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Hemodialysis on End Stage Renal Disease Patients and the Increasing Role for the Nurse
It is a difficult condition of a kidney failure when one's kidney could no longer carry out the proper metabolism system to eliminate waste products. Kidney is the essential organ that is responsible in waste elimination, including others like detoxification process of drugs and toxic materials, also in controlling water balance, salt balance, blood pressures and secrete hormones (Crawford, 2002).
When both kidneys fail to function, which comes to the End Stage Renal Disease, there is suddenly a loss of control to the fluid balance. The kidney cannot filter the fluid and therefore metabolism waste, toxic, salt and water accumulate in the blood, causing swell on the tissues, high blood pressure and heart disease.
Until now, there is no medication offered to cure ESRD. The current treatments to this disease are hemodialysis, peritoneal dialysis, or kidney…
Counts, C., and Holmes, K.T. Oct, 2002. Clinical Research: We Can Make a Difference. Nephrology Nursing Journal Vol. 29, No. 5.
Crawford, W.H. Jr. 2002. End-Stage Renal Disease. Retrieved November 09, 2002 from University of Southern California School of Dentistry. Web site: http://www.usc.edu/hsc/dental/PTHL312abc/312c/25/chapter.pdf
End Stage Renal Disease. Retrieved November 09, 2002 from Aksys Personal Hemodialysis System. Web site: http://www.aksys.com/therapy/images/ESRD.pdf
Kshirsagar, A.V., Hogan, S.L., Mandelkehr, L., and Falk, R.J. 2000. Length Of Stay And Costs For Hospitalized Hemodialysis Patients Nephrologists vs. Internists. Journal of American Society of Nephrology 11:1526-1533, 2000. American Society of Nephrology.
Introduction, Analysis of Existing Evidence, and Quality Improvement Process
Hemodialysis patients are at high risks of infection due to their impaired immune defenses and repetitive access of the bloodstream via vascular access types. The treatment process of hemodialysis involves using different processes and equipment that sometimes worsen the patients’ conditions. For example, frequent antibiotics administration to these patients generates antimicrobial resistance and multidrug-resistant organisms. Central venous catheters (CVCs) are among the most commonly used vascular access types. While the use of CVCs is geared toward enhancing the health and wellbeing of hemodialysis patients, they enhance the risk of hospital-acquired infections. This paper provides a brief overview of the practice problem, analyzes existing evidence on this issue, and describes the quality improvement process and the Quality model that will be used to address this practice problem.
The lifeline for patients suffering from long-term hemodialysis is a well-functioning vascular access.…
Apata et al. (2017, April 2). Chlorhexidine-Impregnated Transparent Dressings Decrease Catheter-related Infections in Hemodialysis Patients: A Quality Improvement Project. The Journal of Vascular Access, 18(2), 103-108.
Gahlot et al. (2014, Apr-Jun). Catheter-related Bloodstream Infections. International Journal of Critical Illness & Injury Science, 4(2), 162-167.
Hymes et al. (2017). Dialysis Catheter-Related Bloodstream Infections: A Cluster-Randomized Control Trial of the ClearGuard HD Antimicrobial Barrier Gap. American Journal of Kidney Diseases, 69(2), 220-227.
Nguyen et al. (2017, June 29). National Healthcare Safety Network (NHSN) Dialysis Event Surveillance Report for 2014. Clinical Journal of the American Society of Nephrology, 12, 1-8.
Saxena, A.K., Panhotra, B.R. & Al-Mulhim, A.S. (2005). Vascular Access Related Infections in Hemodialysis Patients. Saudi Journal of Kidney Diseases and Transplantation, 16(1), 46-71.
Thompson et al. (2017, December). Catheter-related Blood Stream Infections in Hemodialysis Patients: A Prospective Cohort Study. BMC Nephrology. doi: 10.1186/s12882-017-0773-5
In an acute care setting, such Veterans Affairs, this objective is executed by educating patients about how to maintain a healthy diet and lifestyle after the leave the facility, while in a long-term care setting-such as Cobble Hill-this objective is executed on a daily basis by providing nutritious meals for elderly residents. And finally, in an ambulatory, out-patient care setting-such as Atlantic -- the clinical nutritionist works to support patients in maintaining a diet that addresses their personal healthcare needs, while still living independently within a larger community. Perhaps the most significant similarity between facilities is the notion of nutrition as merely one component of a comprehensive care program; hence the necessity of a clinical nutritional to work in conjunction with a full medical, administrative, and social support staff. The apparent goal of such an approach is to promote multiple aspects of health and well-being among patients, regardless setting or…
Cite Health. (2010). Long Island College Hospital. Retrieved December 19, 2010 from http://citehealth.com/dialysis-centers/new-york/cities/brooklyn/long-island-college-hospital
Cobble Hill Health Center. (2010). Resident Services. Retrieved December 19, 2010 from http://www.cobblehill.org/services
United States Department of Veterans Affairs. (2010). Patient Information. Retrieved December,
19, 2010 from http://www.brooklyn.va.gov/patients/index.asp
Translation Evidence Into Nursing Health Care Practice. Chapter 6, "Translation Evidence Leadership" Article: Bakke, C.K. (2010). Clinical cost effectiveness guidelines prevent intravascular catheter-related infections patients' hemodialysis.
Briefly summarize your selected issue and propose new evidence-based practice strategies.
Pressure ulcers, commonly known as bedsores, are frequently observed in otherwise healthy bed-ridden patients in nursing homes. To promote wellness amongst this patient population, it has been suggested that regular turning and positioning of the patients by caregivers should be used to reduce their occurrence. Turning and positioning has long been used amongst healthcare practitioners for a variety of bed-ridden patients, usually at regimented intervals spanning 4-2 hours (Thomas 2001). Based upon the previous research conducted upon this population, the suggested shortened interval is 1-11/2 hours for repositioning of the patient (Thomas 2001).
Q2. Describe the theoretical basis for your strategies.
The theoretical basis for this initiative lies in the idea that passive…
Bluestein, D. & Javaheri, A. (2008). Pressure ulcers: Prevention, evaluation, and management.
American Family Physician, 78(10):1186-1194. Retrieved from:
Krapil, L.A. & Gray, M. (2008). Does regular repositioning prevent pressure ulcers?
ecause this is true, it is critically clear that the nursing leadership manager's role is one of a vital nature and that support for nurses in their role is the primary component that must necessarily be integral to leadership in nursing in dialysis units if the turnover of nurses is reduced to the lowest possible level. The nursing leadership manager's role is one that must proactively deal with burnout of these dialysis unit nurses instead of attempting to address these as they occur. Prevention is 'key' toward this end. As the demands grow for quality and competent nursing staff so does the need grow for competency in leadership nursing manager roles. ecause the dialysis unit nurse is very closely involved in their patient's care and because these patients are required to report for treatment several days a week for several hours a day the nurse's mental, physical and emotional state…
Aiken, L.H., & Patrician, P. (2000). Measuring organizational traits of hospitals: The Revised Nursing Work Index. Nursing Research, 49, 146-153.
Aiken, L.H., & Sloane, D.M. (1997). Effects of organization innovation in AIDS care on burnout among urban hospital nurses. Work Occupation, 42, 453-477.
Aiken, L.H., Clarke, S.P., Sloane, D.M., Sochalski, J., & Silber, J.H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction [Electronic version]. JAMA, 288, 1987-1993.
Aiken, L.H., Clarke, S.P., Sloane, D.M., Sochalski, J.A., Busse, R.A., Clarke, H., Giovanetti, P., Hunt, J., Rafferty, a.M., & Shamian, J. (2001). Nurses' reports on hospital care in five countries [Electronic version]. Health Affairs, 20, 43-53.
Intradialytic weight gain has become a major problem for End Stage enal Disease (ESD) patients who are dependent on hemodialysis. This issue has resulted in more complications and hospitalizations of ESD patients who need effective IDWG management programs that are driven by nurses. This project proposes a project that is geared towards improving IDWG management for these patients by 10% through a 12-week educational program. The paper demonstrates how the project will be implemented in a 19 chair dialysis clinic that functions 6 days every week in order to accommodate 150 hemodialysis patients. The discussion includes a description of the proposed change, rationale for selecting it, implementation methods, and expected results. The author provides evaluation of baseline data collected from patients during implementation and conclusions based on the collected data.
Objectives of CNL Internship Project
The objectives or aim of this CNL Internship Project is to coordinate a plan of…
Barnett, T., Li, Y.T., Pinikahana, J. & Si-Yen, T. (2008, February). Fluid Compliance among Patients having Haemodialysis: Can an Educational Programme Make a Difference? Journal of Advanced Nursing, 61(3), 300-306.
Lingerfelt, K. & Thornton, K. (2011). An Educational Project for Patients on Hemodialysis to Promote Self-Management Behaviors of End Stage Renal Disease. Nephrology Nursing Journal, 38(6), 483-489.
Mento, A., Jones, R. & Dirndorfer, W. (2002). A change management process: Grounded in both theory and practice. Journal of Change Management, 3(1), 45-70. Retrieved from EBSCO Host, AN 7329277.
HDF is a strategy that that enables high potential of hydraulic and solute permiabilityof synthetic membranes hence they can be properly exploited. The high cost of the fluids in bags that are commercially prepared as well as the improvement of technology of dialysate preparation and fluid filtration has made it possible in recent years for the development of the novel technique known as online HDF. In this technique a particular amount of freshly prepared ultrapure dialysate is taken daily from daily dialysate inlet line and then processed with several filtration steps before they are used as replacement fluid. With this technique, large amounts of replacement solutions that are relatively inexpensive are made available and HDF can be carried out with a high fluid turnover under the utilization of pre- and post-dilution or even consecutive pre-post dilution in proportions that differ (Yvonne, 2011).
On-line hemodifiltration provides the largest amount…
Keller, D.(2011). Hemodiafiltration, Hemodialysis Show Similar Survival Rates. Retrieved June 18,2014 from http://www.medscape.com/viewarticle/746131
van der Sande FM, Kooman JP, van Kuijk WH, Leunissen KM. (2001). Management of Hypotension in Dialysis Patients: Role of Dialysate Temperature Control. Retrieved June 18,2014 from http://www.sjkdt.org/article.asp?issn=1319-2442;year=2001;volume=12;issue=3;spage=382;epage=386;aulast=van
Yvonne, W. (2011). Online haemodiafiltration. Retrieved June 18,2014 from http://www.biomedsearch.com/article/Online-haemodiafiltration/264921864.html
RxPG Medical Solutions Private Limited (2008).Dialysis
Critical Pathway: Chronic enal Failure
egents Online Degree Program
Critical Pathway: Chronic renal failure
Chronic renal failure is often occasioned by chronic kidney disease, immune disorder, trauma among other conditions. It does not have any specific symptoms and might include feeling unwell generally and experiencing a reduced appetite. It is diagnosed following screening of individuals who are identified to be at risk of kidney problems, like individuals with diabetes or high blood pressure and others who have blood relative with chronic kidney disease. It always seems complex when trying to come up with the right diagnosis for a patient.
M.A. is a 60-year-old man who has a stage V chronic kidney disease mainly as a result of diabetic nephropathy and a 12-year of type 2 diabetes. He has symptomatic peripheral vascular insufficiency, and 3 years ago he had undergone coronary artery bypass 3. Within the ten months that…
Ahern J, Kruger DF, Gatcomb P, Petit W, Tamborlane W.,(1989). The Diabetes Control and Complications Trial (DCCT): the trial coordinators perspective. Diabetes Educ 15:236 -- 281
Bassilios N, Launay-Vacher V, Khoury N, et al. (2001) Gabapentin neurotoxicity in a chronic haemodialysis patient. Nephrol Dial Transplant.
Blum RA, Comstock TJ, Sica DA, et al.(1994). Pharmacokinetics of gabapentin in subjects with various degrees of renal function. Clin Pharmacol Ther;56(2):154-159
Brawek B, Loffler M, Dooley DJ, Weyerbrock A, Feuerstein TJ.(2008) Differential modulation of K (+)-evoked (3)H-neurotransmitter release from human neocortex by gabapentin and pregabalin. Naunyn Schmiedebergs Arch Pharmacol.:376(5):301-307
Studies conducted over decades have concluded that there is a significant link between diabetes mellitus and cardiovascular disease. For instance, the most common form of diabetes is type 2 diabetes, which involves both the impairment in insulin resistance and the defective secretion of insulin by the pancreas. The development of diabetes often comes with a number of cardiovascular complications including "coronary heart disease (CDC), stroke, peripheral arterial disease, nephropathy, retinopathy, and possibly neuropathy and cardiomyopathy." (Grundy 1999)
Specifically both diabetes type 1 and type 2 are considered to be risk factors for atherosclerotic coronary heart disease. "Moreover, myocardial ischemeal due to coronary atherosclerosis commonly occurs without symptoms in patients with diabetes." (Grundy 1999) In other words, patients with diabetes are more likely to be stricken with congestive heart failure. But it is not only the risk of heart failure that diabetes sufferers are at risk from, another…
"eGFR." Lab Tests Online, Available from http://labtestsonline.org/understanding/analytes/gfr/tab/test
"Glomerular Filtration Rate (GFR)" National Kidney Foundation Available from http://www.kidney.org/kidneydisease/ckd/knowgfr.cfm
Grundy, Scott. Et al 1999, "Diabetes and Heart Disease: A Statement for Healthcare
Professionals from the American Heart Association" AHA Scientific Statement.
Five Forces & Value Chain
NxStage is a medical equipment manufacturer specializing in hemodialysis products for use in the home. Their main flagship, NxStage SystemOne, constitute two-thirds of the company's revenues. The product has been on the market for several years, but NxStage has never been able to turn a profit, nor has it been able to develop a viable second major product. This has created a strategic dilemma for the company as to how best to enhance shareholder value going forward.
The external environment is generally challenging, especially in light of regulatory changes that aim to drive down the cost of medical care, not necessarily good for a company like NxStage that has a differentiated product. There is some demand for the product, but also substitution from dialysis clinics, which can be offered at a lower total…
Baribeau, P. (2012). Task ownership boosts employee engagement. Tribe HR. Retrieved March 24, 2014 from http://tribehr.com/blog/task-ownership-boosts-employee-engagement
Baxter. (N.d.). Corporate Overview. Retrieved from Baxter: http://www.baxter.com/about_baxter/company_profile/corporate_overview.html
BSI. (2014). Balanced scorecard basics. Balanced Scorecard Institute. Retrieved March 11, 2014 from https://balancedscorecard.org/Resources/AbouttheBalancedScorecard/tabid/55/Default.aspx
Clin, J. (2012). Comparing mandated health care reforms: the Affordable Care Act, accountable care organizations, and the Medicare ESRD program. Dialysis Advisory Group of the American Society of Nephrology., 1535-1543.
The results revealed that this route did not lead to any needle stick injuries. The ESA worked as efficaciously as it would have if needles were used and this was proved by the maintenance of the hemoglobin levels. It was observed that 91% of the nursing staff was in favor of the needle free administration of ESA. This study therefore concluded that drugs with detached needles present further routes to prevent needle stick injuries in the future. (Chow et. al, 2009)
Seeing how needle stick injuries can lead to emotional, health related and financial dilemma, experts are working on ways to reduce their occurrence. The study by Chow et al. (2009) shows one way in which these incidences can be reduced. Molen et al. (2011) stated that education reduces the occurrence of needle stick injury. He conducted a study in which one group was educated in a workshop and given…
Adams, D. 2012 Needle stick and sharps injuries: implications for practice. Nursing Standard. 26 (37), pp. 49-57.
Aziz, A.M., Ashton, H., Pagett, A., Mathieson, K., Jones, S., and Mullin, B 2009 Sharps
management in hospital: an audit of equipment, practice and awareness. Br J. Nurs 18(2), pp. 92 -- 8
Blenkharn, J. 2009. Sharps management and the disposal of clincal waste. British Journal of Nursing, 18 (14).
Hard Economic and Finance Choices in U.S. Healthcare
The United States has recently undergone a financial crisis that has made the government, and the citizens, more conscious of what things cost and have produced debates regarding the costs of items. One debate that has intensified in volume is that over the large, and ballooning cost of healthcare. Although the Affordable Healthcare Act is supposed to take care of a portion of that, evidence shows that costs will remain exorbitant. The main reason for that is the research and development costs of therapies and associated drug treatments. Currently, new therapies have been coming on the market that are able to prolong the lives of cancer patients, but a cost-benefit analysis prove that these therapies are too costly. The debate then is whether a few weeks, months, years of life are worth hundreds of thousands to millions of dollars. This…
Short, N.M. (2013). Overview: The Economics and Finance of Health Care. In J.A. Milstead (Ed.), Health policy and politics: A nurse's guide (4th ed.) (pp. 191 -- 206). Sudbury, MA: Jones and Bartlett Publishers.
Stein, R. (2010, November 8). Review of prostate cancer drugs Provenge renews medical cost-benefit debate. The Washington Post. Retrieved from http://www.washingtonpost.com/wp - dyn/content/article/2010/11/07/AR2010110705205.html ?
Sullivan, J.D. (2010). End Stage Renal Disease economics and the balance of treatment modalities. Journal of Service Science & Management, 3(1), 45 -- 50. Retrieved from the Walden Library databases.
In both the case of the dialysis machine sale and the funeral services, a common theme of trust pervades both. These purchasing decisions are completely different than picking out a new car, buying a new iPod, iPad or iPhone, or choosing which new digital camera to buy. These decisions are more driven by how those products contribute to our own sense of who we are and provide us a measure of freedom in defining ourselves while providing enjoyment. All powerful brands, with Apple being one of the most formidable globally, sell not only functionality of their products but the image that goes along with it. This is completely different than choosing a dialysis machine or a funeral home and funeral director. In these instances the uncertainty is far greater, the risk of making a mistake far more intensive, and the level of self-scrutiny is very intense. No one wants to…
Cleary, Paul D., Schlesinger, Mark, & Blumenthal, David. (1991). Factors Affecting the Availability and Use of Hemodialysis Facilities. Health Care Financing Review, 13(2), 49.
Langreth, R.. (2008, November). The Home Cure. Forbes, 182(10), 66.
Glen L. Urban. (2005). Customer Advocacy: A New Era in Marketing. Journal of Public Policy & Marketing, 24(1), 155-159.
Towards of the goal of fulfilling the mission to "help those we care for to experience the best life possible," nursing services provided at the Sarah Neuman Center include:
Twenty-four nursing in a secure residential setting.
Twenty-four medical coverage supported by onsite and on-call physicians.
Onsite medical specialist consulting services.
Individualized therapy sessions, to include speech therapy, physical therapy, art and music therapy.
Nutritional services supported by staff dietitians.
Onsite pharmaceutical and laboratory services. (Sarah Neuman, para. 9)
Patients that require long-term residential care are often transferred to the Bronx nursing home which provides all of the above services, in addition to highly individualized care services and therapies for "more complex clinical needs" (Bronx, para. 4). These needs include-but are not limited to-progressive Alzheimer's, severe vision impairment, severe speech and swallowing impairments, and chronic kidney disease requiring hemodialysis.
Structural Support of Mission
That each facility essentially provides the same services…
"Bronx." jewishhome.org. Jewish Home Lifecare, 2010. Web. 01 January, 2011.
"Manhattan." jewishhome.org. Jewish Home Lifecare, 2010. Web. 01 January, 2011.
"Sarah Neuman." jewishhome.org. Jewish Home Lifecare, 2010. Web. 01 January, 2011.
"Research Institute on Aging." jewishhome.org. Jewish Home Lifecare, 2010. Web. 01 January,
However, recently, anesthesiologists have suggest a low to mid thoracic epidural combined with adequate general anesthesia. This anesthetic technique will allow for adequate inter-operative monitoring. After the operation, the anesthesiologist must continue to monitor the patient for either hypertension, hypotension and hypoglycemia. The presence of either of these conditions may alter the course of the medication given to the patient once the patient is removed from the anesthesia.
Neurofibroma can cause systemic problems within the various components of the Respiratory System. As has already been presented, Neurofibromas can cause partial blockages within upper parts of the trachea. However, Neurofibromas can also pose challenges or the anesthesiologist when dealing with nasal, sinus or maxilofacial cavities with Neurofibromas present within. One example of how devastatingly complex the Neurofibroma can become is seen when a benign neurofibroma can cause a superior vena cava compression. Such was the case of a 21-year-old…
As to catheter straps, if fastened too tightly they can act as tourniquets, cutting off the needed flow of blood and presenting. And at least theoretically, use of straps brings about a risk of increasing the complications such as "…deep vein thrombosis and pulmonary embolism" in those patients with "impaired lower extremity circulation" (Billington 504). Research presented in this article shows that the problem of infection due to poorly attached catheters can be reduced significantly through the use of a product called "Bard StatLock" -- which, the authors insist, is an effective stabilization device because it allows movement (through a swivel clip), because it is a "sterile latex-free, tug-resistant product" (Billington 504). An article in the journal RN, incidentally, states that treating "hemodialysis catheter-related bacteremia" can cost a hospital up to $45,000.
ashing "Bloody Hands": An article in the Australian Nursing Journal asserts, "…hand hygiene is the single most effective…
Aziz, a.M., Ashton, H., Pagett, a., Mathieson, K., Jones, S., & Mullin, B. (2009).
Sharps management in hospital: an audit of equipment, practice and awareness.
British Journal of Nursing, 18(2), 92-98.
Billington, a., Crane, C., Jownally, S., Kirkwood, L., & Roodhouse, a. (2008).
The study will also be important to those in the future, because scientists have not yet found ways to cure these chronic illnesses or correct some of these problems that are seen today, and therefore it stands to reason that there will be more people in the future who will have to face the same problems as those with chronic illnesses and traumatic injuries today.
Scope of the Study
The scope of the study is relatively large, simply because there has been a great deal written about chronic illness and injuries from the perspective of the physician and from the perspective of the patient. Both sides are important, although the focus here will remain largely on the patient perspective. Because there are so many people today that suffer from a chronic illness or traumatic injury, much study has been done about these individuals. Despite these studies, however, not a lot…
Anderson, B.L. (2002). Biobehavioral Outcomes Following Psychological Interventions for Cancer Patients. Journal of Counsulting and Clinical Psychology, 70(3), 590-610.
Brannon, L., & Fiest, J. (2004). Health Psychology: Vol.. An Introduction to Behavior and Health (Fifth ed.) Belmont CA: Thompson/Wadsworth.
DiMatteo, M. (2004). Social Support and Patient Adherence to Medical treatment: A Meta- analysis. Health Psychology, 23(2), 207-218.
Eitel, P., Hatchett, L., Friend, R., Griffin, K.W., & Wadhwa, N.K. (1995). Burden of Self-Care in Seriously Ill Patients Impact on Adjustment. Health Psychology, 14(5), 457-463.
NSF occurs only in patients with advanced kidney disease. ven though the cause-and-effect link is not proven, the association of NSF with gadolinium exposure is strong enough for the FDA to issue a warning. If an MR study with contrast is absolutely required, a nongadodiamide contrast using the lowest possible dose is preferable." It would also seem prudent to perform hemodialysis to enhance gadolinium elimination and to identify other potential cofactors (Busko, M.2007).
There are many issues that impact MR safety that should be considered during site planning for a given MR installation. These have historically not been dealt with in the prior versions of the ACR MR Safe Practice Guidelines. For the first time, we include in this article, as separate appendices, sections that address such issues as well, including cryogen emergency vent locations and pathways, 5-gauss lines, siting considerations, patient access pathways, etc. Yet despite their appearance herein,…
Each site will name an MR medical director whose responsibilities will include ensuring that MR safe practice guidelines are established and maintained as current and appropriate for the site. It is the responsibility of the site's administration to ensure that the policies and procedures that result from these MR safe practice guidelines are implemented and adhered to at all times by all of the site's personnel (Kanal, E., 2007)
Procedures should be in place to ensure that any and all adverse events, MR safety incidents, or "near incidents" that occur in the MR site are reported to the medical director in a timely fashion (e.g., within 24 hours or 1 business day of their occurrence) and used in continuous quality improvement efforts. It should be stressed that the Food and Drug Administration states that it is incumbent upon the sites to also report adverse events and incidents to them via their MedWatch program. The ACR supports this requirement and feels that it is in the ultimate best interest of all MR practitioners to create and maintain this consolidated database of such events to help us all learn about them and how to better avoid them in the future (Kanal, E., 2007).
NSF/NFD is a painful, debilitating, and deadly condition that has no cure or treatment. Therefore, people are becoming affected with an incurable disease that is related to a common medical procedure performed daily (Some Kidney Patients Suffer MRI Poisoning 2007).
(ACS Publication June 2006 A Growing Crisis In Patient Access to Emergency Surgical Care at (http://www.facs.org/ahp/emergcarecrisis.pdf)
Statement of Problem
There is a growing problem in the ability of individuals and communities to receive care, according to the American College of Surgeons, as the changing face of emergency care and medical care in general is putting patients at risk. The ACS and the AMA have both recently conducted professional surveys that indicate that the source of the problem is a lack of specialized surgical providers to cover existing trauma centers and a lack of those same staff members to help to establish new centers of care in areas, with the lowest numbers of provider services. (ACS Publication June 2006 A Growing Crisis In Patient Access to Emergency Surgical Care at (http://www.facs.org/ahp/emergcarecrisis.pdf)
The ACS Publication A Growing Crisis In Patient Access to Emergency Surgical Care stresses that the existing system is not…
Resources for Health 2006, 4:12 at http://www.human-resources-health.com/content/4/1/12
Fishman P.E. MD, Shofer, F.S. PhD, Robey J.L RN, BSN, Zogby, K.E. RN, BSN, Reilly, P.M. MD, Branas, C.C. MS, PhD, Pines, J.M. MD MBA, Hollander, J.E. MD. (October 2006), "The Impact of Trauma Activations on the Care of Emergency Department Patients With Potential Acute Coronary Syndromes" Annals of Emergency Medicine, 48: 4, pp. 347-353
Hofman, Primack, Keusch, & Hrynknow (Jan. 2005), "Addressing the growing burden of trauma and injury in low- and middle-income countries" American Journal of Public Health 95: 1 at http://hestia.unm.edu.libproxy.unm.edu/search/i0090%2D0036/i00900036/1,1,1,B/l856~b1044007&FF=i00900036&1,1,1,0/startreferer//search/i0090%2D0036/i00900036/1,1,1,B/frameset&FF=i00900036&1,1,/endreferer/
Hospital Survey Sheds New Light on Diversions" (July 2004) Emergency Medical Services, at http://hestia.unm.edu/search/temergency+Medical+/temergency+medical/1,25,31,B/l856~b1044565&FF=temergency+medical+services&1,2,1,0
Mock, C.M. & Jurkovich, G.J. (1999) "Trauma System development in the United States," Trauma Quarterly 14:3 pp. 197-209.
I also assumed that the nurse I was observing would likely support the doctor and try to talk the patient into changing her mind. My assumptions were incorrect. Later I took the time to reflect upon my reaction to the situation.
After thinking through the entire situation, it is my belief that she did make the right choice, she no longer wished to live a life tied to a machine, wheeled about in a chair and unable to enjoy even the smallest of pleasures. As a nurse, my approach would be to comfort the patient, understanding and giving support to the family and friends who are attempting to support the patient. The patient is experiencing enough trauma, and should be fully supported in making whatever decision is best for that particular individual.
Other nurses might disagree. One study determined that even though 80% of newly graduated nurses have developed a…
Drennan, J.; (2010) Critical thinking as an outcome of a Master's degree in nursing programme, Journal of Advanced Nursing, Vol. 66, Issue 2, pp. 422 -- 431
Wangensteen, S.; Johannson, I.S.; Bjorkstrom, M.E.; Nordstrom, G.; (2010) Critical thinking dispositions among newly graduated nurses, Journal of Advanced Nursing, Vol. 66, Issue 10, pp. 2170-2181
Club Drugs & Ecstasy
"Though some researchers have indicated club drug users are more likely to be poly-drug users, there remains little known about the prevalence and specific combinations of the substances they use…" (Grov, et al., 2009, p. 848).
The use of club drugs in the United States has been a problem for healthcare agencies and law enforcement for many years. The focus of research on the use of club drugs (notably ecstasy) in most articles is on "rave" events, where loud music and drug use is typical. This paper reviews and critiques the literature related to the use and abuse of club drugs.
The Literature on Club Drugs and the Issues Associated with Club Drug Usage
How extreme is club drug use in Chicago? A profile of adult club drug use was measured by Michael Fendrich and colleagues and published in the peer-reviewed journal Addiction (Fendrich, et al.,…
Banta-Green, Caleb, Goldbaum, Gary, Kingston, Susan, Golden, Matthew, Harruff, Richard,
and Logan, Barry K. (2005). Epidemiology of MDMA and Associated Club Drugs in the Seattle Area. Substance Use & Misuse, Vol. 40, 1295-1315.
Centers for Disease Control and Prevention. (2010). Ecstasy Overdoses at a New Year's Eve
Rave -- Los Angeles, California, 2010. Morbidity and Mortality Weekly Report, 59(22).
The Gram-negative, motile, rod-shaped bacterium Pseudomonas aeruginosa is an opportunistic killer that takes advantage of people suffering from medical problems (Van Delden and Iglewski, 1998).For this reason, P. aeruginosa is one of the most common nosocomial infection that occurs in hospitals. P. aeruginosa is responsible for causing 16% of pneumonia cases, 12% of urinary tract infections, 10% of bloodstream infections, and 8% of surgical infections due to hospital care. Patients who are immune-compromised are also susceptible to P. aeruginosa infections, such as patients undergoing chemotherapy, suffering from HIV / AIDS, recovering in burn units, and suffering from cystic fibrosis. With death rates ranging from 30 to 60% for these patients, P. aeruginosa is considered to be a significant threat to patient health.
P. aeruginosa can switch between a free-swimming planktonic form and colonies enclosed within slime-protected biofilms attached to surfaces (Baltch and Smith, 1994,…
Baltch, A.L. And Smith, R.P. (Eds.). (1994). Pseudomonoas aeruginosa Infections and Treatment. New York, NY: Marcel Dekker, Inc.
Botzenhart, Konrad and Doring, Gerd. (1993). Ecology and Epidemiology of Pseudomonas aeruginosa. In M. Campa, M. Bendinelli, H. Friedman (Eds.), Pseudomonas aeruginosa as an Opportunistic Pathogen (pp. 1-18). New York, NY: Plenum Press.
Hawkey, Peter M. And Kerr, Kevin G. (2004). Laboratory investigation of health care-associated infection. In P. Hawkey and D. Lewis (Eds.), Medical Bacteriology: A Practical Approach (pp. 331-354). Oxford, UK: Oxford University Press.
Hurley, Matthew N., Camara, Miguel, and Smyth, Alan R. (2012). Novel approaches to the treatment of Pseudomonas aeruginosa infections in cystic fibrosis. European Respiratory Journal, published online ahead of print, 1-19. Retrieved 23 July 2012 from http://erj.ersjournals.com/content/early/2012/06/27/09031936.00042012.long .
Bloodstream Infections in NICU
Bloodstream infections in the neonatal intensive-care unit (NICU) are a serious concern for parents and health care professionals. Exposure to bloodstream infections for most patients will caused delayed hospital stays and higher costs associated with hospital visit (Marschall et. al., 2008). There are many procedural changes that can be made at the hospital to decrease risk of bloodstream infections. ecommendations for decreasing bloodstream infections will be based on the practices of the Connecticut Children's Medical Center (CCMC), which is successful in decreasing bloodstream infections. In this paper I will discuss how to get the employees engaged in their work, how to receive buy-in for quality work, how this will reduce errors and increase the quality of work.
Engaging employees in their Work
It is important to train the employees on the recommended techniques for inserting a catheter since this is main cause of blood…
Buttes et. al. (2006). Drive down infection rates. Nursing Management. October.
Deaver, K. (2010). Preventing Infections in Hemodialysis Fistula and Graft Vascular Accesses. Nephrology Nursing Journal. 37 (5) 503-506
Marschall et. al. (2008). Strategies to prevent central line-associated bloodstream infections in acute care hospitals. Infection Control and Hospital Epidemiology. 29 (1) S22-30.
Evidence-Based Solution to educing Incidence
The goal of this assignment is to increase my ability to appraise and synthesize evidence to provide experience a logical argument in support of a proposal for practice change, and to provide experience in designing a detailed implementation and evaluation plan for my project. I need to discuss my project plan with you.
An evidence-based solution to reducing incidence of hospital acquired infections through indwelling medical devices
Hospital-acquired or nosocomial infections are the fourth leading cause of disease in developed countries. The increased insertion and implanting of prosthetic or indwelling medical devices is a leading cause of these infections since the introduction of a foreign body significantly reduces the body's immunity and decreases the number of bacteria needed to produce an infection. Prosthetic or indwelling medical devices such as urethral catheters, suprapublic catheter, nasogastric tubes, hemodialysis catheters, central venous catheters, and tracheostomy tubes are associated…
Chambless, J.D., Hunt, S.M., & Stewart, P.S. (2006). A three-dimensional computer model of four hypothetical mechanisms protecting biofilms from antimicrobials. Appl Environ Microbiol, 72(3), 2005-2013. doi: 10.1128/aem.72.3.2005-2013.2006
Chu, V.H., Crosslin, D.R., Friedman, J.Y., Reed, S.D., Cabell, C.H., Griffiths, R.I., . . . Fowler, V.G., Jr. (2005). Staphylococcus aureus bacteremia in patients with prosthetic devices: costs and outcomes. Am J. Med, 118(12), 1416. doi: 10.1016/j.amjmed.2005.06.011
Cookson, S.T., Ihrig, M., O'Mara, E.M., Denny, M., Volk, H., Banerjee, S.N., . . . Jarvis, W.R. (1998). Increased bloodstream infection rates in surgical patients associated with variation from recommended use and care following implementation of a needleless device. Infect Control Hosp Epidemiol, 19(1), 23-27.
Digiovine, B., Chenoweth, C., Watts, C., & Higgins, M. (1999). The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. Am J. Respir Crit Care Med, 160(3), 976-981. doi: 10.1164/ajrccm.160.3.9808145
Parkland Hospital: A Dallas Icon
The history of the City of Dallas would hardly be complete without consideration of Parkland Hospital and its contributions to the Dallas community. Parkland Hospital began in the Civil ar Reconstruction era and has always maintained operations that were state of the art for the time. Parkland hospital has always aligned itself research and the academic community and it is for this reason that Parkland has always offered the latest in techniques and technology. Parkland Hospital has a long tradition of caring for the poor and those who cannot otherwise care for themselves. The following research will highlight the major accomplishments of the hospital from its primitive beginnings to its present position as a leader in patient care and technology Seven years after the end of the Civil ar; Dallas became a thriving city. In 1885 the Dallas Morning News began publication, at that time…
Abraham, Laurie. Dramatic Differences: Dallas Public Hospital: A Lesson for County? Chicago
Reporter. May 5, 1990. http://www.chicagoreporter.com/1990/05-90/0590%20Dramatic%20Differences.htm Accessed February, 2003.
Conger, Darrell. Southwestern Department of Opthamology History. Department of Opthamology. March 20, 2001. http://www.swmed.edu/ophth/history.htm . Accessed February, 2003.
Dallas Nephrology Associates. History of DNA. Online. http://www.dneph.com/about/history.html Accessed February 2003.
A.J., an 82-year-old female, was admitted three weeks ago with acute on chronic congestive heart failure (CHF) after presenting to the emergency department (ED) with c/o progressive worsening SOB, leg edema, and fatigue. She has a history of severe CHF, atrial fibrillation, myocardial infarction (MI), renal insufficiency, and hypothyroidism. Since admission, A.J. has needed intubation and ventilation for acute decompensated heart failure due to a massive MI. She is alert when not sedated but has been too unstable for a cardiac catheterization and has needed vasoactive medications to support her blood pressure. Her renal function has declined and plans are being made for hemodialysis. Today when speaking with A.J.'s husband, he conveys to you her nurse that "she would not have wanted all of this." "
Discuss the pros and cons of continued therapy and what role nursing can play in helping the patient and family.
This case deals with…
Nursing Leadership and Management and Field Experience
Nursing Leadership and Management Field Experience
The problem identified concerns about patient safety and satisfaction arising out of shortage in nurse staffing. In the contemporary times, staffing has become a major issue concerning nurses, generally, and in this paper we attend to the issue in outpatient clinical settings. This problem of under-staffing of nurses has assumed significant importance and needs to urgent attention, as it has an influence on the satisfaction of the patients and more significantly their safety. An outpatient clinic cannot run if the patients have no desire or wish to go there. In addition, it becomes hazardous in risking the lives of the patients. The purpose of this research is to research the cause of understaffing on outpatient clinics together with the influences it has on patient safety and care. Additionally, the project encompasses examining the perspective of…
Gardner, J., & Walton, J. (2011). Striving to Be Heard and Recognized: Nurse Solutions for Improvement in the Outpatient Hemodialysis Work Environment. Nephrology Nursing Journal, 38(3), 239-253 15p.
Haas, S. A. (2016). Developing Staffing Models to Support Population Health Management and Quality Outcomes in Ambulatory Care Settings. Nursing Economic$, 34(3), 126-13
Halbesleben, Jonathon, Bonnie Wakefield, Douglas Wakefield, and Lynn Cooper. "Western Journal of Nursing Research." Western Journal of Nursing Research. 30(5) (2008): 560-577.
Kalisch, B., Tschannen, D., & Hee Lee, K. (2012). Missed nursing care, staffing, and patient falls. Journal of Nursing Care Quality, 27(1), 6-12.
Cae Planning Analysis
In eality, sound healthcae-elated advanced planning is a continuous convesation, involving pioities, values, QOL (quality of life) and what one's life means. Tool kits, in this context, compise vaious self-help esouces, woksheets, and ecommendations. They aid individuals in pefoming the moe complex tasks of identifying, confiming, and shaing impotant facts with an individual faced with a seious ailment (Ameican Ba Association, 2005). Iespective of whethe the individual is teminally ill o suffeing fom an acute ailment o chonic, long-tem ailment, advanced cae planning (ACP) is capable of facilitating the alleviation of unnecessay suffeing, impoving QOL and offeing a bette gasp of decision-elated challenges faced by the ailing individual, his/he family, and othe caegives. Advanced cae plans may be implemented at any junctue in the patient's life and must be updated when changes occu in patient cicumstances. A peson who contacts a pogessive disease that leaves him/he disabled…
references? A Study of the U.S. Medicare Population. Medical care, 45(5), 386.
Centers for Disease Control. (2013). Advance care planning: ensuring your wishes are known and honored if you are unable to speak for yourself. Retrieved 16 February 2016 from http://www.cdc.gov /aging/pdf/advanced-care-planning-critical-issue-brief.pdf
Wehri, K. (2011). Living well at the end of life: a national conversation. Caring: National Association for Home Care magazine, 30(9), 38.
estless Leg Syndrome
A simple way to define estless legs syndrome (LS) is an overpowering urge to move limbs, especially the legs that mostly take place when relaxing or during bedtime. This neural disorder is a major causative factor of nighttime blood pressure spikes and its associated circulatory consequences which reduces sleep quality and in some cases even eliminates the possibility of sleep. This sleep deprivation causes adverse effects such as nervousness, perpetual sadness and reduced comfort of living. Patients initially suffering from hemodialysis that develops LS have a much higher death rate. In most cases, they suffer from disorders that are difficult to explain. This paper's objective is to educate medical personnel on the need to understand and make deductions from the patient's signs, which are the factors considered and from which a conclusion is made if a patient has LS or some other disorder (Einollahi & Izadianmehr, 2014).…
Allen, R., Chen, C., & Garcia-Borreguero, D. (2014). Comparison of pregabalin with pramipexole for restless legs syndrome. N Engl J. Med, 370(7), 621-31.
Comella, C. L. (2014). Treatment of Restless Legs Syndrome. Neurotherapeutics, 11(1), 177-87.
Einollahi, B., & Izadianmehr, N. (2014). Restless Leg Syndrome: A Neglected Diagnosis. Nephrourol Mon, 6(5).
Gangadharan, S., Perkins, L., Sauerbier, A., & Chaudhuri, K. R. (2016). The treatment challenges of restless legs syndrome. Prescribing In Practice.
academic studies with a passion for the health sciences. In college, I tutored physics and mathematics in my spare time, and felt privileged to meet people from different backgrounds and to be able to help them understand the fundamentals behind different scientific problems. Yet months after entering college, my father suffered from a cervical disk disorder. Doctors were initially unable to accurately diagnose the problem, torn between the possibilities of a brain tumor, a spinal tumor, or multiple sclerosis, leaving me no choice but to begin working full-time in my family's restaurant in order to support my family. I found myself cooking, managing the restaurant, and also doing my studies. It was difficult to adjust to this schedule, but I was eventually able to cope by learning how to use my time as efficiently as possible, working night shifts regularly while still maintaining my academic focus.
Just as everything was…
North Mountain Medical is a super sniff facility as they specialized in high acuity level patient. The patient structure is respiratory, with staff trained in tracheostomy care and ventilator management. In house hemodialysis, in house physical therapy. This facility has been in operation since 2004. Patients in this facility do not self-diagnose. Patient diagnoses are from Medical doctors and Nurse Practitioners that work on site. Patient in the facility are cared for by interdisciplinary team. Certified nursing assistants that care for patient will normally report a Change in patient’s condition to the nurse. Nurse completes an assessment and report changes immediately to the doctor. In the event of an emergency patients are send to emergency room for further evaluation and treatment. Health is a right in this facility. Yes, most of the patient’s life style has impacted the health of the patient. Noncompliance with medication regimen and diet changes. Patients…
Pathologists are often called 'the doctor's doctor ' -- when other doctors are experiencing an impasse, they go to a pathologist for advice, to provide clarity. As someone who has always enjoyed working as a teacher and preparing teaching materials, I look forward to this role in relation to my fellow physicians.
pon arriving in the nited States to practice medicine, I gained experience in the field of pathology-related research, collecting data about survival rates of patients with colorectal cancer and inflammatory bowel disease. I came to learn how pathology touches all fields of medicine. Even in my work with patients suffering substance abuse and psychiatric problems, I saw how the progression of the addiction created a pathology in terms of the way that the body responded to the patient's negative behaviors. I hope that this residency program will expose me to the laboratory and clinical aspects of the field,…
Upon arriving in the United States to practice medicine, I gained experience in the field of pathology-related research, collecting data about survival rates of patients with colorectal cancer and inflammatory bowel disease. I came to learn how pathology touches all fields of medicine. Even in my work with patients suffering substance abuse and psychiatric problems, I saw how the progression of the addiction created a pathology in terms of the way that the body responded to the patient's negative behaviors. I hope that this residency program will expose me to the laboratory and clinical aspects of the field, and give me the ability to learn from -- and perhaps to teach -- others who are grappling with issues spanning from cancer to nephrology to infertility to lifestyle-related illnesses.
From birth to death, I have seen the many varied states the human body can take in health and illness. My desire to engage in a pathology rotation is based upon these past, formative experiences and my desire to place this diversity within the uniquely helpful paradigms particular the discipline. By the end of the residency I know I shall not have realized my goal of becoming a 'doctor's doctor' but I am eager to enter upon the path and begin this lifelong journey.
J. Carlos Manivel, "Choosing pathology as a specialty," the University of Minnesota, May 2, 2010, [August 21, 2010] http://residency.pathology.umn.edu/
At times patients cannot care for themselves, and nurses must remedy these self-care deficits (Dorothea Orem's Self-care theory, 2011, Nursing Theories).
Whenever possible, patients should be empowered to act as best as they can to care for themselves. The nurse is viewed as an aid to remedy the self-care deficit in Orem's view. The nurse is not seen as superseding the patient's basic right to autonomy. Although some nurses know this intuitively, when busy or rushed sometimes it can be easy to forget the value of allowing patients to do as much as possible as they can for themselves, even if this is something as simple as eating and drinking or going to the bathroom.
Given the preponderance of lifestyle-related diseases today, Orem's stress upon patient self-knowledge and awareness is essential. Patients will care for themselves when they return home from a healthcare environment in most instances, and they must…
Cody, W.K. (2006). Philosophical and theoretical perspectives. Sudbury, MA: Jones and Bartlett
Dorothea Orem's Self-care theory. (2011, January 11). Nursing Theories.
Retrieved April 6, 2011 at http://currentnursing.com/nursing_theory/self_care_deficit_theory.html
The researchers analyzed the data as though it were at the interval/ratio level since they calculated means (the measure of central tendency that is appropriate only for interval/ratio level data) and standard deviations (the measure of dispersion for interval/ratio data) to describe their study variables.
What was the mean posttest empowerment score for the control group?
Mean = 97.12.
Compare the mean baseline and posttest depression scores of the experimental group. Was this an expected finding? Provide a rationale for your answer.
The experimental group subjects scored lower on the depression posttest (mean = 13.36 vs. The baseline score of mean = 14.00), meaning that they were less depressed after the completion of the empowerment program. This was an expected
finding, because the researchers hypothesized that the empowerment program would be beneficial to ESRD patients and result in a decrease in their depression scores. However,…