1000 results for “Nursing Care”.
Complete Care Plan
Associated care plan completed
None -- done
Additional research, collaboration, consultation.
Additional isk Factors
Very specific evaluation
Collaborative or nursing issues that are important but may, by necessity, be delayed
Priority identification -- anticipate problem prior to formalizing plan
eview, evise, Assess
Fluid and continuous
Depending on treatment outcome
Surgery or treatment may accentuate
(Carpenito-Moyet, 2009, 25-31)
Process and Planning -- The nursing care plan is a guide, but is meant to be fluid and responsive to the patient's individual needs, issues, and potential emergencies. Both subjective and objective data are collected, and then organized into a systematic plan. This helps each member of the healthcare team glean the appropriate information at any time. More important, it allows the charge nurse to identify and comment on specific areas of concern in order to avoid future problems whenever possible. The basic PES Nursing Diagnosis is used (Problem, Etiology,…
Barrett, Wilson and Woollands. (2009). Care Planning: A Guide for Nurses. Pearson Education.
Brown, C. (2007). "Where are the Patients in the Quality of Healthcare?" Editorial in International Journal for Quality in Healthcare. 19(3): 125.
Burkhard, M., et.al. (2007). Ethics and Issues in Contemporary Nursing. Delmar Cenage.
Carpenito, L. (2009). Nursing Care Plans and Documentation. Kluwer Health.
he care that a nurse provides to these individuals is part of the holistic care of the patient. By ensuring the peace, comfort, and education of those surrounding the patient, the nurse by extension helps contribute to the peace, comfort and education of the patient themselves.
here is no question that nursing is demanding, but I believe that, for a person who holds all of these abilities, nursing is not only a fulfilling profession but in fact the ONLY fulfilling profession. I, for one, have wanted to be a nurse since I was a child, and cannot think of a single other job that would allow me to act on all of the principles I hold dear. I believe deeply in the basic right of every individual to a healthy life, and am committed to helping them achieve that life. I also believe that the suffering or discomfort of those…
There is no question that nursing is demanding, but I believe that, for a person who holds all of these abilities, nursing is not only a fulfilling profession but in fact the ONLY fulfilling profession. I, for one, have wanted to be a nurse since I was a child, and cannot think of a single other job that would allow me to act on all of the principles I hold dear. I believe deeply in the basic right of every individual to a healthy life, and am committed to helping them achieve that life. I also believe that the suffering or discomfort of those who cannot help themselves should never be left unattended. I know that this will often mean dealing with aspects of life that others might find unappealing or menial, but nothing in the service of creating a better life for someone else should be considered too insignificant a task. On the contrary, I think it is the highest calling.
My biggest fulfillment in life has come from helping and nurturing others. By bringing comfort of body, peace of mind, and strength of spirit to those who are suffering, I know I will find those things for myself as well. I feel lucky that there is a profession that will allow me realize my desire to bring happiness to others.
Henderson, Virginia. (1964). The Nature of Nursing. American Journal of Nursing, 64(8): 62-67.
Such is to say that the nurse will be the single greatest resource to the patient and that through this professional, all other necessary resources are channeled. Essentially, this denotes that the relationship established between the patient and nurse will itself be the most valuable resource in combating a condition or improving the subject's health and well-being.
hy should nurse monitors responses of patients throughout each intervention and how should nurse adjusts care accordingly
In such theories as Margaret Newman's "Health as Expanding Consciousness" model, it is clear that the decisions which a nurse must make will be based on the convergence of scholarly nurse and individualized attention. This latter quality especially must define the role that the nurse plays in health intervention on the patient's behalf. Conjecturing that a nurse will provide a specific emotional connection and psychic closeness to patient's who are contending with the absence of certainty,…
Newman, M. (2004). Health as Expanding Consciousness. Nursing Theory.
While it would have been unquestionably beneficial to the patient and indeed to this nurse to be able to engage in a more meaningful, enlightened, and research-based discussion of her condition and methods for addressing it, this nurse simply did not have the time to devote to reading the latest research on diabetes care in addition to remaining prepared for all patients. The policies of the organization in which the nurse was functioning do not support the use of at-work time for engaging in reading, nor is there a substantial knowledge-sharing apparatus at work: the published and long-accepted guidelines for care remain largely unchanged not only from day-to-day but from year to year, as well.
Overcoming this barrier is fraught with practical difficulties, not the least of which are the financial pressures on the organization to perform as a volume operation -- the number of patients treated in a day…
Polit, D.F., & Beck, C.T. (2012). Nursing research: Generating and assessing evidence for nursing practice. Philadelphia, PA: Lippincott Williams & Wilkins.
Zeitz, K., & McCutcheon, H. (2003). Evidence-based practice: To be or not to be, this is the question! International Journal of Nursing Practice, 9(5), 272-9.
Although patient resistance may be high in some instances, the proposed benefits appear to far outweigh the unwillingness of the patient to participate.
The proposed program can be carried out with minimal funding. If funding is required, it is possible that the organization could obtain funding from a government grant or through the assistance of a non-profit organization. The most challenging issue created in this context is that of insurance. Although the organization currently holds insurance for providing occupational therapy for patients, it is possible that the organization will need additional coverage to implement a regular exercise program. If the organization chooses to develop the program as an integral part of its service, the cost of the insurance could be passed to patients. Overall, this cost should be minimal, allowing the organization to provide this service and ensure that patient safety is protected.
Plan the Change
Chen, K., Li, C., Lin, J.N., et al., 2007. "A feasible method to enhance and maintain the health of elderly living in long-term care facilities through long-term, simplified Tai Chi exercises," Journal of Nursing Research, vol. 15, no. 2, pp. 156-163.
Exercise alleviates dementia in elderly," 2006. Nurse Practitioner, vol. 31, no. 3, pp. 51.
Kato, M., 2006. "Development of an exercise program for fall prevention for elderly persons in a long-term care facility," Japan Journal of Nursing Science, vol. 3, no. 2, pp. 107-117.
Luukinen, H., Lehtola, S., Jokelainen, J., et al., 2006. "Prevention of disability by exercise among the elderly: A population-based, randomized, controlled trial," Scandinavian Journal of Primary Health Care, vol. 24, no. 4, pp. 199-205.
Nursing care models serve as important foundations for decision making within the care environment. They influence the scope of tasks nurses engage in as well as how nurses relate to other healthcare professionals and patients in the course of care delivery. Though there may be no one-size-fits-all model, the choice of the appropriate model -- obviously depending on factors such as the nature of the organizational setting and the availability of resources -- is crucial. An effective model is important for achieving the desired patient, staff, and organizational outcomes. This paper discusses the use of two care models in the care setting: the case management model and the inter-professional practice model. The aim of the paper is two-fold. First, a description of the case management model as used at a practice setting known to the author is provided. Next, the paper recommends the inter-professional practice model as an alternative model…
Bridges, D., Davidson, R., Odegard, P., Maki, I., & Tomkowiak, J. (2011). Interprofessional collaboration: three best practice models of interprofessional education. Medical Education Online, 16, 10.
Finkelman, A. (2016). Leadership and management for nurses: core competencies for quality care. Upper Saddle River, NJ: Pearson.
Girard, N. (1994). The case management model of patient care delivery. AORN Journal, 60(3), 408-12.
Nester, J. (2016). The importance of interprofessional practice and education in the era of accountable care. North Carolina Medical Journal, 77(2), 128-132.
HIV / AIDS is a condition that has taken on pandemic proportions. Nursing and other health care professionals are therefore highly concerned not only with the current care of patients suffering from the condition, but also with new advancements in this care. This is why articles such as "CE: Nursing in the Fourth Decade of the HIV Epidemic" by Starr and Springer (2014) are such an important part of nursing practice today. The nurse is required to not only have a thorough knowledge of his or her profession and current practice, but also of research advancements that can improve the lives of HIV positive and AIDS sufferers. This is particularly the case for this condition, since there is currently no known cure. Starr and Springer's article provides some very important information on the advances within medical science and the field of AIDS research. It therefore provides great benefits…
Starr, W.M. And Springer, L.B. (2014, March). CE: Nursing in the Fourth Decade of the HIV Epidemic. American Journal of Nursing, Vol. 114, Iss. 3. Retrieved from: http://journals.lww.com/ajnonline/Fulltext/2014/03000/CE____Nursing_in_the_Fourth_Decade_of_the_HIV.25.aspx
Improving Health Care Delivery by Integrating Information Technology
In order to modernize the operations of their medical facility, Pleasant Manor nursing home should consider contracting to implement the Epic System of electronic medical record (EM) and practice management throughout their campus. A pioneer in the march towards digitization of health care records, "Epic makes software for mid-size and large medical groups, hospitals and integrated healthcare organizations" using proprietary software that efficiently "spans clinical, access and revenue functions and extends into the home" (Epic, 2012). In accordance with Pleasant Manor's stated mission to serve as an "expanded geriatric clinic that provides basic services for seniors, general practice, counseling and education programs, radiology, complete blood work, and an osteo-care unit for citizens of the outlying communities," the facility will make this transition with the goal of standardizing its procedures and streamlining its processes. Located on an expansive campus in the retirement community…
Epic Systems. (2012, August 13). Epic: Who we work with. Retrieved from http://www.epic.com/about-index.php
Freudenheim, M. (2012, Jan 14). Digitizing health records, before it was cool. The New York Times. Retrieved from http://www.nytimes.com/2012/01/15/business/epic-systems - digitizing-health-records-before-it-was-cool.html?pagewanted=all
Versel, N. (2013, November 05). Taking a close look at electronic health records. U.S. News: A
World Report, Retrieved from http://health.usnews.com/health-news/hospital-of-tomorrow/articles/2013/11/05/taking-a-close-look-at-electronic-health-records
Standardized Nursing Terminology
STANDADIZED TEMINOLOGY TO COMMUNICATE NUSING INTEVENTIONS
STANDADIZED TEMINOLOGY TO COMMUNICATE NUSING
Nursing practice is the fabric of patient care with threads running through nearly every patient experience. While a medical diagnosis is typically the catalyst for a nursing care plan, it does not completely define patient care. In this paper, I hope to demonstrate the crucial role that a nursing diagnosis plays in establishing and maintaining quality patient care. I write first about nursing diagnoses, then frame the discussion with a scenario of presenting symptoms and a medical diagnosis. The next sections of the paper address the elements of data collection, integration of information and knowledge, accessing wisdom, and the conclusions drawn from the discussion.
The Nursing Diagnosis
It is helpful to begin with a definition of nursing diagnosis, so as to distinguish it from a medical diagnosis and as a way to lay a path to…
Bulechek, G., Butcher, H., Dochterman, J., & Wagner, C. (Eds.). (2013). Nursing interventions classification (NIC) (6th ed.). St. Louis, MO: Elsevier.
Bavarescol, T., de Fatima Lucenall, A., (2012, December). Nursing Intervention Classifications (NIC) validated for patients at risk of pressure ulcers. Latin American Journal of Nursing, 20(6). http://dx.doi.org/10.1590/S0104-11692012000600013
Gradishar, D., Muzio, L., Filipski, A. & Klopp, A. (2012). Nursing Diagnosis Care Plans. Elsevier Publishing.
Park, H.J. (2010). NANDA-I, NOC, and NIC linkages in nursing care plans for hospitalized patients with congestive heart failure. [Dissertation]. http://ir.uiowa.edu/etd/570 .
Nursing Care of Patients With Neurologic Issues
This article is about a research that compares people who have had strokes and the problems that they experience with eating, three months after their illness. esearchers elaborate on the challenges that stroke victims experience in their daily life, including problems with eating, taking care of their appearance, taking a bath, using the bathroom and their bodily functions with this respect, and moving from one place to another. One of the frequent consequences of stroke is the challenges experienced by victims while eating, and this is something common in the countries in Europe. However, there are insufficient studies on difficulties in feeding that are experienced by victims of strokes in the three months after their attacks. More insight is therefore required into how these difficulties with feeding develop so that the result of the stroke on the victim's ability to function socially can…
Medin J., Windahl J., Von Arbin M., Tham K. & Wredling R. (2012) Eating dif-culties among patients 3 months after stroke in relation to the acute phase. Journal of Advanced Nursing 68(3), 580-589. doi: 10.1111/j.13652648.2011. 05759.x
Niacin and Increased Cholesterol Levels
For most people struggling with undesirable levels of cholesterol that cannot be enhanced sufficiently through diet and exercise, prescribed statin drugs are usually the recommended treatment options. One of the most commonly recommended treatment options is niacin, which is a vitamin that is also known as B3 that is administered in very large doses. This vitamin is recommended because it can enhance the levels of cholesterol while lessening the risk of heart attacks (Berkeley Wellness, 2011). Cholesterol is a waxy substance that is found in an individual’s blood and his/her body cells. While most of the cholesterol comes from the liver, a significant portion is obtained from foods an individual eats. Niacin raises high-density lipoprotein (HDL), which is the healthy form of cholesterol since it helps in transporting extra cholesterol from the arteries to the liver. Additionally, niacin lowers triglycerides, which are fats in the…
Specifically, deficient cae may esult in a child's being vulneable as a consequence of a low intinsic level of self-esteem and self-woth (Pake, Baett, and Hickie, 1992). It is clea that a numbe of factos ae likely to affect the teenaged individual esulting in depession and it is citically noted that this depession must necessaily be addessed, teated and esolved. The client in this instance has bodeline low blood pessue which should be monitoed seveal times each week and futhemoe the body mass index (BMI) of this individual is excessively low indicating that this patient needs to be counseled in egads to thei diet both in tems of quality and quantity of foods consumed.
Logsdon, Cynthia J.(nd) Depession in Adolescent Gils: Sceening and Teatment Stategies fo Pimay Cae Povides Jounal of the Ameican Medical Women's Association Volume 59, No 2.
Lemay, Edwad P. And Ashmoe, Richad D. (2005) the…
reference: Studies of occupational and recreational choice. Social Psychology Quarterly, 49, 11-18.
nursing -- caring, empathy and ethics. The author (Lachman, 2012) uses numerous examples, each of which show the positive impacts of caring. Along with examples of ethical decisions that must be made, and with theories on caring and empathy put forward by scholars, the paper examines morality, competence, and the "reciprocal" relationships between nurses and their patients. That is, caring for a patient is reciprocal because if the needs of the patient are met, there is reciprocity -- the giving of care and the receiving and acknowledgement of that care giving.
Summary of Key Points
On page 113 Lachman references several leading theorists and scholars that have provided important research and results on nursing ethics and the caring concepts alluded to in the Introduction. Dr. Jean atson has a caring theory (112) that has three main components: a) carative factors; b) the "transpersonal caring relationship"; and c) the "caring occasion/caring…
French, Peter. (1999). The development of evidence-based nursing. Journal of Advanced
Nursing, 29(1), 72-78.
Lachman, Vicki D. (2012). Applying the Ethics of Care to Your Nursing Practice. Ethics, Law,
and Policy, 21(2), 112-115.
Nurse-Care Analysis of Sheepshead Bay
The area is 4,074 square miles. Its population is 123,178. The people density of people who live in Sheepshead Bay compared to general inhabitants of Brooklyn of people per square mile is 30,233 to 34,917 (City-data.com; web).
On my visits there, I was astounded by the mass of people rubbing shoulders one with the other. The streets seemed dense and crowded with a great number of apartment buildings, more than those in the more laid back areas such as Flatbush and Queens, and also more than those in the vicinity of Coney Island. There were also a lot of immigrant offices and lawyers specializing in immigration services that was telling of the area.
In fact, involvement with immigrants who had been seeking service with bureaucracy involved with obtaining a Green card revealed that many of them, although living in other parts of Brooklyn (sometimes far…
Berke, N. (2009). Crime Prevention and Safety Workshop. Sheepshead Bites. Retrieved on 3/6/2011 from: http://www.sheepsheadbites.com/2009/06/crime-prevention-and-safety-workshop/#
Chan, S. (2006). Fatal Construction Accidents in the City Rise Sharply Over 12 Months New York Times. p. C13.
Chiswick, Barry R., (1991). Speaking, Reading and Earnings among Low-Skilled Immigrants, Journal of Labor Economics, 9, 149-170.
City-data.com. Sheepshead Bay. Retrieved on 3/6/2011 from: http://www.city-data.com/neighborhood/Sheepshead-Bay-Brooklyn-NY.html )
Roles and ValuesA. Discuss the evidenced-based practice regarding advance directive DNRNursing care is purposed to meet the comprehensive needs of both the patients and their families throughout their healthcare process. This is especially fundamental in the care of patients and their corresponding loved ones at the end of life. Nurses are advocates for the rendering of honourable and compassionate care. Nurses actively take part in examining and ascertaining the responsible and suitable use of interventions so as to decrease any instances of unwarranted treatment and patient anguish and suffering (American Nursing Association, 2012).B. Discuss the nurses moral responsibility by doing the following:1. Describe the nurses responsibility to the patient in the scenarioIn the case of Mr. Miles, the nurse…
Innovative Nursing Care Delivery Models a.This website detailed profiles 24 successful innovative nursing care delivery models. These profiles developed part a research project conducted Health Workforce Solutions LLC (HWS) funded obert Wood Johnson Foundation (WJF).
Innovative nursing care model: The Care Transitions Intervention
Innovative nursing care model
I chose the Care Transitions Intervention Model on which to focus because of the increasing importance of geriatric care in the field of nursing. Although my organization serves the needs of persons of all ages, elderly patients are an increasingly large proportion of the patient base. The Model stresses the need for the empowerment and self-care even of patients with high-risk conditions. The Care Transitions Intervention Model allows elderly patients the maximum amount of mobility and autonomy possible given the limits of the patient's condition and enables them to stay in a home setting as long as possible. As its name suggests, the…
Care Transitions Intervention. (2013). Innovative Care Models. Retrieved:
Kurt Lewin Change Model. (2013). Change Management Coach. Retrieved:
Informed Decision Making (Nursing Role)
The nurse has the utmost responsibility in educating the patient and his/her family about the proposed treatment plan, the availability of alternative interventions, and in general plays a vital role in promoting informed decision making. [ANMC], (2005)] The nurse being more familiar with the patient has a better understanding of the patient's understanding capabilities and can therefore decide as to what type of teaching method a patient is best suited for. While for some patients a simple printed information leaflet is suffice for others a more detailed presentation involving a video maybe necessary. This again helps the patient better understand the procedures and helps them in their decision making process. [Mark H. eers, (2006)] In the case of new treatment modalities that are available with recent medical advancements, the nurse can greatly assist the patient in making well-informed decisions about the available treatment choices. Gene…
1) ANMC, (2005), ' Code of Ethics of Nurses in Australia', retrieved 5th Sep 2010, from, http://www.nrgpn.org.au/index.php?element=ANMC+Code+of+Ethics
2) Jeanette Ives Erickson, RN, (2005), 'Caring for Patients while Respecting their Privacy: Renewing our Commitment ', retrieved 5th Sep 2010, from, http://www.medscape.com/viewarticle/506840
3) ISONG, (2005), 'Informed Decision Making and Consent: The Role of Nursing', retrieved Sep 5th 2010, from, http://www.isong.org/ISONG_PS_informed_consent.php
4) Mark H. Beers, MD & Thomas V Jones MD et.al, (June 2006) 'The Merck Manual of Geriatrics: Chapter 8: Nursing', Pub by Merck Sharp & Dohme Corp.
Clarifying is communication that makes clear the point made by the patient to make sure that no misunderstanding occurs. Conveying information is a simple sharing with the patient of information relevant to his or her health status. Providing feedback is the provision of information that is constructive to the patient in relation to how the nurse has perceived what the patient has stated. Stating observations may be used in communication with patients in a manner that defuses anger while at the same time acknowledging their stress or anger. Confrontation is a method of calling attention to the discrepancies stated by the patient and specifically the discrepancy between what the patient has to say and their actions. Summarizing is the provision of feedback to the patient concerning generalities from the nurses' point-of-view. Silence can be used to convey concern or support and enables the patient in thought-organization and self-reflection. (Zychowicz, nd;…
Robbins, Charles a. (1963) a Therapeutic Milieu in a Continued Treatment Service Mental Hospital 14:494-494 September 1963.
Zychowicz, Michael (nd) Therapeutic Communication. Mount Saint Mary College (MSMC) Online available at http://faculty.msmc.edu/zychowic/therapeutic%20communication_files/frame.htm
Merriam-Webster Medical Dictionary (2008) http://medical.merriam-webster.com
Merriam-Webster Dictionary (2008) http://www.merriam-webster.com
Family Centered Care
Family-centered care is a significant part of the nursing profession, and this is becoming more important as healthcare changes and evolves. Nurses are charged with being compassionate in their duties and treating everyone as being valuable no matter what kinds of conditions they have or where they come from (The Guide, 2010). It is the first Provision of the Code of Ethics for nurses, with sub-issues that address human dignity, relationships with patients, the nature of the health problems, the right to self-determination, and relationships with colleagues and others. These courtesies, however, should also extend to the families of those patients, as caring for the family as a whole can make the process easier and more cohesive. This paper will address family-centered care in the context of the Code of Ethics Provision One and the sub-issues that are contained in it.
Provision One and Family-Centered Care
Bailey, J.J., Sabbagh, M., Loiselle, C.G., Boileau, J., & McVey, L. (2010). Supporting families in the ICU: A descriptive correlational study of informational support, anxiety, and satisfaction with care. Intensive and Critical Care Nursing, 26: 114-122.
Mitchell, M.L. & Chaboyer, W. (2010). Family Centred care -- A way to connect patients, families and nurses in critical care: A qualitative study using telephone interviews. Intensive and Critical Care Nursing, 26: 154-160.
The Guide to the Code of Ethics for Nurses: Interpretation and Application (2010). Code of Ethics for Nurses with Interpretive Statements. Nursing World.
Why should nurses recognize nursing expertise varies with education, experience and context of practice?
Nurses should recognize nursing expertise differs from person to person because of varying experience levels, forms of education, and context of practice. This is substantial knowledge for nurses to remember for several reasons. For one, it will help nurses better understand their colleagues (Husted, 2008). For example, a nurse who attended a better school than their colleague, will be more understanding if their colleague under performs or is hesitant in comparison because he or she had a higher quality education (Husted, 2008). Conflicts between colleagues are less likely to arrive when there is an understanding that performance among each other may differ due to varying circumstances. (Benner, 2009).
In addition, nurses should retain that their coworkers expertise will most likely not be the same due to the varying routes everyone takes to the medical field and…
Apker J., Propp K.M., Ford W.S.Z., Wallac N., Serbenski M., & Hofmeister N. (2006).
Collaboration, Credibility, Compassion, and Coordination: Professional Nurse
Communication Skill Sets in Health Care Team Interactions. Journal of Professional Nursing 22 (3), 180-189.
Benner P.E., Tanner C.A., Chelsa C.A. (2009). Expertise in Nursing Practice: Caring,
The main focus of this essay is going to concern the nurse-patient relationship idea, and why it is important. This was chosen because the researcher desired to achieve a better accepting of how a helpful nurse-patient relationship can be advanced and even from different theorists who have discovered this idea. In this essay, the researcher sets out to demonstrate what they have learnt regarding the nurse-patient relation concept and how this connection can utilized in the clinical practice setting. T The nurse patient connection, according to a study done by Press Gamey Associates Inc., creates the quality of the care experience and generates an influential influence on patient gratification. Nurses will a lot of their time with patients. Patients see nurses' relations with people among the care team and make their own conclusions about the hospital founded on what they are observing. Furthermore, nurses' approaches toward their vocation,…
Berdes, C. & . (2001). Race relations and caregiving relationships: A qualitative examination of perspectives from residents and nurses aides in three nursing homes. Research on Aging, 23(1), 109-126.
Biering, P. (2002). Caring for the involuntarily hospitalized adolescent: The issue of power in the nurse-patient relationship. Journal of Child and Adolescent Psychiatric Nursing, 16(2), 65-74.
Heijkenskjold, K.B. (2010). The patients dignity from the nurses perspective. Nursing Ethics, 6(3), 313-24.
LaSala, C.A.-B. (2007). The role of the clinical nurse specialist in promoting evidence-based practice and effecting positive patient outcomes. The Journal of Continuing Education in Nursing, 38(6), 262-70.
(Sussman and Bates-Jensen, 2007)
Assessment data is reported to enable the clear communication among clinicians about the wound and in making the provision for "continuity in the plan of care" as well as allowing for "evaluation of treatment modalities." (Sussman and Bates-Jensen, 2007) Wounds that are classified as red, yellow and black are those that require examination of deep tissue involvement. (Sussman and Bates-Jensen, 2007) The wound must be monitored during the healing process since monitoring provides the means of "checking the wound on a regular and frequent basis for "signs and symptoms that should trigger a full reassessment, such as increased wound exudate or bruising of the adjacent or periwound skin. Included in monitoring is the "gross evaluation for signs and symptoms of wound complications, such as erthema (change in color) or periwound skin and pus, which is indicative of infection." (Sussman and Bates-Jensen, 2007) Included as well should…
Aseptic Technique (2008) Aseptic Technique. Section G. NHS Foundation Trust. Online available at: http://www.cht.nhs.uk/fileadmin/departments/infection_control/policies/Section_G_-_Aseptic_Technique_Issue_2.pdf
Burney, R.E. et al. (1997) Core Outcomes Measures for Inguinal Hernia Repair. Journal of the American College of Surgeons. Vol. 185, Issue 6. Online available at: http://www.journalacs.org/article/S1072-7515%2897%2900108-7/abstract
Issues in Wound Care: Appropriate Use of Dressings. Report from a Wound Academy Expert Forum. Sponsored by the Molnlycke Health Care Wound Academy. September 2007. Online available at: http://www.molnlycke.com/Global/Wound_Care_Products/UK/Wound%20Academy/IssuesAppropriateusefinalSept07.pdf
Khan, Y. And Fitzgerald, P. And Walton, M. (1997) Assessment of the postoperative visit after routine inguinal hernia repair: A prospective randomized trial. Journal of Pediatric Surgery. Vol. 32, Issue 6. June 1997. Online available at: http://www.jpedsurg.org/article/S0022-3468%2897%2990644-8/abstract
Nursing Concepts and Theory
Conceptual-Theoretical Structure paper
Personal belief about nursing theory and knowledge development process for nursing practice
All nursing theories play an important role in defining nursing and giving the roles that nurses need to play. Originally, the role of nurses was simply to carry out activities as instructed by doctors, however, over the years, this role has been changed to include more responsibilities as the nursing world has evolved. Nursing theories describe, predict and explain the various phenomena in nursing practice and thus create foundations for nursing practice. They also help to generate knowledge in the field of nursing and to point the direction which the field should develop in future. This view is supported by Carper (1978)
who states that nursing theories elaborate nursing practice and create professional boundaries for the profession. Nursing knowledge comes from research that has been conducted on nursing which forms scientific…
Anderson, A.M. (2005). Nursing Leadership, Management, and Professional Practice for the LPN/LVN (3rd ed.). Philadelphia: F.A. Davis Company.
Carper, B. (1978). Fundamental patterns of knowing in nursing. Advances in Nursing Science, 1(1), 13-23.
Clark, M.J. (2003). Community health nursing: Caring for populations (Fourth ed.). Upper Saddle River, NJ: Prentice Hall.
Dayer-Berenson, L. (2010). Cultural Competencies for Nurses: Impact on Health and Illness. Burlington, Massachusetts: Jones & Bartlett Learning.
There are several pros and cons to requiring a nurse to have a BSN to enter nursing practice. The most obvious advantage is that it would standardize practice and ensure excellence. Today, healthcare has been under the spotlight for potential pitfalls and difficulties in areas of care and excellence. If nurses have the same or similar qualifications before entering practice, there is less potential for error (Santina, 2012).
Furthermore, the course requires three years of not only theory, but also of hands-on practice, both in the classroom and in real-time environments such as clinics and hospitals. There are few teaching methods that offer as much in terms of personal and educational development as practical experience. This is particularly true of nursing and other healthcare practice arenas. Hence, more years of hands-on experience is a major advantage of requiring this kind of qualification before allowing nurses to enter practice (Santina,…
Miller, C.D. (2007). A Comparison of Skill Perofrmance of the and BSN Prepared Nurse at Three and Four-Year Post-Graduate Level. Retrieved from: http://gradworks.umi.com/1446281.pdf
MomMD (2012). How to become an advanced practice nurse. Retrieved from: http://www.mommd.com/advanced-practice-nursing.shtml
Orsolini-Hain, L. (2008). What's all the Fuss? Working Towards a Baccalaureate or Graduate Degree in Nursing. NSNA. Retrieved from: http://www.nsna.org/careercenter/fuss.aspx
Santina, J. (2012). The BSN: A Higher Degree of Nursing Care. Health Care Career. Retrieved from: http://www.worldwidelearn.com/healthcare/healthcare/the-bsn-a-higher-degree-of-nursing-care.php
Nursing Mentor Scenario
Introduction- Just as the theoretical and practical backgrounds of nursing have changed over the past several decades, so has the nursing education environment itself. . Students now entering the field are diverse in culture, educational background, and most especially age and experience. Traditional undergraduates coming directly from High School or Junior College often interact with more mature and experienced students. In addition, nursing instructors remain challenged to recognize different learning needs and styles, and respect that adaptive scenarios might be necessary to further the learning opportunities for many students. e thus see that the most effective way of teaching in the modern nursing classroom is to adjust one's pedagogical paradigm outward and to actively find new and innovative ways of reaching each student, rather than expecting each student to completely bend to the tried and true curriculum of previous generations (Young, L., Petson, B., eds., 2006). Too,…
Bradshaw, M., & Lowenstein, A. (Eds.). (2011). Innovative Teaching Strategies in Nursing and Related Health Professions. Sudbury, MA: Jones and Bartlett.
Bulman, C. And Schutz, S. (1998). Reflective Practices in nursing. Sudbury, MA: Jones
And Barlett Publishers.Epp, A., & Price, L. (2011). Designing Solutions Around Customer Network Identity Goals. Journal of Marketing, 75(1), 36-54.
Cramer, C., Davidhizar, R. (2008). Helping At-Risk Nursing Students Succeed on the National Council Licensure Examination-Registered Nurse. The Health Care Manager.27 (3): 269-76.
One of the complexities of 21st century medicine is the evolution of nursing care theories in combination with a changing need and expectation of the stakeholder population. Nurses must be advocates and communicators, but must balance these along with an overall philosophy of ethics while still remaining mindful of budgets and the need for the medical institution to be profitable. It seems as if these issues comprise a three-part template for nursing: respect for patient value & individuality, education of patients, and cognition and respect for the realities of contemporary medicine. In many ways, too, modern technology has advanced further than societal wisdom, especially when confronting the issue of death. The modern nurse's role is to create a nurse-patient culture that encourages the individual to take responsibility for their healthcare and, in partnership with the nurse, to be involved in their recovery. The modern complexities of…
Basford, L. And O. Slevin. (2003). Theory and Practice of Nursing: An Integrated Approach to Caring Practice. New York: Nelson Thomas.
Beckstead, J. And Beckstead, L. (2004). A multidimensional analysis of the epistemic origins of nursing theories, models and frameworks. International Journal of Nursing Studies. 43
Cohen, J. (1991). Two portraits of caring: a comparison of the artists - Leininger
Nurse Patient atios and Quality of Care
This study reviews the broad level of issues that surround the nurse/patient ratio: a critical shortage of trained and experienced nurses; increased political and fiscal demands from all sectors of society; rising costs internally and externally combined with a rising number of under-insured; and the conundrum of nursing ethics and the ability to foster excellence in care and patient advocacy. We note that there remains an issue about hiring more nurses -- where will these nurses come from if the nursing schools do not increase their recruitment efforts and broaden their curriculum. In addition, we note that the large majority of patients and stakeholders primarily want two things when admitted to a healthcare facility: better paid nurses and more highly-trained professionals who are satisfied with their vocation.
Modern nursing is, by necessity, a mixture of complex balance: patient care vs. staffing; procedures…
More Nurses Make the Difference. (February 2012). The Lamp. 69 (1): Retrieved from: http://search.informit.com/au/documentSummary;dn=045435426132502;res=IELHEA
Safe Nurse Staffing: Looking Beyond the Numbers. (2009). Vantage Point, CNA. Retrieved from: https://www.nso.com/pdfs/db/newsletters/Safe_Nurse_Staffing_-_Looking_Beyond_the_Raw_Numbers_20094.pdf?fileName=Safe_Nurse_Staffing_ -_Looking_Beyond_the_Raw_Numbers_2009-pdf&folder=pdfs/db/newsletters
Aiken, L. (2001). The Hospital Nurse Workforce: Problems and Prospects."Draft
For the Council on the Economic Impact of Health System Change. Retrieved from: http://council.brandeis.edu/pubs/hospstruct / Council-Dec-14-2001-Aiken-paper.pdf
As such, a nurse is primarily to recognize herself as an individual in the world, with certain responses to this world. When a patient enters the hospital, such a patient is also to be seen as a unique individual who responds to the world and his or her environment in a certain way.
Humanistic nursing is then primarily experiential rather than experimental. This means that new knowledge is gained with every new patient that arrives for treatment. In giving treatment, responses are observed and noted for future reference in similar situations. It is not however assumed that a treatment will work because it did in the past and in similar conditions. Instead, hypotheses are based upon experiences of the past. The recognition that hypotheses may prove incorrect helps the nurse to be open to new experiences. Each human being is then seen as a "world," as it were, with the…
Cody, William K. & Kenney, Janet W. (2006). Philosophical and Theoretical Perspectives for Advanced Nursing Practice. Jones & Bartlett.
Collaboration for Academic Education in Nursing. (2009). Foundational Perspectives. http://www.caen.ca/content/view/46/133/
Current Nursing (2009, March 16). Nursing Theories. http://currentnursing.com/nursing_theory/development_of_nursing_theories.htm
Kleinman, Susan (2009). Humanistic Nursing Theory. http://www.humanistic-nursing.com/faq.htm
"From an historical standpoint, her concept of nursing enhanced nursing science this has been particularly important in the area of nursing education." ("Virginia Henderson's Need...," 2008) Principles of Henderson's theory, published in numerous primary nursing textbooks utilized from the 1930s through the 1960s, along with principles embodied by the 14 activities continue to prove vital in evaluating nursing care in thee21st century, not only in cases such as Keri's, but in a myriad of others benefiting from nursing.
Kearney, Kathleen M., the Nurse's Duty to eport Child Abuse vs. The Attorney's Duty of Confidentiality: The Nurse Attorney's Dilemma Journal of Nursing Law. Social Science Electronic Publishing, Inc.; January 25, 2007. etrieved September 25, 2007, at http://ssrn.com/abstract=1256366.
esuggan, ay N;PN;MN. (Last Modified: August 17, 2008). "Virginia Avernal Henderson." Nurses.info. etrieved September 25, 2007, from: http://www.nurses.info/nursing_theory_person_henderson_virginia_.htm.
Singleton, Joanne K. "Nurses' perspectives of encouraging clients' care-of-self in a short-term rehabilitation unit within…
Kearney, Kathleen M., the Nurse's Duty to Report Child Abuse vs. The Attorney's Duty of Confidentiality: The Nurse Attorney's Dilemma Journal of Nursing Law. Social Science Electronic Publishing, Inc.; January 25, 2007. Retrieved September 25, 2007, at http://ssrn.com/abstract=1256366 .
Resuggan, Ray RN;RPN;MRN. (Last Modified: August 17, 2008). "Virginia Avernal Henderson." Nurses.info. Retrieved September 25, 2007, from: http://www.nurses.info/nursing_theory_person_henderson_virginia_.htm.
Singleton, Joanne K. "Nurses' perspectives of encouraging clients' care-of-self in a short-term rehabilitation unit within a long-term care facility," Rehabilitation Nursing, January 1, 2000. Retrieved September 25, 2007, from: http://www.highbeam.com/doc/1P348282208.html .
Trail Ross, Mary Ellen. (1993). "Linking Ethical Principles With Community Practice." Journal of Community Health Nursing, Vol. 10. Retrieved September 25, 2007, at http://www.questia.com/read/95780716?title=Linking%20Ethical%20Principles%20W%20Community%20Practice .
The author quotes Gary Zukav as emphasizing that if a nurse perceives herself as powerless and her image as negative, the idea can sink to the subconscious level and realize itself. She will be drawn to those who will reinforce the idea. Practitioner Pauline Robitaille's stresses impact each nurse has on others. Her influence on people she comes in contact at the peri-operative setting cannot be overstated. She found the published feedbacks of registered nurses in nursing journals as very positive while others were very negative. Those who gave positive feedbacks described the efforts of preceptors to teach and support them. Thus the intended learning flowed smoothly. However, other nurses reported the negative, punitive and critical behavior of their preceptors. The nurses described the difficulty of working with these preceptors. Hence, the nurses did not benefit from their experience with the preceptors.
Ulmer emphasizes that those in the profession must…
Gonzales, L. (2005). A mission for the center for nursing advocacy. 3 pages. Nevada RN Foundation: Nevada Nurses Association
Nursing BC (2002). How to create community media coverage for nursing. 2 pages. Registered Nurses Association of British Columbia: ProQuest Information and Learning Company
Ulmer, B.C. (2000). The image of nursing. 4 pages. AORN Journal: Association of Operating Room Nurses, Inc.
Willging, P (2005). it's time to take the politics out of nursing home quality. 5 pages. Nursing Homes: Medquest Communications, LLC
" (1) What does the phrase "concept inventing" mean to you?
2) Does the process of concept inventing add clarity to a unique lived experience that aides in individualizing patient care? - or - Does the process of concept inventing add unnecessary jargon to the profession of nursing which creates barriers in collaboration with other disciplines? (3) State your stance on this issue and create a logical argument to defend your thoughts.
C. (1). "Concept inventing" can be thought of as a way to analyze situations in such a way as to contemplate their meaning to create understanding. Using both the aspects of science, including logic, rationality, and empirical analysis, and art, including intuition, emotion, integrity, honor, and compassion, nurses can process information in such a way as to create a complete conceptual picture of both the abstract aspects and concrete facts of a situation. In doing so, nurses can…
Chen, K.M. (2000, January.) The focus of the discipline of nursing: Caring in the holistic human health experience. Nursing (Graduate Research), 2(1). Retrieved Dec 3, 2006 from Graduate Research. Website: http://www.graduateresearch.com/kueimin2.htm.
Nagai-Jacobson, M.G., & Burkhardt, M.A. (1996). Viewing persons as stories: A perspective for holistic care. Alternative Therapies, 2(4), 54-58.
Rogers, M.E. (1990). Nursing: Science of unitary, irreducible, human beings: In E.A.M. Barrett (Ed.), Rogers' Science-Based Nursing. New York, NY: National League for Nursing.
Wainwright, P. (1999). The art of nursing. International Journal of Nursing Studies, 36, 379-385.
Technology-based teaching strategies can greatly accelerate the how both teaching and learning occur and therefore often reduce traditional issues and concerns faced by students and instructors. This approach changes the conventional way of thinking about how quality nursing programs are assessed and changes the levels of requirements to better suit student learning with better access to libraries, counseling and tutoring services, computing equipment, tuition, and financial aid to name a few.
But where this Associates Degree approach will benefit the profession most is in the healthcare system where it is needed most. New nurses will be better acclimated to the needs of sophisticated logging processes, medical billing and inventory as well as scheduling and other tasks now all handled via digital processing and computer. A modern day nurses are more technologically sophisticated, the overall patient care process also gets better as more available free time is offered back to the…
("Summary of the LPN Declaratory Ruling, 2003)
The selected tasks and shared responsibilities of the licensed practical nurse define such nurses as responsible for being adequately prepared for the nursing responsibilities they assume because they have obtained the validation of completion of an approved preparatory program and have evidence of the successful completion of a nursing licensing examination. A registered nurse, however, as the title conveys, must be registered as a specific health care professional, within a professional organization, rather than merely possess evidence of having a license, and has passed the necessary coursework to obtain his or her master's in the nursing profession. The LPN's validation documents state that he or she has reached the achievement of mastering all theoretical and nursing skill competencies required of an entry level practical nurse in caring for individuals in any age group. It states that the licensed practical nurse has the sufficient…
Carter, Melodie R. (Jun 2004) "ABCs of Staffing Decisions." Journal of Nursing Management. Retrived 2 Sept 2005 at http://www.findarticles.com/p/articles/mi_qa3619/is_200406/ai_n9425719
Nurse Practice Act. (2004) Retrived 2 Sept 2005 at http://www.arsbn.org/pdfs/practice_act/2004/nursepracticeact_2004.pdf
Summary of the LPN Declaratory Ruling." (Feb 2003) Connecticut Nursing Journal. Retrived 2 Sept 2005 at http://www.findarticles.com/p/articles/mi_qa3902/is_200212/ai_n9305171
Autonomy in the nursing profession states the importance of the client's role in making decisions that reflect advocacy for the client (Wade, 1999, p.310). Ultimately, this includes taking care of the patient physically as well as mentally and emotionally, developing a relationship with the patient that is beneficial to his care and actively advocating for the patient's rights and care. This type of autonomy, it is important to note, is not the same as individual or work autonomy, yet it must be considered that empowerment in nursing autonomy will inevitably lead to better professional and personal autonomy and should also lead to increased job satisfaction (Wade, 1999, p.310).
Typical definitions of autonomy would include the idea of complete independence for the person making the decisions. However, in the case of the nursing profession, the client's needs and desires must be heavily weighed and, in fact, become central…
Wade, G.H. (1999). Professional nurse autonomy: Concept analysis and application to nursing education. Journal of Advanced Nursing, 30(2), 310-8.
Gaylord, N. & Grace, P. (1995). Nursing advocacy: An ethic of practice. Nursing Ethics, 2(1),
White, L. (2004). Foundations of nursing: Second edition. Clifton Park, NY: Delmar Learning.
Nursing Future in 2021
Nursing has not changed greatly for decades. Nurses now have more freedom than they did two decades ago, but nurses still provide the same care they have for the past century. This has been changing with the advent of nursing master's programs that are allowing registered nurses the opportunity to become more specialized in fields of their choice. A nurse can choose from many different nurse practitioner specialties to become more engaged in their field. Nurse practitioner programs allow nurses to be more involved in decisions that are made regarding patient care, so that the nurse becomes more responsible. The position of neonatal nurse practitioner is explained more fully in the following essay.
Neonatal care refers to the hospital department that takes care of an infant at the earliest stages of life. A neonatal nurse practitioner "frequently reports directly to a neonatologist or other specialists who…
Ellis-Christensen, T. (2011). What is a neonatal nurse practitioner? Retrieved from http://www.wisegeek.com/what-is-a-neonatal-nurse-practitioner.htm
One need only read the newspaper "Classified" ads to realize that employers are trying many clever marketing tactics to attract prospective nurses into their organizations. Many are offering sign-on bonuses, extra benefits and other amenities to attract a limited supply of nurses. As both the general population and the elderly population grow, the number of nurses needed to care for them increases proportionally as well. The number of people choosing to pursue nursing as a career has been on the decline, mainly due to long working hours, low pay, high job stress and other factors. These factors will not resolve themselves if the nursing deficit continues to increase. In addition, graduate nurses find it difficult to enter the workforce due to their lack of experience and a shortage of mentors to teach them. The solution is simple, more nurses are needed, and soon. Novice nurses are fresh graduates who…
Durkin, Barbara.(2002) Reliving Hospital Mistake: Mom recalls overdose case February
24, 2002. Newsday, Inc.
Lang, Susan. (1996) Lack of nursing assistants is an impending crisis, says Cornell gerontologist. Cornell University. Cornell University. http://www.news.cornell.edu/releases/May96/nursingassistants.ssl.html . Accessed June, 2002.
National League for Nursing (NLN). (2000). Unpublished Data. New York, NY. http://nursing.about.com/gi/dynamic/offsite.htm?site=http%3A%2F%2Fwww.nln.org%2Faboutnln%2Fnews_tricouncil2.htm. Accessed June, 2002.
Nursing is one of those professions that provides the opportunity not only to further oneself on a professional level, but also on a personal level. It provides the individual with the opportunity to connect with others by providing a platform of health care, while also providing a helping hand that promotes not only short-term healing, but also long-term well-being. This makes nursing one of the most caring professions, as it provides the nurse with the opportunity to use his or her skills, and also to lend a hand above the duties of simple physical health care. In this way, nursing extends to caring for the whole person rather than the physical being alone. This is one of the major factors that has attracted me to the profession throughout my life.
According to Limon (2001), there are four central concepts that are central to the metaparadigm of nursing, including the person…
Kocisko, D. (2010, Jan 23). Counselor, patient advocate, researcher, teacher -- and nurse: A Nurse's Journal. Retrieved from: http://www.cleveland.com/healthfit/index.ssf/2010/01/counselor_patient_advocate_res.html
Limon, C. (2007). The Components of the Metaparadigm for Nursing. Nutrition and Health Hub. Retrieved from: http://smalldogs2.com/NutritionHealthHub/The_Components_of_the_Metaparadigm_for_Nursing.html
It is saddening to note that as hospital stays grow more expensive, patients are getting less care and families must resort to the private sector and pay still more money to feel as though their loved ones are being treated competently. The problems are rife, legally in terms of liability and medically in terms of nursing conflicts over patient treatment. There is also the ethical issue that the poor are getting less decent care than the rich, because poor families cannot provide private nurses. Clearly, hiring private nurses or assistants is not the solution to an overburdened medical system, but families will continue to do so to protect their loved ones until a better solution is achieved by policy makers.
Deutsch, Anne, Rodger C. Fielder & Kenneth J. Ottenbacher. Stroke. 37 (Jun
Rehabilitation after a stroke is a critical part of the healing process. The article attempts…
Rehabilitation after a stroke is a critical part of the healing process. The article attempts to assess differences in outcomes between patients treated at inpatient rehabilitative facilities (IRF) versus skilled nursing facilities (SNF). Overall, it was discovered that most patients, except for those patients who had suffered the most minor motor disabilities, had better quality of care and improved general outcomes when they went to the more expensive IRFs. Yet, although IRF payments for Medicare patients were higher, the stays were shorter than the SNF stays and this ultimately might result in lower costs overall to the health care system, when patient treatment is viewed in a long-term fashion.
This article highlights the problems of patients who have similar conditions, yet have vastly different insurance policies. Policymakers and health insurance assessors must ask, what incurs more long-term costs, and how should the value of rehabilitation be calculated? The article provides a compelling case for the superiority of IRFs as well as the difficulties of putting a price on rehabilitation, when more intensive rehabilitation can result in better outcomes for the patient later on.
Patterns of Knowing in Nursing
There is a great abundance of information available to us in the universe. Every second, we are bombarded with thousands if not millions of tiny facts arriving through the unbidden working of our sensory organs, each of which is quietly and usually subconsciously processed by the brain; active study engages other parts of our grey matter, and quickly creates a store of facts and associations; and ultimately all information is judged against the framework that is continuously being constructed from previous information. In addition to these different processes for analyzing, categorizing, and associating information, there are also different types of knowledge, several if not all of them working on subconscious and unconscious levels, that help to inform the way in which the world is perceived and responded to. These are both different subject areas and different ways of viewing the world and receiving…
Chinn, P. & Kramer, M. (2008). Integrated knowledge development in nursing. St. Louis: Mosby.
Lafferty, P. (1997). "Balancing the curriculum: promoting aesthetic knowledge in nursing.." Nurse education today 17(4), pp. 281-6.
Milligan, F. (1999). "Beyond the rhetoric of problem-based learning: emancipatory limits and links with andragogy." Nurse education today 19(7), pp. 548-55.
Nursing Theorist: Sr. oy Adaptation Model
The oy Adaptation model for Nursing had its beginning when Sister Callista oy happened to get admitted in the Masters Program of pediatric nursing in the University of California, Los Angeles, in the year 1964. At that time, Sr. Callista was familiar with the idea of 'adaptation' in nursing, and it must be mentioned that Sr. Callista's adviser at that time was Dorothy E. Johnson, who believed firmly in the need to define nursing as a means of focusing the development of knowledge, for the practice of nursing. When Sr. Callista oy started working with children in the pediatric ward of the hospital, she was quite impressed with the basic resiliency of the small children who had been admitted into the wards for treatment. This was why when the first seminar in pediatric nursing was called for; Sr. Callista oy proposed that the basic…
"Callista Roy's Adaptation Model" Retrieved From
http://www.geocities.com/ninquiry2002/callistaroy Accessed 28 October, 2005
'Case Study" Retrieved From
http://www.geocities.com/ninquiry2002/casestudy.html Accessed 28 October, 2005
Nursing Jobs History
Nursing has changed much since the time before 1945 to now. In the Middle Ages, nursing duties and hospital jobs were sponsored by the Catholic Church, which was popular throughout all Europe and which supported the building of hospitals and the care of the sick in communities. This support fell apart during the Protestant eformation. Monasteries, hospitals and inns were taken from the Church. Also, the study and technique of developing and applying medicine were removed from monasteries and placed in Universities. The art of nursing which had been passed on for centuries in the monasteries was now cut off from the nurses who had practiced it. Protestant society considered nurses to be among "the lowest level of human society" (Sundstrom, 1998). Over the course of the next 200 years, the public approach to nursing changed. A charitable institution in the Middle Ages, suppressed under the Protestants,…
BMJ Quality and Safety. (2013). Registered nurses often lack time for nursing care activities. News Medical. Retrieved from http://www.news-medical.net/news/20131111/Registered-nurses-often-lack-time-for-nursing-care-activities.aspx
Rinehart, M. (1931). Beyond Bed Pans. History Matters. Retrieved from http://historymatters.gmu.edu/d/60/
Sundstrom, A., H. (1998). From the Decline/Dark Ages to the Rebirth/Renaissance of Nursing. Angelfire. Retrieved from http://www.angelfire.com/fl/EeirensFaerieTales/NursingDeclineHistory.html
FCER Points Out Error to erck; erck Confirms Change"
This commentary illustrates the issue of problematic wording within the medical community. A Doctor of Chiropractic expressed concern to the Foundation for Chiropractic Education and Research over improper phrasing written in the erck anual.
The bothersome statement written in the erck anual was thought to have originated from medical data derived over 30 years ago. This article points the importance of knowing one's own specialty, and having a thorough knowledge of medical terminology so as to correct and prevent medical mishaps.
ackechnie C, Simpson, R (2006) "Traceable Calibration for Blood Pressure and Temperature onitoring" Nursing Standard 21, 11, (2006): 42-47
Correct diagnosis and monitoring largely depend on accurate pulse, respiration, blood pressure, and body temperature measurements. any measurement errors can be minimized by confirming that instruments are calibrated. This article emphasizes to need for instruments to be traceably calibrated to national…
Mackechnie C, Simpson, R (2006) "Traceable Calibration for Blood Pressure and Temperature Monitoring" Nursing Standard 21, 11, (2006): 42-47
Correct diagnosis and monitoring largely depend on accurate pulse, respiration, blood pressure, and body temperature measurements. Many measurement errors can be minimized by confirming that instruments are calibrated. This article emphasizes to need for instruments to be traceably calibrated to national standards.
Nurses are responsible for taking measurements, so it is imperative that nurses be aware of the issues of measurement precision. Unreliable instruments (due to lack of traceable calibration) can lead to inaccurate measurements resulting in misdiagnosis and poor patient care.
The Nurses Organization of Veterans Affairs (NOVA)
Purpose, Mission and Vision
NOVA exists to fulfill a very important function in the United States: Providing healthcare services to the nation's war veterans. To be able to do this, the organization's mission is to "shape and influence healthcare in the Department of Verterans Affairs (NOVA Foundation, 2012).
NOVA's vision has six components:
To provide high quality nursing care.
To provide nurses with an optimal work environment.
To keep nurses informed on relevant issues regarding VA health care and nursing.
To create opportunities for VA nurses to function at the leadership level.
To recruit all VA nurses for NOVA membership.
Advantages of Membership
The most obvious benefit of membership is the ability to connect with other members, who can offer support for specific challenges related to the professions. This opportunity to work with others also strengthens the ability of the VA…
Meyers, S. (2003, Oct. 2). Nurse Shortage: Recruitment and Retention. Statement of The Nurses Organization of Veterans Affairs (NOVA) Before the House Committee on Veterans Affairs, Subcommittee on Oversight and Investigations. Retrieved from: http://democrats.veterans.house.gov/hearings/schedule108/oct03/10-2-03/smyers.pdf
Nova Foundation (2012). Nurses Organization of Veterans Affairs. Retrieved from: http://www.vanurse.org/
United States Department of Veterans Affairs. (2012, Jun. 4). NOVA Foundation Scholarship. Retrieved from: http://www.va.gov/NURSING/nova.asp
The data gathered is subjected to statistical analysis using statistical methods of linear regression and chi square testing.
The main purpose of the study was to confirm the hypothesis that consultation with CNS or RN in a drug-monitoring clinic has a significant positive impact on the well being of patients with rheumatoid arthritis. The study involved a single blinded randomized controlled trial over a period of three years. Subjects were chosen from the rheumatology out patient setting in a district general hospital with a drug monitoring service. A total of 71 subjects who were starting out on anti-rheumatic therapy were randomly assigned to either the interventional or the control group. While the interventional group was supervised by the CNS to assess patient needs (using Pendelton's framework) alongside drug safety evaluation, the control group was seen by an outpatient staff nurse purely for drug safety concerns. oth the groups were assessed…
Teri Britt Pipe; Kay E. Wellik; Vicki L. Buchda; Carol M. Hansen; Dana R. Martyn, 2005, "Implementing Evidence-Based Nursing Practice," Urol Nurs. 25(5): 365-370, Available at, http://www.medscape.com/viewarticle/514532
Ryan, S, Hassell, a.B, Lewis, M, & Farrell, a. (2006). Impact of a Rheumatology Expert Nurse on the well-being of patients attending a drug monitoring clinic. Journal of Advanced Nursing, 53(3), 277 -286.
Considine, J. & Botti, M. (2004) Who, when and where? Identification of patients at risk of an in-hospital adverse event: Implications for nursing practice. International Journal of Nursing Practice. 10: pp. 21-31
Nursing Case Study
Managing a possible Case of Gastroenteritis: A Nursing Case Study
The effective delivery of optimal nursing care requires a comprehensive treatment plan that addresses both the patient's symptoms and the security of the immediate environment. This report presents a case study of appropriate evidence-based nursing practices in treating an elderly female patient presenting with abdominal discomfort in a residential care setting.
The client presents with new onset faecal incontinence, diarrhoea and increasing abdominal discomfort and cramps. These symptoms suggest a possible gastrointestinal disturbance (Crisp & Taylor, 2009) and present a number of possible diagnoses. While the client's nursing care plan indicates that she is normally continent, her confidential disclosure to the nurse suggests that her symptoms may be more prolonged. Another relevant client characteristic is her advanced age of 85 years.
The client's proximity to the dirty utility room in the aged care facility and the report…
1. Crisp J, Taylor C. (2010). Potter & Perry's fundaments of nursing (3rd ed.). Chatswood, N.S.W.: Elsevier, Australia.
2. Kirk MD, Hall GV, Veitch MGK, Becker N. (2010). Assessing the ?incidence of gastroenteritis among elderly people living in long-term care facilities. Journal of Hospital Infection, 76, 12.
3. Australian Government: Department of Health and Ageing. (2007). Retrieved from- http://www.health.gov.au/internet/main/publishing.nsf/content/icg-guidelinesindex.htm .
4. Andrew E, Simor MVD. (2010). Diagnosis, Management, and Prevention of Clostridium difficile Infection in Long-Term Care Facilities: A Review. The-Americans Geriatric Societ, 58(8), 1557-1593.
The authors describe findings from a survey designed to gather baseline data about changes organizations experience after implementing the Clinical Practice Model framework, and report how the Clinical Practice Model Resource Center staff used the survey findings to build the capacity of individuals accountable for implementing this integrated, interdisciplinary professional practice framework into the organization's operations." (2002) The following model has been created for monitoring the progress of the nursing staff at the MD Anderson Cancer Center MEDVACM specifically checking progress in Years 1,3, and 5.
MD ANDERSON CANCER CENTER MEDVAMC
Job Performance Review Guide
PERFORMANCE GOALS AND OJECTIVES
ecome familiar with your department's business goals.
Work with your manager to define and document your goals. Include what you are expected to produce by your first review, activities needed to accomplish results, and success criteria.
Magnet Designation (2006) Inside UVA Online Vol. 36, Issue 14 August 26, 2006. Available at http://www.virginia.edu/insideuva/nursing_excellence.html .
Bailey, F. Amos (2000) Balm of Gilead Center, Cooper Green Hospital Pioneer Programs in Palliative Care: Nine Case Studies - Robert Wood Johnson Foundation - Milbank Memorial Fund October 2000. Online available at http://www.milbank.org/pppc/0011pppc.html#foreword .
Forrow, Lachlan (2000) Palliative Care Program, Beth Israel Deaconess Medical Center/CareGroupPioneer Programs in Palliative Care: Nine Case Studies - Robert Wood Johnson Foundation - Milbank Memorial Fund October 2000. Online available at
Nurse Case Manager:
Case management in the nursing field is basically described as the functions and activities carried out by the nurse case manager within a specific care setting. In some cases, these functions and activities are usually performed by a self-governing practitioner, especially in private case management practices and community nursing facilities (Cohen & Cesta, 2005, p.278). Generally case management responsibilities are provided by the nurse case manager in acute care, primary care, home care, and managed care organizations. Nonetheless, these activities may be offered to particular patient populations and communities like the elderly. Some of the most case management activities include patient identification and intake, problem identification and assessment, patient outreach, development and implementation of plan of care, and coordination of care.
oles and Functions of Nurse Case Manager:
In acute care organizations, the roles and functions of the nurse case manager includes coordinating the care provided to…
Blancett, S.S. & Flarey, D.L. (2006). Case studies in nursing case management: health care delivery in a world of managed care. Gaithersburg, MD: Aspen Publishers, Inc.
Cohen, E.L. & Cesta, T.G. (2005). Nursing case management: from essentials to advanced practice applications (4th ed.). St. Louis, MO: Elsevier Health Sciences.
Meadows, P. (2009, January). Community Health Nursing. American Journal of Nursing,
109(19). Retrieved from http://journals.lww.com/ajnonline/fulltext/2009/01001/community_health_nursing.5.aspx
A person's health is an ever-changing state of being resulting from the interaction with the environment. Optimum health is the actualization of both innate and obtained human potential gained through rewarding relationships with others, obtaining goals and maintaining expert personal care. Adaptations can be made as required to maintain stability and structural integrity. A person's state of health can vary from wellness to illness, disease, or dysfunction. Professional nursing is founded on the need to promote wellness practices, the attentive treatment of persons who are acutely or chronically ill or dying, and restorative care of patients during convalescence and rehabilitation. It also includes the education and measurement of those who perform or are learning to perform nursing responsibilities, the support and communication of research to enhance knowledge and practice, and the management of nursing in healthcare delivery systems. Nursing practice centers on the application of a body of knowledge in…
Johnston, N., Rogers, M., Cross, N. And Sochan, a.(2007) Global and planetary health:
teaching as if the future matters. Nursing Education Perspectives 26(3), 152
Nyatanga, L. (2005) Nursing and the philosophy of science. Nurse Education Today 25(8), 670-675
It has been shown through research to be critical that the organization make the provision of support for the nursing staff in terms of their education and provisioning career support as well through making time and financial allocations to provide the necessary support system in which the nursing staff may advance their education and hence their career. (Cook, Horz & Mildon, 2006; paraphrased citing the work of: Robinson, (2001 and Hinshaw (2002) Additionally falling within these provisions of support are time and financial allocations for "research, special projects and publications (Kramer & Schmalenberg, 1988; as cited by Cook, Horz, & Mildon, 2006) the research fact sheet includes the necessity for organizations to "Support a 'bias toward action' (Kramer & Schmalenberg, 1988; as cited by Cook, Horz, & Mildon, 2006); and to "Enhance nurse-staffing rations (Hinshaw, 2002; as cited by Cook, Horz, & Mildon, 2006) and lastly to provide encouragement among…
Cook, a. Hiroz, J. And Mildson, B. (2006) Strategies and Outcomes Associated Magnet Hospitals Fact Sheet II of II - Nursing Health Services Research Unit 2006 September Online available at http://18.104.22.168/search?q=cache:wmmvrr7kMqUJ : www.nhsru.com/factsheets/Magnet%2520factsheet%2520Part%2520II%2520of%2 520II%2520-%2520Strategies.FINAL.pdf+Nursing+Leadership:+Healthcare +organizational+analysis&hl=en&gl=us&ct=clnk&cd=79.
Quality First: Core Values and Concepts for Quality Leadership (2006) American Health Care Association - Provider Guidelines. Online available at http://www.ahca.org/quality/qf_corevalues.htm .
Alexander, Jeffrey; Bloom, Joan; and Nichols, Beverly (1991) Nursing Turnover and Hospital Efficiency: An Organizational Level Analysis (1991) Institute of Industrial Relations University of California Berkley
Nursing Leaderships Role: 'Key' Factors in Organizational Analysis
Also, nurses can ignore patient advice as far as medical procedures are concerned because they obviously don't have the medical expertise to being advice on such matters (Street 2005). It is important that patient's are able to lend their discretion because every decision made by a medical staff member in their regard effects their life and ultimately their life as a whole (Street, 2005). A healthy relationship between patient and nurse yields positive outcomes and allowing patients to participate in their own care leads to a better relationship (Andrews 2008). Nurses need to keep in mind the balance that exists between letting patients participate and voice their opinions about their care and not allowing patients to dictate the entirety of their stay in the care facility.
Explain why patients do not wish to be actively involved in their care, and how nurses can help with this situation
Patients do not…
Andrews M.M. And Boyle J. (2008). Transcultural Concepts in Nursing. England:
Lippincott Williams & Wilkins.
Street L.R., Gordon S.H., Ward M.M., Krupat E., & Kravitz L.R. (2005). Patient
Participation in Medical Consultations: Why Some Patients Are More Involved
Nursing theory chosen, which best aligns with my personal theory of nursing, is Neuman's System Model. This model was created by Betty Neuman, and designed to be holistic in nature (Memmott, et al., 2000). The focus of the model is on the whole person (patient), the environment surrounding that person, the overall health of the person, and the nursing care that person is provided with during his or her illness. While it might seem obvious that all of these areas should be considered, many models of nursing practice today ignore too many important factors regarding a person and why he or she may be ill (Barnum, 1998). With that in mind, it is very important to use a theory like Neuman's Systems Model in order to address more than just a set of symptoms (Memmott, et al., 2000). When nurses and other medical professionals take a look at a chart…
Barnum, B. (1998). Nursing theory: Analysis, application, evaluation. NY: Lippincott Williams & Wilkins.
Memmott, R.J. Marett, K.M. Bott, R.L. & Duke, L. (2000). Use of the Neuman Systems Model for interdisciplinary teams. Online Journal of Rural Nursing and Health Care, 1(2).
The nurse is often expected to act and react only with empirical information, however personal knowledge is considered equally as important by many nurse educators and researchers (Chinn & Kramer 2004). This also helps to explain why "health" and "environment" are considered distinct major components in the metastudy of nursing; both can be understood on highly subjective terms, with the concept of "good health" changing from patient to patient, or "person" to "person." Environment, too, has a major effect on the practice of nursing and the growth of the nursing body of knowledge.
My personal philosophy of nursing centers on the belief that each individual person under my care deserves full attention and the unique application of my knowledge in addressing their immediate and long-term needs and concerns. That is, each person should benefit as much as possible from the full extent of my nursing knowledge, while still being…
Chinn, P. & Kramer, M. (2004). Integrated knowledge development in nursing. St. Louis: Mosby.
Fawcett, J. (2006). "Commentary: Finding patterns of knowing in the work of Florence Nightingale." Nursing outlook 54(5), pp. 275-7.
What area(s) of the cultural assessment would you focus on?
Jarvis urges the use of cultural assessment in conjunction with other types of assessment including family and community assessments. An understanding of culture can inform strengths and weaknesses that can be applied to the development of a treatment plan. During the assessment in this case, I would focus on language, lifestyles, and values. Values might include the patient's value of money, relationships, time, health, education, beauty, and spirituality. I would ask about family background and history to ascertain relational issues. Her communication styles would be important to understand. Cultural values related to food and food beliefs could be influencing the client. Furthermore, the client's culture might impact her attitudes towards the healing process.
b. Discuss the rationale for selecting this.
It is important to know if the client's financial condition is precluding her from seeking care. With regards to…
Boyle JS, Andrews MM (1989): Transcultural Concepts in Nursing Care. Glenview, IL, Scott, Foresman/Little, Brown College Division, 1989
Jarvis, C. (2000). Physical Examination. Saunders.
This is one of the most common forms of research and, for some research questions is clearly a strong design (Ethics in Critical Care Nursing Research, 2005).
The research that was done in this article would be considered a non-experimental type. There were two types of observation that were conducted. The first type was that of focus groups and the second being the file audit, both of which are observational in nature. In this case this was the most appropriate type of research design to use. Since they were simply trying to see what was actually going on in this area and how that was affecting patients the only real way to tot this was by observation. From this article a nursing care issue that can be raised is that of how palliative care nurses manage family involvement with end of life issues. Are there any standard procedures that are…
Nursing and eligion Practice
ELIGION AND NUSING PACTICE
Nursing success depends on the ability to put the patient in a state of rest and comfort as much as it is about administering the prescriptions of the doctor. To secure the rest of the patient, nurses need to understand their needs and show respect to their beliefs and values. This requires courteous and open communication with the patient and adopting a patient-centric orientation. Along with other factors, the religious background of the patient makes a lot of difference to their values and expectations. eligious doctrines and practices may differ across religions and denominations such as Jehovah's Witnesses, Muslims, Seventh Day Adventists and Scientologists and may impose restrictions on certain kinds of interaction between nurse and patient or on certain forms of treatment. Moreover, people with a different religious background are not usually aware of such differences. Therefore, it is necessary for…
Banja, J.D. (2010). Overriding the Jehovah's Witness patient's refusal of blood: A reply to Cahana, Weibel, and Hurst. Pain Medicine, 10(5), 878-882. doi: 10.1111/j.1526-4637.2009.00648.x.
Charles, C.E., & Daroszewski, E.B. (2012). Culturally competent nursing care of the Muslim patient, Issues in Mental Health Nursing. 33(1), 61-63. doi: 10.3109/01612840.2011.596613.
Cort, M., & Cort, D. (2008). Willingness to participate in organ donation among Black Seventh-Day Adventist college students. Journal of American College Health, 56(6), p. 691-697. Retrieved from EBSCO Academic Search Primer.
Effa-Heap, G. (2009). Blood transfusion: Implications of treating a Jehovah's Witness patient. British journal of nursing, 18(3), 174-177.
Getting old is not very fun when considering the opinions of the elderly. This is true because many hard and difficult decisions must be made in terms of health and health care. Two options immediately arise when one is not able to take care of themselves and seek the assistance of others. The first option is home health care and the other is nursing home health care. The purpose of this essay is to examine, weigh and discuss these two options. This essay will then conclude on when it is best to choose nursing home care and when it is not wise or advisable to do such a thing.
Home Health Care
What exactly is home health care and what does it entail? Home health care helps seniors live independently for as long as possible, given the limits of their medical condition. It covers a wide range of…
Berger, Joseph, (2012). A Shift From Nursing Homes to Managed Care at Home. The New York Times, 23 Feb 2012. Web. http://www.nytimes.com/2012/02/24/nyregion/managed-care - keeps-the-frail-out-of-nursing-homes.html?pagewanted=all&_r=0
Bojorquez, Manuel, (2013). Eleven states get failing grades for nursing home care. CBS News, 9 Aug 2013. Web . http://www.cbsnews.com/8301-18563_162-57597944/eleven-states - get-failing-grades-for-nursing-home-care/
Friedland, R. (2009). Home Care vs. Nursing Home Care. Care, 25 Nov 2009. Retrieved from http://www.care.com/senior-care-home-care-versus-nursing-home-care-p1017- q14698.html
Klauber, M. (2001). The 1987 Nursing Home Reform Act. Public Policy Institute, Feb 2001. Retrieved from http://www.aarp.org/home-garden/livable-communities/info - 2001/the_1987_nursing_home_reform_act.html
Nusing poblem 1: May's pain must be contained so she does not injue heself.
Because childen cannot always expess thei sensations of pain, thei pain may go unnoticed until it becomes sevee and fightening.
Nusing poblem 2: Vomiting and the possibility of choking.
Anxiety and pain can cause childen to vomit, making teatment of pain and administeing pope nutition difficult.
Nusing poblem 3: May is attempting to emove he oxygen mask.
A lack of knowledge on the pat of the child as to why cetain teatments ae administeed can esult in noncompliance.
Nusing poblem 4: The need fo social suppot when May's mothe is not pesent.
The unfamiliaity of the hospital envionment is exacebated by May's lack of paental cae.
Diagnosis 1: Pain management
Outcome: The FLACC: a behavioual scale fo scoing postopeative pain in young childen that can be helpful in detemining how to teat…
Almond, C. (1998). Children are not little adults. Australian Nursing Journal, 6(3), 27 -- 30.
Bruce, E., & Franck, L. (2000). Self-administered nitrous oxide (Entonox () for the management of procedural pain. Paediatric Nursing, 12(7), 15 -- 19.
Manworren R. & Hynan L.S (2003) Clinical validation of FLACC: preverbal patient pain scale. Paediatric Nursing 29(2):140-146.
McInerney, M. (2000). Paediatric pain. Pulse Information Sheet of Royal College of Nursing,
Why it is nurses' responsibility to report to relevant persons when the level of resources risk compromising the quality of care?
It is nurses' responsibility to report to the correct persons when dwindling resources are affecting patients' health and the quality of care (Miller, 2008). Nurses accept this responsibility when they become a nurse as it is an aspect of treating a patient properly (Miller, 2008). Considering a nurses' job revolves around providing care for those in need, not reporting dwindling resources is a direct violation of the sole purpose of being a nurse and is irresponsible (Miller, 2008). Another reason nurses should be sure to inform their superiors of a detrimentally low amount of supplies is in order to save their jobs. If a patient's health worsens or if they decease due to missing resources, the hospital may be blamed or sued by the family (Miller, 2008). Once this…
Miller, C.A. (2008). Nursing for wellness in older adults (6th ed.). Lippincott Williams & Wilkins.
Holmes, B (2011). Safe patient care and nurses' professional obligations. NSW Nurses'
Studies suggest that more computerized order entry of medications helps reduce errors by limiting interpretation errors due to handwriting (Meadows, 2003). Thus more order entry is involving computers to protect patients. A culture that supports safety and safe practices has also been adopted to provide nursing staff and patients information about drug therapy and medication to ensure that everyone is aware of the need for safe practices when utilizing and dispensing medications.
Describe the strategies used to ensure nursing practice is performed within legal requirements and ethical frameworks
Nurses now "live and work in a world where there is no single reality but many coexisting realities among which they must choose" (Johnston, 1999:1). Given that through more and more nurses are forced to make legal and ethical decisions and take steps that will determine the best processes to adopt to ensure that moral and legal processes are adopted and followed.…
Campbell, D.W. & Sigsby, L.M. (1995). "Nursing interventions classification: A content analysis of nursing activities in public schools." Journal of Community Health Nursing, 12(4): 229.
Caretto, V.A. & McCormick, C.S. (1991). "Community as Client: A Hand's on experience for baccalaureate nursing students." Journal of Community Health Nursing, 8(3): 179.
Johnston, M.J. (1999). Bioethics: A nursing perspective. Sydney: Harcourt Saunders.
Lumby, J. & Picone, D. (2000). Clinical challenges: Focus on nursing. St. Leanords:
Nightingale's philosophy demanded a completely clean and sterile environment in order to best provide for a healthy recovery of patients in need. This is also seen in Martinsen's philosophy and the way it approaches nursing care and practice as a meticulous science.
However, Nightingale's philosophies presented a passive patient, who did not really engage in their own health care strategies. These patients were not involved in the manipulation of the environment around them in order to best facilitate successful care strategies. Rather, the nurses and physicians seemed to work autonomously and outside of the patient's involvement. This isolated the very people who were receiving care and created a situation where the patient could not contribute to the strategy of care of the process of recovery. On the other hand, Martinsen's philosophy is very much influenced by phenomenology. Thus, Martinsen's philosophy of care is centered more around treating the patients and…
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It has been shown through research to be critical that the organization make the provision of support for the nursing staff in terms of their education and provisioning career…Read Full Paper ❯
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Also, nurses can ignore patient advice as far as medical procedures are concerned because they obviously don't have the medical expertise to being advice on such matters (Street 2005).…Read Full Paper ❯
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Nursing theory chosen, which best aligns with my personal theory of nursing, is Neuman's System Model. This model was created by Betty Neuman, and designed to be holistic in…Read Full Paper ❯
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The nurse is often expected to act and react only with empirical information, however personal knowledge is considered equally as important by many nurse educators and researchers (Chinn &…Read Full Paper ❯
Nursing What area(s) of the cultural assessment would you focus on? Jarvis urges the use of cultural assessment in conjunction with other types of assessment including family and community…Read Full Paper ❯
This is one of the most common forms of research and, for some research questions is clearly a strong design (Ethics in Critical Care Nursing Research, 2005). The research…Read Full Paper ❯
Mythology - Religion
Nursing and eligion Practice ELIGION AND NUSING PACTICE Nursing success depends on the ability to put the patient in a state of rest and comfort as much as it…Read Full Paper ❯
Nursing Argument Getting old is not very fun when considering the opinions of the elderly. This is true because many hard and difficult decisions must be made in terms…Read Full Paper ❯
Cae plan Nusing poblem 1: May's pain must be contained so she does not injue heself. Because childen cannot always expess thei sensations of pain, thei pain may go…Read Full Paper ❯
Health - Nursing
Why it is nurses' responsibility to report to relevant persons when the level of resources risk compromising the quality of care? It is nurses' responsibility to report to the…Read Full Paper ❯
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Studies suggest that more computerized order entry of medications helps reduce errors by limiting interpretation errors due to handwriting (Meadows, 2003). Thus more order entry is involving computers to…Read Full Paper ❯
Health - Nursing
Nightingale's philosophy demanded a completely clean and sterile environment in order to best provide for a healthy recovery of patients in need. This is also seen in Martinsen's philosophy…Read Full Paper ❯