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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…
Hitcho EB, et al. (2004). Characteristics and circumstances of falls in a hospital setting: a prospective analysis. J Gen Intern Med;19(7):732-9.
Landro L. (2005). The informed patient: hospitals aim to curb injuries from falling; risk for young patients. Wall Street Journal: Mar 23;D1, D7.
National Center for Injury Prevention and Control. Division of Unintentional Injury Prevention. Falls among older adults: an overview. Centers for Disease Control and Prevention. 2008. Available at http://www.cdc.gov/ncipc/factsheets/adultfalls.htm .
U.S. Department of Veteran's Affairs. Morse Fall Scale. Available at http://www.patientsafety.gov/CogAids/FallPrevention/index.html#page=page-4
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…
Suda, M., et al. (2008). Emotional Responses to Music: Towards Scientific Perspectives on Music Therapy. Neuroreport. 19 (1): 75-8.
Taylor, D., et al. (2011). Effectiveness of Tai-Chi as a Community-Based Falls prevention Intervention. Journal of the American Geriatric Society. 60 (5): 841-8.
Tomkins, C. And Orwat, J. (2010). A randomized trial of telemonitoring heart failure patients. Journal of Healthcare Management. 55 (5): 312-22.
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…
Mandl, L.A., lyman, S., Quinlan, P., Bailey, T., Katz, J. & Magid, S.K. (2013). Falls Among Patients Who Had Elective Orthopaedic Surgery: A Decade of Experience from a Musculoskeletal Specialty Hospital. Journal of orthopaedic & sports physical therapy, 43(2), 91-96.
Quigley, P. & White, S. (May 31, 2013). Hospital-Based Fall Program Measurement and Improvement in High Reliability Organizations, OJIN: The Online Journal of Issues in Nursing Vol. 18, No. 2
Vitor, A.F., Moura, L.A., Fernandes, A.P., Botarelli, F.R., Araujo, J.N. & Vitorino, I.C. (2015). Risk for Falls in Patients in The Postoperative Period, Cogitare Enferm. 20(1):29-37.
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…
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…
Vernikos, J. (2011). Sitting Kills, Moving Heals: How Simple Everyday Movement Will Prevent Pain, Illness, And Early Death-- And Exercise Alone Won't. Fresno, Calif: Quill Driver Books
Vincent, C. (2010). Patient Safety. Chichester, West Sussex: Wiley-Blackwell.
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…
CDC (2012). Adult falls. Web. Accessed at: http:/ / www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.htm
Currie, LM. (2006). Fall and injury prevention. Annual Review of Nursing Research. 24(1):39-74.
Fischer ID; Krauss MJ; Dunagan WC et al. (2005). Patterns and predictors of inpatient falls and fall-related injuries in a large academic hospital. Infection Control and Hospital Epidemiology. 26(10):822-7.
Grubel, F. (1959) Falls: A principal patient incident. Hosp Manage. 88:37-8.
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…
Measuring Health Care Chapter 2. Fundamentals of Data (Chap. 2)
K.R. Tremblay Jr., and C.E. Barber (2005) Preventing Falls in the Elderly
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…
Falls in Nursing Homes. (n.d.). Retrieved from Centers for Disease Control and Prevention: http://www.cdc.gov/HomeandRecreationSafety/Falls/nursing.html
Patient falls: How to prevent them. (n.d.). Retrieved from patient Safety Partnership: http://www.patientsafetypartnership.org/Patient_Falls.html
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…
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…
Beauchamp, TL and Childress, JF (2001) Principles of Biomedical Ethics. Oxford University Press. 15 Feb 2001. Retrieved from: http://books.google.com/books?id=_14H7MOw1o4C&source=gbs_navlinks_s
Coghlan, A.K (2012) New Cancer Drug Sabotages Tumor's Escape Route. 24 Feb 2012. New Scientist. Retrieved from: http://www.newscientist.com/article/dn21516-new-cancer-drug-sabotages-tumours-escape-route.html
Beauchamp, TL and Childress, JF (2001) Principles of Biomedical Ethics. Oxford University Press. 15 Feb 2001. Retrieved from:
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,…
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.
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…
Barber, N., Parsons, J., Clifford, S., Darracott, R., & Horne, R. (2004). Patients' problems with new medication for chronic conditions. Quality and Safety in Healthcare. 13(3): 172-175.
Chatterjee, J. (2006). From compliance to concordance in diabetes. Journal of Medical Ethics. 32(9): 507-510.
Chisholm, M., Lance, C. & Mulloy, L. (2005). Patient factors associated with adherence to immunosuppressant therapy in renal transplant recipients. American Journal of Health- System Pharmacy. 62 (17): 1775-1781.
Eastern, J. "Dismissing Patients Properly." 1 Jun 2006. OB/GYN News. Accessed 11 Sept. 2008. http://findarticles.com/p/articles/mi_m0CYD/is_/ai_n26906768 .
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…
Michael Rothberg, 2005. Improving Nurse-to-Patient Staffing Ratios as a Cost-Effective Safety Intervention Med Care 2007;45: 571-578)
Patricia W. Stone, PhD,* Cathy Mooney-Kane,
Nurse Working Conditions and Patient Safety Outcomes.
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…
Block, Bruce. The Visual Story, Second Edition: Creating the Visual Structure of Film,
TV and Digital Media. Focal Press; 2nd edition, 2007. Print.
Ebert, Roger. "The Fall." The Sun Times. Web. Accessed on January 25, 2011:
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…
A., B. (2012). Research methods in health: investigating health and health services. United Kingdom: Open University Press.
Campbell AJ, R. M. (2013). Rethinkingindividual and community fall preventionstrategies: a meta- regression comparingsingle and multifactorial interventions. Age and Ageing, 21(6), 656-662.
JM., H. (2009). Cognitive and Emotional benefits of exercise may mediate fall reduction. British Medical Journal, 128, 325(.
Lord SR, T. A. (2013). The effect of an individualized fall prevention program on fallrisk and falls in older people: A Randomized Controlled Trial. Journal of the American Geriatrics Society, 14(8), 1296-1304.
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…
Anuradha Thirumalai, (1998). Nursing Compliance with Standard Fall Prevention
Protocol Among Acute Care Hospital Nurses. Retrieved September 26, 2012 from http://digitalscholarship.unlv.edu/cgi/viewcontent.cgi?article=1191&context=thesesdissertations&sei-redir=1&referer=http%3A%2F%2Fwww.google.co.ke%2Furl%3Fsa%3Dt%26rct%3Dj%26q%3Dnursing%2520compliance%2520with%2520standard%2520fall%2520preventionprotocol%2520among%2520acute%2520care%2520hospital%2520nurses%26source%3Dweb%26cd%3D1%26ved%3D0CCAQFjAA%26url%3Dhttp%253A%252F%252Fdigitalscholarship.unlv.edu%252Fcgi%252Fviewcontent.cgi%253Farticle%253D1191%2526context%253Dthesesdissertations%26ei%3Dg-NiUPW8CuLB0QW_r4DgAw%26usg%3DAFQjCNE6__5zNu8vjRxc-jIFBXbBfKVIng#search=%22nursing%20compliance%20standard%20fall%20preventionprotocol%20among%20acute%20care%20hospital%20nurses%22
Dykes, P.C., Carroll, D.L., Hurley, A.C., Benoit, A., & Middleton, B. (2009). Why do patients in acute care hospitals fall? Can falls be prevented? Journal of Nursing Administration, 39(6), 299-304. doi:10.1097/NNA.0b013e3181a7788a
Laurence Z. Rubenstein, Karen R. Josephson & Alan S. Robbins, (1994). Falls in the Nursing
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…
Colon-Emeric, C., Schenck, A., Gorospe, J., McArdle, J., Dobson, L., Deporter, C., & McConnell, E. (2006). Translating Evidence-Based Falls Prevention into Clinical Practice in Nursing Facilities: Results and Lessons from a Quality Improvement Collaborative. Journal of the American Geriatrics Society, 1414-1418.
Renteln-Kruse, W., Krause, T., & Georgr, D. (2007). Incidence of In-Hospital Falls in Geriatric Patients Before andAfter the Introduction of an Interdisciplinary Team -- BasedFall-Prevention Intervention. The American Geriatric Society, 2068-2076.
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…
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:
Aberg AC, Lundin-Olsson L, Rosendahl E. (2009). Implementation of Evidence-Based Prevention of Falls in Rehabilitation Units: A Staff's Interactive Approach. J Rehabil Med 41(13): 1034-40.
American Nurse Today. (2012). Special Supplement to American Nurse Today - Best Practices for Falls Reduction: A Practical Guide - American Nurse Today. Retrieved January 22, 2016, from http://www.americannursetoday.com/special-supplement-to-american-nurse-today-best-practices-for-falls-reduction-a-practical-guide-2/
KanolanK. (n.d.). Nursing 110 final. Retrieved January 22, 2016, from https://quizlet.com/20498057/nursing-110-final-flash-cards/
McHugh, M. D., & Lake, E. T. (2010). Understanding clinical expertise: nurse education, experience, and the hospital context. Research in nursing & health, 33(4), 276-287.
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…
Alireza, N., 2014. Evidence of Using FOCUS PDCA. [Online]
Available at: http://npmcweb-en.tbzmed.ac.ir/Uploads/37/cms/user/File/54/MEP/Effectiveness.pdf
[Accessed 10 December 2015].
Anon., 2015. What is the quality improvement process?. [Online]
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…
Schultz, D. (2012). As patients' records go digital, theft and hacking problems grow
Kaiser Permanente Health News. Retrieved: http://www.kaiserhealthnews.org/Stories/2012/June/04/electronic-health-records-theft-hacking.aspx
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…
Lloyd, H. And Craig, S. (2007). A guide to taking a patient's history. Nursing Standard. 22(13),
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…
Smith, M., & Segal, J. (2011). Depression in older adults and the elderly. Retrieved from http://www.helpguide.org/mental/depression_elderly.htm
Vanwanseele, B. (2009). To rehab or not to rehab following a total hip replacement. Retrieved from http://sydney.edu.au/research/opportunities/opportunities/561
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…
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…
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…
Cripps, R. 2001, 'Deaths from falls in the elderly top 1,000-year,' Australian Institute of Health and Welfare [Online] Available at http://www.aihw.gov.au/media-release=detail/?id=6442464404
CFA 2011, 'Fall rates need to fall further,' Continence Foundation of Australia [Online]
Available at http://www.continence.org.au/news.php/38/fall-rates-need-to-fall-further
Ory, M.G. et al. 2009, 'Implementing and disseminating on evidence-based program to prevent falls in older adults, Texas, 2007-2009,' Preventing Chronic Disease [Online]
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…
Rycroft-Malone J. (2004). The PARiHS framework -- A framework for guiding the implementation of evidencebased practise. Journal of Nursing Care Quality, 19(4), 297 -- 304.
Rycroft-Malone J., Harvey G., Seers K., Kitson A., Mc- Cormack B. & Titchen A. (2004). An exploration of the factors that influence the implementation of evidence into practise. Journal of Clinical Nursing, 13, 913 -- 924.
Rycroft-Malone J., Kitson A., Harvey G., McCormack B., Seers K., Titchen A. & Estabrooks C. (2002). Ingredients for change: Revisiting a conceptual framework. Quality Safe Health Care, 11, 174 -- 180.
Semin-Goossens A., Van Der Helmi J.M.J. & Bossuyt P.M.M. (2003). A failed model-based attempt to implement an evidence-based nursing guideline for fall prevention. Journal of Nursing Care Quality, 18(3), 317 -- 325.
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…
Faber, M., Bosscher, R.J. & Van Wieringen, P.C. (2006). Clinimetric properties of the performance-oriented mobility assessment. Physical Therapy, 86(7), 944-954.
Functional assessment. (2012). NursingLink. Retrieved 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 adults. Journal of Rehabilitation Research & Development, 45(8), 1105-1113.
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
1. Stedman's Medical Dictionary. 27th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2000.
2. Butalia S, Palda V, Sargeant R, Detsky A, Mourad O. Does This Patient With Diabetes Have Osteomyelitis of the Lower Extremity?. JAMA: Journal of The American Medical Association [serial online]. February 20, 2008; 299(7):806-813. Available from: Academic Search Premier, Ipswich, MA. Accessed September 19, 2012.
3. Lavery L, Peters E, Armstrong D, Wendel C, Murdoch D, Lipsky B. Risk factors for developing osteomyelitis in patients with diabetic foot wounds. Diabetes Research & Clinical Practice [serial online]. March 2009; 83(3):347-352. Available from: Academic Search Premier, Ipswich, MA. Accessed September 19, 2012.
4. Turns M. The diabetic foot: an overview of assessment and complications. British Journal of Nursing [serial online]. August 12, 2011;:S19-S25. Available from: Academic Search Premier, Ipswich, MA. Accessed September 19, 2012.
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.…
Aud, M.A., Oliver, D., Bostick, J. And Schwarz, B. 2011. Effectiveness of Social Model Care Units for Dementia. International Nursing Research Congress 2005.
Care, N.D. 2010. Teaching and Learning. Pulse. Winter Edition.
Fletcher, S. And Zimmerman, S. 2010. Trainee and trainer reactions to a scripted dementia care training program in residential care/assisted living settings and nursing homes. Alzheimer's Care. 11(1): 61-70.
Goodman, C. 2011. The organizational culture of nursing staff providing long-term dementia care is related to quality of care. Evidence-Based Nursing. 47:1274-1282.
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…
Abood, S. (2007). Influencing health care in the legislative arena. Online Journal of Issues in Nursing, 12(1), 12 pp.
Aikan, L.H., Sloane, D.M., Cimiotti, J.P., Clarke, S.P., Flynn, L., Seago, J.A., Spetz, J., & Smith, H. (2010, April 9). Implications of the California nurse staffing mandate for other states. Health Services Research. Retrieved from http://www.nursing.upenn.edu/chopr/Documents/Aiken.2010.CaliforniaStaffingRatios.pdf
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…
Hord, J.D., Rehman, W., Hannon, P., Anderson-Shaw, L. And Schmidt, M.L. (2006). Do parents have the right to refuse standard treatment for their child with favorable-prognosis cancer? Ethical and legal concerns. Retrieved from the Journal of Clinical Oncology Web site: http://jco.ascopubs.org/cgi/content/full/24/34/545417 Oct. 2007.
Richards, E.P. And Rathbun, K.C. (2007). Medical risk management. Retrieved from the Louisiana State University Web site: http://biotech.law.lsu.edu/books/aspen/Aspen-Chapter-9.html17 Oct. 2007.
Silvers, a. (2007). The individual rights of the difficult patient. The Hastings Center Report, 37(2), 13+.
" 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…
Wright, Robert. (2006). An American Foreign Policy That Both Realists and Idealists Should
Fall in Love with. The New York Times. Retrieved February 3, 2011, from http://www.nytimes.com .
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…
references for boarding locations when hospitals are at full capacity. Ann Emerg Med.
Greene J. (2007). Emergency department flow and the boarded patient: how to get admitted patients upstairs. Ann Emerg Med. 49: 68-70.
Holliman CJ, Wuerz RC, Kimak MJ, et al. (1995). Attending supervision of nonemergency medicine residents in a university hospital ED. Am J. Emerg Med. 13:259 -- 61.
Richardson DB. (2006). Increase in patient mortality at 10 days associated with emergency department overcrowding. Med J. Aust. 184: 213-216.
Sox CM, Burstin HR, Orav EJ, et al. (1998) The effect of supervision of residents on quality of care in five university-affiliated emergency departments. Acad Med.73:776 -- 82.
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…
Bentham J. (1996) "The Principles of morals and legislation," Oxford, England: Clarendon Press.
Griffin J. (1986), "Well Being," New York: Oxford University Press.
Margolis H. (1996), "Dealing with risk: why the public and the experts disagree on environmental issues," Chicago, IL: University of Chicago Press.
Roberts, M.J. & M.R.Reich (2002), "Ethical analysis in public health," the Lancet, Vol. 359: pp. 1055-1059.
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)
Burda, D. (2007, June 4). Hey, you asked for it. Modern Healthcare, 37(23), p.25.
Cavolo, D.J. (2007, July). Electronic medical record system: know the cost of ownership. Nursing Homes, 56(7), pp. 17-19.
Evans, M. (2007, July 30). Push for Quality Starts with it. Modern Healthcare, 37(30), pp.22,24,28.
Freudenheim, M. (2005, September 19). Doctors collaborate to find less costly way to add electronic medical records. New York Times, p. C4.
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…
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…
Byrne, M. Disseminating and presenting qualitative research findings - Research Corner
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…
Armstrong, M., Litvan, I., Lang, A., Bak, T., Bhatia, K., Borroni, B., Boxer, A., Dickson, D., Grossman, M., Hallett, M., Josephs, K., Kertesz, A., Lee, S., Miller, B., Reich, S., Riley, D., Tolosa, E., Troster, A., Vidailhet, M. and Weiner, W. (2013). Criteria for the diagnosis of corticobasal degeneration. Neurology, 80(5), pp.496-503.
Ballard, C., Jacoby, R., Del Ser, T., Khan, M., Munoz, D., Holmes, C., Nagy, Z. and Perry, E. (2004). Neuropathological Substrates of Psychiatric Symptoms in Prospectively Studied Patients With Autopsy-Confirmed Dementia With Lewy Bodies: American Journal of Psychiatry: Vol 161, No 5. American Journal of Psychiatry, [online] 161(5), p.843. Available at: http://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.161.5.843 [Accessed 19 Sep. 2015].
Burke, A., Yaari, R., Tariot, P., Dougherty, J., Fleisher, A. and Brand, H. (2012). The Shadow People. The Primary Care Companion For CNS Disorders.
Ciro, C., Hershey, L. and Garrison, D. (2013). Enhanced Task-Oriented Training in a Person With Dementia With Lewy Bodies. American Journal of Occupational Therapy, 67(5), pp.556-563.
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…
Florida Healthcare Law (n.d.). - A Florida Medical Malpractice Blog - Shoulder Dystocia Erbs Palsy. What are the Elements of a Medical Malpractice Claim? -- Florida Healthcare Law - A Florida Medical Malpractice Blog - Shoulder Dystocia Erbs Palsy. Retrieved March 8, 2016, from http://floridahealthcarelaw.com/what-are-the-elements-of-a-medical-malpractice-claim/
Kurreck, & Twersky. (2012). Home -- AHRQ Patient Safety Network. Residual Anesthesia: Tepid Burn -- AHRQ Patient Safety Network. Retrieved March 8, 2016, from http://psnet.ahrq.gov/webmm/case/276
Nahed, B., Babu, M., & Smith, T. (2012, June 22). Malpractice Liability and Defensive Medicine: A National Survey of Neurosurgeons. Retrieved March 7, 2016, from http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0039237
Saltzman, J. (2008, January 29). Medical Malpractice Attorneys Lubin & Meyer -- Boston, MA, NH, RI. Family Sues in Operating Room Fall - Wrongful Death Lawsuit. Retrieved March 8, 2016, from http://www.lubinandmeyer.com/news/or_fall.html
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…
Clemson, L., Mackenzie, L., Ballinger, C. & Close, J.C.T. (2008). Cumming RG. Environmental interventions to prevent falls in community-dwelling older people: A meta-analysis of randomized trials. J Aging Health. 20(8):954-971.
Gillespie, L.D., Robertson, M.C., Gillespie, W.J., Lamb, S.E., Gates, S., and Cumming, R.G. (2009). Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. (2), Art.No.: CD007146
Panel on Fall prevention in Older Persons, American Geriatrics Society and British Geriatrics Society, (2011). Summary of the Updated American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons. J Am Geriatr Soc.;59(1):148-157.
Scott V, Gallagher E, Higginson A, Metcalfe S, & Rajabali F. (2011). Evaluation of an evidence-based education program for health professionals: The Canadian Falls Prevention Curriculum (CFPC). Journal of Safety Research. 42(6):501-507.
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…
RCA Train. Retrieved http://vaww.ncps.med.va.gov/RCAtrain.html
Patient Safety. Gov. Retrieved
Quality One. Retrieved
(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…
Stoessel, Kathleen B. (2009) the Joint Commissions' National Patient Safety Goals: Implications for Infection Preventionists. Virgo Publishing. 2009 July 08. Online available at: http://www.vpico.com/articlemanager/printerfriendly.aspx?article=252020
Powell, Stephen M. (2009) Can the Ambulatory Care Setting Learn Lessons from Other High Risk Domains. Advocate MD. Online available at: http://www.advocatemd.com/downloads/risk_management/CantheAmbulatoryCareSettingLearnLessons.pdf
2007 Home Care National Patient Safety Goals (2006) the Joint Commission 1 June 2006. Online available at: http://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/07_ome_npsgs.htm
2007 Disease-Specific Care National Patient Safety Goals (2006) the Joint Commission 1 June 2006. Online available at: http://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/07_dsc_npsgs.htm
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…
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…
Florence L., et.al., (2008). Hallmarks of Unsafe Practice: What Preceptors Know. Retrieved April 18, 2014 from http://www.nursingcenter.com/lnc/CEArticle?an=00124645-200811000-00001&Journal_ID=54029&Issue_ID=830968
Kreimer S. (2014). 10 Best Practices for Patient Safety. Retrieved April 18, 2014 from http://www.nursezone.com/nursing-news-events/more-news/10-Best-Practices-for-Patient-Safety_33666.aspx
Royal College of Nursing, (2014). Patient Safety and Human factors. Retrieved April 18, 2014 from http://www.rcn.org.uk/development/practice/patient_safety
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,…
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…
CARROLL, N., SLATTUM, P., & COX, F. (n.d.). Academy of Managed Care Pharmacy. The Cost of Falls Among the Community - Dwelling Elderly. Retrieved December 13, 2015, from http://www.amcp.org/data/jmcp/research_307_316.pdf
(n.d.).Public Health Agency of Canada (PHAC) -- Agence de la santepublique du Canada (ASPC).Seniors' Falls in Canada: Second Report - Public Health Agency of Canada. Retrieved December 13, 2015, from http://www.phac-aspc.gc.ca/seniors-aines/publications/public/injury-blessure/seniors_falls-chutes_aines/index-eng.php#s1-1
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…
Fadiman, A. (2012). The Spirit Catches You And You Fall Down. New York: Farrar, Straus, and Giroux.
Identify Distinctions Among MCU, Dementia, and Alzheimer's
· Distinctions Among MCU, Dementia, and Alzheimer's
2. Information about medical conditions you are addressing
Dementia: Dementia is a syndrome characterized by diminished cognitive abilities, memory loss, and reduced thinking capacity. Dementia-related symptoms affect the day-to-day activities of the victim. Alzheimer's, a condition that causes brain cells to degenerate, is the leading cause of dementia. A slow decline of memory destroys thinking skills, and it translates into disrupted daily life. Inability to live an independent life affects the relationships, and as a result, the victims feel neglected by close family members or friends. Dementia can also occur due to other diseases such as thyroid or lack of essential vitamins in the body, but the good thing is this kind of condition can be reversed (AA, 2017).
Dementia can manifest different signs, but common ones include: Patients Being forgetful, losing track of…
AA. (2017). What is Dementia. Retrieved from Alzheimer\\\\'s Association: https://www.alz.org/alzheimers-dementia/what-is-dementia
AA. (2018). Why Get Checked? Retrieved from Alzheimer\\\\'s Association: Why Get Checked?
AS. (n.d.). Normal aging vs. dementia. Retrieved from Alzheimer\\\\'s Society: https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/how-dementia-progresses/normal-ageing-vs-dementia
BPS. (2007). Dementia: A NICE-SCIE Guideline on Supporting People with Dementia and Their Carers in Health and Social Care. Leicester: British Psychological Society.
Burns, B. (2020, May 12). Researchers link high calcium levels in mitochondria to neuronal death in Alzheimer\\\\'s disease. Retrieved from Media Press: https://medicalxpress.com/news/2020-05-link-high-calcium-mitochondria-neuronal.html
Harada, C., Love, M. N., & Triebel, K. (2014). Normal Cognitive Aging. Clin Geriatr Med., 737–752.
Larson, E., Kukull, W., & Katzman, R. (1992). Cognitive impairment: dementia and Alzheimer\\\\'s disease. Annu Rev Public Health.
Liao, Y., Dong, Y., & Cheng, J. (2017). The Function of the Mitochondrial Calcium Uniporter in Neurodegenerative Disorders. Int J Mol Sci, 248.
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…
Alaloul, F., Williams, K., Myers, J., Jones, K. D., & Logdson, C. (2015). Impact of a Script-based Communication Intervention on Patient Satisfaction with Pain Management. Pain Management Nursing, 321 - 327.
Brosey, L., & March, K. (2015). Effectiveness of structured hourly nurse rounding on patient satisfaction and clinical outcomes. Journal of Nursing Care Quality, 153.
Cholli, P., Meyer, E., David, M., Moonam, M., Mahoney, J., Hession-Laband, E., . . . Bell, S. (2016). Family Perspectives on Whiteboard Use and Recommendations for Improved Practices. Hospital Pediatrics, 426 - 430.
Emerson, B., Chumra, K., & Walker, D. (2013). Hourly rounding in the pediatric emergency department: patient and family safety and satisfaction rounds. J Emerg Med, 99 - 104.
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…
Agency for Healthcare Research and Quality. (2015). Non-pharmacologic Interventions
for Agitation and Aggression in Dementia. U.S. Department of Health and Human Services. Retrieved from http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?productid=1999&pageaction=displayproduct
Bupa. (2015). A dementia friendly society. Bupa. Retrieved from https://www.bupa.com/corporate/our-purpose/healthy-ageing-and-dementia/reports-and-publications/a-dementia-friendly-society
Fleming, R., Purandare, N. (2010). Long-term care for people with dementia:
Evidence-Based Project Proposal
Graduate Project in Nursing
The incidence of sexually transmitted diseases has been increasing among adolescents in countries around the world, but there remains a dearth of timely and relevant studies concerning salient differences in knowledge level and attitudes between different cultures and ethnic populations. One common factor that has been consistently demonstrated in improving the effectiveness of treatments for sexually transmitted diseases is promoting adherence to treatment regimens, most especially for medications since these are used in all treatments for sexually transmitted diseases. While there have been some studies concerning various strategies for promoting adherence levels to treatment regimens, there remains a lack of studies concerning evidence-based practices that incorporate technological solutions. To this end, the proposed study intends to conduct an experiment using innovative face recognition and motion detection smartphone app to evaluate its effectiveness in promoting adherence to medication regimens among a population of adolescents…
6. Identify the collaborative team members pertinent to the care of the geriatric patient in the scenario, including the emergency room nurse's response to changes in the level of consciousness and increasing respiratory distress.
The collaborative team here would consist of a primary care physician / geriatrician, pain management specialist, laboratory specialists, and x-ray team. Additional consultants may be neurologist, neurosurgeon, gastroenterologist, psychologist, and drug and alcohol detoxification specialist.
In the case of increasing respiratory distress, the nurse is advised to continue or modify the interventions: to continue to teach patient how to breath and cough correctly; to summon a productive cough; to attempt to clear lungs to auscultation; and to achieve symmetric chest excursion of at least 4 cm; also that her respirations and pulse beats should be regular, and that she should inhale a normal volume of air. This is done by encouraging Fowler or semi-Fowler's position; monitoring…
Eliopoulos, C. (2001). Gerontological nursing Philadelphia: Lippincott,
Kandel, J. (2009). The encyclopedia of elder care New York, NY: Facts on File,
Marvin J.A. (1995). Pain assessment vs. measurement. J Burn Care Rehabil 16, 348-357
Melzack R. (1975). The McGill Pain Questionnaire: Major properties and scoring methods. Pain 1, 277-299
Ethical Scenario: Skills as a Nurse Practioner
Nurses and other health care suppliers are the ones that are continuously confronted to make ethical choices in regards to things like life and death matters in giving out care to individuals, communities and families. To be pertinent and ethical, these choices need to be measured in the larger context of personal, societal, cultural and professional values and ethical ideologies. As scientific and medical technology advance, persons and society look at dilemmas and hard ethical choices. Nurses, as part of society and as frontline health care specialists, day-to-day face ethical dilemmas connected to life and death and fairness in health care. With that said, this paper examines the scenario of patient and nurse utilizing ethical principles.
As a nurse, the first thing to do is to understand that an unintended pregnancy further confuses the already confusing physical and mental changes of teens. Adolescents…
Begley A.M., 2. (2008). Truth-telling, honesty and compassion: a virtue-based exploration of a dilemma in practice. International Journal of Nursing Practice, 8, 336-341.
Lawlor, A. (2015, July 29). Morning-after pill poses moral dilemma for some MDs. Retrieved from http://www.consciencelaws.org/background/procedures/birth008.aspx
Marsh, B. (2015, July 29). Nurses' fear for morning-after pill. Retrieved from Daily Mail: http://www.dailymail.co.uk/health/article-179092/Nurses-fear-morning-pill.html
RN, M.S. (2013). The Ethical Component of Nursing Education: Integrating Ethics into Clinical Experiences. LWW; 1 edition.
Quality Improvement Project
Diabetes -- Chronic Condition Background
Type 1 and Type 2 Diabetes
isk factors for type 1 diabetes
isk factors for prediabetes and type 2 diabetes
isk factors for gestational diabetes
The ationale for Selection
The Target Population
It has been estimated that in New York there is roughly two million people, or over twelve percent of the population, that have diabetes; furthermore, of this population, over half a million people have the condition but are not aware that they have it (American Diabetes Association, N.d.). It is further estimated that nearly five and a half million people, or over a third of the population, have prediabetes. Diabetes and diabetes-associated cardiovascular diseases have become the leading cause of death in the region accounting for roughly two-thirds of the deaths and the rates of diabetes has lead this trend to be referred to as the…
American Diabetes Association. (N.d.). Health Disparities. Retrieved from American Diabetes Association: http://www.diabetes.org/advocacy/advocacy-priorities/health-disparities.html
American Diabetes Association. (N.d.). New York, New York. Retrieved from American Diabetes Association: http://www.diabetes.org/in-my-community/local-offices/new-york-new-york/
CDC. (2013). Diagnosed Diabetes, Age Adjusted Rate (per 100) Adults - Total 2013. Retrieved from Center for Disease Control: http://gis.cdc.gov/grasp/diabetes/DiabetesAtlas.html
Department of Health. (N.d.). Diabetes. Retrieved from New York State: https://www.health.ny.gov/diseases/conditions/diabetes/
ICU and Delirium
Evidence-Based Project Proposal
Patients that are sixty-five years or older account for an average of more than fifty percent of the visitors to the Intensive Care Unit (ICU) and there are a host of known risk factors that are associated with individuals who are among this demographic and many elderly patients are discharged directly to long-term living facilities due to the fact that they are unable to continue to function independently and maintain daily activities (Tang, Tang, Hu, & Chen, 2016). It is further estimated that approximately one quarter of all of the elderly patients that are admitted to the emergency department display some form of metal impairment related to delirium, dementia, or both, and many hospital departments have made mental assessments for these demographics part of their routine operations (Soryal & al., 2014). Therefore, not only does the prevalence of mental impairments serve as a serious…
Barr, J., & al., e. (2013). Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit. Critical Care Medicine, 263-306.
Malone, M., & al., e. (2014). Acute Care for Elders: A Model for Interdisciplinary Care. Aging Medicine, 233-244.
Soryal, S., & al., e. (2014). Best Practice Models of Emergency Department. Aging Medicine, 220-231.
Tang, H., Tang, H., Hu, F., & Chen, C. (2016). Changes of geriatric syndromes in older adults survived from Intensive Care Units. Geriatric Nursing, 1-6.
In situations where outcome or decision control is ceded to a legitimate decision-maker, the available legal procedure may be judged according to whether it provides adequate 'voice' for the aggrieved, adequate process control, and/or the satisfaction of being respected and afforded an appropriate level of procedural justice as a litigant, defendant or citizen.
In any event, continued dialogue between lawyers and psychologists from both types of system is encouraging. To this end, van Koppen and Penrod (2003) have collected legal psychological analyses of American and European criminal justice procedure together in a recent volume allowing comparisons between adversarial and inquisitorial mentalities.(n10) If this type of work continues, we may better understand when each type of process works best and when people, be they socialised in Australia, America, England or continental Europe, react best to adversarial or inquisitorial systems of legal decision-making in particular contexts.
In many jurisdictions, the approaches of…
Balmford, R. 'The Life of the Administrative Appeals Tribunal: Logic or Experience' in R. Creyke (ed) Administrative Tribunals: Taking Stock (Canberra: Centre for International and Public Law, 1992) 50, 68-71
Bronitt, Simon; Mares, Henry. 2004. The history and theory of the Adversarial and Inquisitorial systems of law. (cover story). Legaldate (3): 1-3.
Lind EA et al. 1978. Reactions To Procedural Models For Adjudicative Conflict Resolution: A Cross-National Study. Journal of Conflict Resolution 22: 318.
Nolan, Mark. 2004. The Adversarial mentality vs. The Inquisitorial mentality. Legaldate 16 (3): 7.
The prescriptions include wisdom, honesty, and courage, as well as human dignity, integrity, respect, health, and independence.
Part 3: Formulate possible evidence-based practices and an action plan that could work towards achieving improvement outcomes.
Provide insight into the diagnostic processes (e.g., root cause analysis) used to determine the primary causes of the problem. Consider both qualitative (cause-effect diagram, barrier analysis), and quantitative (theory testing or drill down analysis) methods.
Analyze the cost-effectiveness of your initiative and how your initiative mitigates risk and improves health care outcomes.
Countless interventions have been used for fall prevention amongst the elderly population. These include risk-assessment and management programs, I.e. Designed to screen those who are most at risk and to design interventions that will reduce their risk of falling; exercise programs slanted dot enhancing flexibility, endurance, and strength; education programs (including one-to -one counseling on methods to prevent falls); environmental modification in homes or…
ANA Nursing-Sensitive Indicators. http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/PatientSafetyQuality/Research-Measurement/the-National-Database/Nursing-Sensitive-Indicators_1
Butts, JB Ethics in professional Nursing Practice
Broe, K et al. (2007) a Higher Dose of Vitamin D Reduces the Risk of Falls in Nursing
The participants of the case study were the members of the medical surgical nursing staff and patients were in hospital since last 6 months. Data was collected and summarized by Gallup Organization, which surveyed 200 medical surgical patients in for two quarter. Patients were also interviewed during the rounding to get their feedback.
The results showed that rounding made a significant difference in the patients and nurses satisfaction. 4P program was also used in this study as it was used in last studies. It was also reported that patients used less call lights less than before and only for serious needs. Patient's complaints regarding staff also decreased to 43% during these two quarters.
Health care including Nursing are very sensitive issues and any conclusions made in this field have impact on the lives of people. Therefore it is not convenient at all to reach to conclusion only by analyzing…
Blakley, D., Kroth, M., & Gregson, J. (2011). The Impact of Nurse Rounding on Patient Satisfaction in a Medical Surgical Hospital Unit. MEDSURG Nursing (MEDSURG NURS), 2011 Nov-Dec; 20(6): 327-32.
Ford, B. (2010). Hourly Rounding: A Strategy to Improve Patient Satisfaction Scores. MEDSURG Nursing
(MEDSURG NURS), May- Jun; 19(3): 188-91.
Gardner, G., Woollett, K., Daly, N., & Richardson, B. (2009). Measuring the effect of patient comfort rounds on practice environment and patient satisfaction: A pilot study. Journal of Nursing Practice (INT J. NURS
interest, an identification of the problem that you have selected, and an explanation of the significance of this problem for nursing practice
My research question: Among acute patients on medical surgical units does hourly rounding as opposed to only setting the bed alarm help decrease patients falls by 75%.
Falls are a major problem amongst acute patients, particularly amongst the 65+ population and can lead to so many related problems, occasionally to fatal results, that this essay considers it a crucial topic for nurses and caregivers to look into and investigate.
The fall is traumatic aside from which consequences of falling can also include post-fall anxiety, fractures, head injuries and loss of independence through falling, each of which has far wider ramifications impacting physical, social, mental, emotional, and behavioral spheres of the patient's life. The ramification of falling, therefore, for the patient has a wider and far-reaching impact that touches…
Broe, K et al. (2007) A Higher Dose of Vitamin D Reduces the Risk of Falls in Nursing
Home Residents: A Randomized, Multiple-Dose Study JAGS 55:234 -- 239
Oliver D. et al. (2004) Risk factors and risk assessment tools for falls in hospital in-patients: a systematic review Age and Ageing 33:122 -- 130
Davies, K.S. (2011). Formulating the evidence-based practice question: A review of the frameworks. Evidence-Based Library and Information Practice, 6(2), 75a€"80. Retrieved from https://ejournals.library.ualberta.ca/index.php/EBLIP/article/viewFile/9741/8144