Preventing Patient Falls
The primary goal of every hospital and care facility is the health and safety of their patients. hile some problems, such as illness cannot be avoided, compounding illness with injuries can and should be avoided. Risks such as slipping, tripping, and falling while in the hospital are an increasing problem for hospitals. The purpose of this paper is to identify a preventable patient injury and suggest a corrective policy for the hospital to reduce the amount of incidence.
Identification of Problem
Patient falls are a growing problem in hospitals. In fact, according to the Centers for Disease Control and Prevention, "In 2004, 14,900 people 65 and older died from injuries related to unintentional falls; about 1.8 million people 65 and older were treated in emergency departments for nonfatal injuries from falls, and more than 433,000 of these patients were hospitalized." (National Center for Injury Prevention…… [Read More]
patient falls in U.S. healthcare institutions is staggering. They increase insurance costs, staff pressure, and even more accidental injuries other than falls. esearch has shown that there are a number of ways patient falls may be mitigated: more nursing rounds, patient exercise, and body awareness conditioning. Tai Chi is a Chinese martial art that is practices for both defense training and health benefits, as well as longevity. The overall theory is to allow the individual to become more flexible, increase strength in certain muscle groups that are not always used in modern life, and to become more aware and attuned to the individual's own body. A 2012 study looked at the effectiveness of tai chi and low-level exercise in reducing falls in older adults, but concluded that there was no difference between the control group and the experimental group over a 1.5-year period. In fact, the study shows that the…… [Read More]
Postoperative Patient Falls
Hospitalized patient falls affect health in huge way as they directly affect safety of patients as well as the concern for the quality of healthcare public health facilities around the world provide to patients. While limited data and information is available concerning inpatient falls following patients going on surgery, falls among hospitalized patients have been extensively studies. Falls is one of the major causes of morbidity like lacerations, closed head injuries and fractures among patients (Vhurch et al., 2011).
It has been shown that fall measurements determine patient outcomes since falls are often reported as adverse events in hospitals among the adult patient population. Falls make up a big part of the problems plaguing the health sector globally. Of all the adverse events in a hospital setting, falls is one of the most significant with nearly 3-20% of inpatients experiencing a fall at least once over the…… [Read More]
According to the United States Department of Health and Human Services Agency for Healthcare Research and Quality (2018), between 700,000 and one million patients in the United States fall while in hospital each year, and about one third of these falls could have been easily prevented with effective administrative procedures and best practice protocols. Yet many organizations lack the quality and safety initiatives they need to prevent patient falls in hospital. As a result of negligence to prevent falls, patients experience a number of injuries that could even lead to higher mortality rates. Hospitals like this, which do not have fall preventing strategies in place, risk malpractice suits and fail to fulfill their ethical responsibilities to patients. Therefore, the organizational problem is related to insufficient—even nonexistent--fall prevention strategies.
Description of Problem
Falls occur at a rate of three to five per every 1000 bed stays, and are more…… [Read More]
Bed Alarms and Chair Alarms to educe Patients' Falls in A Short-Term Care Facility
Importance of bed alarms and chair alarms
Bed alarms have been taunted as not useful in the modern day healthcare deliveries. Nonetheless, the significance of these facilities always strikes much admiration from different healthcare facilities. Alarms are important as warning gadgets that every section of an organization should consider in its ranks. Hazard preparedness requires that all possible strategies adopted to ensure that there is safety for all the people, and even the property being used within a healthcare facility (Vincent, 2010). Thus, the bed and chair alarms are just material things that have been used to provide avenues for the protection of human health, minimizing and eventually stopping the occurrences of cases like patient fall and strain at the health facilities. In the modern hospitals, communication within and without the healthcare facilities between the patients…… [Read More]
THE ISSUE OF ACCIDENTAL FALLS
At some point, anyone who had learned how to walk has had the experience of falling down -- it is a universal experience for infants as they gain ambulatory ability. In hospitals, however, the accidental fall is the most reported type of patient safety incident, with elderly patient populations displaying a particular vulnerability (Oliver 2007, p.173). Approximately one-third of adults over the age of sixty-five will experience an accidental fall this year (CDC 2012, n.p.) Fischer (2005) offers some clarification as to how these incidents should be defined -- the simplest basic definition is "a sudden, uncontrolled, unintentional, downward displacement of the body to the ground or other object" (p822). This definition takes into account the unpredictable nature of the incident, and the fact that it frequently involves a certain loss of control on the part of the patient; it also reminds us that…… [Read More]
The authors attempted to find a new way of measuring falls -- they were dissatisfied with the previous measure used -- and they argued that all aspects can be measured by the number of events divided by the number of opportunities for that event to occur.
In regards to falls, they argued that if you wanted to know how many falls resulted in fractures you would use the numerator as the number of patient falls that resulted in fractures and the denominator would be the totality of falls. So for instance if there were 20 falls that resulted in fractures and 100 falls altogether it would be 20/100 otherwise read as 20%. The numerator tells you what you want to study / question or investigates, and this -- the authors say -- can be as general or as specific as possible.
The problem is how you define falls. The…… [Read More]
Falls in the Nursing Home
There has been an increase in falls in the nursing home. A number of things can cause residents to fall (Patient falls: How to prevent them). Illnesses, such as dementia among others, can cause residents to be confused. Confusion with residents requires continual monitoring in keeping the resident safe. Muscle weakness and instability cause falls when residents are confused, or when the resident insists on doing things themselves and maintaining their own independence in spite of the weakness or instability issues. Medications can also cause confusion. Sedatives and anti-anxiety medications are a particular concern in causing confusion. Medications can also cause drowsiness that can cause falls if patients are not put to bed when the medications are given.
Environmental factors also play a role in falls. Wet floors, poor lighting, incorrect bed height, improperly fitted shoes, unmaintained wheel chairs, or items…… [Read More]
Fall Reduction Project: An Evaluation of the Implementation Process
Chapter 3: Implementation
Blank hospital had a significant increase in falls in the inpatient acute care setting. For this reason, the need for an immutable and comprehensive fall strategy was identified at the hospital following an evaluation of the various costs (both financial and ethical) associated with falls deemed preventable. Towards this end, a fall prevention project was undertaken. I was responsive for overseeing the fall prevention project implementation.
1. Description of Steps
· Pre-implementation phase
· Implementation phase
· Sustainment phase
1.1. Pre-implementation Phase
The pre-implementation phase took a total of 2 months. In essence, pre-implementation phase was meant to prepare the entire facility for the actual phase of implementation. Towards this end, various steps were undertaken. These will be highlighted below.
1.1.1. Identification of Improvement Opportunities
This was founded on the collected fall data. There was an…… [Read More]
Patient Access to Experimental Drugs
Experimental drugs are being used in treating cancer and other life-threatening diseases in the hopes that effective cures and treatments can be identified. There are however, ethical questions relating to the use of experimental drugs and this work seeks to answer the question that asks whether patients should have access to experimental drugs and to answer why or why they should not have this access.
Experimental drugs have carved inroads to treating cancer patients and most recently; this has been reported in the form of a drug that serves to "neutralize two mechanisms cancers need to survive." (Coghlan, 2012) The new drug is Cabozantinib. This drug is reported by one individual interviewed in this study to have been used by a family member who died while taking the drug for non-small cell carcinoma in the form of lung cancer. When asked the question…… [Read More]
To wit, power is a huge influence in any social interaction, and in a study reported by the University of California Press (est, 2008, p. 87), men often interrupt women during conversations because men are generally viewed as the power in any male-female interaction. "Physicians interrupt patients disproportionately" in doctor-patient interactions, est writes, "except when the doctor is a 'lady'; then, "patients interrupt as much or more than physicians, and their interruptions seem to subvert physicians' authority" (est, p. 87). In other words, the stratification of male doctors having the power to interrupt is reversed when a woman is the doctor.
Blumer, Herbert. (1986). Symbolic Interactionism: Perspective and Method. Berkeley:
Breen, Catherine M., Abernethy, Amy P., Abbott, Katherine H., and Tulsky, James a. (2007).
Conflict Associated with Decisions to Limit Life-Sustaining Treatment in Intensive Care
Units. Journal of General Internal Medicine, 16(5), 283-289.
Donovan, Jenny L., and Blake,…… [Read More]
These studies demonstrate that there are several factors associated with patient noncompliance, regardless of the disease being treated. Medication side effects represent only one of these issues. Nurse practitioners could help to resolve many of these issues by being proactive and asking questions about side effects in patients at risk for becoming noncompliant. They may also be able to predict noncompliance in patients that are prescribed medications with known side effects. By informing the patient of the side effects and giving them practical ways to cope with them, the nurse practitioner can play an active role in helping to eliminate patient noncompliance.
Education was found to play an important role in patient noncompliance. The overall educational level of the patient was found to be important. The nurse practitioner can take positive action by being aware of the patient's overall educational background. Extra care must be taken with those of low…… [Read More]
Many advocates of the move feel that lower patient to nurse ratio would lead to additional savings because it would reduce nurse turnover rate, lawsuits, complications and length of stay. Nursing unions in the state of California have asked for a PTN ratio of 3 to 1. The health association however agreed on 5 to 1 which sound more reasonable than the originally proposed 10 to 1. (othberg, 2005)
Patient to nurse ratio when it is too high can definitely adversely affect care. And with baby boomers aging and needing healthcare, we know that number of people looking for healthcare will continue to rise in the coming years. However staff shortage continues to pose a serious problem. And unfortunately, the problem doesn't always lie with cost control. While it is true that most of the problems with staff shortage can be attributed to hospitals cutting down their costs and hence…… [Read More]
Tarsem is able to tell his story through different acting styles and by changing the tone of the film quite suddenly.
hile the two stories in the film are disparate though they involve similar elements, the stories come to meet when they both tend to go into a darker vein. The audience learns how Roy was hurt and we watch as Roy tries to manipulate Alexandria. hile this is happening, there is also a move toward the darker side when the adventurers meet some pretty dark challenges. There is a great shift in the movie overall, going from fantastic and quirky to almost scary.
hat "The Fall" mainly tells us about stories is that while there are certainly rules to storytelling, once one has a grasp on creating a story through character and plot, one can easily break rules of storytelling (Lamb 2), which is what Tarsem has done. The…… [Read More]
Fall Among the Elderly Age Group
Falls among the Elderly Age Group
Expected falls and unexpected falls
isk Elements for Falls
Outline of Several Different Strategies
Counseling and Health Education Strategies
Exercise and physical activity 8
Interventions of Unidentified Effectiveness
Developed Based on your Understanding of the Public Health Problem
Schedule an appointment with your Medic
Wear sensible shoes
According to JM (2009), "As people get older, falls turn out to be a typical and often hurting issue that occurs among those that are in the elderly category, producing a huge quantity of illness, death and use of health care services as well as premature nursing home admittances ( p. 42)." However, falls are a difficult, multi-faceted problem that comprises of social, medical, and financial elements. Medically, the mixture of a high occurs of falls and an increased…… [Read More]
Nursing and Issue of Falls
Falls are responsible for considerable morbidity, immobility, and mortality among older persons, especially those living in nursing homes. Falls can occur in a home, community, long-term rehabilitation, or acute care Setting (Laurence Z.. et.al, 1994). The risk of falls can be related mostly to mobility status, exposure to hazardous environments and risk-taking behaviors such as climbing ladders for seniors living in the community setting. Factors for a fall in hospitalized adults are greatly influenced by acute illness that often has a marked, albeit temporary, impact on physical and cognitive function compounded by care provided in unfamiliar surroundings in the long-term care setting, the risk factors for falls are influenced by impaired cognition, wandering or impulsive behavior, use of psychotropic medications, incontinence and urgency, lack of Exercise, unsafe environments, and low staffing levels. Patient falls are serious problems
In acute care hospitals and are used as…… [Read More]
educe Patient Falls in a Hospital Environment
Method of Obtaining Necessary Approval(s)
Description of Current Problem
Explanation of Proposed Solution
esources equired for Implementation
isk and quality management is a fundamental and important aspect to many health care organizations and patient lives are often at stake. This is especially true in nursing facilities or hospitals that house elderly patients because of the level of direct patient interactions that occur on a daily basis and the specific needs of this population. There are many potential risks that can emerge from this population. Three common risks were identified from a literature review based on evidence-based practices. One common risk deals medication error and making sure patients receive the right dosage of the correct medication at the right time. Another risk that is becoming increasingly common is the risk of the spread of infection and in severe cases infections that are…… [Read More]
Keeping Patients Waiting? Not in My Office
This particular case is fascinating because so many doctors are not on time with their appointments. It is often surprising to find one that is. There are several ways that the doctor in this case ensures that a good time schedule is kept. The main reason that the schedule is kept to is that the scheduling is realistic. Instead of allowing the same amount of time for each patient, times for how long an appointment should take are determined based on what category the patient falls in when he/she calls the office to schedule a time. Extra time is also allotted for emergencies, patients that might show up late, walk-ins that need treatment that day, and other problems that may appear. This allows the doctor to see 20 to 30 patients a day, but the doctor can see 40 to 50 patients in…… [Read More]
Bed and Chair Alarm in to Help educe Falls in Short-Term Care Facility
In long-term care facilities (e.g., assisted living centres and nursing homes), a fall is one of the single most devastating category of unpleasant events. In consequence, there is need for long-term care facilities to pay attention to issues of resident falls. To a significant extent, adequate fall prevention depends on the ability of caregivers to hold on to a well-structured process that comprises of timely fall risk and post fall evaluations and targeted multidisciplinary involvements, which are based on recognized risk factors and reasons why falls occur. To lend support to nurses in their attempts to control these falls, certain technologies that relate to minimizing the number of hazards linked to falls have been found to be vital strategies against the luxury of resident protection. Some of the most popular technologies used for fall management include:
Fall…… [Read More]
hourly nurse rounds help to reduce falls, pressure ulcers, call light use and contribute to rise in patient satisfaction base on evidence base practice
The healthcare center is faced with numerous challenges affecting clinical results and client satisfaction (e.g., ulcers, use of call light and falls). The above challenges have brought on the need to develop and institute an appropriate framework to improve patient care delivery by means of better and increased interaction between patients and nurses. Chiefly, the creation of this sort of system necessitates striving for required authorization and assistance from leaders and staff members in the organization. This involves meeting with top management at organization appraisal board meetings, in addition to collaborating with peers concerning existing best practices for handling the issue. Taking into account organizational issues and nursing-related evidence-based practices (EBPs), the best answer to dealing with current issues is hourly nurse rounds. Implementing this recommended…… [Read More]
Hourly Nurse ounds, Can They Make a Difference?
[Author Name(s), First M. Last, Omit Titles and Degrees]
Pressure ulcers or as some refer to as bed/pressure sores or decubitus ulcers are categorized as localized areas of damaged tissue that is caused by shearing forces and excess pressure usually from maintaining the same position over a long period of time. Pressure ulcers typically happen in people who have nerve damage and/or limited mobility. When the person feels pressure, from sitting or lying on any certain body part, this often results in nutrient and oxygen deprivation to the wound or affected area. Strategies to circumvent this involve repositioning. epositioning consists of moving the person into a different position to give the body the ability to redistribute or remove pressure from the affected area. "Pressure ulcers are distressing events, caused when skin and underlying tissues are placed under pressure sufficient to impair blood…… [Read More]
Mildred's Case Study
Mildred's Story was made to form part of a 'ecognizing isk and Improving Patient Safety' course. The progression takes a novel method to educating healthcare professionals in regards to the significance of non-clinical services, behavior and attitudes in guaranteeing the safety of the patient. It attracts upon the experiences of patients that are within healthcare settings, and information achieved from other high-risk businesses, to come up with a strategy allowing healthcare workers to disapprovingly appraise and interfere in the development of patient danger. There are so numerous prospects of improvement in Mildred's case study, but the writers designated Effective communication & patient assessment to resolve the issue of (patient falls).With that said, instead the researcher has used the SPO model along with using formwork (FOCUS- PDSA) also using tools (Fishbone, 6 huts, flow chart and 5 whys) in order to improve effective communication and patient assessment to…… [Read More]
The baseline data for the study was recorded during the first 2 weeks of the 6-week study period. The study design consisted of analyses of the data collected from the experimental (1-hour rounds and 2-hour rounds) versus the control nursing units with a nonrandom assignment of hospital units to these respective groups (the assignment was the responsibility of chief nursing officers and nurse managers). Although the determined to conduct 1-hour or 2-hour nursing rounding was left up to the nursing executives at the participating hospitals, the principal investigator ensured that the sample was stratified as to type of unit (i.e., medical, surgical, or combined medical -- surgical), unit size, and frequency of nursing rounds.
Adequacy of the Sample
The researchers identified 26 different reasons for the use of call lights by patients in their review of the literature and coded data from the 14 hospitals whose data satisfied the…… [Read More]
Nursing Unit Turnover on Patient Outcomes in Hospitals
While it might seem intuitive that higher rates of turnover within a unit are problematic, the study by Bae, Mark, & Fried (2010) attempts to show using a quantitative study the extent to which turnover has had a negative impact upon patient care. This study compared the levels of turnover at 268 units from 141 hospitals and assessed its relationship to both patient satisfaction and the nurse's own perceptions of cohesion, relational coordination, and learning. The study is quite distinct in design from qualitative studies which often have an anecdotal approach and emphasize experience vs. data in evaluating policies.
One problem, however, with the use of such a study which emphasizes numbers over narration is the difficulty of quantifying subjective variables like efficacy. In this instance, nurses' own perceptions of what policies were useful were assessed as well as patients' perceptions to…… [Read More]
Examples of 'red flag' usage include logging in during odd hours (over the weekend and in the middle of the night) or unusual activity not typical of specific users. Cloud computing can also lessen the risks by making it more difficult to actively 'transport' data away from secure premises. "According to an HHS database, more than 40% of medical data breaches in the past two and a half years involved portable media devices such as laptops or hard drives" (Schultz 2012)
Q3. How can we minimize injury and harm after such incidents occur?
First and foremost, it is important to inform the affected patients of the nature and extent of the security breach. Patients can take action by putting a credit freeze on their accounts, if they are at risk for identity theft. Offering patients free credit protection might be one way to reduce anger and concern. Passwords must be…… [Read More]
Another way to put the patient at ease during moments like this is for the nurse to be absolutely certain that she is not showing any signs of being judgmental. If this happens, it could throw the patient off guard and create an uncomfortable situation where the patient no longer feels comfortable being honest with the nurse. Once this happens, the nurse will have an inaccurate patient history and the patient runs the risk of not being treated properly for the underlying symptoms.
In order for the history to be as accurate as possible, the nurse should ask questions regarding several issues that may affect the patient's health. The patient's past medical history is vitally important to the process because it can serve as a guide to what has worked in the past and what treatments are ineffective. The patient's mental health is also important. This will give the nurse…… [Read More]
patient was admitted due to a broken hip which required a total hip replacement (TH). This injury has required two weeks of in-hospital rehabilitation to this point, and Mr. Trosak will probably need more physical rehabilitation to completely recover from the injury. Since there are secondary concerns (such as some loss of cognitive function (text, 462)) after a fall, it will be necessary to monitor M. Trosak. The falling incident could also reoccur due to the fact that the patient resides on the second floor of his apartment building. It will be necessary to ensure that Mr. Trosak understands the risk of a recurrence, and that he has sufficient assistance.
Prior to being hospitalized for the fall, Mr. Trosak was not taking any prescription medication, and he has not had a physical examination for more than ten years. While admitted, the patient was found to have chronic hypertension, which is…… [Read More]
Communication Discussion Board Response
I would have to respectfully disagree with the idea that communication is mainly about being clear in one's verbal and nonverbal language. A nurse can clearly communicate how to follow a healthy diet to a diabetic -- or the need to stay clean to a drug addict -- but unless the nurse comprehends the patient's own view of his or her situation, such as the real medical need to follow the diet or the dangers of drug abuse, communication has not transpired in an effectual fashion. It is just as important that the nurse understand the patient's body language, to assess whether he or she is listening, and to ask the patient to restate the treatment plan, and to repeat what he or she feels about his or her condition.
You make a very important point that the process of communicating with patients isn't about…… [Read More]
Medical ethics and rules like the Hippocratic oath are fairly clear-cut when applying them to real-world solutions and situations. However, there are some situations where the "right answer" can be elusive and people will sometimes go against their own self-interest. Such seems to be the case with Mr. Simpson. He has weak lungs and his doctors and family morbidly fear that if/when he gets the flu again, it will literally kill him. However, even with this being the case, Mr. Simpson refuses to get the flu show under the auspices that he could end up getting the flu as a direct result of the shot despite assurances that this will not happen. Of course, this can absolutely happen in real life but that argument is not a factor in this case study as it is assumed he cannot possibly contract the virus. While Mr. Simpson is obviously not making the…… [Read More]
Patient Safety Against Injurious Falls
A White-Paper Testimony on Current Risks
With more than a thousand preventable deaths a day, the need to pay greater attention to improving current patient safety conditions and standards is unquestionable (Gandhi, 2014). This was the gist of a testimony to the U.S. Senate Committee on Health, Labor, Education and Pensions Subcommittee on Primary Health and Aging. The white paper discussed the current safety risks faced by ambulatory patients in the hospital setting. This has been the direction of the patient safety movement since 15 years with emphasis on ambulatory safety problems. Recent studies identified the major safety issues confronting hospital settings. These include medication safety, missed or delayed diagnoses, transitions of care, patients' non-adherence to medication (Gandhi) and poor clinician communication with patients (Schnall et al., 2012). The last issue was the finding of a recent survey of 162 registered nurses attending an…… [Read More]
Incontinence is another condition not frequently intimated to their doctor. Less than a third of them actually report falls despite the availability of initiatives and measures, which can address falls. These include home-based exercises, home environment assessment, cataract surgery, medication review and Vitamin D and calcium supplements (CFA).
Falls Prevention Intervention
Studies reveal the importance of physical activity in preventing or reducing the risk of falls among older persons in the community and at home (Rose 2007). There is, however, limited evidence at present that physical activity benefits very weak ones in care facilities. Physical activity promises benefit to healthy older adults against the risk of falls. Those at moderate risk, on the other hand, will gain more from structured exercise programs aimed at risk factors, which can be manipulated or changed. They can be adjusted to progress according to the individual's capabilities and earlier physical activity experience. And those…… [Read More]
According to the Centers for Disease Control, muscle-related problems and a lack of exercise account for about 24% of the falls in subacute facilities. Other causes, which can also be easily addressed within subacute facilities, "include wet floors, poor lighting, incorrect bed height, and improperly fitted or maintained wheelchairs" (Falls in nursing homes, 2010, CDC). These types of environmental hazards are estimated to cause 16% to 27% of falls for patients. Even seemingly unavoidable problems such as medications that interfere with coordination can be mitigated by flagging the individual as taking such a drug, and notifying staff that additional care of the patient is required.
In the instances of patients with dementia, or those who cannot care for themselves enough to learn to improve their balance skills to mitigate the risk of falls, measures other than educational endeavors should be undertaken. "Grab bars, adding raised toilet seats, lowering bed heights,…… [Read More]
isks for Falls
'isks for falls' have been an area of concern for medical professionals especially nurses. Statistics have shown that an increasing number of falls in hospitals and hospice settings not only raises question marks on the services provided to the patients along with negative consequences for the healthcare professionals and patients but also increases the overall costs of providing healthcare services. There are various researches which have shown that following clinical practice guidelines (CPGs) has found to reduce the number of falls substantially however the effectiveness of these CPGs is mainly dependent on the experiences of the healthcare professionals and patients after falls along with the impact of social factors such as community obligation, organizational resources, and individual resources.
esearch by Stenberg and Wann-Hansson (2011) has shown that the in order to comply with the provided CPGs, personal experience after the event of falls plays a…… [Read More]
As the percentage of older Americans continues to increase, the need for timely and accurate assessment screens and the formulation of effective clinical interventions will become even more pronounced. Fortunately, the research also showed that there are a number of assessment tools that are available to facilitate the process, including sophisticated multifactor instruments with proven validity and reliability. One of the more important issues to emerge from the research concerned the need for individualized interventions that draw on strengths and interests in order to minimize the risk factors that are involved.
Faber, M., Bosscher, .J. & Van Wieringen, P.C. (2006). Clinimetric properties of the performance-oriented mobility assessment. Physical Therapy, 86(7), 944-954.
Functional assessment. (2012). NursingLink. etrieved from http://nursinglink.monster.com / training/articles/331-functional-assessment-the-key-to-geriatric-care-in-the-21st-
Gates, S. & Smith, L., Fisher, J.D. & Lamb, S.E. (2008, October 1). Systematic review of accuracy of screening instruments for predicting fall risk among independently living older…… [Read More]
Osteomyelitis in the Diabetic Patient
Management OF OSTEOMYELITIS IN THE DIABETIC PATIENT
Osteomyelitis is an infection of the bone or bone marrow which is typically categorized as acute, subacute or chronic.1 It is characteristically defined according to the basis of the causative organism (pyogenic bacteria or mycobacteria) and the route, duration and physical location of the infection site.2 Infection modes usually take one of three forms: direct bone contamination from an open fracture, puncture wound, bone surgery, total joint replacement, or traumatic injury; extension of a soft tissue infection such as a vascular ulcer; or hematogenous (blood borne) spread from other infected areas of the body such as the tonsils, teeth or the upper respiratory system.2(p807) Bacteria such as Staphylococcus aureus, Pseudomonas, Klebsiella, Salmonella, and Escherichia coli are the most common causative agents of the disease, although viruses, parasites and fungi may also lead to the development of osteomyelitis.3
Patients…… [Read More]
Mitigating isks from Dementia
Providing adequate care for an individual suffering from dementia presents many difficulties for nurses. Patients with dementia often have debilitating conditions such as Alzheimer's or similar neurologic diseases which are progressive, thereby making it challenging for them to remember, think lucidly, communicate effectively or complete activities of daily living. Furthermore, dementia can cause rapid variations in mood or even modify personality and behavior. With the tremendous number of elderly in society more and more nurses are required to care for patients with progressive dementias. It is imperative that a diagnosis be reached early in the course of the cognitive impairment and that the patient is closely monitored for coexisting morbidities. Nurses have a central role in assessment and management of individuals with progressive dementia. This essay provides some evidence-based practical strategies for managing the behavioral problems and communication difficulties often encountered in this population.…… [Read More]
This is a legislator information sheet on nurse-patient ratios (as adapted from Aikan et al. 2010) for a busy legislator who will only have time to read bullet points:
The ratio of nurse patient is lower in California than in other states with nurses in CA having at least one patient less than nurses have in other states (as for instance in New Jersey and in Pennsylvania as mentioned in Aikman et al. (2010))
California nurses had lower nurse-patient ratio on medical and surgical units when compared to other states. The average amongst CA nurses was 2 patients less than those in other states.
The lower the nurse-patient ration, the lower the level of mortality amongst patients
When nurses' workloads paralleled those of workloads of Californian nurses, the following results occurred:
a. nurses' burnout decreased
b. nurses' job dissatisfaction decreased
c. nurses reported consistently better quality of care…… [Read More]
Consider the case of Mr. a, the irrational quadriplegic who has little movement from the neck down, and lives in a nursing home. He is irrational in his behavior, and often demands very explicit forms of treatment, and then rejects or refuses these treatments or other treatments. He has become violent on occasion, and has created problems between patients and staff. He has been expelled from one nursing home, and may be from another. The home is bound to treat him, as he desires care and chose the nursing home. However, if he harms staff or other patients in any way, the nursing home is bound to provide a safe environment, and Mr. A is a detriment to the health and safety of others. In that case, the facility can refuse treatment for the good of the many, rather than the good of one patient. The author of the article…… [Read More]
" hen and if the U.S. cuts back on the use of fossil fuels to reduce global warming, other nations may well follow our example.
To wit, when we allow the United Nations to conduct searches for potential weapons of mass destruction in our own country, or in countries we have disputes with, other nations may follow and allow inspectors into their country as well. It is idealistic to believe that other nations will do the right thing if only we do the right thing first, but there's no rule that says foreign policy can't have idealism. America was founded on the principals of idealism -- "In order to form a more perfect union" -- and on the other hand America was founded on realism too. If we don't cut the cord with England, we will forever be beholding to tyrants.
right understands that the U.S. can never say we…… [Read More]
ED Patient Boading |
Emegency Depatment Patient Boading
Emegency Depatment (ED) cowding is a nationwide cisis which affects the efficiency and the quality of patient cae (Sox, Bustin, Oav, et al., 2007). A huge contibution to patient ove-cowding is the boading of admitted patients in the ED. An altenative use of time which is lost in the admitting of patients is used to teat patients who ae waiting to be seen; this is seen typical in ove-cowded EDs. The ovecowding of EDs esult in isking patient safety and altenatives to this should be obseved.
Holding admitted patients in EDs always was known to be bad fo patient flow, but thee is a gowing body of eseach showing that it also hams patients. Thee is significant evidence which demonstates that ED cowding due to boading is esponsible fo poo outcomes (Sox, Bustin, Oav, et al., 2007). In many hospitals, it is…… [Read More]
In some cases, only a few patients are unable to go through this procedure and will therefore need a surgically placed gastrostomy tube. The most appropriate procedure for this tube placement is usually determined by the radiologist.
Unlike the surgically placed gastrostomy tubes, the PEG tubes are usually appropriate for long-term use and can stay in the appropriate position for a number of months. Currently, due to their design, they necessitate an endoscopic removal for a patient under general anaesthetic for the initial replacement or removal.
The final category of gastrostomy tubes are the skin tubes that are usually shorter than any other category of the tubes and sit flush with the skin. The skin gastrostomy tubes consist of a mushroom-shaped or balloon end which rests inside the belly and prevents them from falling out. The skin gastrostomy tube are widely considered as the low profile category of…… [Read More]
Thus, if any of us was one of the "actors', we would be tempted to judge each alternative in a subjective manner. If we were the patients, the AECL board or the hospitals we would want Therac-25 to be approved. If we were the public or FDA we would want the equipment out of the market.
The main alternative to the reality would have been for AECL to take under consideration a software error. One other alternative would have been for the company to assign more accurate probabilities for hazard occurrence, while running the Fault Tree Analysis. Finally, the third alternative would have been to use a better method to determine hazard occurrence. A better method is a method that would have been capable to return higher risks associated with the use of Therac-25 and which would have determined AECL to adjust the equipment. The first alternative is superior to…… [Read More]
Gonzalez (2007), discusses the company WellPoint Inc. that provides its members with the capability to develop their own personal health records, an option to receive test results online, provide a limited set of records to their providers and to allow other family members access to the information. In terms of security safeguards, WellPoint tracks who accesses information and has staff members to monitor the systems for potential breaches. This in turn offers users a certain level of security and quality in services rendered.
As pay-for-performance programs flourish, there is a fear that many EHs cannot accurately capture the data that is required to participate. The biggest obstacles for software makers are the sheer volume of performance measures and the lack of standardization among them. One pressing issue is that some EH systems are still text-based and are therefore not as powerful for reporting and extracting information. (McKinney, 2007)
Wilson (2007),…… [Read More]
There are two important things to remember when it comes to the health issues of older adults. First, older and senior adults account for the lion's share of healthcare problems and costs as compared to the younger groups. This makes sense as the body is aging and/or shutting down not to mention that the bad habits (if any) of a person in their younger years truly start to take hold and render their effects once a person reaches their 50's, if not before. Second, there are common sense and evidence-based ways to handle these issues and help improve healthcare outcomes. Rather than try to "reinvent the wheel" and/or go with unproven methods in general, it is generally better to go with what is known to be effective based on past research and initiatives. While the older groups of Americans will always have more health problems than the younger…… [Read More]
CERNER software is built to allow for an enterprise-wide view of a patient\'s clinical information in order to coordinate patient care and document at which point care was delivered especially in acute patient settings. Using the software providers will have access to the right information and at the right time within the clinical workflows in order to make the best possible decision regarding patient care (Curry, 2010). In acute patient settings, it is vital that a nurse has the right information before they start attending to a patient. This is mainly beneficial to ensure that they understand the patient\'s condition or problem before they can begin to offer care. Using the CERNER software, it is easy for a nurse to access this information and make informed decisions based on the information that has been entered regarding the patient’s condition. In acute care, real-time information is vital to the provision of…… [Read More]
I also need to know the length of time that I have scheduled to speak since professional research conventions usually allocate 10 minutes to 90 minutes for a presentation. If only a short time, I may be advised to present highlights and to give handouts of my presentation. Visual images also facilitate the learning. I will need to build in time for question and discussions.
With each audience, I should consider their specific interests and structure the speech accordingly. With non-health laypeople, for instance, I can structure it to the challenges of dealing with relations with dementia and the kind of characteristics they should look for in caregivers as well s ways that can give them less stress and give their patients more comfort in dealing with them. I should also present it in a creative way in order to make it more interesting.
When approaching journals (and there are…… [Read More]
medication for patient named KM is Prothiaden. Prothiaden is used to treat depression as well as limit the feelings of anxiety in those taking it. The case file indicates a normal MI and no previous diagnosis of neurological disorders like Parkinson's disease. Patient KM has complained of depression and anxiety related to the passing of her mother. Progressive functional and cognitive decline has presented ever since mother died four years ago.
Although the patient worked until the age of 60 as an accountant, within the last 18 months patient has experienced fluctuations in mood, confusion, mild word finding difficulties and spatial disorientation. She also has visual hallucinations and violent dreams. She experienced recent falls and a slowing of motor skills. These symptoms extend to the inability to carry out motor sequences with either hand or double alternating hand movements. Although she can detect shapes well, she has poor ability in…… [Read More]
clinical cases and examine malpractice perspectives.
Concerns over mounting healthcare expenses have resulted in increased inquiry into medical practices. With the rise of malpractice risk and medical liability to unprecedented levels, the field of medical law has influenced defensive medical practice as healthcare providers endeavor towards liability risk mitigation (Nahed, et.al, 2012).
Elements Needed to Prove Malpractice
Medical malpractice is associated with four fundamental elements, all of which have to be present for forming the base for any claim. For any case of medical malpractice to succeed, an attorney is required to prove all four aspects, which are: duty, causation, damages, and breach (What are the Elements of a Medical Malpractice Claim? n.d.). The first element -- Duty -- implies that health care professionals owe their patients the duty to take reasonable and appropriate action; i.e., the practitioner is accountable for delivering some form of treatment or care…… [Read More]
With the help of a thorough clinical evaluation, the risk factors, risks associated with falling and working out adequate intervention methods to curb the rate of elderly falls can be achieved. As per the 2011 AGS / BGS guidelines, (Panel on Fall, 2011) certain particulars need to be incorporated in a particular clinical evaluation: 1: Patient history, physical examination, mental and physical functionality; 2: Number of falls occurring, number of medications taken; issues regarding mobility, balance and gait; blurred eyesight; various mental disabilities; weak muscular strength; uneven heartbeat and rhythm; postural hypotension; problems in feet and risks related to environment (Shubert, 2014).
Strategies to Prevent Elderly Falls and Health elated Consequences
Assistive Devices and Other Protective Equipment: Appropriate footwear is required for particular conditions, for instance, wintery weather necessitates anti-slip shoes whilst warmer weather requires cleated footwear, facilitating decreased falls (Panel on Fall, 2011).
Clinical Disease Management (Acute…… [Read More]
Mr. B. was left in his room without appropriate monitoring following the administration of diaxepam and hydromrophone in order to permit reduction of his hip following a fall. The 67-year-old Mr. B. presented with several health concerns in addition to his recent fall that injured his hip.
was on a regimen of oxycodone for chronic back pain and atorvastatin, presumably for elevated cholesterol and lipids, has impaired glucose tolerance and prostate cancer. His injury notwithstanding, Mr. B.'s overall health was not optimal at the time of admission, and included risk of heart problems. The hospital policy for moderate sedation / analgesia or conscious sedation was violated. According to the policy, Mr. B. should have received continuous monitoring of B/P, ECG, and pulse oximeter throughout the procedure and until he met the specific discharge criteria, which include: fully awake, VSS, no N/V, and able to void. An experienced critical care nurse…… [Read More]
(3) Goal 13A states that the means for patients and their families should be defined and communicated in regards to reporting of concerning about safety and that encouragement should be provided for them to follow through on this.
(4) Goal 15 states that the organization "identifies safety risks inherent in its patient population; and (5) 15A states "The organization identifies patients at risk for suicide. [Applicable to psychiatric hospitals and patients being treated for emotional or behavioral disorders in general hospitals -- NOT APPLICALE to CRITICAL ACCESS HOSPITALS] (the Joint Commission, 2009)
Stated as the only change to the 2007 Disease-Specific Care National Patient Safety Goal is the noted change to 8 which adds that the complete list of medications is provided to the patient upon discharge from the health care facility. (the Joint Commission, 2009)
The work of Cooper (2009) entitled: "NYC Hospital to Educate Patients Using Opinionmeter Survey…… [Read More]
Assessment 3: Professional Accountability and Patient Safety
Defining the Issue: Violence from Patients towards Nurses:
In this discussion, I concern myself with ‘violence from patients towards nurses.’ It is important to note, from the onset, that violence meted to nurses by patients is one of the least discussed contemporary nursing issues. In the words of Stevenson, Jack, O’Mara and LeGris (2015, p. 32), “registered nurses (RNs), compared to other healthcare providers are at a higher risk of experiencing violence in the workplace that is initiated by patients and families.” In essence, violence from patients towards nurses includes any act of aggression initiated by the patient and (or) their relatives and friends and directed at the nurse. Acts of aggression in this case could include, but they are not limited to, grabbing, scratching, hitting, and in some cases shouting down the nurse in a threating manner. It is important to note…… [Read More]
Quality and Safety Education for Nurses
The issue of patient safety has been a concern to medics and the stakeholders in the health care system over many years. This has been propelled by constant emergence of life threatening injures to people visiting or working within the healthcare facilities s well as construction of buildings and entrances that do not meet the required standards of hospitals. This largely informs the basis of this paper to find out where the wrongs are and how these can be rectified to provide a good environment for patients.
The patient safety is as important as the rescue of the life of a patient when he walks into the hospital to seek medical attention. The nurses and doctors are hence required to adhere to the call of the Nursing and Midwifery Council of "Nurses and nursing staff manage risk, are vigilant about…… [Read More]
Application: Systems Theory
Healthcare organizations provide nursing services centered on multiple theories. For instance, the Open Systems Theory established in 1978 by Katz and Kahn considers the healthcare organization as social systems divided into interconnected subsystems (Meyer & O’Brien-Pallas, 2010). Meyers and O’Brien-Pallas (2010) provide that these interrelated subsystems include outputs, throughputs, inputs, negative feedbacks and a cycle of events. The primary care hospital environment has various units that handle different cases including the intensive care, intermediate care, medical-surgery, emergency department (ED) etcetera. This paper delves into system theory in the emergency department, identify goals and challenges in this department and establishes an appropriate structural outcome.
Subsystems in Emergency Department
In the emergency department, the inputs include financial resources, supplies, and staffing needed for the unit to be functional. The emergency department is in operation all day and night and needs sufficient nurses and subordinate staff to give a throughput…… [Read More]
Spirit Catches You and You Fall
There were a number of different delivery systems models in place and which attempted to effect positive care for Lia Lee and her family in Anne Fadiman's The Spirit Catches You and You Fall Down. One can successfully argue that more than one model was used throughout the duration of the book for the simple fact that there were a number of barriers preventing success from any of the models due to the simple fact that Lia's family were Laos immigrants with little cultural understanding of the United States. However, it is fairly evident that the model that was initially used and used more than any others in this work of literature was the medical model. The medical model is commonly used within westernized society and is the oldest of the three traditional models (which includes the public health and the human services model,…… [Read More]
health issue of falls among the elderly in Canada.
Community Health Problem
The major reason behind the Canadian seniors' hospitalization is fall-related injury. Approximately 20% to 30% seniors fall in a year. For instance, Canadian Community Health Survey statistics shows mostly over 80-years older seniors, 20% living in the community are fall (Seniors' Falls in Canada: Second eport - Public Health Agency of Canada, n.d).
Extent of the Problem
256,011 older Canadians suffered from fall-related injuries in 2009/2010. Comparing with injured people, other than fall-related, percentage was higher in females over 74-year age (63.6% as compared to 54.3%). Statistically, difference based on marital status was also notable. 55.9% fall-related injured people were married as compared to other injured that were 63.6%. Furthermore, 31% of the fall-related injured people were widows as compared to 23.6% other injured people. In this education group, 30% people had fall related injury as compared to…… [Read More]
Spirit Catches You and You Fall Down is a book by Anne Fadiman about cross-cultural communications, or lack thereof, in the American health care system. The book is about a child named Lia Lee. Lia Lee was the first in her family to be born in the United States. Her parents are Hmong, which is a hill tribe that was settled mainly in Laos and which helped the American government during the War in Vietnam. The Hmong were displaced and persecuted, and thus afforded refugee status. This book is about how the immigrants spoke no English, had different values toward health care, and were therefore excluded from receiving the quality of care needed. As a result, their daughter was taken away from them and eventually Lia Lee became a vegetable and recently died.
When Lia Lee was an infant, she had her first epileptic seizure. However, doctors misdiagnosed the disease…… [Read More]
Patients in hospitals often complain of pain regardless of the diagnosis. Several activities in a patient's life contribute to pain. Some of the activities include amount of sleep, daily chores and quality of life (Alaloul, Williams, Myers, Jones, & Logdson, 2015). While health care expenses have increased significantly over the years, there have been great improvements in increasing both family and patient involvement in medical care. Hourly care is one of the strategies that have worked well in various healthcare settings. Hourly care has been a success in various areas but using it in urgent pediatric settings hasn't been well documented (Emerson, Chumra, & Walker, 2013). Opportunities still exist to look into pediatric family preferences and perspectives as pertains to the use of whiteboards (Cholli, et al., 2016). Several studies have been done in different setups and this paper references many of them. The research projects include in-patient surveys, quasi-experimental…… [Read More]
Nutrition: Ethical or Unethical?
Should nurses withhold or withdraw nutrition & Hydration from terminally ill patients? This is a question that boggles the mind. Some feel that withholding anything from any patient is unethical, while others feel it is acceptable because we must promote quality of life. Furthermore, who decides within this issue the outcome of the patient? Nurses? Nurses? The Court? Recently, we have decided on a combination of the two. However, in order to discover what is actually best for patients, it is important to exmaine this paper.
What care is 'futile'? Throughout the years, the question of whether or not to withhold certain treatments to terminally ill patients has been addressed. Do we continue to treat people who are still alive, even if we know that there is no hope? This is a question that has been asked over and over again by various parties. This notion…… [Read More]
Environmental Interventions for Patients With Dementia
Dementia is a neurocognitive disorder that has been treated in various ways throughout all history. The modern era has proposed pharmacological interventions in the past but these have proved dangerous and degrading to the quality of life that dementia patients and their loved ones prefer. For this reason, environmental interventions have emerged as an alternative method for treating elderly dementia patients. This intervention method consists of altering the environment in which the patient lives by accommodating for the needs of the patient with clearly identifiable pathways, open spaces for communication, naturalistic settings, adequate stimuli and private rooms for quiet. This paper discusses the fundamental principles of environmental interventions for patients with dementia and includes a justification for this approach as a suitable alternative to prevailing psychoactive drug interventions. It also includes a discussion of the historical context of the disorder, its current description according…… [Read More]