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NICU Nosocomial Infections
Preventing NICU Nosocomial Infections
hine (2006) writes an editorial to appeal to clinicians staffing neonatal intensive care units (NICUs) to increase their awareness of patient safety measures because a large number of studies have shown that educating and training clinicians on how to prevent nosocomial infections (NI) can have a significant positive impact on patient outcomes. The author was motivated to write this editorial because of the findings from a NICU study completed at the University of Alabama in Birmingham (UAB). The main findings of this study were clinician education, especially concerning hand hygiene, together with NICU culture, can significantly reduce NIs in the NICU over the long-term.
The UAB NICU intervention capturing the attention of hine (2006) involved a number of steps, but it was unclear which ones were individually the most effective. The author admits this, while at the same time suggesting that a systematic…
Rhine, W.D. (2006). Eliminating nosocomial infections in the NICU: Everyone's duty. Journal of Perinatology, 26(3), 114-143.
Applying the Theory of Planned Behaviors to Nosocomial Infections
Identify a public health theory you will use to support the implementation of your prevention and health promotion activities. Provide evidence that supports the use of this theory within the program you designed
According to the tenets of the theory of planned behavior, individuals first think about a behavior (e.g., the intent to act) and only then proceed to act (Chambers & Benibo, 2011). The dependent variables of intent to act in the theory of planned behavior include individual attitudes, perceived behavioral control, self-efficacy, and behavioral norms which are in turn dependent variables to the actual behavior demonstrated (Chambers & Benibo, 2011). The theory of planned behavior has been applied in a number of different settings, including in the context of nosocomial infections (Hughes, 2008).
In this context, the planned behavior theory conceptualizes individuals' intent to engage in handwashing as involving…
Bijari, R. & Abassi, A. (2014, January 1). Nosocomial infections and related factors in southern Khorasan hospitals. Iranian Journal of Public Health, 43(2), 197.
Chambers, V. & Benibo, B. R. (2011, October 1). Reactions to the 2008 economic crisis and the theory of planned behavior. Academy of Accounting and Financial Studies Journal, 15(4), 17-20.
Davis, R. & Anderson, O. (2012, April). Predictors of hospitalized patients' intentions to prevent healthcare harm: A cross sectional survey. International Journal of Nursing Studies, 49(4), 407-415.
HAIs at a glance. (2017). U.S. Centers for Disease Control. Retrieved from
Long-Term Nursing Facility Management Risks
Long-Term Nursing Family Management Risks
The major risk management issue of our hospital is the spread of nosocomial infections, more popularly known in the medical circle as hospital-acquired infections. This infection is something that a patient can contract or develop besides the condition for which he is admitted (Duel et al. eds, 2004). The include infections, which surface after discharge and occupational types among the workforce of the facility. These are widespread globally and assert strong impact among patients and facility workforce. The most common sites, according to a recent survey, are the urinary tract, the catether site, respiratory tract, bacteremia, skin and soft tissue, lower respiratory, surgical and the eyes (Duel et al., eds).
In our 150-bed facility in Chicago, pneumonia is a critical respiratory nosocomial infection concern. Our facility is a component of one of the biggest network of medical care…
Anderson, BM. And Roschm N, (2000). Hospital-acquired infections in Norwegian long-
term care institution. Vol. 46 Issue 4, Journal of Hospital Infections: The Hospital
Infection Society. Retrieved on March 18, 2015 from http://www.lofhospitalinfection.com/article/S0195-6701(00)90840-5/abstract?showall=true=
Conly J. And Johnston, L. (2001). The impact of health care structures on nosocomial infections and transmission of antimicrobial and resistant organisms. Vol. 12 # 5,
hygiene techniques with traditional soaps may or may not be more effective than using alcohol-based solutions concerning reduction in nosocomial infection rates in acute hospitals. With recent usage of alcohol-based solutions, use of traditional antibacterial soaps may be outdated and take longer. Nosocomial infections present as a major issue for acute care hospitals and require research in identifying the most effective way to sterilize hands to avoid increasing infection rates. While traditional handwashing with antibacterial soaps have been done for years, water availability and time taken to perform handwashing may not promote efficiency among hospital staff. Alcohol-based solutions require no water and additional washing or scrubbing. This research paper will focus on recent articles and studies that highlight which method works best.
Integration and Synthesis of the Evidence
Many articles and studies the past and in recent years attest to the effectiveness and efficiency of alcohol-based solutions. One 2012 studied…
Appelgrein, C., Hosgood, G., Dunn, A., & Schaaf, O. (2016). Ozonated water is inferior to propanol-based hand rubs for disinfecting hands. Journal Of Hospital Infection, 92(4), 340-343. http://dx.doi.org/10.1016/j.jhin.2015.08.029
Chen, S., Chou, C., Huang, J., Tang, Y., Kuo, Y., & Chien, L. (2013). Antibacterial effects on dry-fast and traditional water-based surgical scrubbing methods: A two-time points experimental study. Nursing & Health Sciences, 16(2), 179-185. http://dx.doi.org/10.1111/nhs.12082
Howard, J., Jowett, C., Faoagali, J., & Mckenzie, B. (2014). New method for assessing hand disinfection shows that pre-operative alcohol/chlorhexidine rub is as effective as a traditional surgical scrub. Journal Of Hospital Infection, 88(2), 78-83. http://dx.doi.org/10.1016/j.jhin.2014.06.013
Salmon, S., Truong, A., Nguyen, V., Pittet, D., & Mclaws, M. (2014). Health care workers' hand contamination levels and antibacterial efficacy of different hand hygiene methods used in a Vietnamese hospital. American Journal Of Infection Control, 42(2), 178-181. http://dx.doi.org/10.1016/j.ajic.2013.07.013
From the onset, it is important to note that nosocomial or healthcare-acquired infections (HAIs) happen to be rather common in our healthcare settings. In basic terms, nosocomial infections could be defined as the all those infections that are acquired or contracted within the healthcare environment. To be more specific, the World Health Organization – WHO (2020) defines the said infections as all those infections that “affect patients in a hospital or other health-care facility, and are not present or incubating at the time of admission.” Further, according to WHO (2020), this category of infections could also be inclusive of infections acquired by hospital staff in the course of executing their functions within a healthcare facility. This is the definition that will be adopted in this policy brief. As the Centers for Disease Control and Prevention – CDC (2018) observes, at least 1 out of a total of 31 hospitals…
Andersen, B.M. (2019). Prevention and Control of Infections in Hospitals: Practice and Theory. New York, NY: Springer.
Centers for Disease Control and Prevention – CDC (2018). HAI Data. Retrieved from https://www.cdc.gov/hai/data/index.html
Centers for Disease Control and Prevention – CDC (2020). States with HAI Reporting Mandates. Retrieved from https://www.cdc.gov/hai/state-based/required-to-report-hai-nhsn.html
Despotovic, A., Milosevic, B., Milosevic, I., Mitrovic, N., Cirkovic, A., Jovanovic, S. & Stevanovic, G. (2020). Hospital-acquired infections in the adult intensive care unit—Epidemiology, antimicrobial resistance patterns, and risk factors for acquisition and mortality. American Journal of Infection Control, 48(10), 1211-1215.
McIntosh, D.G. (2018). Healthcare-associated infections: potential for prevention through vaccination. The Adv Vaccines Immunother., 6(1), 19-27.
Stone, P.W., Pogorzelska-Maziarz, M., Reagan, J., Merrill, J.A., Sperber, B., Cairns, C. …Skillen, E. (2015). Impact of laws aimed at healthcare-associated infection reduction: a qualitative study. BMJ Qual Saf., 24(10), 637-644.
World Health Organization – WHO (2020). Health care-associated infections FACT SHEET. Retrieved from https://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf?ua=1
Nurse burnout is a common occurrence. This can exacerbate an ongoing problem that is seen in hospitals, nosocomial infections. Nosocomial infections remain prevalent for patients with extended hospital stays like those in intensive care units. An infection that starts roughly 48 hours after admission, those in intensive care units (ICUs) experience a continued rate of infection leading to increase length of stay, mortality, and morbidity. The number of patients that develop a nosocomial infection are from 7 to 10% internationally (Dasgupta, Das, Hazra, & Chawan, 2015). As such, hospitals have decided to classify nosocomial infection sites based on clinical and biological criteria.
esearch has led to the discovery of several bacterial strains that involve the formation of nosocomial or hospital acquired infections. "The agents that are usually involved in hospital-acquired infections include Streptococcus spp., Acinetobacter spp., enterococci, Pseudomonas aeruginosa, coagulase-negative staphylococci, Staphylococcus aureus, Bacillus cereus, Legionella and Enterobacteriaceae family members,…
CDC. (n.d.). HAI Data and Statistics. Retrieved from https://www.cdc.gov/hai/surveillance/
Cheng, C., Bartram, T., Karimi, L., & Leggat, S. (2016). Transformational leadership and social identity as predictors of team climate, perceived quality of care, burnout and turnover intention among nurses. Personnel Review, 45(6), 1200-1216. doi:10.1108/pr-05-2015-0118
Cimiotti, J. P., Aiken, L. H., Sloane, D. M., & Wu, E. S. (2012). Nurse staffing, burnout, and health care -- associated infection. American Journal of Infection Control, 40(6), 486-490. doi:10.1016/j.ajic.2012.02.029
Dasgupta, S., Das, S., Hazra, A., & Chawan, N. (2015). Nosocomial infections in the intensive care unit: Incidence, risk factors, outcome and associated pathogens in a public tertiary teaching hospital of Eastern India. Indian Journal of Critical Care Medicine, 19(1), 14. doi:10.4103/0972-5229.148633
One possible explanation for the differences observed in the studies could be that the strengths of the chlorhexidine solution were different. It could also be that over time more effective techniques have been developed in the application of the solution, as the results do appear to improve over time.
There are limitations to the methodology of the study which are centered on the use of secondary data for analysis. The use of secondary data allows a wider range of data to be gathered from across the U.S. than would be practical from primary data collection which is the reason for the choice in this study. However this puts the control of several variables beyond the researcher. The results of the techniques may have been affected by the application of different individuals, departments and hospitals, all of whom may vary techniques and other factors influencing the success of these techniques. The…
Adams, D., Quavum, M., Worthington, T., Lambert, P., & Elliott, T. (2005). Evaluation of a 2% chlorhexidine gluconate in 70% isopropyl alcohol skin disinfectant. Journal of Hospital Infections, 61 (4), 287-290.
Brungs, S., & Render, M. (2006). Using Evidence-Based Practice to Reduce Central line Infections. Clinical Journal of Oncology Nursing, 10 (6), 723-725.
CDC. (2002). Guidelines for Prevention of Intravascular Catheter-Related Infections. Morbidity and Mortality Weekly Report; Recommendations and Reports, 51 (RR-10), 1-34.
CDC Mission. (n.d.). Retrieved February 6, 2006, from CDC Web site: http://www.cdc.gov/about/mission.htm
In the U.S healthcare environment, the clinical practice guidelines are the effective healthcare protocol to enhance patient’s safety as well as achieving evidence-based practice. The clinical guidelines provide recommendations to the best available practice to assist clinicians and other healthcare professionals to deliver best and quality care. More importantly, the clinical practice guidelines are designed to optimize patients’ care using the systematic assessment and evidence based review to assess pros and cons of the alternative care options. The guidelines serve as the strongest resources to assist the healthcare professionals to make clinical decisions as well as incorporating evidence gained through practice and scientific investigations into patient practice. Healthcare organizations develop the guidelines in form and policies, which are endorsed across the organization to create a platform that employees will follow and holding employees accountable to achieve a standard of care.
Clabsi Hospital is one of the best healthcare organizations…
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
Caglar S; Yildiz S; Savaser S. (2010). Observation results of hand-washing by health-care workers in a neonatal intensive care unit. International Journal of Nursing Practice, 16(2), 132-137.
In this article the authors wanted to determine whether healthcare professionals were washing their hands and if they were doing so effectively. The researchers observed 344 incidents in which hand washing was warranted and found that nurses were 63% compliant and physicians were 53% compliant. However, when it came to making sure that the job was done thoroughly, physicians were able to do a better job than nurses at a 24% to 13% rate of success. Since hand washing has been proven to be the most effective and simplest method for preventing infection, it is imperative that healthcare professionals perform it as often as needed and thoroughly.
amos M.M., Schrader, ., Trujillo, ., Blea, M., & Greenberg, C. (2011). School nurse inspections improve…
Researchers are trying different techniques to increase the incidence of compliance with hand washing guidelines and in this study they used social pressure. Initially, compliance with hand washing regulations was deemed to be significantly below expected standard within the nursing staff. To hopefully combat this, researchers told the staff that they were going to weigh the soap dispenser bags to see if people were actually using them or not. The object of the study was to determine if this type of pressure would induce the staff into better compliance with hand washing regulations. The researchers found that this type of behavioral technique is very effective.
15. Parish, C. (2008). Patient campaigner calls for TV cameras to check hand-washing. Nursing Standard, 22(38), 6.
The author of the article looked at the compliance records of staff and whether patients and visitors used infection controls. The campaigner, Roger Goss, said that because MRSA and other similar healthcare-acquired infections were becoming more dangerous that staff and visitors needed to be monitored more closely to prevent spread. The man advocated that close-circuit televisions be used to determine compliance with regulations, and he encouraged staff to be fired and visitors not welcomed if they did not comply. The warning here to nurses is that people are watching whether they wash their hands properly, and they are ready to have them terminated if they do not.
Urinary tract infections (UTIs) are typically the most prevailing healthcare-associated infection (HAI) in acute care facilities in the U.S. The Centers for Disease Control and Prevention (CDC) has estimated that up to 150,000 hospital-onset, symptomatic catheter-associated UTIs (CAUTIs) occurred in 2013, resulting in as much as $161 million in excess direct medical costs (Kuntz, 2010, p. 319). Current research examines the reason for such a high occurrence of infection. oughly 75% of healthcare-associated UTIs are connected to improper use of indwelling urinary catheters, to which up to a quarter of hospitalized patients are exposed. Adult ICUs have the highest exposure rate for catheter use and reveal over 95% of UTIs related to catheter use.
In the last twenty years, various strategies have been implemented to aid in reducing the risk of CAUTI in healthcare settings. One of which includes identifying proper times to use catheters and proper care and insertion…
Deron, D.C., Edwards, J.R., Srinivasan, A., Fridkin, S.K., & Gould, C.V. (2011). Trends in Catheter-Associated Urinary Tract Infections in Adult Intensive Care Units -- United States, 1990 -- 2007. Infection Control and Hospital Epidemiology, 32(8), 748-756.
Flynn, M.B., Martins, S.A., Burns, S., Philbricks, D., & Rauen, C. (2013). Putting Evidence Into Nursing Practice: Four Traditional Practices Not Supported by the Evidence. Critical Care Nurse, 23(2), 37. Retrieved from http://www.aacn.org/wd/Cetests/media/C1322.pdf
Goeschel, C.A., Cosgrove, S.E., Romig, M., & Berenholtz, S.M. (2011). Prevention of Central Line -- Associated Bloodstream Infections: A Journey Toward Eliminating Preventable Harm. Current Infectious Disease Reports, 13(4), 343-349.
Kuntz, G. (2010). Guideline for Prevention of Catheter-Associated Urinary Tract Infections 2009. Infection Control and Hospital Epidemiology, 31(4), 319-326.
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 .
Management of Immunocompromised Patients
In beginning I writer specific nursing assignment. The Question: 2000 Words While clinical placement asked prepare a single room an admission. The patient requiring admission isolation room immunocompromised.
Immunocompromised patients usually require isolation in order to prevent them from becoming infected with infections from other patients which is known as protective isolation. For the immunocompromised patients, their immune system is unable to fight the infectious diseases. There are many diseases or conditions that lead to immunodeficiency in patients.
One is AIDS (acquired immunodeficiency syndrome). The pathophysiology of AIDS starts when the person's CD4+ T cell count begins to decrease as the disease kills these cells. This is HIV-induced cell lysis where the virus enters the CD4+ cells where it inserts its genetic information to the cell nucleus thus taking over the cell and replicating itself. The virus then mutates extremely rapidly thus making it more and…
Agusti, C., & Torres, A. (2009). Pulmonary Infection in the Immunocompromised Patient: Strategies for Management. New York: John Wiley & Sons.
Bodey, G.P. (2010). Managing Infections in the Immunocompromised Patient. Clinical Infectious Diseases, 40(Supplement 4), S239. doi: 10.1086/427328
Glauser, M.P., & Pizzo, P.A. (2009). Management of Infections in Immunocompromised Patients New York: Elsevier Health Sciences.
Hayden, R.T. (2008). Diagnostic Microbiology of the Immunocompromised Host. Washington, DC: ASM Press.
This clearly shows that alcohol-based hand-washing, when used regularly and vigorously (e.g. prior to any healthcare procedure by any level of personnel), infection will be reduced.
The Saudi study was a bit more detailed, with protocols varying depending on severity of procedure (surgery, etc.) and the administering of prophylactic antibiotics as part of the regular treatment procedure. Statistical analysis of the samples showed no significant differences between the Betadine Group and the Alcohol-Based Gel Group. However, the total number of infections within both groups were quite small, 20 out of 600 subjects in the trial. This suggests that the conditions at the Saudi hospital were already more sterile, with less than 5% (3.33%) even developing infections; compared to 13.1% in Vietnam. In both cases, demographic differences between patients were not statistically significant in the protocol.
Combining the data from the two studies, however, results in two conclusions: 1) There is…
Al-Naami, M.Y., et al., (2009). EWMA Journal. 9 (3): 5-10.
Nguyen, K., et al., (2008). Tropical Medicine and International Health. 13 (10): 1297-1302.
Hygiene in Medical Settings
My message will be on hand hygiene for everyone that comes to the hospital.
Hand hygiene for hospital guests is just as important as it is for hospital personnel. Everyday interactions and activities can lead to exposure to a variety of bacteria that can create illness. In a hospital setting, this means that guests with good intentions towards loved ones can inadvertently make an illness worse or introduce new germs into clinically sanitized environments. Bacteria and other illness causing agents are often picked up from external environments and surfaces and then transported through body parts such as the nose, throat, skin, and hair. Because the hands are one of the most active parts of the body, we also carry germs between our fingers and underneath fingernails. Therefore, it becomes important that everyone wash their hands properly and frequently to decrease the transmission of bacteria and other…
Kuo, C.C. (2011). What's your hand hygiene?. AAOS Now, 5(10), 17-18.
Smith, S.S. (2009). A review of hand-washing techniques in primary care and community settings. Journal of Clinical Nursing, 18(6), 786-790. doi:10.1111/j.1365-2702.2008.02546.x.
These are questions dealing with attitude and are the most important questions when doing qualitative social science research to gauge relationships among events. In addition to construction questions about attitudes, it is important to have the questions drafted in the correct format (Nachmias, 2008).
The Quantitative methodologies will be the statistical tests designed for the overall model to incorporate the information provided through one, two or all of the Qualitative data analysis methodologies. The tests used to determine the relationship between these "qualitative" factors and increases in Infection rates, will be the Chi-Square, Student's T-Test, ANOVA (to test for variations among the data), the construction of a Linear Regression Model and the calculation of the Pearson Correlation Coefficient, otherwise known as "R-Squared" (Nachmias, 2008).
These tests will be utilized in conjunction with a predetermined level of significance, or alpha. Since these tests will all be measuring the means and relationships…
Barrett, R. & Randle, J. (2008). Hand hygiene practices: nursing students' perceptions. Journal of Clinical Nursing, 17(14), 1851-1857.
Beggs, C.; Noakes, C.; Shepherd, S.; Kerr, K.; Sleigh, P. & Banfield, K. (2006). The influence of nurse cohorting on hand hygiene effectiveness. American Journal of Infection Control, 34, 10, 621-626.
Larson, E.; Quiros, D. & Lin, S. (2007). Dissemination of the CDC's Hand Hygiene Guideline and impact on infection rates. American Journal of Infection Control, 35(10), 666-675.
Roberts, C.; Roberts, J. & Roberts, R.J. (2009). Investigation into the effect of an alcohol-based hand product on infection rate in a nursing home setting. Journal of Infection Prevention, 10(4), 138-142.
Homeostasis, according to Nirmalan and Nirmalan (2017), is the propensity for living organisms to maintain relative stability in the internal environment. Homeostasis is made possible through the cooperation of several regulatory mechanisms and separate sub-systems which make up the normal physiology of a living organism (Nirmalan & Nirmalan, 2017). During critical illnesses internal or external stress can make an attempt at interfering with the self-regulation systems beyond what is considered as normal range in physiology. According to Palaparthi and Med (2017), the word homeostasis is derived from two Greek words i.e. ‘homeo’ (stands for similar) and ‘stasis’ (standing for stable). Homeostasis is the balance, equilibrium and the stability of the body or of the cell (Palaparthi & Med, 2017). Living organisms exhibit this character. The process of maintaining stability in the internal environment necessitates occasional internal adjustments as the environmental conditions continue to change outside and inside the…
Green provides some clear guidelines to assist health education and promotion specialists in the identification and design of health promotion techniques for implementation in health promotion and disease prevention programs. Discuss how five of the guidelines presented by Dr. Green could assist you in the selection of an appropriate health promotion technique. Support your answer with appropriate examples.
The module gives really simple guidelines as to the how the process of health education promotion can work in today's world. Healthcare is a social industry and hence understanding the community structure and its needs is the primary concern. According to the directions given by Dr. Green, the following factors have to be considered before designing and implementing health promotion and disease prevention programs. Hence the process is structured by first identifying the needs of the community and then setting the goals (short-term and long-term) accordingly. Once this is done the following…
Adair, J.E. And Thomas, N. (2004). The Concise Adair on Teambuilding and Motivation. Thorogood. London.
Agron P, Berends V, Ellis K, Gonzalez M. (2010). School wellness policies: perceptions, barriers, and needs among school leaders and wellness advocates. J Sch Health. 2010; 80: 527-535.
Eddy, J. Module 5. Policy Development as a Health Promotion Technique- Dr. James Eddy (59:40). Accessed from: mms://mediasrv1.ccs.ua.edu/CCS-AO2/HHE530/HHE530_Module5_D_combined.wmv
Fitzhugh, E. Module 5a. The Focus Group- Dr. Eugene Fitzhugh (1:00:14). Accessed from: mms://mediasrv1.ccs.ua.edu/CCS-AO2/HHE530/HHE530_Module5_A_combined.wmv
Naturally, any problem that results in 1.7 instances of illness and 100,000 preventable deaths is automatically extremely clinically significant. What makes this topic especially clinically significant is that nosocomial infections are largely a function of behaviors that violate established principles of standard hygiene and antisepsis in clinical settings. If the information can be used to publicize the importance of reducing hospital acquired infections and to increase healthcare worker compliance with antiseptic protocols, it could greatly improve the safety and quality of the American healthcare system.
Primary Barriers to Hand Washing Compliance
The main barriers reported in connection with the low rate of hand washing compliance in U.S. hospitals include ignorance, laziness, habit, and convenience. Ignorance comes into play when healthcare providers fail to consider how vulnerable hospitalized patients are to infection and how easily bacterial infections can be caused by hand-to-hand or hand-to surface contamination. Laziness is an issue because…
Methicillin-esistant Staphylococci (MSA), most common Healthcare Associated Infections
The PICOT question to be discussed is: For adult patients using catheters, does the use of sterilization practices reduce the future risk of health associated infections like MSA compared with standard procedure in one week?
The answer is yes.
The support given to answer the question will be based on peer-reviewed journals and scientific literature. A summary of the evidence will be availed in a chart plus a conclusion that summarizes evidence used will also be given.
Methicillin-resistant Staphylococcus aureus (MSA) bacteria is resistant to several antibiotics. A significant proportion of MSA infections in the community are on the skin. It results in alarming infections of the bloodstream, surgical site infections and pneumonia in health facilities. Studies have revealed that one person in every three individuals have staph in the nose - most of the time they don't show any illnesses (General…
General Information About MRSA in the Community. (n.d.). Retrieved February 21, 2015, from http://www.cdc.gov/mrsa/community/index.html
Sydnor, E., & Perl, T. (2011). Hospital Epidemiology and Infection Control in Acute-Care Settings. Clinical Microbiology Reviews,24(1), 141-173. Retrieved February 21, 2015, from http://cmr.asm.org/content/24/1/141.full
Moreover, the specific cause of transmission are the low compliance rates of hospital personnel with basic antiseptic protocols such as simple hand washing. Surprisingly, the worst offenders were those with the highest degree of formal training: namely physicians and registered nurses. In some studies, compliance rates among hospital personnel were only between fifteen and thirty percent. Finally, empirical studies have also concluded that compliance rates are lowest in high-volume institutions and among understaffed medical units.
The solution is rather obviously quite simple. Among the most important aspects of reducing hospital-acquired nosocomial hospital infections is increasing the rates of hand washing among hospital personnel. Naturally, the more direct patient contact individual personnel have, the more important adherence to strict hand-washing policy is. Since physicians and nurses routinely care for many patients during a typical shift, it is crucial for them to become the most compliant rather than the least compliant…
Sheridan-Leos, Norma. "Oncology care setting design and planning Part II: Designing healthcare settings to prevent fungal infections and improve handwashing."
Clinical Journal of Oncology Nursing (June 1, 2008).
Full Text of Article Below
This is the second in a two-part series on designing healthcare settings to improve patient safety. Part I addressed concepts of error theory and evidence-based practice as they relate to planning safe care environments (Sheridan-Leos, 2008). Part II describes the design and planning of oncology care settings to prevent fungal infections and improve provider handwashing.
Among the most important aspects to the health promotion plan will be the benefits associated with a care manager, who can ensure that all six core elements of CCM are implemented fully. If this is accomplished, there should be a significant reduction in health disparities for patient and caregiver outcomes across generations.
AHQ. (2012). National Healthcare Disparities eport, 2011. No. 12-0006. ockville, MD: Agency for Healthcare esearch and Quality. etrieved 16 Apr. 2014 from http://www.ahrq.gov/research/findings/nhqrdr/nhdr11/nhdr11.pdf.
Braveman, P.A., Kumanyika, S., Fielding, J., Laveist, T., Borrell, L.N., Manderscheid, . et al. (2011). Health disparities and health equity: The issue is justice. American Journal of Public Health, 101(Suppl. 1), S149-55.
Brodaty, H. & Donkin, M. (2009). Family caregivers of people with dementia. Dialogues in Clinical Neuroscience, 11, 217-28.
Castro, A. & uiz, E. (2009). The effects of nurse practitioner cultural competence on Latina patient satisfaction. Journal of the American Academy of Nurse…
AHRQ. (2012). National Healthcare Disparities Report, 2011. No. 12-0006. Rockville, MD: Agency for Healthcare Research and Quality. Retrieved 16 Apr. 2014 from http://www.ahrq.gov/research/findings/nhqrdr/nhdr11/nhdr11.pdf .
Braveman, P.A., Kumanyika, S., Fielding, J., Laveist, T., Borrell, L.N., Manderscheid, R. et al. (2011). Health disparities and health equity: The issue is justice. American Journal of Public Health, 101(Suppl. 1), S149-55.
Brodaty, H. & Donkin, M. (2009). Family caregivers of people with dementia. Dialogues in Clinical Neuroscience, 11, 217-28.
Castro, A. & Ruiz, E. (2009). The effects of nurse practitioner cultural competence on Latina patient satisfaction. Journal of the American Academy of Nurse Practitioners, 21(5), 278-86.
Omit itles and Degrees]
Klompas M., Speck, K., Howell M.D., Greene, L.R., & Berenholtz, S.M. (2014). Reappraisal of routine oral care with chlorohexidine gluconate for patients receiving mechanical ventilation: systematic review and meta-analysis. JAMA internal medicine, 174 (5), 751-761.
his article deals with the routine oral care of patients using chlorhexidine gluconate as standard care when they receive mechanical ventilation during their hospital stay. heir aim is to assess the overall impact routine oral care has in conjunction with chlorhexidine in regards to patient-centered outcomes for patients receiving the aforementioned mechanical ventilation. hey chose randomized clinical trials that compared a placebo to chlorhexidine and chose only sixteen studies out of the 171 citations they explored because the 3,630 patients observed in the selected studies met criteria.
he results showed chlorhexidine provide patients with a lesser occurrence of infection than with placebo, although pneumonia risk was around the same for both.…
This webpage gives information on what VAP is. It also provides links on possible prevention information. It does not really highlight use of chlorhexidine. However, it does include monitoring practices to check for VAP for early intervention.
15. Beraldo, C.C., & Andrade, D.D. (2008). Oral Hygiene with chlorohexidine in preventing pneumonia associated with mechanical ventilation. Jornal Braisileiro de Pneumologia, 34(9), 707-714
This article failed to provide any new information with the exception of reducing another bacterium through the use of chlorhexidine. It is a search kind of article. They chose eight studies. From those eight studies, seven of them confirmed the use of chlorhexidine reduces instances of VAP.
Success in several high-profile areas, such as stroke prevention, acute coronary intervention, or nosocomial infection have the benefits of focusing the organization on a task which can bring tangible results, measured in clinically-relevant ways.
Specific Program for our Institution
This memo recommends that we choose five treatment areas, and implement specific quality improvement programs for each one. The focus on each should include procedures which are important to the overall quality of this institution's morbidity and mortality results. Given the hospital's focus on acute care, the following procedures might be candidates for quality improvement programs:
Ischemic stroke treatment
ACS treatment (acute coronary syndrome).
Trauma in the ER related to gunshot wounds.
Maternal ward delivery performance
Nosocomial infection reduction.
In each case, the procedures should proceed as outlined above: (1) an identification of the problem, (2) identification of best practices as demonstrated in peer-reviewed clinical trials, (3) adoption of the best…
CancerCenter. (2007). Cancer Treatment Centers of America. Retrieved November 23, 2007, from CCA: www.cancercenter.com
Civitarese, L.A. (1999). Congestive Heart Failure Clinical Outcomes Study in a Private Community Medical Group. Journal of American Board of Family Practice, 467-472.
Dana Farber. (2005). Dana-Farber attains nation's highest honor for nursing excellence; first cancer center in New England to earn Magnet recognition. Boston: Dana Farber Cancer Institute.
Katzan, I.L. (2003). Quality Improvement and Tissue-Type Plasminogen Activator for Acute Ischemic Stroke. JAHA, 799-800.
Simply put, it is impossible to regulate motivation and concern on the part of caregivers. On the other hand, there are various ways that at least some of the external manifestations of lack of concern for patient welfare can be better identified and addressed than they seem to be at many facilities. Failure to adhere to fundamental protocols, such as those pertaining to antisepsis have been proven time and again to contribute directly to the unacceptably high rate of nosocomial infections in clinical environments (eid, 2009). Generally, those types of protocols, such as compliance with hand-washing requirements and glove changing are some of the first signs that a health care worker is not highly motivated to provide the best possible care to patients (Hamric, Spross, & Hanson, 2009). That problem is one that government regulators have sought to resolve, at least indirectly, by shifting the financial burden of several types…
Hamric, a.B., Spross, J.A., and Hanson, C.M. (2009). Advanced Practice Nursing: An
Integrative Approach. St. Louis, MO: Saunders.
Reid, T. (2009). The Healing of America: A Global Quest for Better, Cheaper, and Fairer
Healthcare. New York, NY: Penguin.
Evidence-Based Design in Healthcare Facility Planning
This Letter to Stakeholders aims to help the recipients appreciate the importance of evidence-based design in the planning of Healthcare Facilities.
Dear Sir / Madam
I feel happy to share with you the letter that explains about the upcoming healthcare renovation project. There are a lot of disruptive changes happening in the healthcare landscape and the application of evidence-based design (EBD) is prominent among them. It is essential that we understand the features of the model before taking a final decision. I have put my perspective on why adopting the EBD model for our renovation project is important.
History of Healthcare Facility Design
The original idea that Florence Nightingale had of a hospital was a place that would have abundant fresh air, view of nature and light. This idea sought to substitute deep plan hospitals that rose after World War II which were more…
Burpee, Heather (2008). 'History of Healthcare Architecture'. Integrated Design lab Puget Sound.
Gormley, Tom (2010). 'The History of Hospitals and Wards'. Healthcare Design. Extracted from http://www.healthcaredesignmagazine.com
Kroll, Karen (2005). 'Evidence-based design in Healthcare facilities'. Building Operating Management. Extracted from http://www.facilitiesnet.com/
Becker, Franklin and Kelley S. Parsons (2007). 'Hospital Facilities and the role of evidence-based design'. Journal of Facilities Management Vol. 5 No. 4, 2007 pp. 263-274
Prevention and Management of Ventilator-Associated Pneumonia in the Hospitals
Ventilator-associated pneumonia is an infection in the airways that develops more than 48 hours after a patient is intubated. While the prevention and management of pneumonia of any kind is considered as a commendable objective, it is characterized with several concerns given the significant effect of pneumonia linked to ventilator use. Ventilator-associated pneumonia has attracted considerable concern in the recent past because it has become the leading cause of death among infections acquired in the hospital. Actually, the rates of deaths from ventilator-associated pneumonia have exceeded those associated with central line infections, respiratory tract infections, and serious sepsis in the non-intubated patient ("Preventing Healthcare and Community Associated Infections," n.d.). It is increasingly likely that the most concerning aspect of ventilator-associated pneumonia is the high associated mortality (Kalanuria, Zai & Mirski, 2014). Consequently, several peer reviewed studies have been carried out to…
Junega et. al. (2011, May). Prevention and Management of Ventilator-Associated Pneumonia: A
Survey on Current Practices by Intensivists Practicing in the Indian Subcontinent. Indian Journal of Anaesthesia, 55(2), 122-128.
Kalanuria, A.A., Zai, W. & Mirski, M. (2014). Ventilator-Associated Pneumonia in the ICU.
Critical Care, 18(208). Retrieved from http://ccforum.com/content/18/2/208
New Sepsis Guidelines and Nurses: Factors, Compliance and Consideration
Introduction to Sepsis
Sepsis refers to the body’s dangerous reaction to an existing infection. Sepsis is extremely serious and if not treated swiftly with appropriate action it can lead to fast tissue and organ damage and death. The medical community has long been focused on getting better control of sepsis, as it is a damaging and debilitating condition that contributes to a host of preventable deaths. In fact, sepsis is one of the primary reasons for death in the number of hospitalized patients and is the cause of 20% of all admissions to intensive care units. (Ferrer et al., 2008). This data clearly indicates that sepsis is an aggravated problem that experts need to have better protocol for and preventative measures to counteract. In America, the rate of death from sepsis is one of the highest rates in the world with…
Some of the symptoms of ventilator assisted pneumonia may be the onset of fever, a higher white blood cell count, and a new or changing lung infiltrate that may be visible on a normal chest x-ray. Cultures taken as samples from the patient's airways may show the presence of microorganisms or bacteria and fungi that would eventually cause the dreaded ventilator assisted pneumonia in the patient. JAMA states that these risk factors may be eliminated to a large extent if the nurses and medical practitioners were to follow certain simple but essential steps in preventing the onset of the symptoms of pneumonia. First and foremost, the nurse must maintain a high degree of hygiene; he must wash his hands both before and after coming into contact with any patient, and second, he must try to keep the bed elevated to a 30 degree head up position, so that…
Druding, Mary. C. (1997, Aug) "Re-examining the practice of normal saline installation prior to suctioning" Medical Surgery Nursing, Retrieved 8 October, 2007 at http://findarticles.com/p/articles/mi_m0FSS/is_n4_v6/ai_n18607505
Medscape. (2007) "Should Normal Saline be Used When Suctioning the Endotracheal Tube of the Neonate?" Retrieved 8 October, 2007 at http://www.medscape.com/viewarticle/552862
Schwenker, Ferrin, M; Gift, a.G. (1998) "A survey of endotracheal suctioning with installation of normal saline" American Journal of Critical Care, vol. 7, no. 4, pp: 255-260.
Torpy, Janet M. (2007, Apr) "Ventilator assisted pneumonia" the Journal of the American
However, this study was discredited and criticized by subsequent studies. Only one study directly addressed the use of untied mittens as restraints in the critical care unit. All other studies addressed other forms of restraint systems.
The results of this literature review indicate that studies regarding the use of restraints in the critical care unit is inconclusive. Only one study addressed the use of mittens as a restraint system, This is clearly an area that deserves further exploration. The use of mitten restraints may prove a more acceptable form of restraint than other restraint forms. This issue needs to be addressed in future research studies.
M. Bryan (2009). Use of Physical estraints From a Bedside Practice Perspective
Am. J. Crit. Care., March 1, 2009; 18(2): 101-102.
Chang, LY., Wang, KW., & Chao, YF et al. (2008). Influence of Physical estraint on Unplanned Extubation of Adult Intensive Care Patients: A…
M. Bryan (2009). Use of Physical Restraints From a Bedside Practice Perspective
Am. J. Crit. Care., March 1, 2009; 18(2): 101-102.
Chang, LY., Wang, KW., & Chao, YF et al. (2008). Influence of Physical Restraint on Unplanned Extubation of Adult Intensive Care Patients: A Case-Control Study. Am. J.
Crit. Care 17: 408-415.
The situation described is entirely unacceptable. Hospital-acquired infections are already a tremendous problem in contemporary clinical care facilities and are responsible for as many as 100,000 patient deaths annually, in addition to adding billions of dollars to the national cost of healthcare unnecessarily (eid, 2009). In this situation, all health care providers have an obligation to intervene and to do whatever is necessary to protect patients from harm caused by the negligence of health care workers. The ethical obligation to intervene effectively in this scenario arises as a function of the fundamental obligation of health care workers to protect the health and safety of patients and derives from concepts of patients' rights, and more broadly, from altruism and respect for the basic obligations of health care workers to patients and to their employing organizations (Beauchamp & Childress, 2009).
From a staff-development problem, this scenario actually represents more of…
Beauchamp, T.L. And Childress, J.F. (2009). Principles of Biomedical Ethics, 6th
Edition. Oxford University Press: New York
Reid, T. (2009). The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care. Penguin Group: New York.
Tong, R. (2007). New Perspectives in Health Care Ethics: An Interdisciplinary and Cultural Approach. Pearson: Princeton.
People die each year of cardiac related health problems. Some die of heart attacks and others of congestive heart failure and so forth. This research proposal highlights five peer reviewed journal articles that show how to improve, step-by-step, the infrastructure of a hospital cardiac program. Quantitative data from the studies along with in-hospital data will reveal the need for quality improvement as well as how successful certain methods are when implemented among specific populations. Information was gathered through the search engine Google Scholar and PubMed. All articles are less than four years old and reveal ways to not just improve the safety and care of patient's but also how to improve surgical outcomes and enhance IT infrastructure, all of which are essential to running a great hospital cardiac program.
Several patients in (Hospital Name) have come in complaining of cardiac related health problems. Some have had issues with cardiothoracic…
Elliott, M.J. (2012). The role of information in ensuring quality and patient safety. Progress in Pediatric Cardiology, 33(1), 5-10. Retrieved from http://www.sciencedirect.com/science/article/pii/S1058981311000853
Grace, S.L., Poirier, P., Norris, C.M., Oakes, G.H., Somanader, D.S., & Suskin, N. (2014). Pan-Canadian Development of Cardiac Rehabilitation and Secondary Prevention Quality Indicators Endorsed by the Canadian Association of Cardiac Rehabilitation. Canadian Journal of Cardiology, 30(8), 945-948. Retrieved from http://www.sciencedirect.com/science/article/pii/S0828282X14002335
Guillamondegui, O.D., Gunter, O.L., Hines, L., Martin, B.J., Gibson, W., Clarke, C., Cecil, W.T. (2012). Using the National Surgical Quality Improvement Program and the Tennessee Surgical Quality Collaborative to Improve Surgical Outcomes. Journal of the American College of Surgeons, 214(4), 709-714. Retrieved from http://www.sciencedirect.com/science/article/pii/S1072751511013287
IEEE Conference on Software Engineering Education and Training, & IEEE Computer Society. (2011). Educating software engineers of the future: Software quality research through problem-based learning. In CSEE&T 2011: Proceedings (pp. 91-100). Los Alamitos, California: IEEE.
Force 12: Image of Nursing. The VA recognizes the importance of individual care to the perception of quality healthcare in its facilities. Even if the entire organization operates in an effective and compassionate manner, if the nurse that cares for a patient fails to deliver on this level of care, the individual perception of nursing care will be diminished. To this end, the organization's nursing fact sheet proclaims, "VA Nursing Service is dedicated to promoting optimal health, patient safety, quality health care, and the highest professional standards, in order to ensure that our veterans receive the best possible care and that our staff work in the best possible health care system" (VA Nursing Service, 2005).
Force 13: Interdisciplinary elationships. The VA's Web page, "VA & Experienced Professionals" (2008) states, "Our doctors, physician assistants, nurses, therapists, pharmacists, and other professionals work together in an interdisciplinary care team structure" (p. 3).
About Office of Nursing Services. (2008). Department of Veterans Affairs. [Online]. Available: http://www1.va.gov/nursing/page.cfm?pg=111.
About VA. (2008). Department of Veterans Affairs. [Online]. Available: http://www.va.gov/about_va/ .
Bliss-Holtz, J., Winter, N., Scherer, Elaine M. (2004, September). An invitation to magnet accreditation. Nursing Management, 35(9), 36-42.
Facts about the Department of Veterans Affairs. (2008). Department of Veterans Affairs. [Online]. Available: http://www1.va.gov/opa/fact/vafacts.asp.
Nursing Culture: Overcoming Barriers to Change
Introduction and Theoretical Framework
This program of study continues personal research and professional practice in the field of nursing within the area of public and private health systems. In an era characterized by increasing calls for more efficient approaches to healthcare delivery and accountability on the part of healthcare providers, there is a growing need for identifying opportunities to overcome organizational barriers to change that facilitate the implementation and sustainment of evidence-based practices over time. In order to accomplish this challenging enterprise, the nature of existing organizational barriers must be better understood, an issue that directly relates to the problem to be considered by the study proposed herein and which is discussed further below.
Statement of the Problem
According to Mannion, Davies and Marshall et al. (2005), the results of much of the research to date have identified a relationship between nursing culture and…
Banyard, V.L., & Miller, K.E. (1998). The powerful potential of qualitative research for community psychology. American Journal of Community Psychology, 26(4), 485.
Burton, S., & Steane, P. (2004). Surviving your thesis. New York: Routledge.
Dennis, C., & Harris, L. (2002). Marketing the e-business. London: Routledge.
Department of Health. (2000). The NHS plan: A plan for investment, a plan for reform. London:
Another study surrounding the use of restraints in non-psychiatric patients (Strumpf and Evans, 1998) reported that the nurses had difficulty reconciling the administration of restraints with concerns regarding patient dignity and autonomy. So it appears that the use of restraints is difficult on staff and patients alike. Interestingly enough, in a literature review for this paper, the writer could find no significant supporting data to recommend restraint devices as effective in the management of the confused or persistently agitated patient. In this case, it appears that many times patients are being placed into restraints more "because we have always done so with this kind of patient" rather than on the basis of any science that the use of restraint is beneficial to the patient.
Restraints and the Law
Any time a patient is to be considered for the application of restraint devices, it is important that all members of the…
Castle, NG, Mor V. (1998) Physical restraints in nursing homes: A review of the literature since the Nursing Home Reform Act of 1987) Nursing Home Reform 55:139-176.
Catchen, H. (1983). Repeaters: Inpatient accidents among the hospitalized elderly. The Gerontologist, 23, 173-176.
Difabio, S. (1981). Nurses' reactions to restraining patients. American Journal of Nursing, 81, 973-975.
Evans, L.K., & Strumpf, N. (1989). Tying down older persons: A review of the literature on physical restraints. Journal of the American Geriatrics Society, 37, 6-14.
Kangaroo Care and Premature Babies
Kangaroo care entails holding a full term infant or premature so that there is a skin-to-skin contact between the newborn and the individual holding it. Individuals practice kangaroo care for premature infants for approximately two to three hours every day over a certain period. This takes place during early infancy, and the parent holds the baby against her bare chest. Medically stable babies can receive kangaroo care for up to any period since there is no maximum duration for them (Feldman et al., 2002).
Most parents may keep their babies in their arms for hours each day. According to research carried out, kangaroo care is essential as close bodily contact between the infant and the mother helps to stabilize the heartbeat, breathing and temperature of the premature infant. This is crucial as premature babies always have problems in harmonizing their heart and breathing rate. Mothers…
Aucott, S., Donohue, K., Atkins, E., & Marilee, C (2002). Neurodevelopmental Care In The
Nicu, 8, 298 -- 308.
Dodd, L. (2003). Effects of kangaroo care in preterm infants,
Feldman, R., Weller, A., Sirota, L., & Eidelman, A. (2002). Skin-to-Skin Contact (Kangaroo Care) Promotes Self-Regulation in Premature Infants: Sleep -- Wake Cyclicity, Arousal Modulation, and Sustained Exploration, Vol. 38 (2), 194 -- 207.
Baker, 2000).The measurement of project effectiveness, an element of project impact evaluation, is crucial for the success of every proposed project. In this section, we present the method/mechanism for evaluating the effectiveness of the proposed solution. The process starts with the identification of the project users (Ventilation associated pneumonia patients), gathering data to be used in determining if the user received output, identification of process of transmission and ends up with the change process. This is indicated in the flowchart model (see figure 1.) which provides for an elaborate systematic way of examining the process within the proposed project and the outcome of the proposed project. The evaluation of the outcomes is the major purpose of the framework even though the outcomes can never be seen in total isolation of the proposed project "mechanics" (including transmission, project reception as well as use).At certain points in the project evaluation framework, it…
Apisarnthanarak A, Thongphubeth K, Sirinvaravong S, et al.(2007) Effectiveness of multifaceted hospitalwide quality improvement programs featuring an intervention to remove unnecessary urinary catheters at a tertiary care center in Thailand. Infect Control Hosp Epidemiol 2007; 28(7):791 -- 798
Baker, JL (2000). Evaluating the Impact of Development Projects on Poverty: A Handbook for Practitioners. A Handbook for Practitioners. http://siteresources.worldbank.org/INTISPMA/Resources/handbook.pdf
Gawlinski A. (2007)Evidence-based practice changes: measuring the outcome. AACN Adv Crit Care. Jul-Sep;18(3):320-2. Review. PubMed PMID: 180195
Hugonnet, S., S. Harbarth, H. Sax, R.A. Duncan and D. Pittet. (2004). "Nursing Resources: A Major Determinant of Nosocomial Infection?" Current Opinions in Infectious Diseases 17: 329 -- 33.
In the world today, health care is probably one of the most important rights a human being should be able to expect. In fact, the quality of health care offered at any given time can mean the difference not only between illness and health, but even between as much as life and death. For this reason, all health care personnel are subject to a code of ethics based upon the Hippocratic oath, which in essence focuses on maintaining health and well-being, or achieve these as quickly and as far as possible. This is also the underlying for the recent addition of Magnet status to healthcare providing institutions.
The term "magnet" was first applied to health care settings in 1982, when the American Academy of Nursing used it to refer to the phenomenon of "attracting and "retaining" nurses within high quality work environments (Aiken, n.d.). By 1990, the importance…
Aiken, L.H. (n.d.) Magnet Hospitals: The Gold Standard for Nursing Care. Center for Health Outcomes Research. Retrieved from: http://www.fpnl.co.za/
ANCC (2013). American Nurses Credentialing Center. Retrieved from: http://www.nursecredentialing.org
The Center for Nursing Advocacy. (2008, Jan.). What is Magnet status and how's that whole thing going? Accessed from http://www.nursingadvocacy.org/faq/magnet.html
OGANIZATIONAL SYSTEMS & QUALITY LEADESHIP
Organizational Systems and Quality Leadership
Efforts to measure and improve the quality of nursing care provided to patients began with Florence Nightingale, who measured patient outcomes and worked towards the improvement of hospital conditions. ecently, studies linking nurses to patient outcomes have been given significant focus within healthcare. Efforts to measure the indicators of the quality of care dispensed by nurses have led to the phrase "nursing sensitive indicators," which has become a buzzword in healthcare. These are "outcomes from patient care that reflect the nursing care provided" (Kelly, Vottero, & Christie-McAuliffe, 2014). These indicators reflect the structure, nursing care process, and nursing care outcomes (American Nurses Association, 2014). Structural indicators include nursing staff supply, skill level of nurses and certification. The process indicators include patient assessment measures of nursing interventions while outcome indicators include all patient experiences such as falls, pressure ulcers, and readmissions…
American Nurses Association. (2013). Code of Ethics for Nurses with Interpretive Statements. Retrieved 2014, from Nursing World: http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf
American Nurses Association. (2014). Nursing-Sensitive Indicators. Retrieved 2014, from Nursing World: http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/PatientSafetyQuality/Research-Measurement/The-National-Database/Nursing-Sensitive-Indicators_1
ANA. (2014). ANA Indicator History. Retrieved 2014, from Nursing World:
Treatment to Patients
The main objective of providing treatment to patients is to relieve symptoms along with decreasing the progression of the disease as well as the mortality or morbidity. However, in some cases, this objective is not fully achieved, especially in the case of the patients who are admitted to the ICU with some serious and almost always a terminal stage of the disease. For example, when old patients are admitted in the ICU, their immunity is extremely low and this is the perfect time for the opportunistic infections to make matters worse for these patients. There are many infections that are specifically associated with patients admitted in the hospitals. Pseudomonas Aurigeonosa is a micro-organism that is well documented to cause bacterial pneumonia and bacteremia in the patients who are terminally ill and are receiving treatment in the hospital setting. Since most of the patients in the ICU are…
Beekmann, SE;Diekema, DJ; Chapin, KC;Doern, GV (2003) Effects of rapid detection of bloodstream infections on length of hospitalization and hospital charges.J ClinMicrobiol, 41:3119-3125.
Boussekey, N, Leroy, O, Georges, H, Devos, P, d'Escrivan, T, Guery, B (2005).Diagnostic and prognostic values of admission procalcitonin levels in community-acquired pneumonia in an intensive care unit.Infection, 33:257-263.
Charles, PE, Dalle, F, Aho, S, Quenot, JP, Doise, JM, Aube, H, Olsson, NO, Blettery, B: Serum procalcitonin measurement contribution to the early diagnosis of candidemia in critically ill patients. Intensive Care Med, 32:1577-1583.
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. RespirCrit Care Med, 160:976-981.
Cryptosporidium Case Study
Cryptosporidium is reported as a "coccidian protozoan parasite" and one that has received a great deal of attention over the past two decades as a "clinically important human pathogen." (Hannahs, nd, p.1) The discovery of Cryptosporidium is reported as associated with E.E. Tyzzer who described a "cell-associated organism in the gastric mucosa of mice" in 1907 as reported in the work of Keusch et al. (1995). (Hannahs, nd, p.1) Cryptosporidium was believed for several decades to be a "rare, opportunistic animal pathogen." (Hannahs, nd, p.1)
The first case of human cryptosporidiosis occurred in a three-year-old girl in rural Tennessee in 1976 suffering from severe gastroenteritis for two weeks and reported in the work of Flanigan and Soave (1993). Cryptosporidium parvum was discovered through use of an electronic microscopic examination of the intestinal mucosa. Cryptosporidium parvus was associated with AIDS cases in the 1980s and this resulted in…
Cabada, MM (2011) Cryptosporidiosis Medication. MedScape. Retrieved from: http://emedicine.medscape.com/article/215490-medication#2
Cabada, MM (2011) Crytosporidiosis Treatment and Management. MedScape. Retrieved from: http://emedicine.medscape.com/article/215490-treatment#aw2aab6b6b6
Casemore, D.P., Garder, C.A., and O'Mahony, C. "Cryptosporidial infection, with special reference to nosocomial transmission of Cryptosporidium parvum: a review." Folia Parasitol, 1994; 41 (1): 17-21.
Cryptosporidiosis in Immunocompromised Persons (2012) Illinois Department of Health. Healthbeat. Retrieved from: http://www.idph.state.il.us/public/hb/hbcrypto.htm
(a) provides an account of your observations on the management of peripheral intravascular devices from your clinical practicum in NMIH202;
Clinical practicum NM1H202 introduces nurses to the management of peripheral devices via scholarly inquiry and clinical practice. The practicum includes a thorough training in handling, inserting, replacing, and dressing peripheral intravascular devices including peripheral venous catheters. Because the primary risk associated with peripheral intravascular devices is infection, proper management of the devices is crucial. Bloodstream infections can cause patient casualties, leading not just to humanitarian disasters but also financial ones as well.
Hand washing vigilance is a primary part of the introduction to peripheral intravascular device management. While it may seem like an abundance of common sense, hand washing and aseptic techniques themselves depend on continued knowledge acquisition and training. Nurses must stay abreast of latest products and tools that promote hygiene in relation to the management of peripheral…
Bregenzer, T., Conen, D., Sakmann, P., & Widmer, A.F. (1998). Is Routine Replacement of Peripheral Intravenous Catheters Necessary? Arch Intern Med. 1998;158:151-156.
Crnich, C.J . & Maki, D.G. (2002). The Promise of Novel Technology for the Prevention of Intravascular Device -- Related Bloodstream Infection. I. Pathogenesis and Short-Term Devices. Clin Infect Dis. (2002) 34 (9): 1232-1242
Crnich, C.J. & Maki, D.G. (n.d.). The role of intravascular devices in sepsis. Current Infectious Disease Reports 3(6): 496-506.
Elliot, T.S.J. (1988). Intravascular device infections. Journal of Medical Microbiology 27(1988): 161-167.
Elevating heads of beds for patients on mechanical ventilation
Along with the recommendations for removal of plaque, there is also a guideline made by CDC that for proper treatment to "elevate at an angle of 30 to 45 degrees the head of the bed of a patient at high risk for aspiration." The benefits elevation of the head of the bed is on the theory that then gravity will reduce the possibilities of regurgitation that exists in an overly distended stomach. The recommendation by CDC also clearly states that the patients should not be lying flat unless there is some clinical need for that. At the same time, some medical authorities feel that this is likely to make the patients uncomfortable, though the recommendation is from CDC. This makes them reduce the angle of laying the patients bed at a lower angle than the angle specified by CDC.…
Afessa, Bekele. (May, 2004) "From pro and con debate to evidence-based practice: ventilator- associated pneumonia" CHEST. Retrieved at http://www.findarticles.com/p/articles/mi_m0984/is_5_125/ai_n6094553 . Accessed on 20 July, 2005
Caffery, Lisa. "Preventing Ventilator associated Pneumonia" Retrieved from www.genesisheart.com/clinical_staff/ventilator_pneumonia.pdf+elevating+patient's+beds+for+ventilator+acquired+pneumonia&hl=en" http://www.genesisheart.com/clinical_staff/ventilator_pneumonia.pdf . Accessed on 20 July, 2005
Chulay, Marianne. (1 March, 2005) "VAP Prevention: The latest guidelines" Retrieved at http://rnweb.com/rnweb/article/articleDetail.jsp?id=149672Accessed on 20 July, 2005
Geyer, Sherree. "Breathing easy" Retrieved from www.matmanmag.com/matmanmag/jsp/articledisplay.jsp?dcrpath=AHA/PubsNewsArticleGen/data/0407MMH_FEA_Cover_Story&domain=MATMANMAG
"Elimination of these and other pathogens from the lower respiratory tract is made possible by an effective innate immune response, which is necessary yet potentially dangerous to the infected host."
E. coli Outbreak:
There have been numerous E.coli outbreaks over the years. Pakalniskiene, Falkenhorst, Lisby, and Madsen (2009) studied one of the larger single source outbreaks. On November 11th, 2006, there was an outbreak in Greater Copenhagen, Denmark. The director of a high school had contacted the regional health authority to report an outbreak of diarrhea and vomiting among guests of a school dinner party. A total of 750 people, nearly all of the teachers and students at the school, had attended the dinner. The evening, the first people became sick. Three days later, when the director made the report, approximately 200 to 300 teachers and students had reported gastroenteritis. It was found that the fresh basil used in the…
Cegelski, L., Marshall, G., Eldridge, G., Hultgren, S. (Jan 2008). The biology and future prospects of antivirulence therapies. Nature Reviews: Microbiology. (6). Retrieved May 7, 2009, from Proquest.
Hacker, J. & Blum-Oehler, G. (2007). In appreciation of Theodor Escherich. Nature Reviews. Microbiology, 5(12) Retrieved May 7, 2009, from ProQuest.
Justice, S., Hunstad, D., Cegelski, L., & Hultgren, S. (2008). Morphological plasticity as a bacterial survival strategy. Nature Reviews. Microbiology, 6(2). Retrieved May 7, 2009, from ProQuest.
Pakaliniskiene, J., Falkenhorst, G., Lisby, M., Madsen, B., Olsen, K., Nielsen, E., Mygh, A., Boel, J., & Molbak, K. (2009). A foodborne outbreak of enterotoxigenic E. coli and Salmonella Anatum infection after a high-school dinner in Denmark, November 2006. Epidemiology and Infection, 137(3) Retrieved May 7, 2009, from ProQuest.
Another problem is that of "infections, such as nosocomial and post-surgical wound infections' (Medical errors, 2009, AHRQ). Careful hand-washing to prevent infections is a required part of most hospital procedures. Nurses should take additional precautions during times when the flu is likely to be spread or epidemic outbreaks. Nurses must strive to spot epidemics or a spike in communicable diseases or infection in their daily work. Once this is spotted, patients can also be educated about minimizing their exposure to harmful infections, by being encouraged to wash their hands, shield their mouth and nose when they cough or sneeze, and engaging in appropriate aftercare.
Nurses are often overtired and overstressed on hospital wards. A lack of sleep can result in a higher propensity to commit errors. The shortage of nurses in America results in the current ranks of nurses required to work longer hours, often back-to-back, and a greater likelihood…
Medical errors: The scope of the problem: An epidemic of error. Fact sheet, Publication No.
AHRQ 00-P037. Agency for Healthcare Research and Quality (AHRQ). Retrieved July
22, 2009 at http://www.ahrq.gov/qual/errback.htm
deaths in childbirth were a major problem for the medical community (Ey). The most significant cause for the large number of women dying during this process was the occurrence of puerperal sepsis which was more commonly known as childbed fever. A variety of theories were offered to explain this phenomena but some dated theories surrounding the causes of diseases such as malaria and typhoid made progress toward reaching a cure for childbed fever more difficult. The prevailing thought was that both diseases were caused through contact with water and this fact, added to the lack of indoor plumbing, caused doubt to be raised when Hungarian born Ignaz Phillip Semmelweis first suggested his germ theory and its relationship to childbed fever.
Semmelweis, before Lister introduced his germ killing theory, began insisting that the failure to properly wash one's hands between procedures was the cause of infections and, therefore, the reason why…
Biddle, C. "Semmelweis revisited: hand hygiene and nosocomial disease transmission in the anesthesia workstation." AANA Journal (2009): 229-237.
Carter, K. Codell. Childbed Fever: A Scientific Biography of Igna Semmelweis (Revised Edition). Piscataway, NJ: Transaction Publishers, 2005.
Cork, D.P. "Remembering Semmelweis: hand hygiene and its importance on today's clinical practice." American Surgeon (2011): 123-125.
Ey, Bridson. "Iatrogenic epidemics of puerperal fever in the 18th and 19th centuries." British Journal of Biomedical Science (1996): 134-139.
This is exactly where the problem usually starts.
There are a number of reports published which revealed that even the physicians are not so keen into attending more seminars and trainings to learn the new systems (Ball, 1992). Physicians are expectedly always busy. They sometimes work from hospital to hospital. They are always on call hence they really find it hard to squeeze in their thigh schedule the time for further training and semi-are regarding the system. At some point in time, physicians will also worry about their income that will be affected if they will get a time off just to attend the training.
In the same manner, most of the administrators, who will manage the new systems for the hospitals, also show signs of hesitance regarding the training. It must be noted that the being considered as a 'wired hospital' the institution must have uniform data standards (Aspden…
Aspden, P., J.M. Corrigan, J. Wolcott, and S.M. Erickson. 2003. Patient Safety: Achieving a New Standard for Care. Washington, DC: National Academies Press.
Ball, M. 1992. "Computer-Based Patient Records: The Push Gains Momentum." Health Informatics 9 (1): 36-38.
Bates, D.W., J.M. Teich, J. Lee, D. Seger, G.J. Kuperman, N. Ma'Luf, D. Boyle, and L. Leape. 1999. "The Impact of Computerized Physician Order Entry on Medication Error Prevention." Journal of the American Medical Informatics Association 6 (4): 313-21.
Benefits of it to Medical Profession http://www.cica.org.uk/bre-cica_survey/ranking_of_it_benefits.htm . September 25, 2006
Practice Issue Evidence-Based Practice (EBP) Project in courses DNP program, asked
The practice issue I have chosen to explore is whether or not q2 hourly turning and positioning actually decreases the incidence of pressure ulcers in the elderly bed bound population in nursing homes. The conception that turning does help to relieve the pressure associated with these types of ulcers has been longstanding. Specifically, there is clinical evidence to indicate the fact that "Unrelieved pressure is a well-known clinical risk factor for ulcer development" (Salcido, 2004, p. 156). As such, the turning of patients at least every two hours has been carried on for quite some time in the nursing population, although there are some salient points of concern that need to be addressed with this issue.
One of the major things that individuals need to be aware of who take on such a practice is the fact that the…
Leeds, L. (2004). Importance of turning q2. www.denvernursingstar.com. Retrieved from http://denvernursingstar.com/specials/newsletter_view.asp?newsid=310&catid=85&active=0&mode=current&count=0
Salcido, R. (2004). Patient turning schedules, why and how often? Advances in Skin & Wound Care: The Journal for Prevention and Healing. 17(4), 156.
Wound, Ostomy & Continence Nurses Society. (2012). Patient turning and repositioning: current methods & challenges, a WOCN perspective. www.sageproducts.com. Retrieved from http://www.sageproducts.com/documents/pdf/education/studies_articles/sacral/WOCN%20White%20Paper_Aug2012.pdf
These examples highlight that technology is always a tool, a way of enhancing human judgment -- we must not mistake it as a replacement for good nursing practice.
After all, the use of a computer is no substitute for a medical education. Anyone who works in a hospital can see this -- the increased accessibility of information through the Internet also means that patients often come in, convinced that they are suffering from a serious illness, allergy, or condition, based more upon a diagnosis Googled on WebMD, rather than upon the fact that they saw a doctor! If a computer alone was required to diagnose, everyone would have a degree!
Don't get me wrong -- I use technology every day in my life, and thank my lucky stars, and my patient's lucky stars, that it is so ubiquitous. When health care providers wish to communicate, the use of cell phones…