PICO
Nursing theory informs nursing practice, and especially evidence-based practice. Theory offers a framework for decision-making and policy. Neuman's systems model provides the perfect theoretical framework with which to conduct my research and inform best practices. My PICO question is as follows: "For hospitalized patients who are susceptible to catheter associated Urinary Tract infection (CAUTI), if nurses and other assistive personnel develop an action plan with a systematic team approach of evidence-based infection control practices, compared to current practices, could it reduce or eliminate incidences of CAUTI?"

Developed by Betty Neuman, Neuman's systems model has a variety of applications in the workplace. Although it is a broad mid-range theory, Neuman's systems model also has specific applications for daily nursing practice. According to Neuman (2011), the systems model "provides a unifying focus for approaching a wide range of international health concerns." One of these concerns regards the correct use of catheters in hospitalized…...

mla

References

Lowry, L.W. & Anderson, B. (1993). Neuman's framework and ventilator dependency: A pilot study. Nursing Science Quarterly 6(4): 195-200.

Neuman, B. (1990). Health as a continuum based on the Neuman systems model. Nursing Science Quarterly 3(3): 129-135.

Neuman, B. (2011). Neuman systems model. Retrieved online: http://www.neumansystemsmodel.org/

intervention for my PICO problem is changing the policies and procedures in hospital with the goal of reducing instances and severity of catheter-related urinary tract infections among affected patients. Although it is an administrative intervention, the outcomes are related to patient data.
The independent variables in the research include structure of nursing staff teams; the specific policies that are implemented including catheter insertion and removal procedures and regulations; and finally, the materials that are used in catheterization. Specific independent variables are listed in Appendix A.

Dependent variables include overall number of instances of CAUTI, tracked according to patient population and why the patient was catheterized. In addition to rate of CAUTI infections, the costs associated with the infection can also be a dependent variable. The material used to measure dependent variables is listed in Appendix B of this report.

Materials: Summary

Written guide related to catheter removal, with express role delegation

2. Data from…...

Summations by Supreme Court Justices Brennan and Blackmun clearly express why the court voted in favor of the plaintiffs in this important case. First of all, Justice Brennan maintains that the case "does not involve textbooks, or indeed any books that... students would be required to read. The only books at issue are library books (which) are optional rather than required reading." What Brennan is attempting to say is that the students at Island Trees were not being forced to read the so-called "filth," but if they chose to read these books, their rights as protected under the First Amendment allowed them to read as much or as little as they pleased.

Similarly, Justice Blackmun asserts that the books in question may not be removed from library shelves "for the purpose of restricting access to the political ideas or social perspectives" of the authors. Also, these books cannot be removed if…...

mla

References

Crutcher, Chris (2007). "Board of Ed. v. Pico." Internet. Retrieved at http://www.chriscrutcher.com/content/blogcategory/60/49.

Patient Falls and Nursing
PICO Question -- Among acute care patients on a Medical-Surgical Unit, does hourly rounding, as opposed to only setting the bed alarm, significantly reduce patient falls (at least by 50%)?

Modern healthcare and nursing are more complex than ever before. The nurse's role is far more than simply an assistant, and requires the understanding and application of a large toolbox to deal with many different situations within the course of any given time period. (Borkowski, 2011). More often than not, nurses tend to act as the "moral agents" within the system because they are the locus of communication between the physician, the patient, and the family. The modern nurse leader must act with moral courage and conviction since "nursing leaders are responsible for creating cultures that support acts of courage in nursing… [because] these acts have the potential to increase nurse retention, promote patient comfort, relieve patient suffering,…...

mla

REFERENCES

Hourly Rounding & Fall Prevention: A Winning Strategy. (2012). RN.com. Retrieved from:  http://www.rn.com/getpdf.php/1820.pdf 

Berg, K., Sailors, C., Reimer, R., O'Brien, Y., & Ward-Smith, P. (2011). Hourly rounding with a purpose. Iowa Nurse Reporter, 24(3), 12-14.

Borkowski, N. (2011). Organizational Behavior in Health Care. Sudbury, MA: Jones and Bartlett.

Davis, S., Hubbart, B., & Kautz, D. (2011). Nurses' experiences with bed exit alarms may lead to ambivalence about their effectiveness. Rehabilitation Nursing, 36(5), 196-199

Man?
Giovanni Pico della Mirandola asks the question as to what is man's highest calling. He finds it in the deepest of religious beliefs and offers rational spirituality as the way to perfection. He believed that man was the greatest of God's creations, the highest form of life, even rivaling the angels. His reason was based on his firm belief in God and man's relationship with God as the creator and father of all men. He pointed out that man was the intermediary between God and the lower animals. He based this on the fact that Man has reason and intelligence. He is the one to interpret nature, and use nature. Giovanni writes from the premise that man is created by God, and that there is a Divine order to the Universe. His belief is agreement with other religious leaders including the writings of Teresa of Avila, and Saint Augustine.…...

Evidence-Based Practice using PICO
The question posed for this search activity will be, "Does early referral of terminally ill patients into a hospice program results in better patient outcomes, in particular, with regard to pain management?" The patient group in this question is terminally ill patients. The intervention is terminally ill disease. The comparison is time entered into hospice care. The outcome is reduced pain. The primary search terms for this search are hospice and pain management. ynonyms for the search are in-home care, bereavement care, critical condition, deathbed, palliative, and anesthesia. The Meh terms are Hospices, Terminal Care, Pain management and Chronic Disease.

Based on the located synonyms, the better phrasing of the question may be, "Do early admitted hospice patience have a better outcome regarding pain management?" The reason for shaving the question slightly is that only terminally ill patients can be admitted into hospices. o, the term does not…...

mla

Shepperd, Wee; et al. (2012). Home-based end of life care.

This search engine did not seem very helpful at all. Perhaps it is meant more for basic definitions as opposed to research-based questions.

The most helpful article that I found during my searching was the Miller article "Does receipt of hospice care in nursing homes improve the management of pain at end of life." I think this article will be helpful as it implies using hospice care sooner and integrating it with the care of physicians and nurses at nursing homes.

In the study, patients attending an asthma clinic were instructed during a two-hour educational session on asthma, its potential triggers, the appropriate use of medications, proper inhaler techniques, and the self-management of their disease. This study was more dramatic in its findings regarding the improving benefits of education. 230 patients were recruited for the study, and 83% completed the study. The group demonstrated significant improvements in lung function. There were also significant improvements in inhaler technique, asthma knowledge and patient's self-rating of the severity of their asthma symptoms. There were also reductions in the numbers of hospitalizations, visits to family physicians and accident and emergency room attendance during the study period. Patients with moderate to severe asthma were most likely to benefit from the program, thus the study concluded that patient education was beneficial.

Defense of Choices

These studies are useful, because while both examine educational initiatives targeting adult asthmatic populations, they…...

mla

Works Cited

Choy D.K., M. Tong, F. Ko, S.T. Li, a. Ho, J. Chan, R. Leung, & C.K. Lai. (1999, Jan).

Evaluation of the efficacy of a hospital-based asthma education program in patients of low socioeconomic status in Hong Kong." Clin Exp. Allergy.

29(1):84-90. Retrieved from PubMed on 22 Sept 2007 at  http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=10051706&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus 

Cote, J., a. Cartier, P. Robichaud, H. Boutin, J.L. Malo, M. Rouleau, a. Fillion,

Philosophy
Both Luther and Pico believe that human nature is duplicitous and binary, and that human beings have the ability to choose between the two poles. Those two poles are also framed similarly by Pico and Luther, who claim that a human being is both body or animal as well as spirit or soul. In "Concerning Christian Liberty," Luther claims that human beings have a dual nature, comprised by the body and the soul. In "Oration," Pico states that human beings exist between two worlds, the divine world and the mundane one. The goal of human life is to reach the highest potential of human nature, which is to aspire toward God. Luther and Pico differ regarding their suggested methods by which a human being aspires toward God, but not in a significant way. For Luther, a human being need only have faith in Jesus. Pico believes a human being does…...

mla

Works Cited

Luther, M. Concerning Christian Liberty. Retrieved online:  http://www.bartleby.com/36/6/2.html 

Pico "Oration." Retrieved online:  http://www.panarchy.org/pico/oration.html

2010). While there is of course a mandate for emergency departments to provide necessary care to any individual that requires it, more efficient and effective care can be proved when crowding in the department is kept to a minimum and releases of boarded patients are made as soon as possible (McCarthy et al. 2009; Bair et al. 2010). Crowding itself was seen to have an effect on waiting room and boarding times, and though treatment was not typically delayed due to crowding -- at least not nearly to the same levels as boarding times -- but the efficacy of treatment and the overall efficiency of a given emergency department's operations were greatly enhanced by a lack of patient crowding, which can be conversely affected by decreasing boarding times (McCarthy et al. 2009).
The desired outcomes as stated is the improvement of safety and health outcomes for boarded emergency department patients,…...

mla

References

Bair, a., Song, W., Chen, Y. & Morris, B. (2010). The Impact of Inpatient Boarding on ED Efficiency: A Discrete-Event Simulation Study. Journal of Medical Systems 34: 919-29.

McCarthy, M., Zeger, S., Ding, R., Levin, S., Desmond, J., Lee, J. & Aronsky, D. (2009). Crowding Delays Treatment and Lengthens Emergency Department Length of Stay, Even Among High-Acuity Patients. Annals of Emergency Medicine 54(4): 492-503.

It is also quite possible that there is a significant "placebo effect" when dealing with GI (or other) treatments. The patients may be truly relaxing, but may also believe that they are managing their pain through breathing and imagery, meaning they are, in fact doing just that (resler; Menzies).
Evidence-ased Practice Analysis -- Clearly, the use of GI techniques to supplement and help wean patients off pharmaceutical pain management solutions is not only positive, but cost-effective and more efficient. The research shows that not only is GI helpful for pain management, it can also be an effective technique to lower blood pressure, reduce anxiety, work in a pre- and post-op setting, to help prevent patients from "test or exam" panic, and to increase pain tolerance. Physicians could help disseminate this technique by supplying their patients with a disk or zip-drive with several different (length, style, etc.) GI scenarios. Giving the…...

mla

Bibliography

Bresler, D. (2010, July 1). Raising Pain Tolerance Using Guided Imagery. Pratical Pain Management, 1-5. Retrieved May 2013, from  http://www.practicalpainmanagement.com/treatments/psychological/raising-pain-tolerance-using-guided-imagery 

Ferrell, B., et al. (1994). Pain Management for Elderly Patients with Cancer at Home. Cancer, 74(1), 2139-46. Retrieved May 2013, from  http://prc.coh.org/pdf/Pain%20mgt%20elderly.pdf 

Menzies, V., et al. (2006). Effects of Guided Imagery on Outcomes of Pain, Functional Status, and Self-Efficacy in Persons Diagnosed with Fibromyalgia. The Journal of Alternative and Complimentary Medicine, 12(1), 23-30. Retrieved May 2013, from  http://www.encognitive.com/files/Effects%20of%20Guided%20Imagery%20on%20Outcomes%20of%20Pain,%20Functional%20Status,%20and%20Self-Efficacy%20in%20Persons%20Diagnosed%20with%20Fibromyalgia.pdf 

Weydert, J., et al. (2006). Evaluation of guided imagery as a treatment for recurrent abdonimal pain in children. British Medical Journal of Pediatrics, 6(18), 29-37. Retrieved May 2013, from  http://www.ncbi.nlm.nih.gov/pubmed/17090333

This ahs some relevance to the PICO question in the ability of individuals to provide proper self-care, but it does not address the issues of diet or exercise at all.
The Two Best

The two most relevant articles that were uncovered during this research process in regards to the specific PICO question identified above were Gulve's 2008 article concerning the effects of different exercise types on glucose levels, and the Mayo Clinic's 2009 general information article on developing a healthy eating plan. These two articles have very different approaches both in collecting their information and in presenting it to the reader, but both also came the clsoest to directly answering the PICO question, or at least specific portions of the PICO question, and had highly reliable information.

In the case of the Mayo Clinic's article, the dietary plan was directly and explicitly linked to changes in glucose levels, aiding the patient (and…...

PICOT
Population/Patient

Adults with congestive heart failure requiring hospitalization

Intervention

Heart Failure education (signs, symptoms, pathophysiology), self-care interventions (diet, fluid restrictions, sodium dietary restrictions, review of medications, exercise recommendations, weight monitoring), patient support (telephone support, increased clinic visits, home visits, social support, psychological support, multidisciplinary care).

Comparison

Usual care vs. intervention, one intervention vs. another intervention

eadmission rates (all causes), length of hospital stay, health care utilization, mortality rates (all causes), quality of life.

Timeframe

One Month follow up

Question

In congestive heart failure patients 50 years and older, what is the effectiveness of interventions to support post-discharge care compared with the usual care to prevent readmission?

How can we prevent readmissions for patients with congestive heart failure?

Introduction

Congestive Heart Failure (CHF) occurs when the heart is unable to pump enough blood flow to meet the needs of the body. It can cause a number of symptoms, including shortness of breath, exercise intolerance, swelling in the extremities, numbness, and even mimic the symptoms…...

mla

REFERENCES

Andrietta, M., et al. (2011). Hospital discharge plan for patients with congestive heart failure. Latino-American Enfermagem, 19(6), 1445-52.

Bradke, P., & Brinker, E. (2011). To reduce heart failure readmissions use the teach-back mehtod. Patient Education Management, 18(10), 109-20.

Crowther, M. (2012). Heart failure readmissions: Can hospital care make a difference? Nursing Made Incredibly Easy, 10(2), 1-3. Retrieved from  http://journals.lww.com/nursingmadeincrediblyeasy/Fulltext/2012/03000/Heart_failure_readmissions____Can_hospital_care.1.aspx 

Hines, P., Yu, K., & Randall, M. (2010). Preventing Heart Failure Readmissions: Is Your Organization Prepared?, 28(2), 74-86.

PICO Question: Bariatric Surgery As the obesity rate continues to be an issue of great concern in America, the question arises as to the best ways to reduce the BMIs of individuals already suffering from the condition, as well as how to enact preventative means. Although the ideal is for people to never become obese at all, the fact remains that there is a need to develop proactive measures to facilitate weight reduction. For most patients, modifications in diet and exercise is recommended but, as even people who have attempted casual weight loss know, deploying such techniques in an effective and consistent fashion is far easier said than done.
PICO Question
The PICO question for the purpose of this study is, from the perspective of a family nurse practitioner, when treating patients with type 2 diabetes and obesity, can bariatric surgery be more effective than standard medical therapy at increasing the probability of…...

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…...

mla

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.

The findings yielded a direct correlation between poor inhaler use and poor literacy: Poor inhaler technique was found in 89% of patients reading at less than the third-grade level compared with 48% of patients reading at the high-school level (Nowlan, illiams, Baker, Honig, Lee 1991).
This study's result would have a direct impact upon traditional patient educational efforts, as health education still tends to rely heavily on printed materials. These materials might also be written at too high a level. Making use of pictorial materials and personal demonstrations, the authors concluded, might be more effective than using traditional verbally-based media. The study suggests that different approaches are needed, and more personalized intervention may be required for asthmatics, at least during early stages of treatment. However, there is an issue of correlation vs. causation -- individuals with low levels of literacy may have difficulty learning in general, regardless of the medium,…...

mla

Works Cited

Huss K., M. Salerno, & R.W. Huss. (1991, August). Computer-assisted reinforcement of instruction: Effects on adherence in adult atopic asthmatics. Research in Nursing & Health, 14 (4): 259-67. ISSN: 0160-6891 PMID: 1891611 CINAHL an: 1991128860.

Database: CINAHL Plus

Meer, V. van der, M.J. Bakker, W.B. van den Hout, K.F. Rabe, P.J. Sterk, J. Kievit, W.J.J.

Assendelft, & J.K. Sont. (2009, July 21). Internet-based self-management plus education compared with usual care in asthma. A randomized trial. Annals of Internal Medicine. 151 (2): 110-120.

Looking for the best practices on endotracheal suctioning often involves determining whether open or closed suctioning is better.  Open suctioning requires disconnecting the patient from the ventilator, while closed suctioning allows the patient to remain connected to the ventilator.  While closed suctioning is generally preferred, it is not always the best practice, but the research investigated looked specifically at closed suctioning because of the research question presented.   

In 1999, Kinloch ran an observational study that compared oxygenation in patients that either had normal saline instilled at the start of endotracheal tube suctioning or did not have saline instilled.  Until....

I. Introduction
A. Brazil's captivating allure as a travel destination
B. A melting pot of diverse landscapes, vibrant culture, and rich history
C. Thesis statement: Unveiling the captivating elements that make Brazil a must-visit bucket list item

II. Natural Wonders and Diverse Landscapes
A. Amazon Rainforest: The largest rainforest in the world, teeming with biodiversity and home to indigenous cultures
1. Explore the intricate ecosystem and witness the mesmerizing wildlife
2. Embark on a riverboat journey through the labyrinthine waterways
B. Iguazu Falls: A breathtaking natural spectacle, straddling the border between Brazil and Argentina
1. Marvel at the thunderous cascades and rainbows that adorn the falls
2. Wander through the....

Implementing evidence-based practice in nursing care can help improve patient outcomes in several ways:

1. Better use of current research and best practices: By implementing evidence-based practice, nurses can incorporate the latest research findings and best practices into their patient care, ensuring that patients receive the most effective treatments and interventions.

2. Increased efficiency and effectiveness of care: Evidence-based practice helps nurses make informed decisions about patient care based on the best available evidence, leading to more efficient and effective interventions that can improve patient outcomes.

3. Consistency in care delivery: Following evidence-based guidelines and protocols helps ensure that all patients receive consistent....

Implementing Evidence-Based Practice in Nursing Care

Evidence-based practice (EBP) is a systematic approach to healthcare that incorporates the best available research, clinical expertise, and patient values to deliver optimal patient outcomes. In nursing care, implementing EBP has proven instrumental in enhancing the quality and effectiveness of interventions.

Benefits of EBP in Patient Outcomes

Improved Patient Safety:

EBP guidelines reduce medication errors, hospital-acquired infections, and other adverse events by providing standardized protocols based on proven research.
Risk assessment tools and early warning systems help identify and intervene on potential complications early on.

Enhanced Treatment Efficacy:

EBP supports the use of therapies and interventions that have....