death rates had reduced by 50% ((McLaren, 2017).

Environmental factors

These factors entail pollution of the environment through the use of toxic chemicals. Contamination of the environment affects water and the air of the affected region. Several deaths have been reported within the UK as a result of chemical, air and water pollution. However, such deaths and illnesses created by such pollution can be avoided.

However, the reduction in environment pollution in the UK has reduced deaths and diseases considerably making the nation a safe environment for its citizens. Therefore,, the effect on morbidity and mortality has been a positive one as it has reduced the rates in UK over the ten year period.

Review of statistical and research evidence

Research conducted in the field of health regarding eating disorders reveal the following facts. “People in the UK estimated to have an eating disorder are estimated at 725,000 in a report produced by PwC” (“Eating Disorder Statistics – Beat,” 2017). The report further identified the common types of disorders defined in the population as mainly (BED) Binge Eating Disorder, Bulimia, and anorexia.

However, the most common among the three eating disorders was binge eating disorder. The eating disorder was attributed to starting mainly among adolescents without negating the fact that even children young as six years and adults as old as 70 years could develop it. The level of eating disorders reflect on the reduced level of morbidity happening in the UK because of careful watch on their health.

In a correlated research carried out by Institute for Health Metrics and Evaluation in 2013, it was discovered that approximately two-thirds of the male and female population in the UK are overweight. “The study identified the largest victim of obesity being men with a representation of 67% while women came close with 57%” (Sedghi, 2014). In a cancer research, it was estimated that around 50% of cancer patients in Wales and England have survived for ten years or more.

However, in the UK the results are more positive as the rate of cancer survival has moved from 24% to 505 within the same duration of time. “The variation in survival of different types of cancer has grown further to 98% in the UK” (B-eat.co.uk, 2017). The improved rate of cancer survival has impacted the mortality rate in the UK hence reduced it substantially.

Patterned inequalities in health and illness

Bennett et al., among other authors have recognized variations in the delivery of health by age, gender, ethnicity and social class (Bennett et. al, 2015). Disparities in access to healthcare have become measured through application of many different outcomes such as mortality rates, infant deaths, morbidity, life expectancy, and disability.

The Black report in 1980 was done to identify the inequality challenge as the health of the nation had improved but not equivalent to societal classes (Sim, & Mackie, 2006). The findings revealed that standards of health care were linked directly to social class. “One of the leading causes of the inequalities involved unemployment, low income, substandard housing, poor education and poor environment (B-eat.co.uk, 2017).”

As for gender, research showed that men in industrialized countries such as the UK live shorter than women and show to less experience of the adverse condition. “Although men have greater death numbers from causes of deaths such as lung cancer and ischemic heart disease, more women than men feel pain from somatic grievances such as a headache, tiredness, and muscular aches (Bartley, 2004).”

Table 2: Selected developed countries by order of life expectancy at birth in 2014

Source: (“Health status – Life expectancy at birth – OECD Data”, 2014).

Evaluation of sources

The sources for the information obtained above include the office for national statistics in the United Kingdom. The source is credible as it is a national website and information provided to the public has to be evaluated for credibility before posting. “The other sources entail data and statistics from research conducted by credible scholars in the field of economics and the field of health care (McLaren, 2017).”

The work by McLaren provides a detailed analysis of the health inequalities happening in the UK. A clear and structural look is provided by the policy paper supports the same information provided by McLaren that provide similarity and confirms consistency as well as reliability of the sources. Article reviews written by other authors have provided support to the applied sources. The reviews assist in making the sources applied credible as well as reliable.

Evaluation of contrasting reasons for health inequalities

• The structural material explanation.

“The argument entails the lack of proper housing and access to health facilities due to poverty contribute to health inequalities (Policy Paper-GOV.UK, 2017).” It requires assessment of factors such as the workplace, the neighborhood and the home environment. The attempt to reduce health inequality through reduction of health inequality is viable and reasonable. The explanation is not applicable in the modern environment as most of the health facilities have been upgraded to quality standards.

• The artefact explanation.

It attempts to account for the health inequalities as a creation of the process of measurement. It looks at the class differentials in two aspects, all-cause and specific cause data for both mortality and morbidity. “However, the explanation as reviewed by several critiques proved pervasive and complex (McLaren, 2017).” The application of this explanation is still relevant and applicable in the current period but its complexities requires proper understanding.

• The social selection report.

Social selection involves the concept of personal health affecting their mobility in the social setting, leading to a particular state in the social hierarchy which is an essential element that contributes towards social class variation seen in health care. It provides a clear framework of how social selection positions an individual in the society and results to health inequalities. The social selection report is very applicable today as social hierarchy still exists. Social variation remains a challenge in the society and the report provides a clear explanation.

• The behavioural-cultural explanation.

            The description clearly describes the interconnection between culture and behaviour. The behavior of individuals such as association with aggressive and violence acts result to a culture of crime, and drug abuse will lead to discrimination in health care provision. The connection between behavior and culture is still a prominent factor in 2017 that contributes to health inequalities. Therefore, the behavioral-cultural explanation is a reliable explanation for the inequalities within the health care in UK.

Relationship between welfare inequalities and theories of health alongside health policies development

• Cultural/behavioral.

            The cultural or behavior of an individual can be explained better using the social cognitive theory. The theory suggests that people learn from their experiences as individuals alongside the interaction with the environment. “It helps in the provision of self-efficacy and application of observational learning which can easily be applied to various populations and setting in the formulation of health policies (Sedghi, 2014).”

The cultural and behavioral theory provides observational data that provides foundation for health policies. An example is the policy regarding a culture of safety that heavily relies on data collected on behavior of patients.

• Material structural.

The material structure can well be defined through the use of the theory of planned behavior. The application of health policies requires determination of a pattern of individual behaviors within a specified population. Therefore, the material and structural model applied in solving health inequality will be suitable in ensuring that people receive the material support needed.

The material structural theory focuses on the established patterns which provide a framework that can be used in forecasting hence helps in formulation of health policies. An example of such a policy is an injury prevention policy done at the community level heavily relies on the material structural theory where individuals planned behavior are recorded.

• Collectivism.

The collectivism approach entails the use of class to define the constructs of a health belief. Therefore, the health belief model is appropriate in providing understanding on the health inequality concern in the UK. It is a theoretical structure applied in conducting health advancement and illness deterrence programs.

The constructs of health belief provided by the collectivism theory assist in establishing sound health policies within the required health guidelines. An example entails the stewardship as a policy in health that helps in ensuring that the health of people in the society is a social obligation.

• New Right.

The approach asserts that constant provision of aid by the government affects the process of a free market. “The argument states that regular provision of assistance contributes to perpetual poverty among the affected population” (Sedghi, 2014).

The policies within health care require quality attention, and when own standards of health care outperform those of public care, then health inequalities arise. The theory provides a framework under which health policies are formulated. Policies created that rely on family such as social policy heavily employ the New Right approach in the health sector.

Conclusion

The provision of health in the UK is perceived to have grown and improved tremendously. However, the Black Report in 1980 and the Acheson report in 1998 among others have identified that the improvement has several inequalities ranging from various factors such as economic, social, ethnic and environmental factors.

The differences can be seen across gender, age, social class, and ethnicity. The solutions and various explanations in the paper reveal that it is possible to bridge the gap created as a result of social class differences among other factors as highlighted through the use of the health theories.

References

B-eat.co.uk. (2017). Eating Disorder Statistics – Beat. [online] Available at: https://www.b-eat.co.uk/about-beat/media-centre/information-and-statistics-about-eating-disorders [Accessed 24 Apr. 2017].

Bennett, J. E., Li, G., Foreman, K., Best, N., Kontis, V., Pearson, C., … & Ezzati, M. (2015). The future of life expectancy and life expectancy inequalities in England and Wales: Bayesian spatiotemporal forecasting. The Lancet, 386(9989), 163-170.

Cancer Research UK. (2017). Cancer survival statistics. [online] Available at: http://www.cancerresearchuk.org/health-professional/cancer-statistics/survival [Accessed 24 Apr. 2017].

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Devaux, M. (2015). Income-related inequalities and inequities in health care services utilization in 18 selected OECD countries. The European Journal of Health Economics, 16(1), 21-33.

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Diabetes Education

Diabetes Education
Diabetes Education

Diabetes Education

Description of The Learners

The class is made up of young adults ranging from 20-26 years. Some of the listeners are people with the condition but have not publicly spoken about it, or have close relatives or friends with the condition. Others might have the condition but do not know their status since they have not and cannot go for examination. This is a group that wants to learn about the various types of diabetes to adopt appropriate ways of living their lives better.

For those with the condition already, they want to understand the right course of action to take and for those without; they want to learn about how they can modify their lifestyles and prevent themselves from engaging in the way of life that can result in them acquiring the condition. Also, the fact that they are relatively young, most in their 20s, they are energetic and keen about life. For some too, this is the age to enjoy life without limits.

They lust for knowledge but must be handled with care so as not to antagonize them. Their opinions, whether well informed or not, must be listened to and accorded the respect. Thus, the best way to progress with the class is through discussion. It should be highly interactive to give room for them to air their opinions confidently.

Educational Setting

The setting of the class is a college. The staff working here are mostly degree and diploma holders depending in their area of specialization and the department they work. All the academic staff is made up of degree holders as a requirement by the government. The support staff, on the other hand, is mostly people with diplomas. However, we must face the fact that the students mostly meet with the teachers and interact more with them.

It is thus safe to conclude that they interact with well-educated and informed people in the school whether the academic or support staff. Another fact that cannot go unmentioned is that most of the staff is made up of young adults ranging from 30-45 years. It shows the institution’s aim of trying to integrate the student body and the staff better. Several in-service training for the staff exists to continuously equip the staff with necessary skills in dealing with the students.

Being college students, they are knowledgeable about diabetes. They are aware of the causes, and the fact that it has no cure is universal knowledge among all the students. However, most of them have never dealt or cared for a diabetic patient. They only feel it is beyond their league. They believe it is a specialty for the medical personnel. And others too feel it is an exaggerated illness. They believe diabetes is not a top killer as they consider cancer and HIV being the worse illnesses.

The learners come from diversified family backgrounds. It is quite hard to put them into categories regarding their education. Some parents are semi-educated while others are well educated. But one fact is, all the parents are socially educated. They know what is right and what is wrong with their children. However, most of these parents believe in some myths surrounding the diabetes calamity. The good thing is that they agree about the causes of the disease.

Learner Assessments

The class is made up of college students. At the end of their course, they will be qualified diploma holders. This is a relatively educated group, which can grasp the fairly complex material and do what is expected of them. If well taught about a certain subject, they will understand the concepts and how to implement the ideas.

Also, at this age, they are eager to conquer the world. They understand the importance of education and thus are eager to learn more. They want to show the world that they are knowledgeable and that keeps their academic thirst going. The reason for choosing this seemingly normal disease is that it resonates well with the class. The class is made up young people who are mostly dating. To most of them, it is a thrill being in a relationship, which is cool by itself. However, the peak of these relationships is engaging in harmful lifestyles about their diets and lack of exercises.

This is despite the fact that most cases of diabetes are caused by lack of proper exercise and the consumption of sugary food. The lesson is to question why this continually happens with parents and teachers guiding these young people. Can the prevalence be blamed on the teachers, parents or the students themselves? To fill this gap, the lesson is very vital since the answer lies in the minds of these students.

Topic Selection Rationale

The main teaching philosophy is through discussion. The discussion is the best method of delivery due to the nature of this sensitive subject. Despite the fact that the young people know the dangers of not exercising proper diet, it is still an increasing trend. Moreover, most people hate being guided in such intimate matters. They feel like the others are intruding into their private life.

They want to be left alone and do what they want with their lives. In any case, they say they are adults albeit naïve ones. The discussion thus becomes handy in such a situation. This becomes easier with college students since they are educated, eager to explore and ever ready to be heard. The discussion should start with a simple introduction. A brief introduction to the topic, reasons for the topic and specifically why the class is chosen.

It is to remove further any imaginary boundaries between the educator and the students that may exist in the minds of the students. The discussion should focus on a patient suffering from the disease. It should be a right scenario where the focus rotates on how the patient acquired such a disease. Also, on how he behaved upon learning of his condition and how he lives with the condition.

The discussion will be around a man living with diabetes known as Peter. He is 28 years of age, which is a small deviation from the age of some students. The only minor difference is that he was diagnosed with the disease while still in the university some five years ago. The description of his college social life leaves nothing to be desired though it clearly resonates with the young students.

He was a person that did not like practicing and used to consume a lot of sugary food. He slept with almost all of them who were too eager to be linked with the campus celebrity. Besides the lazy behavior, Peter was an alcoholic and would regularly be found in the clubs if he was not in his room sleeping. This behavior made him have a very poor hygiene with no regular exercises and the use various sugary foodstuffs besides the alcohol that had turned to be his best friend.

After some time, Peter developed some complications that were associated with often urination, regular feelings of thirst, blurry vision, extreme fatigue, loss of weight and numbness in the hands and feet (Herr, et al. 2013). This led to him being examined by the doctor for the symptoms of diabetes. After the examination, received the shock of his life when the results returned positive of diabetes mellitus.

He felt as if his celebrated life was over. It took some time and the efforts of his parents to make him accept the situation. He followed the doctors’ advice, and he coped well. His winning attitude helped a lot too. And now, he has four years to his name living with diabetes. His simple advice to young people is; avoid inappropriate diet and alcohol and also practice regularly through running or other field events.

Conclusion

The students discussed all aspects of this case above from the causes to the final stage of accepting one’s status. They found out that speaking out also helps a great deal. The discussion is fruitful if the class participates well. The interactions amongst themselves and also between them and the educator equip them with knowledge on diabetes. The discussion is the best mode of teaching a young class which is expected to impart this knowledge to others further. It gives them the freedom to think on any angle and widen their knowledge gap due to the peer discussion.

References

Herr, R., Pouwer, F., Holt, R. I. G., & Loerbroks, A. (2013). The association between diabetes and an episode of depressive symptoms in the 2002 World Health Survey: an analysis of 231 797 individuals from 47 countries. Diabetic Medicine, 30(6), e208-e214.

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Resuscitation: Case Study

Resuscitation
Resuscitation

Resuscitation: Case Study

Part 1: Code Blue educational video from the Regina Qu’Appelle Health Region.

Time sequenceIssue notedcodecomments
0-22 seconds  Breach of Australian Resuscitation Council Guidelines:  BARCG- Guideline 2 priorities in an emergency        Finds Mr. Smith unresponsive. Fails to follow the Guide 2 BLS algorithm because she failed to assess danger, but she assessed the airway, as she is seen checking for the escape of air from the patients mouth or nose as recommended by guide 5.  Implications: Delay in resuscitation processes increases the risk of reduced cardiac output to the brain due to poor compressions.

 
Time 3.26Poor technical skills  PTS – BARCG Guide 6 & 8Chest compressions inadequate as recommended by Guide 6. The recommended chest compressions are 30 chest compressions followed by two breaths.
The chest compressions are slow than required by Guide 8. “A good CPR should deliver chest compressions over the lower half of the sternum at a depth of 5 cm” (ARC guide 8). Long pauses in CPR before shock delivery. Guide 6 discourages long pauses and distractions during a CPR Implications: Long pauses, distractions, slow and inadequate chest compressions lower the chance of  patient’s survival
Poor Non-Technical skills PNTS
Time 0.30Situation awarenessPNTS- SA The nurse did not press the emergency push button system to call for help immediately and instead used the overturn
Implications: Delayed response  by the code blue team
Time 0.30 secs Time 2.26 minutesDecision makingPNTS- DMDelay in full code response. The team arrived 2 minutes later after the call alert Implications: This led to delay important activities such as defibrillation. However, the rest of the decisions such as medication, hyperventilation and defibrillation activities went on well once the code blue captain arrived.
Time 3.36Task managementPNTS-TMCompressors for more than five cycles. One compressor was working for almost 5 minutes which is too long for a compressor. According to Guide 5, “the compressor roles approximately after 2 minutes or after five cycles of compressions and ventilations at a ratio of 30:2 so as to maintain the quality of compressions” (ARC guide 5).  However, other task management processes such as airway positioning, nasopharyngeal airway placement, bag-valve mask ventilation were correctly performed.
Time 5.28   Time 12.55CommunicationPNTS- comm  Occasionally fails to use the closed up communication which leads to miscommunications. For instance, at minute 12.55, the recorder had missed recording the endotracheal tube particulars due to poor communication strategy.
  The team used the SBAR technique to report the patient’s medical history to the code blue team leader. All the information was recorded including all the medication administered and other CPR outcomes such as cardiac rhythm before a shock was delivered. This is vital for future references.
 TeamworkPNTS-TeamNo introduction was done by the team members, but they delegated the resuscitation duties appropriately. The team consisted of a coordinator, compressor nurse, airway manager, nurse in charge of defibrillator, captain/leader and crash cart manager.
 LeadershipPNTS- LeadershipThe leader failed to evaluate the BLS on arrival. However, Mr. Sellinger (the code captain) performed his tasks effectively including identification of cardiac rhythm, initiation of ACLS protocol, and evaluation of the protocol reviewed the code blue documentation form and signed the code blue form after completing the code blue.

PART 2: Analysis of the issues covered

Code blue should be contacted immediately for all unresponsive patients. Calling for help and initiation for help should be done simultaneously.  One of the issues identified in this case study is delayed in the response of code blue code due to poor call out systems. The code team member should call out loudly for help through the facility-wide response system. In this technology, the nurse should have pressed the Blue code push button to ensure that the code blue team were notified accordingly (Bayramoglu et al., 2013).

As the nurse in charge waits for code blue team, he or she should initiate CPR (Clarke, Apesoa-Varano, & Barton, 2016). The code team are expected to introduce themselves as they arrive as well as and their roles statements such as “Am Mr. J. and will take document” or “I’ll take the airway” which helps in ensuring there is clear role differentiation. The service user physician should be contacted  immediately.

According to Price, Applegarth & Price (2012), the healthcare provider should first assess the patient dangers and risks before they start the air management. This was not done in the case study and violated the ARC guide four which states that the patient’s mouth should be opened and head slightly turned downwards to remove the airways (Australian Resuscitation Council, 2008).

 An ineffective cough indicates a severe obstruction. In this case, if the patient is responsive, the healthcare provider should give about five back blows, and if still, it is ineffective, they should give at least five chest thrusts (McInnes et al., 2012). This article states that for all unresponsive patients, the healthcare should send for help and start CPR immediately. Similarly, guideline 5 recommends that all patients who are breathing abnormally or are unresponsive require being resuscitated.

The first thing when assessing breathing, the rescuers should check for   movement around the chest (lower part) and abdomen (upper part). They should check for the exhalation through the patient’s oral cavity or nose, and feel the movement of air in the patient’s mouth or nose. The guide recommends a ratio of compressions to rescue breaths as 30:2 (Australian Resuscitation Council, 2008).

According to this article, the first nurse to respond should start saving the patient’s life by performing chest compressions immediately (100 compressions per minute). Although important, the nurse should not wait for backboard , they should start chest compressions as it can be put in place later when  the code team arrives. The switching the compressor roles in the case study is present but it took quite a long time than that recommended by ARC guide 6 which is approximately after 2 minutes.

To maintain the quality,  the ventilations ratio should be maintained at 30:2 (Castelao et al., 2013). This is supported by Guide 6 which recommends that interruptions to chest compressions should be minimized. The  best location to perform the compressions is the sternum- the lower half part of it. The healthcare provider’s heel is placed at the central part of the chest and put the other hand on top it. The recommended rates of compressions are 100 to 120 compressions per minute which are about two compressions per second.  

The guide also outlines on the quality of compressions ( which is identified as poor in the case study)  where it suggests that depth of compressions should be “at least 2 inches (5cm) with complete chest recoil after every compression” this helps the heart to re-fill completely by the next round of compressions. The number of interruptions should be minimized to ensure maintain the quantity and quality of compressions (Eroglu et al., 2014).

 According to the article, the patient should be given 2 ventilations for every 30 seconds of  oxygen-bag-mask device assisted ventilation. The oxygen level should be set to the flow meter 15 L/min, and where applicable, the reservoir should be fully open ensure that  the patient gets 100% oxygen for each breath. One strength observed in the study is the fact that bag-mask device is best done by two blue code team members where one open the airway to fasten the mask on whereas the second one squeezes the oxygen bag.

Also, the article states that defibrillation is very critical and that the use of placement hands-free defibrillation pads is a safer option than hands held defibrillation paddles (Girotra et al., 2012; Prince et al., 2014). The article states that the deployment of automated external defibrillators (AED) should be used as soon as possible as it reduces mortality and morbidity associated with cardiac arrest caused by either ventricular fibrillation or ventricular tachycardia (Australian Resuscitation Council, 2008).

The compressions should resume immediately after delivering shock even with a normal heart rhythm as it will not provide enough cardiac output that will ensure adequate perfusion. It is recommended that 2 minutes the cardiac rhythm should be assessed after 5 cycles of a CPR (Merchant et al., 2014). The use of vasopressors in cardiac arrest is recommended only when there are no high-quality CPR. It is important to be extra cautious when administering a drug. This is because miscommunication is a common issue which often leads in the administration of incorrect drug doses or medications.

This can be prevented by using “closed loop” method of communication (Segon et al., 2014; William et al., 2016). For instance, when a nurse receives an order to inject some medicine, they should repeat the information of drug prescribed out loud, inject it and then announce it again after administration (Price et al., 2012). This method was used in some instances, but in the instance that it was absent, the recorder was prone to miss out some key aspects; for example, in this code blue simulation, the recorder had missed recording the endotracheal tube measurements.

The article suggests that an effective code blue team should have leader who controls the all the procedures and efforts of resuscitation. They communicate with the staff involved and evaluate the cardiac rhythm of a patient. Mr. Sellinger is the team captain of the case study and was standing in a position such that he could effectively see all of the resuscitation procedures and efforts. If the organization allows, the family member can be allowed into the room. It is also important to ensure that the information is well recorded.

In the case study, the recorder is shown documenting all the resuscitation process. However, it is important to understand that documentation process is done according the healthcare facility’s policy (McEvoy et al., 2014; Sahin et al., 2016). The recorder should remind the code team when time for a specific task has elapsed and must record all the activities taking place including the medicines prescribed. The article also suggests that all clinical areas should grant quick access to equipment such as blood glucose, blood pressure, and equipment of pulse oximetry and other equipment so as to effectively manage a deteriorating patient (Clarke, Carolina Apesoa-Varano, & Barton, 2016).

Through this case study, it is evident code training programs using simulation is beneficial and has been recommended by various healthcare institution organizations since 1999. This training will help the learners to improve cardiac resuscitation outcomes as it offers an opportunity  for  regular hands-on practice within the hospitals.  This also helps the team to understand the various roles and responsibilities expected during a full code. Along with continuing education and mock codes, the team members become confident in their responsibilities (Gutwirth, Williams, Boyle, & Allen, 2012).

References

Australian Resuscitation Council. (2008). Standards for Resuscitation: Clinical Practice and Education. Retrieved from  http://www.resus.org.au/clinical_standards_for_resuscitation_march08.pdf

Bayramoglu, A., Cakir, Z. G., Akoz, A., Ozogul, B., Aslan, S., & Saritemur, M. (2013). Patient-Staff Safety Applications: The Evaluation of Blue Code Reports. The Eurasian Journal of Medicine, 45(3), 163–166. http://doi.org/10.5152/eajm.2013.34

Castelao, E. F., Russo, S. G., Riethmüller, M., & Boos, M. (2013). Effects of team coordination during cardiopulmonary resuscitation: A systematic review of the literature. Journal of critical care, 28(4), 504-521.

Clarke, S., Apesoa-Varano, E. C., & Barton, J. (2016). Code Blue: Methodology for a qualitative study of teamwork during simulated cardiac arrest. BMJ open, 6(1), e009259.

Eroglu, S. E., Onur, O., Urgan, O., Denizbasi, A., & Akoglu, H. (2014). Blue code: Is it a real emergency? World Journal of Emergency Medicine, 5(1), 20–23. http://doi.org/10.5847/wjem.j.issn.1920-8642.2014.01.003

 Girotra, S., Nallamothu, B. K., Spertus, J. A., Li, Y., Krumholz, H. M., & Chan, P. S. (2012). Trends in Survival after In-Hospital Cardiac Arrest. The New England Journal of Medicine, 367(20), 1912–1920. http://doi.org/10.1056/NEJMoa1109148

Gutwirth, H., Williams, B., Boyle, M., & Allen, T. (2012). CPR compression depth and rate about physical exertion in paramedic students. Journal of Paramedic Practice, 4(2).

McEvoy, M. D., Field, L. C., Moore, H. E., Smalley, J. C., Nietert, P. J., & Scarbrough, S. (2014). The Effect of Adherence to ACLS Protocols on Survival of Event in the Setting of In-Hospital Cardiac Arrest. Resuscitation, 85(1), 10.1016/j.resuscitation.2013.09.019. http://doi.org/10.1016/j.resuscitation.2013.09.019

Merchant, R. M., Berg, R. A., Yang, L., Becker, L. B., Groeneveld, P. W., & Chan, P. S. (2014). Hospital Variation in Survival After In‐hospital Cardiac Arrest. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 3(1), e000400. http://doi.org/10.1161/JAHA.113.000400

McInnes, A. D., Sutton, R. M., Nishisaki, A., Niles, D., Leffelman, J., Boyle, L., … Nadkarni, V. M. (2012). The ability of code leaders to recall CPR quality errors during the resuscitation of older children and adolescents. Resuscitation, 83(12), 1462–1466. http://doi.org/10.1016/j.resuscitation.2012.05.010

Price, J. W., Applegarth, O., Vu, M., & Price, J. R. (2012). Code Blue Emergencies: A Team Task Analysis and Educational Initiative. Canadian Medical Education Journal, 3(1), e4–e20.

Prince, C. R., Hines, E. J., Chyou, P.-H., & Heegeman, D. J. (2014). Finding the Key to a Better Code: Code Team Restructure to Improve Performance and Outcomes. Clinical Medicine & Research, 12(1-2), 47–57. http://doi.org/10.3121/cmr.2014.1201

Segon, A., Ahmad, S., Segon, Y., Kumar, V., Friedman, H., & Ali, M. (2014). Effect of a Rapid Response Team on Patient Outcomes in a Community-Based Teaching Hospital. Journal of Graduate Medical Education, 6(1), 61–64. http://doi.org/10.4300/JGME-D-13-00165.1

Sahin, K. E., Ozdinc, O. Z., Yoldas, S., Goktay, A., & Dorak, S. (2016). Code Blue evaluation in children’s hospital. World Journal of Emergency Medicine, 7(3), 208–212. http://doi.org/10.5847/wjem.j.1920-8642.2016.03.008

Williams, K.-L., Rideout, J., Pritchett-Kelly, S., McDonald, M., Mullins-Richards, P., & Dubrowski, A. (2016). Mock Code: A Code Blue Scenario Requested by and Developed for Registered Nurses. Cureus, 8(12), e938. http://doi.org/10.7759/cureus.938

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Nursing care: Concept Analysis Critique

Nursing care: Concept Analysis Critique
Nursing care: Concept Analysis Critique

Nursing care: Concept Analysis Critique

Introduction

 The concept analyzed in this article is nursing care. Evidently, nursing scholars, theorists, and healthcare professions have varying interpretations of the concept. However, in the middle of these disparities, nursing care is a vital aspect of nursing practice and a beneficial factor for both patients and nurses.

Several studies have explored the meaning of the concept (from both nurses and patients perspective) with the aim of identifying the relationship between nursing caring and patient satisfaction. Most textbooks, scientific articles, ethical codes and legal documents use the term nursing as a synonym to caring which are characterized as a nurse’s main ethical obligation (Dalpezzo, 2009).

Therefore, the aim of this concept analysis critique is to help clarify the vague concepts such that every person using it speaks the same thing. This is important in healthcare discipline because it helps people to develop knowledge related nursing concepts.

The overall intention of this analysis to provide a meaningful nursing care concept that can be used by nurse researchers and theorists to get its deeper insights and to identify better means that can be used to assess this complex nursing concept. The specific aims for this concept analysis article critique is; a) to clarify the nursing care concepts, b) identify the strengths of this article in clarifying the nursing concepts and c) to identify the weakness and d) to highlight its implication for practice.

Strengths

The concept analysis criterion background and purpose is clearly described which is to explore the concepts of nursing care and its essence with the aim of developing an operational definition of nursing care (Dalpezzo, 2009, p. 256). Also, the article analyzes the relevant literature to determine the definitions of the nursing care concept terms and in arriving at the core defining attributes of the nursing concept.

For instance, the researcher uses Dictionary.com Unabridged v 1.1, 2006a and the American Heritage Dictionary of the English to define the term ‘care’ and ‘nursing.’ The article also explores the basic definitions of the words ‘caring’ and ‘nursing’ in major nursing models and nursing theories (Dalpezzo, 2009, p. 259).

The author also explores the definition of the concept nursing care from the allied health literature; where he reviewed 16 randomly selected peer-reviewed articles. This research ensured that the analysis of the concept is done extensively, making it clear, distinct and is unambiguously differentiated from the other nursing concepts.

  The author develops the definition of the nursing concept in logically, and the discussions of the empirical referents and antecedents are clear. For instance, the author begins by identifying the purpose of the study. This is followed by a brief description of Walker and Avant’s concept analysis method. To start with, the rationale for the selection of the concept nursing care is well outlined which is the lack of clear definition within the nursing literature (Dalpezzo, 2009).

The article describes the purpose of the analysis and clearly identifies the uses of the nursing care concepts in different disciplines.  The author also determines concepts defining attributes which include a) nursing care procedures- those needed by patients, b) nature of nursing care – including the high quality of care, nursing skills, safe, holistic and evidence-based, and c) the core functions of nursing care including listening, assessing, preventing, advocating. 

The concept is further developed by reviewing additional cases to identify the antecedents and the consequences and to define the concepts empirical referents. This extensive research to define nursing care concept ensures that the analysis of the concept is accurately developed and illuminated (Dalpezzo, 2009).

Weakness

  Nursing discipline has set forth an explicit desire to serve the public and commitment to the overall well-being of the society. Therefore, concept analysis is performed to refine the definition of nursing care, with the aim of differentiating it from other similar or dissimilar concepts. The concept analysis of nursing care outlines the focus and boundaries of nursing discipline and also highlights the aspects of the concept that are significant to nursing practice, and can be traced back to the nursing field fundamental concepts(Dalpezzo, 2009).

The terms, meanings, usages, definition and attributes are derived from the nursing care concept analysis is derived from dictionaries, thesauruses, Walker and Avant (2005) method and the current literature. The term nursing care is used throughout the disciplines allied to health, but its meaning is not clear. There are varied themes of nursing care concepts in the literature which present the world’s views and perceptions about nursing care.

However, the concept analysis is limited in that the definition of nursing care concept is a context- based activity; however, the activities differ between the operational environments and the measures or methods used to assess the nursing care outcomes (Koy, Yunibhand, Angsuroch, 2015).

 Also, the concept analysis is limited because the attributes gathered from the literature are the only ones used to define nursing care concepts. For instance, the description of nursing care concept from the literature ranges from general conceptions of just being helpful to include divine oriented interventions.

Therefore, the lack of clear definition of nursing care concept in the context of socio-cultural and religious aspects is the greatest dilemma associated with quality nursing practice because it hinders nurse’s efforts to meet patient’s socio-cultural needs. Therefore, future nursing care concepts should put into consideration the cultural contexts (Koy, Yunibhand, Angsuroch, 2015).

Implication for practice

  Caring is a complex universal phenomenon and is deeply rooted in the primitive society. For instance, women care for their children and other dependent members of the family. Women involvement in all aspects of care is common in many cultures (Sarpetsa, Tousidou, & Chatzi, 2013). Also, the word ‘nursing’ is highly connected to the term ‘care.’ 

Nurses deliver nursing care to other people with the aim of maintaining and promoting their health during illness, ordeal or disability. Care is an important element of nursing; and that the conception of the term ‘care’ in nursing affects the way it is delivered. Therefore, people’s perception, experiential, and socio-political aspects of nursing influence provision of care (Schrijvers et al., 2012).

Nursing care is a continuous phenomenon that follows human existence since the time they are born to death.  According to Institute of Medicine (IOM) study, nursing care is patient-centric and is directly linked to quality and safety. Nurses have the potential to foster a quality healthcare environment through various ways (Kvist et al., 2014). Nursing care starts with non-verbal communication between the nurses and patients.

It has been found that emotions expressed by nurses towards their patient have an effect on their outcomes, with positive emotions improving their recovery rate. Also, it is through emotional empathy, a respectful, and trusting relationship with the patients is established. Patient-centric care provides a distinct advantage of consistent daily assessment of the patient’s health condition which allows the nurses to detect slightest changes in patients health that require them to proactively make some modifications to the patient care plan when needed (Cheung et al., 2008).

Addressing the variance in nursing care perception is important when interpreting inconsistencies of the concept in nursing literature because it affects patient care outcomes. Nursing care also influences the quality of interaction by the healthcare team (Samina et al., 2008).

While caring is vital between patients and nurses, it is equally important for the healthcare staff because it helps the team to adapt and work together and to understand each person’s individual responsibilities and to provide constructive feedback. Every nurse is a leader because they are in a unique position to make a difference in patient’s recovery. The concept of nursing care facilitates communication, especially when implementing care plans for the patients (Sarpetsa, Tousidou, & Chatzi, 2013).

At administration level, nurses utilize their hands on experience (nursing care) to identify the most effective strategies to delegate the available healthcare recourses to ensure positive patients outcome. Therefore, this concept analysis ensures that one gain the knowledge and technical know-how so that they car skilfully integrate their knowledge into practice (Sarpetsa, Tousidou, & Chatzi, 2013).

Understanding the concepts of nursing care helps one understand the nursing discipline, its culture and the changes needed to make changes that positively impact on the patient’s health outcomes. Tapping into the sufficient knowledge developed by the nursing care concepts analysis, nurses can foster a combination of personal skills, evidence-based practice to collaboratively improve patient outcomes (Schrijvers et al., 2012).

References

Cheung, R. B., Aiken, L. H., Clarke, S. P., & Sloane, D. M. (2008). Nursing care and patient outcomes: international evidence. Enfermeria Clinica, 18(1), 35–40.

Dalpezzo, N.K. (2009). Nursing Care: A concept analysis. Nursing Forum 44(4); 256- 264

Koy, V., Yunibhand, J., Angsuroch, Y. (2015). Nursing care quality: a concept analysis. International Journal of Research in Medical Sciences 3(8): 1832- 1838 DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20150289

Kvist, T., Voutilainen, A., Mäntynen, R., & Vehviläinen-Julkunen, K. (2014). The relationship between patients’ perceptions of care quality and three factors: nursing staff job satisfaction, organizational characteristics, and patient age. BMC health services research, 14(1), 466.

Samina, M., GJ, Q., Tabish, S., Samiya, M., & Riyaz, R. (2008). Patient’s Perception of Nursing Care at a Large Teaching Hospital in India. International Journal of Health Sciences, 2(2), 92–100.

Sarpetsa, S., Tousidou, E.,  & Chatzi, M. (2013). The Concept of” Care” as Perceived by Greek Nursing Students: a Focus Group Approach. International Journal of Caring Sciences, 6(3), 392.

Schrijvers, G., van Hoorn, A., & Huiskes, N. (2012). The care pathway: concepts and theories: an introduction. International Journal of Integrated Care, 12(Special Edition Integrated Care Pathways), e192.

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How VITAMIN D Deficiency Affects the immune response in HIV patients

vitamin D deficiency
VITAMIN D Deficiency

How VITAMIN D Deficiency Affects the immune response in HIV patients

ABSTRACT

Vitamin D deficiency is a common issue in patients diagnosed with chronic conditions including Human Immunodeficiency Virus (HIV) infection. Research estimates that vitamin D deficiency in HIV infected people range between 12-100% (Lake & Adams, 2011). Generally, vitamin D deficiency is associated with various risk factors including age, race, overweight, geographical location and exposure to some antiretroviral therapy medication.

However, there is little research on the role of vitamin D in human immune system. This systematic review explores in depth analysis of on the factors associated with vitamin D deficiency. The paper also explores the role of vitamin D on the immune system (both adaptive and innate immune system).

However Ginde, Liu and Camargo(2009) believes, Vitamin D deficiency and supplementation in patients diagnosed with HIV is not well understood. The rationale of this dissertation is to provide to review current information on the role of vitamin D on HIV patient’s immune system.  The aim of this literature review is to understand the impact of Vitamin D in HIV patients.

The key words that were used during literature search were structured the dissertation topic which was to find the impact of vitamin D on HIV patients. This included; Vitamin D, HIV, Vitamin D deficiency, Vitamin D role in innate immune system, Vitamin D in adaptive immune system, ; disease progression, pathogenesis of HIV, CD4, CD4+ T cells, CD$ count, Vitamin D supplementation, CD4 percent, role of Vitamin D,25(OH)D and the immune system, and factors that influence Vitamin D levels in HIV patients

Current strategies to help manage HIV

Regardless of the fact of progress in antiretroviral treatment (ART) in the last 10 years, HIV diagnosis is still very high. Recent studies stress on the importance of nutrition in HIV patients, especially the Vitamin D. Most of HIV patients are diagnosed with vitamin D deficiency. The deficiency has been shown to affect the immune cells (B cells and T cells) because the immunologic cells may not metabolize the active part of the vitamin D which is D3. There are many factors that contribute to vitamin D deficiency such as skin colour and diet. These limitations will be discussed in more detail in chapter 2.

 Sun  (2010) suggests, vitamin D has an impact in anti-inflammation and anti-infection which has newly founded and important movement for calcitriol receptor . Salahuddin (2013) suggests that vitamin D increases protective immune responses to Mycobacterium tuberculosis (TB) by reducing Interferon-gamma (IFN-g) and suppressing diseases linked with inflammation in the host. This study suggests, increased vitamin D dosage helped TB patients and enhanced their host immune response compared to deficient vitamin D levels. This suggests vitamin D can be used to treat TB. Vitamin D deficiency causes patients to be more susceptible to autoimmune conditions such as tuberculosis (Norman & Henry 2006; Aranow,  2016).

Vitamin D deficiency in HIV populations

The published rate of associated with Vitamin D deficiency/ insufficiency in HIV infected people range between 12% and 100% posted by Lake & Adams(2011). Generally Lake & Adams, (2011) suggest the rates of low 25 (OH)D in HIV patients is high and is associated with  traditional risk factors such as age, race, overweight, seasonality, overweight and exposure to ART Research by Aranow (2011), suggests that the impact of Vitamin D status on health status of human being played a significant role.

Therefore, Ginde, Liu and Camargo(2009) believe the African community in Europe, UK, and USA are likely to be affected by the geographical location, such that their current vitamin D intake is low due to restriction due to high melanin content in their skin. In addition, the USA Black ethnic group is associated with vitamin D deficiency because they need longer exposure to produce the same level of vitamin D as the white ethnic people do. 

For instance, in USA, the average 25(OH) D concentrations are low for blacks is 17.4 ng/ml as compared to 21.9 ng/ml d 28.3 ng/ml  in fair skin tones respectively. Therefore Prietl et al(2013) suggests , HIV patients with darker skin pigment in these regions are likely to report Vitamin D deficiency These studies suggests that  in the future, skin pigmentation is an effective strategy to identify people who are at risk of vitamin deficiency, especially among the HIV infected population so as to reduce further HIV related issues.

In some specific ART sessions and agents are associated with Vitamin D deficiency. Some studies have indicated that non-nucleoside reverse transcriptase inhibitor (NNRTI) is associated with 25OHD deficiency.

Giusti, Penco, & Pioli (2011), suggest that the protective function of Vitamin D against disease progression and mortality in HIV patients can be explained by its role in immune response. Djukic et al., (2017) suggest 1, 25 (OH) 2D is active in all organ systems and plays an important role in human immune system.  Especially, 1, 25 (OH) 2 D reduces T cell activation and genes associated in cell differentiation and ability to spread.

Furthermore Djukic et al., (2017) believes it reduces the amount of pro-inflammatory cytokines such as Tumor Necrosis factor (TNF – α),Interlukin 2 and 12  (IL2, IL-12) and Interferons (IFN –γ) triggers the T cells to response to TH1 and TH2 responses; these responses also play an important function in controlling the immune cells and antimicrobial defense including monocyte chemotaxis and their differentiation into macrophages, releasing  nitric oxide by macrophages and production of ß defensin 4 and cathelocidin and anti-microbial peptides that stops virus from copying. Due to these antimicrobial and anti-inflammatory functions, it has been suggested that Vitamin D deficiency has a great role in immune anti-inflammatory (Giusti, Penco, & Pioli, 2011).

Effects of vitamin D on immune response

Bailey et al., (2010) suggest that Vitamin D triggers the immune system.  The results suggest that Vitamin D plays a major role in boosting the immune system.  Many studies including Rathish(2012), have looked at human T cells in the lab to study the complex process of Vitamin D in innate and the adaptive immune system, and how the different cells fights infection. These findings are supported by the discovery of people with vitamin D deficiency tend to be more likely to have  infections and that supplementation of vitamin D  may boosts immunity. This chapter explores the role of vitamin D in innate and adaptive immune response.

The studies provided suggest that Vitamin D deficiency allegedly had an effect on immune cells and the reaction quickly destroys CD4 count and furthers the disease. Evidence from Langfordet,al,(2007) does provide that low CD4 is associated with low vitamin D in HIV paitents knowing that, CD4 count are low compared to intracellular pathogens .

Moreover Sun (2010) suggests, enough vitamin D can help increase that natural immune system, fight pathogens, regulate infected CD4 cells and other immune cells. Vitamin D can reduce the progression of HIV progression through CD4 response, recognizing cytokines secretions.

References

Diamond, T., Levy, S., Smith, A. and Day, P. (2000). Vitamin D deficiency is common in muslim women living in a Sydney urban community. Bone, 27(4), p.27.

Djukic, M., Onken, M. L., Schütze, S., Redlich, S., Götz, A., Hanisch, U. K., … & Bollheimer, C. (2014). Vitamin D deficiency reduces the immune response, phagocytosis rate, and intracellular killing rate of microglial cells. Infection and immunity, 82(6), 2585-2594.

Giusti, A., Penco, G., & Pioli, G. (2011). Vitamin D deficiency in HIV-infected patients: a systematic review. Nutr Dietary Suppl, 3, 101-111.

Holick, M.F. (2007). Vitamin D deficiency. New England Journal ofMedicine, 357, 266–281.

Holick, M. (2007). Vitamin D Deficiency. New England Journal of Medicine, 357(3), pp.266-281.Prietl, B., Treiber, G., Pieber,

T. R., & Amrein, K. (2013). Vitamin D and Immune Function. Nutrients, 5(7), 2502–2521. http://doi.org/10.3390/nu5072502

Rona, Z. (2010). Vitamin D. 1st ed. Summertown, TN: Books Alive.

Rathish Nair, A. (2012). Vitamin D: The “sunshine” vitamin. [online] PubMed Central (PMC). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356951/ [Accessed 28 Mar. 2017].

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Healthcare Delivery: Case Study

Healthcare Delivery
Healthcare Delivery

The Impact of Electronic Health Record (EHR) Systems on Healthcare Delivery in Australian Hospitals

Abstract

Variations in healthcare needs of today’s population compel modern healthcare organizations to change the manner in which they deliver healthcare. A good number of contemporary healthcare organizations have taken advantage of advancements in information technologies, and they increasingly integrate electronic health record (EHR) systems into healthcare delivery.

The current study aims at finding the impact of electronic health record systems on healthcare delivery in Australian healthcare organizations. The study will utilize a theoretical research approach that involves a review of records of selected companies in order to obtain relevant data. Findings obtained from this study will be used to advise modern healthcare organizations on some of the reasons why they should either adopt or avoid implementation of electronic health record systems.

The Impact of Electronic Health Record (EHR) Systems on Healthcare Delivery in Australian Hospitals

1.0 INTRODUCTION

With the rapid rate of advancements in information communication technologies, contemporary healthcare organizations have integrated electronic health record system into healthcare delivery to match healthcare needs of the current population (Zeng, 2016). An electronic health record (EHR) system is a computerized version of a patient’s health data, including past medical history, laboratory reports, vital symptoms, demographics, medications, and progress notes, that can be shared among healthcare practitioners within a healthcare organization (Bowman, 2013).

According to Gao, Sorwar, and Croll (2013), Australian healthcare industry began to consider electronic health record systems in 2000. Since then, many hospitals in the country have made an effort to develop and implement electronic health record systems. As opposed to the traditional paper records system, it is anticipated that electronic health record systems will enhance the quality of care, minimize medical errors, improve patient satisfaction, and reduce healthcare costs in Australian healthcare organizations (Gao, Sorwar, and Croll, 2013).

This proposal will direct a study on the impact of electronic health record systems on healthcare delivery in Australian hospitals. It provides a detailed analysis of existing body of literature on the study topic. Additionally, the paper outlines the procedures and processes that will be followed to gather data to answer the research question. It also highlights the relevance of the study approach as well as the implications of study findings.

1.1 Problem Identification

Traditionally, hospitals used to rely on paper records to keep important medical information of patients. Although clinicians used well-organized templates to document their patient’s health data, retrieving this information was sometimes difficult due to illegible handwriting. Furthermore, the handwritten information could not be shared among healthcare providers through computer systems.

Paper records were also easy to destroy, thereby resulting in loss of patient’s data. Advancements in information technology systems allow contemporary healthcare organizations to store patients’ medical data electronically to allow easy sharing and analysis. The number of hospitals which are implementing electronic health record systems is on the rise in today’s society due to the anticipated benefits of this new technological advancement.

In order to help Australian hospitals to evaluate the financial feasibility of implementing electronic health record systems, it is important to investigate and reveal the nature of impact that an electronic health record system has on healthcare delivery.

1.2 Significance of the Problem

An electronic health record system makes it much easier to track and retrieve patient data as compared to paper reviews. Availability of these systems in hospitals makes patient information available to authorized healthcare practitioners who may need it within the organization. For this reason, healthcare organizations that use electronic health record systems are highly likely to have a form of healthcare delivery that is different from those organizations that use paper records (Bowman, 2013).

1.3 Research Question

Have electronic health record systems improved healthcare delivery in Australian Hospitals?

1.4 Hypotheses

Alternate Hypothesis (H1): Electronic health record systems have improved healthcare delivery in Australian hospitals

Null Hypothesis (HO): Electronic health record systems have not improved healthcare delivery in Australian hospitals

1.5 Variables

Independent variable; an electronic health record system

Dependent variables; health care quality, medical errors, and patient safety

2.0 LITERATURE REVIEW

A number of studies have been performed with the aim of finding out the benefits of electronic health record systems as far as their influence on clinical outcomes is concerned. The main clinical outcomes that have been the center of focus in a large percentage of these studies are patient safety, healthcare quality, and medical errors (Menachemi and Collum, 2011). Healthcare quality is achieved when the healthcare provider delivers the right type of care, in the right manner, at the right time, and to the right patient, with the aim of having the best results possible.

In order to maximize patient safety, healthcare providers must avoid injuries for their clients and ensure that services offered are able to generate the intended help (Gao, Sorwar and Croll, 2013). As Gao, Sorwar and Croll (2013) explain, medical errors are minimized during care delivery when data is entered accurately and when there is clarity of medical records. According to Menachemi and Collum (2011), electronic health record systems generally minimize medical errors, improve health care quality, and enhance patient safety.

In a survey conducted across Australian health organizations in 2015, Australian Digital Health Agency revealed that electronic health records have got numerous benefits for healthcare providers which translate into improved healthcare delivery for patients. According to the Australian Digital Health Agency (2015), electronic health record systems enable healthcare providers to spend more time with their patients as they do not have to waste time looking for clinical information.

This gives patients an opportunity to share their important health information with health care providers thereby contributing to improved health care quality. Furthermore, healthcare providers in Australian health organizations which have implemented electronic health record systems are able to closely monitor their patients’ progress, including those with chronic health problems, while at the same time offering them necessary medical support. This helps patients to have a comprehensive understanding of their health problems (Australian Digital Health Agency, 2015).

Australia is one of the industrialized countries which support the integration of electronic health record systems into healthcare delivery. The version of electronic health record system which majorly operates in Australia is the Personality Controlled Electronic Health Record (PCEHR) system (Gao, Sorwar and Croll, 2013). The Australian public has demonstrated support for PCEHR system due to a number of benefits they have experienced since its adoption.

For instance, with PCEHR systems, patients can now have immediate access to their health information, easily track their prescriptions and medications, as well as make necessary changes to their health records. Basically, PCEHR system has helped Australian healthcare organizations to keep accurate patients’ health records, deliver the right care at the right time, and to maximize patient safety (Gao, Sorwar and Croll, 2013).

Several researchers agree that electronic medical systems are associated with reductions in medical errors in healthcare organizations because they improve the accuracy with which patients’ health data is maintained (Menachemi and Collum, 2011). In a study conducted by Bates, Leap, and Cullen (1998), an electronic health record system reduces medical errors in healthcare settings by approximately 50 percent.

In a similar study, Bowman (2013) found out that computerization of patients’ health data results into an error rate reduction of approximately 10 percent. These findings indicate that clarity and accuracy of medical records are greatly enhanced with the use of electronic health record systems in healthcare organizations.

Although electronic health record systems generate numerous benefits, healthcare organizations serious negative consequences by adopting the technology due to inappropriate design choice and careless use (Bowman, 2013). For instance, poor design choice of an electronic health record system will increase medical errors instead of reducing them. Additionally, poor use of the system may interfere with the integrity of data thereby endangering patient safety and decreasing the quality of care (Zeng, 2016).

In most instances, these are unintended consequences which may make an organization to face lawsuits and pay huge legal fines. As health information technology becomes increasingly involved in the delivery of care, healthcare organizations must be prepared to manage HIT-related risks which may damage their reputations if no appropriate actions are taken. The most appropriate ways through which such risks can be avoided are; choosing appropriate electronic health record system design, and ensuring proper use of the system (Sitting and Singh, 2011).

3.0 METHODOLOGY

The study will involve a detailed analysis of the impact of electronic health record systems on healthcare delivery in Australian hospitals. The first step of the study approach will involve selecting Australian health organizations which have already adopted electronic health record system. A list of this category of hospitals will be obtained from the Australian Public Health Database. Top 30 largest hospitals which have adopted the EHR systems will be used in the study.

The Chief Executive Officers of the selected organizations will be contacted via email in order to obtain an appointment to visit their organizations. The chosen healthcare organizations will be visited physically in order to obtain consent from them and to request usage of their health records for purposes of the study. During the visit, the Chief Executive Officers will be informed about the purpose of the study, the study objectives, how research findings will be used, benefits of taking part in the study, as well as the risks involved. Only those organizations that will agree with the provided terms will be used in the study.

Under the permission of Chief Executive Officers, health records and annual reports of the selected organizations will be reviewed. Changes in a number of factors will be recorded from when the selected companies used paper-based records to the period following adoption of the electronic health record systems.

Specific items which will be extracted from the health records include changes in; patients’ waiting time, the manner in which care is delivered, clarity of medical records, the accuracy of patients’ data, recovery period, readmission rates, and death rates. Similar data will be collected across all healthcare organizations which will have agreed to take part in the study. The collected data will be analyzed using Statistical Packages for Social Sciences (SPSS) software.

4.0 DISCUSSION
4.1 Relevance of the study approach

The proposed methodology is highly appropriate for this study because it will help in gathering data that will best answer the research question. A list of Australian healthcare organizations which have adopted electronic health record systems is found in country’s Public Health Database. The rationale behind selecting top 30 largest organizations in the list is the large volume of relevant data that these organizations can provide.

In addition, it is important to obtain consent from the Chief Executive Officers of the selected organizations due to high privacy concerns associated with the release of important health records. The Chief Executive Officers of the chosen health care organizations must be convinced that their health records will be used solely for purposes of research before they can allow anybody to access them.

The effectiveness of healthcare delivery in hospitals are best measured in terms of major clinical variables namely; quality of care, medical errors, and patient safety (Gao, Sorwar and Croll, 2013). The type of data collected during health records’ review can easily tell the degree of health care quality, medical errors, and patient safety in the selected hospitals. For instance, data related to changes in patients’ waiting time and the manner in which care is delivered will help the researcher to understand the quality of care in the selected organizations.

Data related to changes in clarity of medical records and accuracy of patients’ data will tell more about medical errors, while data related to changes in the recovery period, readmission rates, and death rates will inform the researcher more about patient safety in the selected hospitals. By analyzing the collected data using SPSS software, the researcher will be able to see the impact of electronic health record systems on healthcare delivery in Australian hospitals. This research approach will help the researcher to easily answer the research question.

4.2 Limitations of Methodology

            The main limitation of the methodology is reviewing health records of only 30 hospitals. By limiting the data collection process to only top 30 hospitals which have already adopted electronic health record systems, the researcher may leave out other small hospitals which might have successfully adopted HER systems, and which may have better information than the organizations used.

The other limitation of the methodology is over-reliance on secondary data which is available in company records and annual reports. Conducting actual research would produce more accurate data because the validity of information available in company records might be questionable.

4.3 How the study findings may lead to further research

            The proposed study focuses on how clinical factors may be impacted by the adoption of an electronic health record system. For instance, in the study, the researcher intends to evaluate how electronic health record system will impact health care quality, medical errors, and patient safety in Australian hospitals. Findings obtained from this study can guide further research on the impact of electric health record systems on organizational factors such as healthcare cost.

5.0 CONCLUSION

            The number of Australian hospitals which are adopting electronic health record systems is on the rise. Australian healthcare organizations which are implementing electronic health record systems anticipate that the new technology will help them to improve the quality of care, minimize medical errors, improve patient satisfaction, and reduce healthcare costs.

Prior to spending a lot of money in the implementation of electronic health record systems, Australian healthcare organizations should be aware of the financial feasibility of implementing those systems. Making a decision of whether the approach is financially possible requires a comprehensive knowledge of the nature of impact that EHR systems will have on the quality of care, medical errors, and patient safety.

The proposed study intends to investigate whether electronic health records systems have improved healthcare delivery in Australian hospitals, by focusing on three variable; quality of care, medical errors, and patient safety. A comprehensive analysis of available literature has been conducted to show previous studies on the topic.

In addition, a methodology that will help to answer the research question has been identified. Findings obtained from this study will be used to advise modern healthcare organizations on some of the reasons why they should either adopt or avoid implementation of electronic health record systems.

References

Australian Digital Health Agency. (2015). Retrieved May 19, 2017, from https://www.digitalhealth.gov.au/get-started-with-digital-health/benefits

Bates, D., Leap, L. & Cullen, D. (1998). Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA, 280(15):1311-1316.

Bowman, S. (2013). Impact of electronic health record systems on information integrity: Quality and safety implications. Perspectives in Health Information Management, 10(Fall):1c.

Gao, J. X., Sorwar, G. & Croll, P. (2013). Implementation of E-health record systems in Australia. The International Journal Technology Management Review, 3(2):92-104.

Menachemi, N. & Collum, T. H. (2011). Benefits and drawbacks of electronic health record systems. Risk Management and Healthcare Quality, 4: 47-55. Doi:10.2147/RMHP.S12985

Sitting, D. F. & Singh, H. (2011). Defining health information technology-related errors. Archives of Internal Medicine, 171:1281.

Zeng, X. (2016). The impacts of electronic health record implementation on the health care workforce. North Carolina Medical Journal, 77(2):112-114. Doi:10.18043/ncm.77.2.112

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