Picot Statement
P: Nurses and Nursing.

Nursing leadership and patient outcome

eview of studies and literature that examine the association and relationship between nursing leadership practices and patient outcomes.

O: Evidence suggests relationships between positive relational leadership styles and higher patient satisfaction and lower patient mortality, medication errors, sentinel events, and hospital-acquired infections.

Over three months

Healthcare faces an economic downturn, stressful work environments, upcoming retirements of leaders and projected workforce shortages, implementing strategies to ensure effective leadership and optimal patient outcomes are significant.

The nursing shortage continues to be a serious concern for the healthcare industry as a whole. "According to the Bureau of Labor Statistics' Employment Projections 2012-2022 released in December 2013, egistered Nursing (N) is listed among the top occupations in terms of job growth through 2022. The N workforce is expected to grow from 2.71 million in 2012 to 3.24 million in 2022, an increase of 526,800 or 19%" (osseter 2014). Although certain…...

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References

Impact of the nursing shortage on patient care. (2014). AACN. Retrieved from:

 http://www.aacn.nche.edu/media-relations/nursing-shortage-resources/impact 

Nevidjon, B. & Erickson, J. (2001). The nursing shortage: Solutions for the short- and long-term.

Online Journal of Issues in Nursing, 6 (1) 4. Retrieved from: www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume62001/No1Jan01/NursingShortageSolutions.aspx

Nursing Shortage on Patient Outcomes
The objective of this study is to examine the effects of nursing shortage on the outcomes of patients. Towards this end, this study will conduct a review of the literature in this area of inquiry.

There is a severe shortage of nursing in today's healthcare workforce. This impacts the outcomes of patients in terms of their healthcare and their overall health. According to the 'Nursing World' website "Nursing is integral to patient care and is delivered in many and varied settings. The sheer number of nurses and their central role in caregiving are compelling reasons for measuring their contribution to patients' experiences and the outcomes that are attained." (2010, p.1)

AACN eport

According to a report by the American Association of Nurses "n an article published in Health Services esearch in August 2008, Dr. Christopher Friese and colleagues found that nursing education level was significantly associated with patient…...

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References

The Impact of Nursing Care on Quality (2010) Nursing World. Retrieved from:  http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/PatientSafetyQuality/Research-Measurement/Nursing-and-Quality.pdf 

Impact of the Nursing Shortage on Patient Care (2015 AACN. Retrieved from:  http://www.aacn.nche.edu/media-relations/nursing-shortage-resources/impact 

Buerbhaus, PI, et al. (2003) Impact of the Nursing Shortage on Hospital Patient Care: Comparative Perspectives. Health Affairs. (2007) Health Affairs. Retrieved from:  http://content.healthaffairs.org/content/26/3/853.full 

Keenan, P and Kennedy, JF. (2007) The Nursing Workforce Shortage: Causes, Consequences, Proposed Solutions. Retrieved from:  http://www.commonwealthfund.org/usr_doc/keenan_nursing.pdf

Nursing -- Measuring Patient Outcomes
Measuring Patient Outcomes

Measuring patient outcomes is crucial to evaluating the quality of healthcare since achieving positive patient outcomes is the most fundamental of all goals of healthcare in general (Hamric, Spross, & Hanson, 2009; Taylor, Lillis, & LeMone, 2008). In principle, patient outcome indicators should include seven objective elements or characteristics, namely: (1) they should be based on precise agreed definitions; (2) they should be sufficiently specific and sensitive to eliminate false positive and false negative findings; (3) they must be valid and reliable; (4) they must discriminate sufficiently for findings to be meaningful; (5) they must relate to clearly identifiable events for the targeted audience; (6) they must allow and promote useful comparisons; and (7) they must be strictly evidence-based (Mainz, 2003). Generally, the quality of healthcare is directly determined by many factors among which the specific roles of healthcare workers are some of the…...

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References

Hamric A.B., Spross, J.A., and Hanson, C.M. (2009). Advanced Practice Nursing: An

Integrative Approach. St. Louis: Saunders.

Mainz, J. "Defining and classifying clinical indicators for quality improvement."

International Journal for Quality in Health Care, Vol. 15, N. 6; (2003): 523-530.

Ethics in EOL Decisions
Finding Common Ground in EOL Care Decisions

Churchill (2014) presents to readers a case study to highlight some of the ethical and moral issues that will occur during end-of-life (EOL) decisions. The case study is not a factual event, but represents the mean severity and complexity of the EOL struggles experienced by the typical stakeholders. In this example, the treating physician has unsuccessfully tried to convince the adult daughter that her father will never recover from a coma and would benefit the most by palliative care, while the daughter refused to give up on the hope that her father would recover. Churchill (2014) spent time with clinicians and family member to try and understand their perspectives, thereby fulfilling his duties as a clinical ethics consultant. He discovers the patient has a living will and durable power of attorney, which prevented the use life-sustaining interventions in circumstances just like…...

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References

Churchill, L. (2014). Narrative awareness in ethics consultations: The ethics consultant as story-maker. Hastings Center Report, 44(1 Suppl.), S36-9.

O'Mahony, S., McHenry, J., Blank, A.E., Snow, D., Eti Karakas, S., Santoro, G. et al. (2010). Preliminary report of the integration of a palliative care team into an intensive care unit. Palliative Medicine, 24(2), 154-65.

Shuman, A.G., Montas, S.M., Barnosky, A.R., Smith, L.B., Fins, J.J., & McCabe, M.S. (2013). Clinical ethics consultation in oncology. Journal of Oncology Practice, 9(5), 240-5.

Voigt, L.P., Rajendram, P., Shuman, A.G., Kamat, S., McCabe, M.S., Kostelecky, N. et al. (2014). Characteristics and outcomes of ethics consultations in an oncologic intensive care unit. Journal of Intensive Care Medicine, published online ahead of print 10 Jun. 2014.

Enhancing Postoperative Nursing Management to Minimize Postoperative Complications in Surgical PatientsIn the dynamic landscape of healthcare, the provision of exceptional postoperative care holds pivotal significance for fostering positive patient outcomes, particularly in the context of individuals who have undergone monitored anesthesia care (MAC). With the evolving nature of medical practices and advancements, nurses emerge as pivotal players in surgical patients' holistic recovery and well-being. Their role extends beyond mere procedural assistance, encompassing vigilant monitoring, timely intervention, and personalized care plans tailored to the unique needs of postoperative individuals. As the complexity of surgical procedures increases, the demand for nuanced and specialized nursing care becomes more pronounced, emphasizing the essential contribution of nurses in shaping the trajectory of patient recovery and ensuring the overall success of surgical interventions (Abaziou et al., 2020). This essay aims to articulate a comprehensive PICOT question that serves as the foundation for a capstone project change…...

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References

Abaziou, T., Tincres, F., Mrozek, S., Brauge, D., Marhar, F., Delamarre, L., Menut, R., Larcher, C., Osinski, D., & Cinotti, R. (2020). Incidence and predicting factors of perioperative complications during monitored anesthesia care for awake craniotomy. Journal of Clinical Anesthesia, 64, 109811.

Boulos, N. M., Burton, B. N., Carter, D., Marmor, R. A., & Gabriel, R. A. (2020). Monitored anesthesia care is associated with a decrease in morbidity after endovascular angioplasty in Aortoiliac disease. Journal of cardiothoracic and vascular anesthesia, 34(9), 2440-2445.

Lee, S.-W., Lee, S., & Hahm, K.-D. (2021). Postoperative pulmonary complications after transcatheter aortic valve implantation under monitored anesthesia care versus general anesthesia: retrospective analysis at a single large volume center. Journal of Clinical Medicine, 10(22), 5365.

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, the data…...

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 selecting the highest…...

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 combined…...

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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 safety is a very important element with the overall healthcare system. egulations and new initiatives set forth by the Affordable Care Act have created much elevated culture of safety. As a result, facilities must now alter the manner in which they deliver and administer treatment to patients. A culture that once focused on transactions and bloated costs has now been replaced with one predicated on safety. Creating a culture of safety is no easy task however. In fact, it can be particularly difficult when older employee habits have been deeply engrained in the daily processes of work. To create a culture of safety, management must first communicate its expectations to all stakeholders involved. Communication is an integral aspect of patient safety. Communication is important because it sets the overall tone within the organization. Communication regarding expectations is particularly potent when top-level management is heavily involved. Consistent emphasis on quality…...

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References:

1. Clinton HR, Obama B (2006). "Making patient safety the centerpiece of medical liability reform." N. Engl. J. Med. 354 (21): 2205 -- 8

2. Kraman SS, Cranfill L, Hamm G, Woodard T (December 2002). "John M. Eisenberg Patient Safety Awards. Advocacy: the Lexington Veterans Affairs Medical Center." Jt Comm J. Qual Improv. 28 (12): 646 -- 50

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 educational…...

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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 .

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 vs. patient load;…...

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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: -_Looking_Beyond_the_Raw_Numbers_2009-pdf&folder=pdfs/db/newslettershttps://www.nso.com/pdfs/db/newsletters/Safe_Nurse_Staffing_-_Looking_Beyond_the_Raw_Numbers_20094.pdf?fileName=Safe_Nurse_Staffing_

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

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

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 control, and (4)…...

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References

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

Reducing Patient Waiting Time for Better Patient Outcomes Step 1
Most healthcare institutions start their day with the intention of perfectly managing their time schedules. While the expected outcome is excellent patient outcome many practices often end up bringing in more patients into a schedule that is already overloaded hence requiring more time to attend to the scheduled patients (Capko, 2015). The outcome of the busy schedules is inefficiency, bottlenecks, frustration, and more waiting time for the patients. Patients are forced to spend more time in the exam room or reception area waiting for an opportunity to be attended to (Capko, 2015). For the patient things appear to be moving in slow motion.
In order to overcome the scheduling problems it is important to address the foundation of this patient scheduling problems. It may seem easy but it is more complex than many would think. It takes a lot of dedication and time…...

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…...

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Bibliography

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

Inpatient Whiteboards
This study is a theoretical framework exploring whiteboard use preferences and recommendations for patient-centered care and communication through whiteboard use.

This study is a theoretical framework exploring whiteboard use, script-based communication, and hourly rounding to evaluate effectiveness of care associated with pain management and patient satisfaction.

The study utilizes a conceptual framework.

This article uses a conceptual framework that provides a literature review

Conceptual framework

Conceptual Framework

Conceptual Framework

A 3-week pilot involving multidisciplinary whiteboard use

The setting is Stanford University Medical Center

Sample characteristics (# of patients) Patients available for the pilot were 104 patients: 56 from inpatient units with use of whiteboards and 48 from inpatient units with no use of white boards.

internal medical residents were also surveyed.

Design: The study involved a semi-structured interview.

Setting: The interview took place in a pediatric urban academic hospital inpatient surgical service

Sample characteristics (# of patients) The number of people interviewed were 29 families.

Design: The researchers used a prospective, quasi-experimental…...

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References

Alaloul, F., Williams, K., Myers, J., Jones, K. D., & Logsdon, M. C. (2015). Impact of a Script-based Communication Intervention on Patient Satisfaction with Pain Management. Pain Management Nursing, 16(3), 321-327. doi:10.1016/j.pmn.2014.08.008

Brosey, L. A., & March, K. S. (2015). Effectiveness of Structured Hourly Nurse Rounding on Patient Satisfaction and Clinical Outcomes. Journal of Nursing Care Quality, 30(2), 153-159. doi:10.1097/ncq.086

Cholli, P., Meyer, E. C., David, M., Moonan, M., Mahoney, J., Hession-Laband, E., . . . Bell, S. K. (2016). Family Perspectives on Whiteboard Use and Recommendations for Improved Practices. Hospital Pediatrics, 6(7), 426-430. doi:10.1542/hpeds.2015-0182

Emerson, B. L., Chmura, K. B., & Walker, D. (2014). Hourly Rounding in the Pediatric Emergency Department: Patient and Family Safety and Satisfaction Rounds. The Journal of Emergency Medicine, 47(1), 99-104. doi:10.1016/j.jemermed.2013.11.098

First, we want to reassure you that being confused about nursing worldviews puts you in some good company.  Many nurse practitioners find that the approach that place worldviews at the beginning of nursing inquiry may actually be hampering the development of nursing scholarship and keeping the profession from evolving as quickly and as efficiently as it should.  In addition, the material can become very confusing because different authors use the words paradigm and worldview interchangeably, though they distinguish them from metaparadigms. 

Broadly stated, an individual’s worldview consists of the beliefs and assumptions that the person uses to interpret....

Electronic medical records, which refer to medical records that are not only stored in electronic systems (which includes almost all medical records in the modern world, with the exception of some medical records maintained in non-industrialized nations), but that are accessible to multiple healthcare providers across different platforms.  The question is whether these records are able to improve quality of care by allowing healthcare providers to get a full picture of a patient’s medical history, as well as any presenting concerns or issues, as soon as the patient presents for medical treatment.  It would seem like the....

For several years, healthcare has been an important topic, not just in the world at large, but also in academia.  Healthcare has been one of the fastest growing sectors of our economy, has offered a boom in terms of employment, and is a hot button political issue since access to healthcare remains very class-based in the modern United States.  The COVID-19 pandemic and what it has meant about access to health care and the quality of healthcare that is being provided has only made it that much more important to focus on

What is the history of nursing in Ghana?

Many articles that explore the history of nursing are very focused on the evolution and history of nursing in the Western world, which leads people to mistakenly conclude that nursing evolved in the West and then was transported to other parts of the world, including Ghana.  On the contrary, Ghana has a rich tradition of nurses as healthcare practitioners and the profession evolved in Ghana alongside developments in other parts of the world. The history of nursing in Ghana may not contain any figures as....