Patient acuity system provides the nurses and other healthcare practitioners in health cares' information that can guide them in their attention towards the patients. The nurses track information and then weigh them in accordance to the urgency of assessment. The basis that the nurses use is the complexity of the level to which patients are unwell. An example is the determination of whether the patients immediately require ventilation and those who do not need any. The nurses are able to pick on the various patients in the healthcare and then record the data. In a single healthcare, there are many patients with different degrees of illnesses. As a result, they all require varying levels of evaluations from the nurses. It is, therefore, imperative that the nurses spread their attention appropriately to avoid any inconveniences. This system helps the nurses to determine the attention that patients require within a short period.…

References

Brennan, C., & Daly, B. (2009). Patient acuity: a concept analysis. Journal Of Advanced Nursing, 65(5), 1114-1126. doi:10.1111/j.1365-2648.2008.04920.x

Garza, A., Gratton, M., McElroy, J., Lindholm, D., & Glass, E. (2008). The association of dispatch prioritization and patient acuity. Prehospital Emergency Care, 12(1), 24-29.

Lewis, R. (2008). Comparison of a 5-level triage classification system with a 4-level triage classification system as it relates to acuity assignment and predictability of patient outcomes. Southern Online Journal of Nursing Research, 8(2),

Perroca, M., & EK, A. (2007). Utilization of patient classification systems in Swedish hospitals and the degree of satisfaction among nursing staff. Journal of Nursing Management, 15(5), 472-480. doi:10.1111/j.1365-2834.2007.00732.x

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…

References

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.

The author also explains that the data stored in the system can be used to help public health officials identify medical issues facing the community as well as track various trends from the community and public health perspectives.

Article Relevance

(How does this article relate to you as doctor?)

As a physician, I recognize that my time will be in very short supply. Therefore, any system or resource capable of saving time and increasing the efficiency of the healthcare services that I provide will be greatly appreciated. Similarly, patient safety, elimination of medical errors, and patient outcome are always paramount concerns for any physician. Therefore, I would welcome the opportunity to use EHR systems to the extent they address those issues positively. Moreover, as a physician, I am always interested in any approach that might be beneficial to human welfare and community and public health issues. According to the article,…

Evidence Based Practice
University of Illinois Evidence Based Medicine Resources: Lessons Learned
From the search resources I learned that in evidence based medicine, patient values comprising of their unique concerns, preferences, and expectations introduced to the clinical encounter ought to be integrated in determining the ideal care for patient. This integration will guarantee that the individual patient’s clinical state, the clinical setting and best patient outcome prevail in ideal decisions on optimal service delivery to the patient (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996).
The second aspect learned is that in order to integrate Evidence-Based Nursing and clinical care, there is the need for a basic comprehension of the attributes related to the inherent published evidence. Resources in Evidence-Based Practice are categorized in a hierarchy relating to the quality of the research or evidence. In Evidence-Based Practice, decisions making on best care to patient are not just basically guided by…

Introduction

Patient-centered care is the goal of many healthcare organizations, but the ability of an organization to deliver patient-centered care is influenced by a number of factors both internal and external. Business practices, regulatory requirements, and reimbursement all can impact patient-centered care in any healthcare organization. Promoting patient-centered care requires an organizational culture committed to this paradigm, which also needs to be embedded in the mission and values of the organization.

Executives and administrators create the organizational culture that promotes patient-centered care. All leaders in the organization are responsible for using patient-centered practices and communications styles in their interactions with patients and their families. Furthermore, administrators oversee the policies and procedures that directly impact the culture of care. Analyzing areas of weakness within the organizational structure and culture via established assessments like the Patient-and Family-Centered Care Organizational Self-Assessment Tool, it is possible to create multidisciplinary teams that promote the organization’s…

Patient-Centered Care

The author of this report has been asked to answer several questions relating to a survey that was taken and the conclusions or outcomes that can be drawn from the same. Within this report, the current practice setting will be describe as well as the patient- and family-centered nature (or lack thereof) of the organization. The gaps that exist will be described, there will be an analysis of how business practices and regulatory requirements can impact patient- and family-centered care and there will be a strategy created based on all of the above. While all businesses need to make a profit and while not all feedback is helpful or based on the most good for the most people, cutting out the feelings and feedback of families and patients is less than wise and should never be happening.

State of the Practice

The basic state of the practice at…

References

Ahmed, S.M., Lemkau, J.P., Nealeigh, N., & Mann, B. (2001). Barriers to healthcare access in a non-elderly urban poor American population. Health & Social Care In

The Community, 9(6), 445-453. doi:10.1046/j.1365-2524.2001.00318.x

Brown, B.P. (2014). Interpreting Medicine: Lessons From a Spanish-Language

Clinic. Annals Of Family Medicine, 12(5), 473-474. doi:10.1370/afm.1661

Patient Centered Medical Homes

In the 1960s, the medical home concept referred to as patient centered medical home was developed.In order to reform the healthcare in the U.S.; the patient centered medical homes are evolving as a centerpiece of efforts (Bates, 2010). Basically, PCMH can be defines as a primary care model that offers coordinated and comprehensive care to the patients in order to improve health outcomes. PCMH is also recognized by the National Committee for Quality Assurance (NCQA). Patient centered medical homes can be portrayed as a team of people working together in form of a community. The purpose is to improve the health as well as healing of the people in that community. In comparison with the primary care, PCMH is more responsive towards the needs of local patients.

PCMH offers a number of benefits including complementary nutrition as well as wellness counseling along with providing prevention education…

References

Aysola, J., E.J. Orav, and J.Z. Ayanian. 2011. "Neighborhood Characteristics Associated With Access To Patient-Centered Medical Homes For Children." Health Affairs no. 30 (11):2080-2089.

Bates, D.W., and A. Bitton. 2010. "The Future Of Health Information Technology In The Patient-Centered Medical Home." Health Affairs no. 29 (4):614-621.

Nutting, Paul A., William L. Miller, Benjamin F. Crabtree, Carlos Roberto Jaen, Elizabeth E. Stewart, and Kurt C. Stange. 2009. "Initial Lessons From the First National Demonstration Project on Practice Transformation to a Patient-Centered Medical Home." Ann Fam Med no. 7 (3):254-260.

Patient, Mr. D., is a 74-year-old male Caucasian, married and retired. Mr. D. complains of dizziness and weakness. Type-2 diabetes was diagnosed in 1994, hypertension in 2002, and arthritis in 2007. Mr. D. is currently taking 20mg Lipitor/daily; 81 mg Aspirin/daily; 333mg Calcium/daily; 5mg zinc/daily, and 500mg Vitamin C/3X day. He denies any drug or herbal use, and uses 650 mg of Tylenol for pain as needed. He has no known food allergies, does not use tobacco or illicit drugs, but has a family history of diabetes and heart disease with both mother and father. His general health acuity is strong (bowels, urinary, etc.), but has occasional slurred speech, weakness in right lower limb, syncope, vertigo, and vision fluctuations. Mr. D. reports that his wife complains he asks the same question repeatedly within a short time period.

Areas for Focused Assessment- The combination of syncope, vertigo, vision, and memory issues…

REFERENCES

Hypoglycemia. (2012). Web MD. Retrieved from:  http://symptoms.webmd.com/#./conditionView 

Ezzo, J., et.al. (2001). Is Massage useful in the Management of Diabetes? Diabetes Spectrum -- The American Diabetes Association. 14 (4): Retrieved from:  http://spectrum.diabetesjournals.org/content/14/4/218.full 

Madden, S., Loeb, S. (2009). An integrative literature review of lifestyle interventions for the prevention of diabetes mellitus. Journal of Clinical Nursing, 17(2), 2243-56.

Polin, B. (2011). Why Water Aerobics is Good Exercise. Diabetic Lifestyle. Retrieved from:  http://www.diabeticlifestyle.com/exercise/why-water-aerobics-good-exercise

Patient Centered Medical Homes (PCMH) are often confused as being actual "homes" for patients to be admitted in and given medical treatment and care. PCMH is actually a health care model based on which health care is provided to patients, under the supervision of physicians. The PCMH model of health care provides patients with continuous, comprehensive medical care, in order to increase the chances of achieving the goal of benefitting the patient with as much attention and medical care in order to maximize his/her health outcomes.

Over the years the PCMH model of health care has become widely adopted and preferred. This is because of the philosophy and approach that the model adopts in organizing and delivering the health care initiatives. The PCMH model is based upon delivering medical care and attention to patients with team-based health and medical experts that are focused strongly on the quality and the safety…

Bibliography

109-432, P.L. (2006, December 20). TAX RELIEF AND HEALTH CARE ACT OF 2006. Public Law 109-432 (109th Congress) .

Backer, L.A. (2009). Building the Case for the Patient-Centered Medical Home. Family Practice Management 16 (1), 14-18.

De Geest, S., Moons, P., Callens, B., Gut, C., Lindpaintner, L., & Spirig, R. (2008). Introducing advanced practice nurses/nurse practitioners in health care systems: a framework for reflection and analysis. Swiss Medical Weekly (138), 621-628.

NASHP. (2013, April). Medical Home & Patient-Centered Care. Retrieved from The National Academy for State Health Policy:  http://www.nashp.org/med-home-map

I also added, honestly, that the family members who had changed their ways actually felt better on a daily basis, as well as had a better prognosis in terms of their health. This was the true essence, I stated, of "loving life" in my opinion. I tried to make him see what he was going to have to do after his operation as a gain, rather than a loss. He would be regaining control over his health, and would feel younger and better.

I tried to help this patient feel empowered, by going into detail what would happen to him during the operation in layperson's terms. I could see that feeling in control was very important to him, and I tried to facilitate that sense of control. After the operation, I saw the patient again, when he was going to see his grandson who had had some minor surgery on…

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.

orks Cited

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,…

Works Cited

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.

Most of the literature deals with healthcare issues experienced in the United States or Europe. hat small amount of literature there is available on healthcare in Malaysia seldom has anything to do with the clinic(s) in specific. This study could help, in some small measure, to alleviate that problem.

orks Cited

Chowdhury, N., (1999) the Power of Towers, Fortune, Vol. 139, No. 7, pp. 110-112

Kurokawa, I., Takami, M., Cheriex, H., (1999) Futuristic flight plan - the Kuala Lumpur International Airport was designed for the new millennium, Lighting Design + Application, Vol. 29, No. 8, pp. 42-45

Manson, L.A., Baptist, a.J., (2002) Assessing the cost-effectiveness of provider-based status, Healthcare Financial Management, Vol. 56, No. 8, pp. 52-59

Romano, M., (2006) Physicians in pain, Modern Healthcare, Vol. 36, No. 4, p. 40

Shameen, a., (2004) Malaysia: Coining it in Kuala Lumpure - Start-up ECM Libra has capitalized on strong markets, hard…

Works Cited

Chowdhury, N., (1999) the Power of Towers, Fortune, Vol. 139, No. 7, pp. 110-112

Kurokawa, I., Takami, M., Cheriex, H., (1999) Futuristic flight plan - the Kuala Lumpur International Airport was designed for the new millennium, Lighting Design + Application, Vol. 29, No. 8, pp. 42-45

Manson, L.A., Baptist, a.J., (2002) Assessing the cost-effectiveness of provider-based status, Healthcare Financial Management, Vol. 56, No. 8, pp. 52-59

Romano, M., (2006) Physicians in pain, Modern Healthcare, Vol. 36, No. 4, p. 40

Patient Education Decrease Anxiety Undergoing Invasive Cardiac Procedures

Annotated Bibliography

In this case, one of the main areas of topic is based on the role played by initial patient education on the anxiety of patients undergoing noninvasive cardiovascular surgery. It has been reported that the initial education provided by the nurses to the patient in relation to the noninvasive cardiac surgery helps the patient, as there is a great reduction in stress and level of anxiety in relation to the surgical procedures and the outcomes.

Riegel, B (ed). Journal of Cardiovascular Nursing. Philadelphia, U.S..

The journal is a complete online source for the information needed by the nurses in accordance to the procedures that can be used to reduce anxiety levels in the patients undergoing noninvasive cardiac surgery. These days it is important that the patients be taken into complete confidence by making sure they are aware of the procedures…

Patient-Centered Medical Home

Medical Home

How the Patient-Centered Medical-Home reducing cost and improving quality and safety for patients.

The patient centered medical home is a platform that fills a need in the current healthcare system. The U.S. healthcare system has been plagued for quite some time with a trend of substantially rising healthcare costs as well as another trend of slipping quality standards. These two trends are argued to be a phenomenon that has emerged at least partly from poor planning and ineffective use of resources. One solution to some of these issues can be found in the patient-centered medical home (PCMH) model of primary care. This model has been developed with the coordination of long-term physician-patient relationships in mind. Developing these relationships further can not only reduce costs in unnecessary procedures that are the result of the missed opportunity for preventive care, but also have been shown to improve…

References

Christensen, E., Dorrance, K., Ramchandiani, S., Lynch, S., Whitmeore, C., Borsky, A., . . . Bickett, T. (2013). Impact of a Patient-Centered Medical Home on Access, Quality, and Cost. Military Medicine, 135-141.

Ewing, M. (2013). The Patient-Centered Medical Home Solution to the Cost-Quality Conundrum. Journal of Healthcare Management, 258-266.

Kern, L., Dhopeshwarker, R., Edwards, A., & Kaushal, R. (2013). Patient Experience Over Time in Patient-Centered Medical Homes. American Journal of Managed Care, 403-410.

Nielsen, M., Olayiwola, J., Grundy, P., & Grumbach, K. (2014). The Patient-Centered Medical Home's Impact on Cost & Quality. Patient-Centered Primary Care Collaborative, 1-38.

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…

References

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 .

PATIENT & HEALTH POFESSIONAL PESPECTIVES

Patient & Professional Perspectives

Quality of care is a massive concern when it comes to healthcare in general. The issue is so multi-dimension and complicated. Even further, there are a lot of ideological bents and perspectives that further shape and form the issue as it exists today. A significant part of the paradigm mentioned above would be the perspectives of both patients and healthcare professionals as it relates to the aforementioned quality of care. Obviously, there are going to be some differences and similarities when talking to any large swath of patients or healthcare providers. The differences could be huge divides in some cases due to what is being expected being too different than what is able to be delivered given the resources or even the perspective or opinion of the healthcare professionals or providers. While there is no simple or neat answer to how…

References

Bagchi, A., af Ursin, R., & Leonard, A. (2012). Assessing Cultural Perspectives on Healthcare Quality. Journal of Immigrant & Minority Health, 14(1), 175-182.

doi:10.1007/s10903-010-9403-z

Butala, N. (2010). Perspectives on efficiency and quality in an ever changing system:

Healthcare 2010. The Yale Journal Of Biology And Medicine, 83(2), 93-95.

Treatment to Patients

The main objective of providing treatment to patients is to relieve symptoms along with decreasing the progression of the disease as well as the mortality or morbidity. However, in some cases, this objective is not fully achieved, especially in the case of the patients who are admitted to the ICU with some serious and almost always a terminal stage of the disease. For example, when old patients are admitted in the ICU, their immunity is extremely low and this is the perfect time for the opportunistic infections to make matters worse for these patients. There are many infections that are specifically associated with patients admitted in the hospitals. Pseudomonas Aurigeonosa is a micro-organism that is well documented to cause bacterial pneumonia and bacteremia in the patients who are terminally ill and are receiving treatment in the hospital setting. Since most of the patients in the ICU are…

Bibliography:

Beekmann, SE;Diekema, DJ; Chapin, KC;Doern, GV (2003) Effects of rapid detection of bloodstream infections on length of hospitalization and hospital charges.J ClinMicrobiol, 41:3119-3125.

Boussekey, N, Leroy, O, Georges, H, Devos, P, d'Escrivan, T, Guery, B (2005).Diagnostic and prognostic values of admission procalcitonin levels in community-acquired pneumonia in an intensive care unit.Infection, 33:257-263.

Charles, PE, Dalle, F, Aho, S, Quenot, JP, Doise, JM, Aube, H, Olsson, NO, Blettery, B: Serum procalcitonin measurement contribution to the early diagnosis of candidemia in critically ill patients. Intensive Care Med, 32:1577-1583.

Digiovine, B; Chenoweth, C; Watts, C; Higgins, M (1999)The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. Am J. RespirCrit Care Med, 160:976-981.

Demographic Perception Survey of Patients with Atypical CP Who Present to Cardiac Care Doctors and Patient Outcomes

This study intends to examine gender differences in individuals who present to cardiac doctors with chest pain and specifically, atypical chest pain in women. The work of Debra L. Issac (2000) states that over the past ten years "there has been increasing awareness of both the importance of CAD in women and of the significant differences between men and women who have the disease. Potential gender biases, both within the medical community and within the general population of women themselves also have been identified. These gender differences and biases have the potential to influence investigation and management of suspected or confirmed CAD in women, and should be taken into consideration when faced with a woman with potential cardiovascular disease." (p.157)

Issac also states that chest pain in women is "common and often non-ischemic.…

References

Cayley, WE (2005) Diagnosing the Case of Chest Pain. American Family Physician. 15 Nob 2005. Retrieved from:  http://www.aafp.org/afp/2005/1115/p2012.html 

Gotzsche PC, Nielsen M. Screening for breast cancer with mammography. Cochrane Database Syst Rev. (1):CD001877, 2011.

Issac, DL (2000) Women with Ischemic Heart Disease. Presented at the Canadian Cardiovascular Congress, Vancouver, British Columbia, October 2000. Retrieved from:  http://www.stacommunications.com/journals/cme/images/cmepdf/oct01/womencv.pdf 

Khan, JJ, Albarran, JW, Lopez, V, and Chair, SY (2010) Gender Differences on Chest Pain Perception associated with Acute Myocardial infarction in Chinese patients: A Questionnaire Survey. J Clin Nurs. 2010 Oct, 19 (19-20)2720-0. Retrieved from:  http://www.ncbi.nlm.nih.gov/pubmed/20846222

Care:

Issler is a patient who recently moved with his daughter-in-law who is no longer married to his son. As part of her interest in helping to take care of Mr. Issler, she noticed that he was pale and diaphoretic after a two and a half hour flight. The daughter-in-law took him to an emergency room where he was attended to by a cardiologist and set a follow-up check up for an echo cardiogram next week. Mr. Issler has complained of congestive heart failure and a history of deep vein thrombosis. The cardiologist recommended that he seeks out a primary care provider and check up of his thyroid. As the primary care provider, the patient has also expressed his uncertainties on whether he has hyper of hypo thyroidism though he has been under thyroid medication for several years. In addition to being very pale, he has a large bag of…

References:

Bray, D.L. (n.d.). Thyroid Storm and the AACN Synergy Model. Journal of Nursing. Retrieved from http://rnjournal.com/journal-of-nursing/thryoid-storm-and-the-aacn-synergy-model

Drewes at. al. (2012, October). The Effectiveness of Chronic Care Management for Heart Failure: Meta-Regression Analyses to Explain the Heterogeneity in Outcomes. Health Services Research, 47(5), 1926-1959.

Hardin, S. & Hussey, L. (2003, February). AACN Synergy Model for Patient Care Case Study of a CHF Patient. Critical Care Nurse, 23(1), 73-76. Retrieved from  http://ccn.aacnjournals.org/content/23/1/73.full.pdf 

Kaplow, R. & Reed, K.D. (2008). The AACN Synergy Model for Patient Care: A Nursing

Health Information Technology has significant impacts on nursing policy and practice including the role of these professionals in patient education. Actually, the Information Technology development process in healthcare is based on the nurses' ability to understand the community and provide distinctive insights about patient education among other factors (Effken & Abbott, 2009). Since nurses are important elements of the healthcare system, they are critical in ensuring that the confidence of patients in the health providers is maintained even as technology mediates interactions.

The main impact of the emergence of Health Information Technology on the role of a nurse in patient education is that technology mediates interactions between patients and their care providers. As a result, nurses are required to ensure that the role technology plays in mediating these interactions does not affect the insights provided in the process or the delivery of improved patient care. Moreover, through Health Information Technology,…

References:

Adams, K., Greiner, a.C. & Corrigan, J.M. (2012). Chapter 5 -- Patient Self-Management

Support. Retrieved from the National Academies Press website:  http://www.nap.edu/openbook.php?record_id=11085&page=57 

Bastable, S.B. (2008). Nurse as educator: principles of teaching and learning for nursing practice (3rd ed.). Sudbury, MA: Jones and Bartlett Publishers.

Effken, J.A. & Abbott, P. (2009, August). Health it-enabled Care for Underserved Rural

Nurse-Patient Relations

The main focus of this essay is going to concern the nurse-patient relationship idea, and why it is important. This was chosen because the researcher desired to achieve a better accepting of how a helpful nurse-patient relationship can be advanced and even from different theorists who have discovered this idea. In this essay, the researcher sets out to demonstrate what they have learnt regarding the nurse-patient relation concept and how this connection can utilized in the clinical practice setting. T The nurse patient connection, according to a study done by Press Gamey Associates Inc., creates the quality of the care experience and generates an influential influence on patient gratification. Nurses will a lot of their time with patients. Patients see nurses' relations with people among the care team and make their own conclusions about the hospital founded on what they are observing. Furthermore, nurses' approaches toward their vocation,…

Works Cited

Berdes, C. & . (2001). Race relations and caregiving relationships: A qualitative examination of perspectives from residents and nurses aides in three nursing homes. Research on Aging, 23(1), 109-126.

Biering, P. (2002). Caring for the involuntarily hospitalized adolescent: The issue of power in the nurse-patient relationship. Journal of Child and Adolescent Psychiatric Nursing, 16(2), 65-74.

Heijkenskjold, K.B. (2010). The patients dignity from the nurses perspective. Nursing Ethics, 6(3), 313-24.

LaSala, C.A.-B. (2007). The role of the clinical nurse specialist in promoting evidence-based practice and effecting positive patient outcomes. The Journal of Continuing Education in Nursing, 38(6), 262-70.

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…

References

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.

Nurse Patient atios and Quality of Care

This study reviews the broad level of issues that surround the nurse/patient ratio: a critical shortage of trained and experienced nurses; increased political and fiscal demands from all sectors of society; rising costs internally and externally combined with a rising number of under-insured; and the conundrum of nursing ethics and the ability to foster excellence in care and patient advocacy. We note that there remains an issue about hiring more nurses -- where will these nurses come from if the nursing schools do not increase their recruitment efforts and broaden their curriculum. In addition, we note that the large majority of patients and stakeholders primarily want two things when admitted to a healthcare facility: better paid nurses and more highly-trained professionals who are satisfied with their vocation.

Introduction

Modern nursing is, by necessity, a mixture of complex balance: patient care vs. staffing; procedures…

REFERENCES

More Nurses Make the Difference. (February 2012). The Lamp. 69 (1): Retrieved from: http://search.informit.com/au/documentSummary;dn=045435426132502;res=IELHEA

Safe Nurse Staffing: Looking Beyond the Numbers. (2009). Vantage Point, CNA. Retrieved from: https://www.nso.com/pdfs/db/newsletters/Safe_Nurse_Staffing_-_Looking_Beyond_the_Raw_Numbers_20094.pdf?fileName=Safe_Nurse_Staffing_ -_Looking_Beyond_the_Raw_Numbers_2009-pdf&folder=pdfs/db/newsletters

Aiken, L. (2001). The Hospital Nurse Workforce: Problems and Prospects."Draft

For the Council on the Economic Impact of Health System Change. Retrieved from: http://council.brandeis.edu/pubs/hospstruct  / Council-Dec-14-2001-Aiken-paper.pdf

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.

e. incurable cancer; (2) referral to the Department of Palliative Medicine. The exclusion criteria for the study were: (1) estimated prognosis of less than 1 week; (2) significant cognitive impairment, i.e. unable to provide consent; (3) significant physical impairment, i.e. unable to complete protocol; (4) clinical evidence of dehydration; (5) current/recent (less than 2 weeks) use of antifungal medication. (Davies, railsford and eighton, 2005)

Davies, railsford and eighton (2005) report that the clinical component of the study involved "...completion of a study questionnaire (demographic data and clinical data), completion of the Memorial Symptom Assessment Scale, clinical examination of the oral cavity, measurement of the unstimulated whole salivary flow rate (UWSFR), measurement of the stimulated whole salivary flow rate (SWSFR), and performance of an oral rinse." ( p.698) The study results states that all patients/participants "...had either locally advanced, or metastatic cancer. The prevalence of different cancer diagnoses were: carcinoma breast…

Bibliography

Davies, Andrew N., et al. (2008) Oral Candidosis in Community-Based Patients with Advanced Cancer. Oral Candidosis in Advanced Cancer. Vol. 35, No. 5, May 2008. U.S. Cancer Pain Relief Committee.

Chang, AM, Molassiotis, A, Chan, CWH, and Lee, IYM (2007) Nursing Management of Oral Mucositis in Cancer Patients. Hong Kong Med J. Vol 13 No 1 Supplement 1 February 2007.

Alred, Michael J. (1991) Oral Health in the Terminally Ill: A Cross-Sectional Pilot Survey. Special Care in Dentistry, Vol 11 No 2, 1991.

Davies, Andrew N., Brailsford, Susan R. And Beighton, David (1991) Oral Candidosis in Patients with Advanced Cancer. Oral Oncology. 15 Sept 2005.

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…

Blueprint for Evaluating Patient Safety Competency in Nursing Students

Ever since the report To Err is Human was published in 2000 by Kohn and colleagues, healthcare stakeholders in Western countries have intensified reform efforts designed to increase patient safety. The report revealed that nearly 100,000 patients were dying annually from medical errors in the 1990s, a statistic that caught the attention of legislators, healthcare policymakers, clinicians, patients, and the general public. Additional research revealed that nurses were considered to be the source of most medical errors and also the best defense against errors, but nurses had little, if any, control over patient care planning (Lachman, 2007). Systems were therefore a major determinant of patient safety.

Patient safety and nursing ethics are also inseparable (Lachman, 2007, p. 401). While avoiding specific recommendations, provision three in the American Nurses Association Code of Ethics states that nursing professionals must protect the safety of…

References

AACN (American Association of Colleges of Nursing). (2012). Graduate-level QSEN competencies knowledge, skills, and attitudes. Retrieved from  http://www.aacn.nche.edu/faculty/qsen/competencies.pdf .

Clark, C.C. (2008). Classroom Skills for Nurse Educators. Sudbury, MA: Jones and Bartlett Publishers.

IAR (Instructional Assessment Resources). (2011). Assess Students: Multiple-choice questions. Retrieved from https://www.utexas.edu/academic/ctl/assessment/iar/students/plan/method/exams-mchoice-bloom.php.

Institute of Medicine. (2010). The future of nursing: Focus on education. Retrieved from https://www.iom.edu/~/media/Files/Report%20Files/2010/The-Future-of-Nursing/Nursing%20Education%202010%20Brief.pdf.

Improved quality of care is one of the major issues that has characterized modern healthcare practices. Ferreri et al. (2016) conducted a study to examine enhanced quality of life and decrease of traditional drugs in homeopathy treatment of allergic patients. The study was carried out in the Centre for Integrated Medicine in Pitigliano, Tuscany. These researchers conducted their study in this healthcare facility because its an innovative hospital that provides homeopathy and acupuncture in combination with conventional clinical care. Therefore, this facility provides integrated medical care for patient treatment, which makes it ideal for examining enhanced quality of life and decrease in conventional drugs. This paper examines the study conducted by these researchers in relation to establishing the reliability of its findings and conclusions as well as the suitability of the research process.
Brief Summary of the Research

Ferreri et al. (2016) conducted a research in which the examined the…

cute care facilities try to maintain low costs and employ quality nurses. Within this statement is a double standard. How can we have quality nurses and cut costs at the same time? This is where the skill mix comes into play. In the skill mix, there are Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and unlicensed staff. If the lesser skilled staff free RNs they can be better able to perform their nursing duties and assessments. If acute care facilities can agree on an appropriate number of each type of staff member within the facility, they might be better able to accomplish safe patient outcomes while keeping costs down.

Determining nurse-to-patient ratios is a complex issue where one solution is not sufficient to cover all circumstances. The merican Nurses ssociation assembled a panel of nursing and health professionals to research appropriate staffing levels. The panel developed the following Matrix for…

Aiken and colleagues have been pioneers in studying nurse patient ratios and their relationship to patient outcomes.

Aiken, Sochalski, and Lake (1997) demonstrated that nursing presence, whether measured as RN ratios or as RN hours relative to other nursing personnel hours, is significantly correlated to mortality. When studying patient outcomes in specialized AIDS units,

Aiken, Sloan, Lake, Sochalski, and Weber (1999) found that at 30 days post admission, mortality rates were 60% lower in magnet hospitals, and 40% lower in dedicated AIDS units than in conventional scattered bed units. The researchers concluded that higher nurse patient ratios were a major factor in these lower

Diabetes Foot Care

Qualitative esearch Critique: Diabetes Foot Care

Sue Flood (2009) saw a need to examine the nurse-patient interaction in relation to diabetes foot care outcomes, in part because at least one health care organization (Agency for Healthcare esearch and Quality) has concluded that diabetes care received by patients often do not meet best practice standards. The impact of substandard care includes a 45 to 85% difference in the incidence of foot ulcers and amputations, as reported by the U.S. Centers of Disease Control and Prevention. The author further justified this study based on the ongoing global obesity and diabetes epidemics.

Flood (2009) decided to examine the nurse-patient interactions because this relationship has been shown to have a significant impact on patient outcomes. This represents the primary assumption the author tests in her study. The four components of nurse-patient interactions are: (1) affective support, (2) health information, (3) decisional…

References

Flood, L.S. (2009). Nurse-patient interactions related to diabetes foot care. MEDSURG Nursing, 18(6), 361-370.

Improving Provider-Patient Communication Among LEP Patients
Abstract
Elderly Hispanic patients experience numerous challenges when seeking for healthcare services since they are only eloquent in their native language and are classified as Limited English Proficient (LEP) patients. Language barriers contribute to poor provider-patient communication and necessitate the integration of third parties in the care delivery process. This paper whether the use of professional interpreters improves patient-provider communication and results in better health outcomes. Through a study that was carried out a sample of 40 elderly Hispanic diabetic patients at a Wellness Center in Los Angeles, using a professional interpreter improves provider-patient communication. The use of professional interpreters and language concordance is associated with improved provider-patient interactions, enhanced interpersonal care, and better medication adherence within three months.
Keywords: elderly Hispanics, patients, medication adherence, bilingual interpreters, treatment, patient-provider communication, healthcare providers.
Overview
Provider-patient communication is an important factor in enhancing patient outcomes in…

This created problems in the care of patients that should have been admitted to other units, as well as for all patients receiving care in the emergency department on an inpatient or an outpatient basis.

In addition, research was undertaken that examined alternatives to simply increasing the efficiency with which ED patients are either treated and released or admitted on an inpatient basis, and it was found that increasing staffing level and other practices were still insufficient. The research all quite clearly suggested that the practice of inpatient boarding in emergency departments was detrimental to patients as well as to medical, nursing, and support staff, and was also not cost effective for hospitals. It was recognized that a huge benefit could be derived from a comprehensive and conclusive survey of the issue, which would lead to clearer recommendations for nursing and medical staff as well as hospital administrators than have…

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…

High Nursing Turnover in a Hospital Affecting Patient Operations

In every healthcare institution, it is the expectation of every patient to receive adequate medical care when he/she visits the health care institution. Often, the hospital management and stakeholders must always ensure that all patients are treated as their health needs require. This will be critical in maintaining and enhancing the reputation of the hospital. However, when the patient is visiting the hospital increases, it will reach an extent that the nurses and other staff working in the hospital are overwhelmed. When the nurses and other staff are overwhelmed, the patients will not receive satisfactory medical care (Bae, Mark, & Fried, 2010). In the end, the hospital's reputation will be severely affected. Since not all the patients will be served as expected, they will opt to visit other near hospitals to seek better services. The hospital will receive stiff competition due…

References

Bae SH, Mark B, & Fried B. (2010). Impact of Nursing Unit Turnover on Patient Outcomes in Hospitals. J Nurs Scholarsh. 42(1):40-9. doi: 10.1111/j.1547-5069.2009.01319.x.

Buerhaus, P. I. (2007). Impact of the Nurse Shortage on Hospital Patient Care: Comparative Perspectives. Health Affairs, vol. 26 no. 3 853-862

Hayes, L. J. (2012). Nurse turnover: A literature review -- An update. International Journal of Nursing Studies, Volume 49, Issue 7: 887-905

Safe Environment -- Patient Outcomes

hat are the best practices that nurses and nursing leaders can implement to assure safe working conditions and high quality patient care? This paper delves into those issues using the available literature -- scholarly articles -- as guiding references to reach an understanding of how to assure safe working conditions for nurses and patients.

Required time and staffing for safe and effective patient care

According to author Kathy Malloch, the task of creating safe practices for nursing staff "…continues to be illusive for nurse leaders" (Malloch, 2015). The problem is that discovering the amount of time needed in order for a nurse to provide proper patient care is still a work in progress; measuring that needed time is not in the "mature stage" yet, according to Malloch. As of the publishing of this article in Nursing Economics (2015), there was as yet no "gold standard…

Works Cited

Hunter, B., Branson, M., and Davenport, D. (2010). Saving Costs, Saving Health Care

Providers' Backs, and Creating a Safe Patient Environment. Nursing Economics, 28(2).

Malloch, K. (2015). Measurement of Nursing's Complex Health Care Work: Evolution of the Science for Determining the Required Staffing for Safe and Effective Patient Care.

Nursing Economics, 33(1), 20-25.

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

Intervention Plans

Target Goals

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…

References

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…

Works Cited

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.

Nursing Philosophy

Perhaps the most fundamental tenet of my nursing philosophy is the administration of care in an intrinsically empathetic manner which benefits the patient. I unequivocally believe in patient-centered care and that nurses who are able to maintain this component of their practice as their primary goal are able to produce the greatest efficacy in administering to patients. Moreover, with all of the concerns of the contemporary healthcare market, including various facets of financial and technological concern, the shortage of various practitioners, and innovations in precision medicine, it is easy to forget that the most vital component of the health care industry is the patients themselves. Quite simply, patients have the most to gain and lose from the health care system. Therefore, I readily believe that keeping those patients as the center of the care delivered by me and others within my profession is the best way we can…

References

Andrist, C., Nicholas, P. and Wolf, K. (2006). The Evolution of the Environment Paradigm in Nursing. A history of nursing ideas (pp. 97- 108). Sudbury, MA: Jones and Bartlett.

Bourdeau, M. Auguste Comte. The Stanford Encyclopedia of Philosophy.  https://plato.stanford.edu/archives/win2015/entries/comte/ 

McEvoy, L., Duffy, A. (2008). Holistic practice -- a concept analysis. Nurse Education in Practice. 8, 412-419.

Zborowsky, T. (2014). The legacy of Florence Nightingale's environmental theory: nursing research focusing on the impact of healthcare environments. Health Environments Research & Design Journal. 7(4), 19-34.

patients undergoing mechanical ventilation contract Ventilator Associated Pneumonia (VAP). This acute medical condition always results in increased death rates and associated medical costs among patients. This article reviews several literatures that try to enlighten masses on the diagnosis, medical treatments and VAP prevention methods. In addition, this article outlines recommendations medical practitioners can implement in their daily practices to curb VAP and offers an insight on controversies that usually arise during VAP diagnoses, treatment plans and prevention methodologies. This article defines VAP to be the causative agent of approximately 25 to 54% mortality rates among patients undergoing mechanical ventilation in ICUs. Factors responsible for VAP among patients include patients' population in ICUs, hospital stay durations and antimicrobial treatments. Even though antimicrobial medications are confirmed to reduce VAP casualties, further studies should be undertaken such as the ones outlined in the literatures below to help in early identification and treatment of…

References

Arroliga, A.C., Pollard, C.L., Wilde, C.D., Pellizzari, S.J., Chebbo, A., Song, J., et al. (2012).

Reduction in the Incidence of Ventilator Associated Pneumonia: A Multidisciplinary

Approach. Respiratory Care, 688-696.

Camargo, L.F., De Marco, F.V., Barbas, C.S., Hoelz, C., Bueno, M.A., Rodrigues Jr., M., et al.

Biology -- Patient Scenario

What are the components of physical examination? Describe each component.

Physical examination consists of 5 basic components after obtaining a patient's description of the history of his/her systems. First, the provider observes the patient for physical signs of disease and evaluates such factors as mobility, posture, facial expression, alertness, responsiveness to stimuli and changes in skin color (Jarvis, 2011, pp. 33, 127-9). Secondly, one must take a patient's vital signs, including blood pressure, heart rate, breathing rate and temperature, and compare the patient's results with the reference ranges (Jarvis, 2011, pp. 136-150). Third, one must perform auscultation, using a stethoscope to listen to the patient's lungs, heart and bowel (Jarvis, 2011, p. 118). Fourth, one performs percussion by tapping on the patient's chest and abdomen to listen for sounds indicating normal conditions, fluid, excess air, size of the lungs and size of the affected area (Jarvis,…

Reference values) for each laboratory tests in the table above from the second set of tests.

The second round of Mr. Smith's tests, when compared with the normal ranges, indicate that: his blood potassium level is below the normal range; his

Responsibilities of Nurses to Patients

Why is it important

The role of nurses has a direct implication on the patients. For example, nurses observe and provide direct care to the patients. The physicians give orders and thus are the role of the nurses to implement (Aiken et al., 2014). Often, the work of the physicians is not complete without the help of the nurses. The nurses are responsible for changing clothes and giving the medications to patients. Often, the patients are unable to do basic tasks, and therefore the roles of nurses become very important. Nurses keep medical records for the patients and therefore give medications to the patients in time and monitor their progress.

Another important role of the nurse is assessing the response of the patients to medications. Keep the records for the progress of patients is an invaluable practice. The records help the nurses to monitor how…

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…

Bibliography

Lloyd, H. And Craig, S. (2007). A guide to taking a patient's history. Nursing Standard. 22(13),

Structured interviews of the subjects were conducted at the end of each individual set of simulation runs to obtain triangulation data.

Video segments were coded by nursing experts.

Statistical and content analyses of the data were conducted.

Limitations

All nurses were female. Males may have provided different response. The sample may have been too small; only 10 individuals of each handedness were involved. The sample was extracted from only one environment, the participants were familiar with environment. Replication of various other environments may have provided different response. The repeated measures design may have influenced response second time around.

Commentary

I found details of structured interview to be too vague. The best accounts of experimental studies are those that reader can replicate. Many of the steps of this study were sufficiently elaborate for repllication, but I found details of interview questions vague and incompletely elaborated upon so that one left with…

1. Subjective
Patient’s chief complaint: A man aged 69 comes to the emergency room with a sharp pain to his chest’s left side, lasting between 30 and 40 mins and then subsiding.
History of present illness: The pain has woken him up thrice in the last 7 days. He claims the pain first started roughly six months ago. Initially, however, the pain used to surface only occasionally, commonly while he was doing gardening. The patient’s past medical history reveals a diagnosis of hypertension twenty-five years back.
Precipitating/alleviating factors: The patient has been smoking a half-cigarette pack daily for the last forty-five years.
Family History: The patient has lost two brothers and his dad to heart disease. The patient does not report any other significant illness history in the family.
Social History: His typical pastimes include sharing a drink with pals and gardening.
Review of Systems: From a physical examination of…

older patients over the age of 80 due to complications in health such as dementia and depressive symptoms, do not go for additional follow-ups. Yes, the authors explain repeated in person visits help better identify risk factors. There is no obvious research question however they do highlight the use of a study to confirm the hypothesis of whether or not repeated in person follow-ups help with problems experienced as patient's age. "We hypothesized that the type of visit would be related to key demographic, lifestyle, health and function characteristics and that the oldest aged participants would have the poorest retention for in-person visits, particularly clinic visits" (Strotmeyer et al., 2010, p. 697). This is a directional hypothesis because the retention rates are directly associated with increase in age. It is a simple hypothesis because it directly states a cause and effect. The hypothesis was tested and it revealed in-home visits…

References

Strotmeyer, E.S., Arnold, A.M., Boudreau, R.M., Ives, D.G., Cushman, M., Robbins, J.A., Newman, A.B. (2010). Long-Term Retention of Older Adults in the Cardiovascular Health Study: Implications for Studies of the Oldest Old. Journal of The American Geriatrics Society, 58(4), 696-701. doi:10.1111/j.1532-5415.2010.02770.x

1. Subjective
Patient’s chief complaint, reason for visit
Ms. Richards arrived complaining that she was experiencing severe anal pain, so much so that using a tissue was also proving impossible. She claimed the pain began a couple of days earlier and has aggravated considerably since.
History of Present Illness
Ms. Richards arrived complaining of anal pain which commenced a couple of days earlier and has aggravated since. With regard to her intimate relationships, Ms. Richards states that though she has a boyfriend, their relationship isn’t serious as the two are also seeing other people. According to internal assessment reports, patient has normal hair distribution, an intact perineum, and intact urethral meatus without any discharge or inflammation. However, patient experiences unbearable pain on vaginal opening palpation, redness, and edema. Further, a mass has been identified on the right, with spontaneous, dark-yellow, smelly secretion with palpation over the Bartholin's glands.
Physical examination…

It should be noted that Mrs. Ozdemir's problems are not entirely physical in nature. Her loneliness and isolation in a country in which she has limited command over English have caused her to pour her energies into cooking traditional, heavy meals for her family and using overeating as a coping mechanism.

Seeing a counselor who speaks her language and can aid her in talking about her cultural adjustment issues seems essential. Without psychological support, it is unlikely that Mrs. Ozdemir will feel sufficiently motivated to change her lifestyle. Ideally, diabetes education at the secondary level should also be culturally sensitive, and provide dietary and exercise-related suggestions. Proposed menus can reflect Mrs. Ozdemir's culture, such as Mediterranean dishes that emphasize vegetables and beans, rather than sugary sauces and meats. Also, walking rather than taking public transportation is a potential source of exercise. Ozdemir should receive regular lipid screening, and, if warranted,…

References

Peeples, Malinda & Seley, Jane Jeffries. "Diabetes care: The need for change."

American Journal of Nursing. June 2007. 107.6 (June 1007):13-19. 7 Apr. 2011.



"Primary care." A Dictionary of Nursing. 2008. Encyclopedia.com. 7 Apr. 2011

Alarm Fatigue

Theories in nursing generally center on the relationship of four concepts -- nursing, environment, person and health. These concepts are interrelated and impact one another in diverse ways, often seen in issues of nursing when problems arise that require analysis. The issue of alarm fatigue is one problem in nursing that touches on each of these four concepts. Alarm fatigue can be defined as exhaustion that occurs for nurses when they are exposed to many alarms throughout their shift, which causes "sensory overload" and the nurses to develop a "non-existent response to alarms" (Horkan, 2014, p. 83). Complacency and dissension can follow in the nursing workplace as too many alarms for nurses can render them unresponsive.

Alarms are needed in nursing because they alert nurses and care providers to emergency situations that require immediate action and intervention, especially in the intensive care unit. However, nurses and staff work…

References

Despins, L., Scott-Cawiezell, J., Rouder, J. (2010). Detection of patient risk by nurses:

a theoretical framework. Journal of Advanced Nursing, 66(2): 465-474.

Horkan, A. M. (2014). Alarm fatigue and patient safety. Nephrology Nursing Journal,

47(1): 83-85.

Merrill, in the UK. Following his experience with heart surgery using innovating surgical techniques, the physician noted the problems he experienced in understanding all of his alternatives compared to a simpler earlier procedure, and finally trusted to the advice of his cardiologist to surgically intervene. In response to the experience, Dr. Merrill emphasized that, "As a physician talking to colleagues, I had the best information possible under the circumstances. But it wasn't the same as my hernia repair. The experience brought home to me the realization that the progress of medicine has made informed consent impossible -- even for me" (Merrill 1999: 190).

ationale of Study

Taken together, the foregoing issues indicate that there is an ongoing need for an assessment of knowledge levels of informed consent among perioperative nurses and operating department practitioners. Perioperative nurses and operating department practitioners, though, are frequently subjected to an enormous amount of stress…

References

Calloway, S.J. (2009) 'The Effect of Culture on Beliefs Related to Autonomy and Informed

Consent.' Journal of Cultural Diversity 16(2): 68-69.

Cobb, W.G. (2005) 'Defending the Informed Consent Case.' Defense Counsel Journal 72(4):

330-331.

The Argument -- She Could be Given a Transplant

I could not find a prohibition against liver transplants for those 70 or over, but there is a good deal of information in the literature supporting transplants for older people. In the PubMed section of the National Institutes of Health a study of 1,446 "consecutive liver transplant recipients was conducted" and 241 elderly patients (over 60) in that group were compared with younger counterparts. The conclusion: "Low-risk elderly patients fare as well as younger patients after liver transplantation" (Levy, et. al, 2001).

Meanwhile, Dr. Gerald S. Lipshutz, assistant professor of surgery at the David Geffen School of Medicine at the University of California reports the results of the findings at the orld Transplant Congress in 2006. In a study of 62 patients (Group I) between the ages of 70-79 that had received liver transplants -- compared with a group of 864…

Works Cited

Flaman, Paul. "Organ and Tissue Transplants: Some Ethical Issues." St. Joseph's College, the University of Alberta. Retrieved June 23, 2011, from  http://www.ualberta.ca/-pflaman/organtr.htm . (2001): 1-14.

Kahn, Katherine. "Age Alone Does Not Affect Outcome of Liver Transplant in Elderly."

Medscape Medical News. Retrieved June 24, 2011, from  http://www.medscape.com . (2006): 1-2.

Levy, Marlon, Somasunder, Ponnandai S., Jennings, Linda W., Jung, Ghap J., Molmenti,