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Many people say that an ulcer is caused by stress whereas scientific journals states that it is caused by bacteria. Actually, ulcer has traditionally been thought as a condition brought by stress as well as the consumption of coffee and spicy foods. Generally, an ulcer was believed to be a by-product of lifestyle factors like diet and stress. In the past few years, it has emerged that an ulcer is caused by a bacterial infection as stated in various scientific journals on ulcers. This change can be attributed to the fact that researchers determined that stomach acids like hydrochloric acid generates the formation of an ulcer. The determination that an ulcer is largely caused by bacterial infections raises concerns on whether bacteria survive the gastric juice and cause harm to an individual's body.
Gastric juice is primarily made of hydrochloric acid and pepsin, an enzyme that breaks down protein.…
Pressure Ulcers in the Elderly During Hospital Stays
Pressure ulcers are potentially fatal skin lesions that develop especially in frail, elderly patients on bony or cartilaginous areas such as the sacrum, elbows, and ankles. Within acute care in the United States, the incidence of pressure ulcers lies between 0.4% and 38%. The incidence within long-term and home care is significantly lower while intensive care units report that 8% to 40% of ICU patients develop pressure ulcers during the hospital stay (Cuddigan, Berlowitz & Ayello, 2001). An epidemiological study of pressure ulcers reports that hospital-acquired pressure ulcers cost the U.S. $2.2 to $3.6 billion per year in 1999 (Vandenkerkhof, Friedberg & Harrison, 2011). These statistics carry important implications for guidelines of identification and treatment of pressure ulcers in the United States. In the complexity of the medical system, the application of Jean Watson's Theory of Nursing Caring and the developing role…
Baumgarten, M., Margolis, D.J., Localio, A.R., Kagan, S.H., et al. (2006). Pressure Ulcers Among Elderly Patients Early in the Hospital Stay. The Journals of Gerontology, 61, 7, 749-754.
Baumgarten, M., Margolis, D.J. Localio, A.R., Kagan, S.H., Lowe, R.A., Kinosian, B., Abbuhl, S.B., Kavesh, W., Holmes, J.H., Ruffin, A., Mehari, T., et al. (2008). Extrinsic Risk Factors for Pressure Ulcers Early in the Hospital Stay: A Nested Case-Control Study. The Journals of Gerontology, 63, 4, 408-413.
Cara, C. (2003). Continuing Education: A Pragmatic View of Jean Watson's Caring Theory. International Journal of Human Caring, 7, 3, 51-61.
Clegg, A., Bradley, M., Smith, P., Kirk, Z. (2006). Developing the nurse's role in the care of older people. Nursing Older People, 18, 5, 26-30.
Pressure Ulcers/Case Study
Bedsores are also known as pressure ulcers. They are lesions that are primarily caused when soft tissues are pressed against bone for a long period of time, restricting blood flow to the area. These often occur when a patient is immobile or reclining in a recovery bed for a long period of time. They are common on the hips, elbows, knees, ankles and even the back of the head. Current research shows that they are exacerbated by other conditions like diabetes, perspiration, incontinence, infection, or medications that impair the circulatory system. Pressure ulcers are particularly serious in older patients -- particularly those in a wheel chair or in cases in which the patient does not move or exercise. Bedsores are often fatal, even when treated aggressively and are one of the leading causes of death from complications in many developed countries -- second only to adverse drug…
Coverage Information retrieved from http://www.medicare.gov
Medicare Nonpayment for Hospital Acquired Conditions. (2012). National Conference of State Legislatures. Retrieved from: http://www.ncsl.org/issues-research/health/medicare-nonpayment-for-hospital-acquired-conditio.aspx
Medicare Will Not Pay for Hospital Mistakes and Infections. (2007, August 20).
Medicalnewstoday. Retrieved from: http://www.medicalnewstoday.com/articles/80074.php
Peptic Ulcer Disease: Pathophysiology
A peptic ulcer can be defined as "a focal mucosal defect with inflammatory cell infiltration and coagulation necrosis extending through the muscularis mucosae" (Halter, 1995, p. 2). Contrary to erosion, a peptic ulcer extends beyond the epithelial structures into that intestinal tract section that happens to be in constant contact with pepsin and acid-containing gastric juice (Halter, 1995). Peptic ulcers cause an imbalance between the gastro duodenal defense-influencing factors such as prostaglandin, bicarbonate and mucus, and those such as NSAID use, H. pylori, pepsin and gastric acid, which promote mucosal damage (Elsevier, 2012). If peptic ulcers keep recurring at the same site, the imbalance worsens, resulting in peptic ulcer disease (PUD).
Two types of peptic ulcers can be deduced from the explanation above; duodenal and gastric ulcers (Elsevier, 2012).
Gastric Ulcers: there are four major classifications of gastric ulcers: type I, type II, type III and…
Elsevier. (2012). Peptic Ulcer Disease. Clinical Key Elsevier. Retrieved from https://www.clinicalkey.com/topics/gastroenterology/peptic-ulcer-disease.html
Halter, F. (1995). Pathophysiology of Peptic Ulcer Disease. In D. Hollander & G. Tytgat (Eds.), Sucralfate: from Basic Science to the Bedside (Ch. 10). New York: Plenum Press.
UMMC. (2013). Peptic Ulcer. The University of Maryland Medical Center. Retrieved from http://umm.edu/health/medical/ency/articles/peptic-ulcer
Preventing Pressure Ulcers in Postoperative Patients
this is a nursing research evidence-based practice project paper. THIS IS A NURSING PROJECT. SINGLE SPACE. 6 PAGES FOR THE PROJECT, 2 PAGES FOR THE LISTED INFO Directions: 1. You developed EVIDENCE-BASED NURSING PRACICE PROJECT (EBP).
What are the best practices to prevent pressure ulcers in postoperative patients?
This project aims at implementing evidence-based prevention strategies for pressure ulcers in postoperative patients.
There are many risk factors associated with pressure ulcers such as lack of movement, poor nutritional intake, hypothermia, and dry skin. Postoperative patients are at increased risk of developing pressure ulcers because they often have long period of immobility and poor nutritional intake. As a result, they experience pain and discomfort and poor quality of life as a result of pressure ulcers. Pressure ulcers are preventable using strategies such as repositioning of patients to prevent accumulation of pressure, use of mattress overlays…
Otherwise, the resources are either short or unavailable. These situations tend to make gains in pressure ulcer care quickly vanish (Cuddigan et al.).
Lastly, national records on pressure ulcer rates have remained incomplete and unreliable (Cuddigan et al. 2001). Hospital discharge records do not all reflect or include pressure ulcer cases even if the patients reach Stage III or IV. In addition, these records are unable to recognize and tally the difference between pressure ulcers at different stages and complications already present on admission. It is still a fact that pressure ulcer rates in these databases remain lower than those gathered in clinical studies, indicating the inaccuracy of the databases. Yet valid and complete information from these national databases is needed to provide accurate feedback to providers. They form the basis for sound clinical, educational and public policy decisions for the future (Cuddigan et al.).
Allman R.M. et al.…
Allman R.M. et al. (1995). Pressure Ulcer Risk Factors Among Hospitalized Patients with Activity Limitation. 5 pages. Hopkins Medicine. Retrieved on January 5, 2008 at http://www.hopkinsmedicine.org/geriatrics/education/MedStudent/Geriatrics/SummerScholarsProgram/Section8.pdf
Berman, K (2007). Pressure Ulcer. 1 web page. MedlinePlus: National Institute of Health
Collins, N (2002). Vitamin C and Pressure Ulcers. 4 pages. Advances in Skin and Wound Care: Springhouse Corporation
Cuddigan, J. et al. (2001). Pressure Ulcers in America: Prevalence, Incidence and Implications for the Future. 9 pages. Advances in Skin and Wound Care: Springhouse Corporation
The use of aspirin and other NSAIDs has not been eliminated by studies as possible causes of PUD. H. pylori infection generally occurred less among patients with complicated ulcer disease than in those with uncomplicated ulcer disease. Many studies point to aspirin or NSAIDs as the other identifiable risk or cause of PUD. PPI has been shown to reduce dyspeptic symptoms, which develop from NSAID use. In the past, lansoprazole was the only FDA-approved PPI. Recently, however, professors at the University Hospital, Queen's Medical Centre of Nottingham in the United Kingdom presented their findings on a comparison among PPIs. Their study was internationally-based with more than 500 patients. It showed that esomeprazole was superior to other PPIs in managing upper gastrointestinal symptoms of arthritic patients. It also enhanced their quality of life (Howden).
PUD is not only likely to remain a persistent condition (Howden, 2003). More cases of ulcers unconnected…
Hansen, J.M.; Wildner-Christensen, M.; Hellas, J.; and Schaffalitzky de Muckadell, O.
B. (2008). Effects of a community screening for helicobacter pylori 103 (5): 1106-
1113 The American Journal of Gastroenterology: Blackwell Publishing. Retrieved on July 24, 2009 from http://www.medscape.com/viewarticle/578729
Howden, C.W. (2003). Peptic ulcer disease. Medscape Public Health & Prevention:
ummary of Common and Conflicting Findings
Hart, Bergquist, Gajewski & Dunton (2006); Gunningberg (2005); Wipke-Tevis, Williams, Rantz, Popejoy, Madsen, Petroski & Vogelsmeier (2004); and Vanderwee, Grypdonck, DeBacquer & Defloor (2006) all indicate that pressure ulcers are unnecessarily common among patients in nursing care facilities. Pressure ulcers are generally defined as "lesions caused by unrelieved pressure, resulting in damage of underlying tissue," (Hart et al. 2006, p. 257). They occur mainly along bony protuberances such as the sacrum, hips, and ankles. Of the four studies, only Vanderwee et al. (2006) draw attention to the differences between observing pressure ulcers at different points on the body. Vanderwee et al. (2006) found that finger pressure and transparent disk methods of observation were both less sensitive at the heels and that the greatest correspondence between methods occurs at the sacrum. None of the other studies distinguished between the two main pressure ulcer observation methods:…
Summary of Common and Conflicting Findings
Hart, Bergquist, Gajewski & Dunton (2006); Gunningberg (2005); Wipke-Tevis, Williams, Rantz, Popejoy, Madsen, Petroski & Vogelsmeier (2004); and Vanderwee, Grypdonck, DeBacquer & Defloor (2006) all indicate that pressure ulcers are unnecessarily common among patients in nursing care facilities. Pressure ulcers are generally defined as "lesions caused by unrelieved pressure, resulting in damage of underlying tissue," (Hart et al. 2006, p. 257). They occur mainly along bony protuberances such as the sacrum, hips, and ankles. Of the four studies, only Vanderwee et al. (2006) draw attention to the differences between observing pressure ulcers at different points on the body. Vanderwee et al. (2006) found that finger pressure and transparent disk methods of observation were both less sensitive at the heels and that the greatest correspondence between methods occurs at the sacrum. None of the other studies distinguished between the two main pressure ulcer observation methods: finger and transparent disk.
All four researchers note that the greatest prevalence of pressure ulcers occurs among geriatric care patients, but Gunningberg (2005) found that intensive care, acute care, and neurological care patients may also be at an increased risk for developing pressure ulcers. Moreover, all four studies clearly indicate the need for improved nurse training and education in preventing pressure ulcers from occurring. Wipke-Tevis et al. (2004) state that research-backed risk assessment methods like the Braden Scale are "underused" in long-term nursing care facilities (p. 586). Furthermore, some patients in long-term care facilities are assessed more often than necessary whereas others are not monitored enough (Wipke-Tevis et al., 2004).
Treatment for a Patient With a Duodenal Ulcer
Until relatively recently, stress and spicy foods were deemed to be the likely causes of ulcers. That has changed, however, with the discovery of the causal link between H. pylori and duodenal ulcers. "Infection with Helicobacter pylori (commonly just called H. pylori) is the cause in about 19 in 20 cases of duodenal ulcer" (Kenny 2012). For some people who are infected, the bacteria causes no symptoms while for others it causes a disruption of the mucus barrier and an increase in the amount of digestive acid in the lining of the stomach, resulting in inflammation and discomfort, ultimately cumulating in an ulcer (Kenny 2012).
This revelation about the causation of ulcers has caused a dramatic shift in how they are treated. Instead of prescribing surgery, a 4-8-week course of acid-suppressing medication is used. The intention is to allow the ulcer to…
DiMarino, M. (2014). Peptic ulcer disease. Merck Manual. Retrieved from:
Kenny, T. (2012). Duodenal ulcer. Patient. Retrieved from:
Marshall and arren discovered that the organism was there in almost every patient with gastric ulcer and inflammation. Based on the results of their findings, they suggested that Helicobacter pylori are involved in the aetiology of these diseases. In fact, Helicobacter pylori cause over 90% of duodenal ulcers and about 80% of gastric ulcers. After this discovery, research has been deep.
This bacterium can be diagnosed by identification of the organism in biopsies, by antibody tests or by non-invasive breath test which recognizes bacterial production of an enzyme in the stomach. The use of antibiotics to eliminate Helicobacter pylori may lead to severe problems since bacteria and chronic inflammation of the stomach remains. Marshall, arren and other researchers showed that patients could be cured from peptic ulcer by eradication of the bacteria from the stomach. Due to Marshall and arren's discovery, peptic ulcer is no longer a chronic disabling disease…
Claessen, Elin L. "How Stomach Ulcer Bacteria Survive in the Stomach." UNIVERSITY of GOTHENBURG. University of Gothenburg, Sweden, 1 Nov. 2007. Web. 10 Mar. 2010. .
"The Nobel Prize in Physiology or Medicine 2005." Nobelprize.org. Nobel Web, 3 Oct. 2005. Web. 10 Mar. 2010. .
United States. National Digestive Diseases Information Clearinghouse. Centers for Disease Control and Prevention. Viral Gastroenteritis. By Mary K. Estes and Robert Atmar. National Institute of Diabetes and Digestive and Kidney Diseases, Feb. 2006. Web. 10 Mar. 2010. .
United States. National Digestive Diseases Information Clearinghouse. National Digestive Diseases Information Clearinghouse. H. Pylori and Peptic Ulcer. National Institute of Diabetes and Digestive and Kidney Diseases, Oct. 2004. Web. 10 Mar. 2010. .
Prevention / Intervention
Screening tools can be a cost effective means of identifying patients who are at risk for developing pressure ulcers. These tools identify specific areas that need to be addressed and watched closely. After areas of risk are identified, targeted interventions can be put into place that can further reduce the risk of pressure ulcer development.
Knowledge of pressure ulcer prevention strategies is vital. Implementation of targeted prevention strategies may be dependent on the areas that have been acknowledged to be at risk. Education is the essential piece of pressure ulcer prevention. This includes education for staff at all levels, as well as patients and caregivers. Staff education should include information on the facilities specific policies and pressure ulcer prevention program. Staff should be educated on the risk assessment tool used, excellent skin assessment skills, how to consult the wound care specialist if need be and the importance…
Avent, Y. (2010). Prevention Spotlight: Pressure Ulcers," Nursing Made Incredibly Easy,
Role of Staff Education in Pressure Ulcer Incidence in Long-Term Care Residents
Pressure ulcers (PUs), also known as bed sores, decubitus ulcers, or pressure sores, are formed where skin and tissue are squeezed between bone and an outside surface for long periods of time, often due to immobility ("Pressure Ulcer," 2002). The development of PUs is a common problem in long-term care of the elderly. A recent report by a national pressure ulcer organization estimates the prevalence of PUs in acute care at about 15%, with about a 7% incidence after admission (National Pressure Ulcer Advisory Panel, 2001).
Because PUs are so common, cause distress to the patient and their family, and can form the basis for litigation, it is important for the long-term medical care community to find ways to reduce their prevalence and incidence. Two commonly suggested solutions to the PU problem include identifying patients at risk using…
Peptic ulcer, often known as a peptic ulcer disease, is a painful condition of the abdomen resulting in mucosal erosion of the gastrointestinal tract usually by excessive acid (consult, 2007) these erosions can only be categorized as peptic ulcers if they are larger than 0.5cm in diameter. Peptic ulcers can be classified according to the location where they appear hence the ulcers occurring in the duodenum are known as duodenal ulcers, those occurring in the stomach are known as gastric ulcers and those in esophagus are known as esophageal ulcers. The causes of peptic ulcers majorly include special spiral bacteria known as Helicobacter pylori which produces excessive acid in the gastrointestinal tract and makes its mucosa eroded. Helicobacter pylori are responsible for at least 70-90% of peptic ulcers although only 40% of these cases are reported to the doctors. Another well-known cause of peptic ulcers is the excessive usage of…
A, S., & Muller-Lissner SA, V.E. (1981). "Predictors of duodenal ulcer healing and relapse. Journal of Gastroenterology, 81 (6): 1061 -- 1067.
consult, G. (2007, 08-26). perforated peptic ulcer. Retrieved 10-29, 2011, from GI consult: http://www.emedmag.com/Default.aspx
Kato, I., & Abraham M.Y. Nomura, G.N.-H. (1992). "A Prospective Study of Gastric and Duodenal Ulcer and Its Relation to Smoking, Alcohol, and Diet." American Journal of Epidemiology, 135 (5): 521 -- 530.
Kurata JH, H.B. (1984). Epidemiology of peptic ulcer disease. Clin Gastroenterol., 13(2):289-307.
Evidence-based studies that delineate how to manage and treat pressure ulcers have determined that the most effective approaches include keeping the wound moist, appropriate repositioning, using support surfaces, and proper nutrition. Non-traditional approaches, including electrical stimulation, hyperbaric oxygen, growth factors and skin equivalents, and negative pressure wound therapy, are also showing promising results (esources for Managing Hospital-Acquired Conditions, 2008).
Organizational level activities for dealing with hospital-acquired pressure ulcers include:
developing and adhering to a written plan and procedure for preventing and treating pressure ulcers educating and training staff in the care processes associated with skin assessment, staging of pressure ulcers, prevention strategies, and treatment modalities carefully selecting and provisioning the necessary equipment and supplies to prevent and treat pressure ulcers the measuring and monitoring of pressure ulcer rates that depend on honest, transparent reporting of all pressure ulcers (esources for Managing Hospital-Acquired Conditions, 2008).
The significance of this study in…
Bedsores (pressure sores). (2007). Retrieved April 29, 2009, from MayoClinic.com Web site:
Fitzpatrick, R., Fletcher, A., Gore, S.,Jones, D.,Spiegelhalter, D.,and Cox, D. Quality of Life
Measures in Healthcare.I:Applications and Issues in Assessment. (1992). Retrieved April
Planning and Implementing Change
Pressure ulcers are one of the most serious concerns facing hospitals and nursing homes today. This is particularly the case with older people and those with serious disabilities that keep them bed-bound for an extended period of time. emaining in one position for too long can cause painful and severe pressure ulcers, which often require hospitalization and invasive intervention. Indeed, according to Perry et al. (2012), nearly 60,000 hospital patients in the United States die as a result of complications resulting from pressure ulcers they acquire in hospitals.
In addition to mortality, the financial costs can also be severe, with a single full thickness pressure ulcer requiring as much as $70,000 to manage. Indeed, the total cost of treatment for pressure ulcers in the country is estimated at $11 billion per year.
Obviously, the effects of these costs are severe, including many stakeholders, including those suffering…
Black, J.M., Edsberg, L.E., Baharestani, M.M., Langemo, D., Goldberg, M., McNichol, L., and Cuddigan, J. (2011). Pressure Ulcers: Avoidable or Unavoidable? Results of the National Pressure Ulcer Advisory Panel consensus conference. Ostomy Wound Management 57(2). Retrieved from: http://www.npuap.org/wp-content/uploads/2012/01/A-UA-pr-ul1.pdf
Hagisawa, S. And Furguson-Pell, M. (2008, Aug.). Evidence supporting the use of two-hourly turning for pressure ulcer prevention. Journal of Tissue Viability. 17(3). Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/18722313
Lyder, C.H. And Ayello, E.A. (2008, Apr.). Pressure Ulcers: A Patient Safety Issue. Patient Safety and Quality: An Evidence-Based Handbook for Nurses edited by RG Hughes. Retrieved from: http://www.ncbi.nlm.nih.gov/books/NBK2650 /' target='_blank' REL='NOFOLLOW'>
Preventing Pressure Ulcers in Nursing Home Patients
With growing numbers of the American population joining the elderly ranks, there has been a corresponding increase in the number of residents of long-term care facilities including approximately 16,100 nursing homes in recent years (Palumbo & Mclaughlin, 2011). As a result, there has also been increased interest among clinicians concerning optimal turning and repositioning rates for immobile nursing home patients to reduce pressure ulcers (Miller & Ward, 2010). The need for improved care of pressure ulcers is great, and it has been estimated that the cost of each pressure ulcer incident ranges between $500 and $70,000 for a staggering total of $11 billion annually (Lilly & Estocada, 2014). Therefore, the question of interest for this study is whether turning and repositioning a patient more frequently (i.e., every 2 hours) reduces the risk of patients developing pressure ulcers compared with patient turned and repositioned…
Lilly, D. & Estocada, N. (2014, December 1). Validation of the NE1 Wound Assessment Tool to improve staging of pressure ulcers on admission by registered nurses. Journal of Nursing Measurement, 22(3), 438-441.
Miller, L. L. & Ward, D. (2010, Spring). Evidence-based practices in nursing. Generations, 34(1), 72-77.
Palumbo, M. V. & Mclaughlin, V. (2011, Winter). Practical nurses' health and safety in nursing homes. Journal of Health and Human Services Administration, 34(3), 271-277.
Peterson, M. J. & Gravenstein, N. (2013, April). Patient repositioning and pressure ulcer risk-monitoring interface pressures of at-risk patients. Journal of Rehabilitation Research & Development, 50(4), 477-481.
Patient Turning Every Two Hours and Positioning Decreases the Development of New Pressure Ulcers
The objective of this study is to determine whether turning and positioning of a patient every two hours decreases in the development of new pressure ulcers. Toward this end, this study will conduct a review of the literature in this area of inquiry.
The work of ich, et al. (2011) entitled "Frequent Manual epositioning and Incident of Pressure Ulcers Among Fracture Patients" reports that frequent manual repositioning "is an established part of pressure ulcer (PU) prevention, but there is little evidence for its effectiveness." (p.1) The study reported by ich, et al. conducted an examination of the link between repositioning and incidence of pressure ulcers among elderly patients that were bedbound fracture patients. The study findings indicate that there was no link between patient repositioning and incidence of pressure ulcers. However, the work of Ostadabbas, et…
Baldwin, C. (nd) New Turning and Positioning System Facilitates Patient Repositioning to Aid in Pressure Ulcer Healing. Kindred Healthcare. Retrieved from: http://www.sageproducts.com/documents/pdf/education/case_studies/sacral/21495.pdf
National Institutes of Health, National Institute of Nursing Research, National Institute on Aging, et al. (2008) Pressure Ulcer Prevention: Turning for Ulcer Reduction (TURN) Clinical Trials Gov. Retrieved from: http://clinicaltrials.gov/ct2/show/NCT00665535
Prevention of Pressure Ulcers (2011) National Guideline Clearinghouse. Retrieved from: http://www.guideline.gov/ syntheses/printView.aspx?id=47794
Rich, SE (2011) Frequent manual repositioning and incidence of pressure ulcers among bedbound elderly hip fracture patients. Wound Repair Regen, Jan 2011; 19(1): 10-18. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3059225/
Hourly Nurse ounds to Help educe Falls, Call Light Use, and Pressure Ulcers
The objective of this paper is to carry out the literature review to investigate whether the hourly rounding is able to reduce pressure ulcers, falls, and call light use and contribute to the overall increase in patient satisfactions. The outcomes of the literature review assist in identifying the gaps in the literature.
Hicks, (2015) in his study, "Can ounding educe Patient Falls in Acute Care? An Integrative Literature eview." (p 51) defines fall as an unexpected descent from a sitting, standing or supine position. Typically, falls are the critical problem within the healthcare organizations and are the top cause of injury-related deaths among older adults. More than "20% of people who fall suffer moderate-to-severe injuries, such as head trauma bruises or hip fractures." (Hicks, 2015, p 51). In 2000, the costs of managing fall injuries were more…
Ford, M.B. (2010). Hourly Rounding: A Strategy to Improve Patient Satisfaction Scores. MEDSURG Nursing. 19(3):188-191.
Hicks, D. (2015). Can Rounding Reduce Patient Falls in Acute Care? An Integrative Literature Review. MEDSURG Nursing. 24 (1):51-55.
Hodgson, G.L.L (2012). Hourly rounding in a high dependency unit. NURSING STANDARD / RCN. 27(8): 35-40.
Saleh, B.S. Nusair, H. Zubadi, N.A. et al. (2011). The Nursing Rounds System: Effect of Patient's Call Light use, Bed sores, fall and Satisfaction Level. International Journal of Nursing Practice. 17: 299-303.
Evidence-Based Practice on Hourly ounding
Impact of Hourly ounding on Falls Preventions, eduction of Pressure Ulcers and Call Light Use
In the contemporary health environment, falls are the common phenomenon that may cause fatal injuries to older adults of 60 years and older. Nearly 50% of hospitalized older adults face the risks of falls that can lead to a fatal or non-fatal injury. Consequently, falls can lead to negative effects that include elevated hospital costs and longer hospital stay. To overcome high rates of falls within a healthcare environment, different organizations have devised different strategies for hospitalized older adults. While these health practices are devised to enhance safety among patients, however, all these health practices are ineffective to prevent falls. For example, call lights use may be effective to prevent falls, however, its overuse can increase the nursing workloads, and consequently reduce nursing satisfactions.
An hourly rounding has been identified…
Callahan, L., McDonald, S., Voit, D., McDonnell, A., Delgado-Flores, J., & Stanghellini, E. (2011). Medication review and hourly nursing rounds: An evidence-based approach reduces falls on oncology inpatient units.Nursinglibrary.org. Retrieved 12 December 2015, from http://www.nursinglibrary.org/vhl/handle/10755/164025
Ford, M.B. (2010). Hourly Rounding: A Strategy to Improve Patient Satisfaction Scores. MEDSURG Nursing. 19(3):188-191.
Hicks, D. (2015). Can Rounding Reduce Patient Falls in Acute Care? An Integrative Literature Review. MEDSURG Nursing. 24 (1):51-55.
Olrich, T., Kalman, M. & Nigolian, C. (2012, January/February). Hourly Rounding: A Replication Study. MEDSURG Nursing, 21(1), 23-36.
The mechanics of breathing are greatly compromised in each of the cases in the following manners: infant respiratory distress syndrome leads air sacs to collapse when air is expired and increases the energy needed to breathe; emphysema leads to air sacs becoming damaged and enlarged, which makes it difficult to breathe; and pulmonary fibrosis leads to air sacs becoming scarred, which makes it difficult to breathe.
The physiology that plays a vital role in the development of these diseases consists of the following: infant respiratory distress syndrome stems from a lack of surfactant in the lungs; premature birth is often one reason for this lack.[footnoteRef:2] The physiology of the development of emphysema can include the presence of chronic bronchitis which can lead to it; smoking, or exposure to harmful chemicals and irritants over time. For pulmonary fibrosis, the physiology includes exposure to silica dust, asbestos, coal dust, and…
Cutter, Richard D. “Auditory nerve involvement after tetanus antitoxin: first reported case.” Journal of the American Medical Association 106, no. 12 (1936): 1006-1007.
Di Saverio, Salomone, Marco Bassi, Nazareno Smerieri, Michele Masetti, Francesco Ferrara, Carlo Fabbri, Luca Ansaloni et al. “Diagnosis and treatment of perforated or bleeding peptic ulcers: 2013 WSES position paper.” World Journal of Emergency Surgery 9, no. 1 (2014): 45.
Haberal, M., Abali, A. E. S., & Karakayali, H. “Fluid management in major burn injuries.” Indian Journal of Plastic Surgery: official publication of the Association of Plastic Surgeons of India, 43(Suppl) (2010): S29.
Jasani, Bonny, Nandkishor Kabra, and Ruchi Nanavati. “Surfactant replacement therapy beyond respiratory distress syndrome in neonates.” Indian Pediatrics 53, no. 3 (2016): 229-234.
Sgroi, Michael D., and Brian R. Smith. “Severe Epigastric Abdominal Pain.” In Surgery, pp. 493-499. Springer, New York, NY, 2015.
Pathophysiology of Gastric Acid Stimulation and Production
The human body produces gastric acid in the stomach, primarily to digest proteins (Anand, 2015; Huether & McCance, 2012). It is composed o hydrochloric acid and sodium chloride. It digests proteins through the action of digestive enzymes and allowing digestive enzymes break down the long chains of amino acids from digested proteins. The production of gastric acid us regulated by the autonomous nervous system and a number of hormones, and by positive regulators and negative feedback processes (Anand, Huether & McCance). But these structures and processes change when diseased conditions, like gastroesophageal relux disease or GED, peptic ulcer disease and gastritis, develop.
GED includes all the offshoots and by-products of acid reflux and other stomach irritants pushing up into the esophagus (Anand, 2015; Huether & McCance, 2012). The reflux is primarily caused by the failure of the anti-reflux barriers to perform their…
Anand, B.S. (2015). Peptic Ulcer Disease. Retrieved on July 22, 2015 from http://www.emedicine.medscape.com/article/181753-overview
Dach, J. (2015). Bioidentical hormones. Chapter 36 Heartburn, GE Reflux (GERD) ad Acid
Blocker Drugs. Retrieved on July 25, 2015 from http://www.bioidenticalhormones101.com/Heartburn_Reflux_PPI_Drug.html
Huether, S.E. & McCance, K. I. (2012). Understanding Pathophysiology. Laureate custom edition.. Philadelphia, PA: MosbyHiuHuntrHune
performing a clean and sterile technique wound dressing change.
The term sterile refers to being free from microorganisms, making the sterile technique method one that reduces exposure to microorganisms in a comprehensive way. Sterile wound dressing changes would mean meticulous hand washing, the use of sterile field, use of sterile gloves, and sterile instruments (Wound, Ostomy and Continence Nurses Society (Potter, et al., 2013; WOCN, 2012). The sterile techniques would be important in acute care and other settings in which patients may be at high risk for infection (WOCN, 2012).
The clean wound dressing change techniques imply methods that are sensible for reducing overall exposure to microorganisms or exposure to infections, but which do not count directly upon "sterile to sterile" rules (WOCN, 2012). Thus, meticulous hand washing and sterile environment are called for, but the process does not strictly deny contact between sterile instruments and non-sterile surfaces or products.…
Lippincott Nursing Center (2008). Wound wise: Basic wound cleaning step-by-step. Nursing Made Incredibly Easy 6(5): 30-31.
Perry, A.G. & Potter, P.A. (2012). Nursing Interventions. 5th Edition. St. Louis: Elsevier.
Potter, P.A, et al. (2013). Fundamentals of Nursing. 8th Edition. St. Louis: Elsevier.
WOCN (2012). Clean vs. sterile dressing techniques for management of chronic wounds: a fact sheet. Retrieved online: http://journals.lww.com/jwocnonline/Fulltext/2012/03001/Clean_vs__Sterile_Dressing_Techniques_for.7.aspx
The antibiotic agents most commonly used in treatment are Tetracycline and minocycline. 
Certain anti-inflammatory agents have also been found to be a means of accelerating the healing process, as well as relieving the symptoms of the condition. These agents have been found to be particular effective in the management of recurrent minor aphthous ulcers.  a preparation of Triamcinolone 0.1% can be applied to ulcers two to four times a day. This treatment also provides a protective local coating for the ulcer. 
The use of Immune Modulators in the management and treatment of aphthous ulcers is more aligned to research in those patients who have HIV / AIDS. In these patients the healing times of the ulcers may be protracted due to the depressed immune response. A treatment for ulcers that has been found to be effective is Thalidomide (Thalomid). 
However, as McBride (2001) points out,"... Thalidomide…
1. McBride D.R. Management of Aphthous Ulcers. American Family Physician; 2001 July 1 [cited 2007 Sept. 5]. Available at http://www.aafp.org/afp/20000701/149.html
2. Aphthous ulcers: What are aphthous ulcers? Derm Net NZ; 2007 Mar. 5 [cited 2007 Sept. 5]. Available at http://dermnetnz.org/site-age-specific/aphthae.html
3. Etiology, Prevalence, and Pathogenesis. Journal of Contemporary Dental Practice; Sept. 5, 2007[cited 2007 Sept. 5]. Available at http://www.thejcdp.com/issue009/tilliss/07tillis.htm
Assessing the Abdomen
Understanding patient history is important when formulating a diagnosis of a patient. In the case of the patient JR, there is a lot of information that is not reported that could be very useful when determining the correct diagnosis for this patient. Some questions still need to be asked to find out what that history is and whether or not the new information would apply to JR’s case and help the nurse understand what is impacting his health more clearly. In this paper, a review of the SOAP will be conducted and a discussion of what physical exams are required in order to make it known what JR’s condition is or what is causing the symptoms that he is experiencing. The paper will also identify five conditions that may be considered a differential diagnosis for what is causing his pain.
JR has a chief…
Chanu, O. R., & Raj, V. K. (2018). Acquisition and characterization of bowel sounds using labview software. Biomedical Engineering: Applications, Basis and Communications, 30(02), 1850006.
Dujic, T., Causevic, A., Bego, T., Malenica, M., Velija?Asimi, Z., Pearson, E. R., & Semiz, S. (2016). Organic cation transporter 1 variants and gastrointestinal side effects of metformin in patients with Type 2 diabetes. Diabetic Medicine, 33(4), 511-514.
Lenhart, A., & Chey, W. D. (2017). A systematic review of the effects of polyols on gastrointestinal health and irritable bowel syndrome. Advances in Nutrition, 8(4), 587-596.
Mustafa, M., Menon, J., Muiandy, R. K., Fredie, R., Sein, M. M., & Fariz, A. (2015). Risk factors, diagnosis, and Management of Peptic ulcer disease. J Dent Med Sci, 14, 40-6.
Pressure Ulcers in the Elderly
Dr. Judi Kuric
DNP Project Question
Will Every Two Hourly Turning and Positioning Decrease Pressure Ulcers in the Elderly Bed Bound Population in Nursing Home.
Will Every Two Hourly Turning and Positioning Decrease the Pressure Ulcers in the Elderly Bed Bound Population in Nursing Homes.
Pressure ulcers are a common cause of immobility among the elderly, which results in immense pain, suffering, and substantial costs with charges because of increased length of stay in the nursing homes. Prior studies suggest that patients who receive care in accordance to evidence-based guidelines are not at risk of developing pressure ulcers. However, the empirical evidence on the effectiveness of the measures is inadequate. Nevertheless, frequent manual repositioning of patients is a firmly established standard of care for the elderly; although there has been no much evidence on the same, experts suggest that…
One important aspect of nursing home living is that most of the time the people living there are helpless to accomplish many tasks that are part of everyday living. The employees are trained (for the most part) and as one study found it is "important to assess whether nursing staff levels and skills are meeting nursing home resident care needs" (Zhang, Unruh, Wan, 2013, p. 290). For example, incontinence is a significant risk factor for skin breakdown. The moisture changes the chemical balance of the skin, and often without adequate ventilation and care, a route for bacterial infection. In either case, pressure on the wound area, increased bacteria and moisture, all contribute to the lesions becoming rather serious (Gefen, 2008).
Many of the employees are taught to turn the elderly in their beds to relieve pressure, presumably thereby lowering the incidence of pressure ulcers. According to Fossum et al., "pressure ulcers can be prevented if residents at risk are identified early and relevant preventive measures are implemented" (Fossum, et al.,, 2011, p. 2429).
Current research shows that, at least in nursing homes, employees have a cognitive nature concerning pressure ulcers (amongst other things) and the positive results from taking preventive measures. Much of the current literature espouses the fact that nurses are trained to do so, but there is not really a lot of specific information on
Evidence-Based Project Implementation Issues: Pressure Ulcers
Evidence-based research as opposed to evidence-based practice is defined as "research [that] is generating new knowledge about a phenomenon or validating existing knowledge…Although evidence-based practice may have opinion -- expert opinion, but opinion still -- woven in, research is built in such a way to avoid bias" ("Evidence-based practice and avoiding confusion," 2014). Experiments must have controlled variables to ensure that extraneous data does not influence the result. In the case of my DNP project, the use of two-hour turning and positioning to decrease pressure ulcers in elderly bed-bound patients in nursing homes, one clear issue is the extent to which the patient's poor health could influence outcomes. Nursing home patients can have a variety of issues which could impact the results and both experimental and control groups must be carefully balanced. "More than 100 risk factors of pressure ulcers have been identified in…
Evidence-based practice and avoiding confusion. (2014). Health Leader's Media Council.
Retrieved from: http://www.healthleadersmedia.com/page-1/nrs-245879/EvidenceBased-Practice-and-Nursing-Research-Avoiding-Confusion
Haynes, B & Haines, A. (1998). Barriers and bridges to evidence-based clinical practice. BMJ,
317(7153): 273 -- 276. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1113594/
ressure ulcers are a serious risk for all bedridden patients, particularly the elderly. Ideally, assessing the patient's risk for developing pressure ulcers before the ulcers occur is the most effective way to mitigate risk. The quantitative analysis by Freitas & Alberti (2013) was designed to determine if one of the most commonly-used assessment tools, the Braden Scale, was a useful method of assessing a patient's risk for pressure ulcers in a home-based setting. The literature review of the article discusses the evolution of the scale which evaluates the patient based upon the following factors: the patient's sensory perception; levels of moisture; patient's activity level; patient mobility; ability to take nutrition; and finally, friction and shear on a scale from 1-5 for measures 1-4 and on friction and shear from 1-3 (Freitas & Alberti 2013). The lower the point value, the higher the risk of developing pressure ulcers. Some studies have…
Polit, D. & Beck, C.T. (2012). Trustworthiness and integrity in qualitative research. Nursing Research: Generating and assessing evidence for nursing practice. Lippincott Williams
One important ethical component of all research is that it accurately reflects participants' experiences and expressions. With qualitative research in particular this becomes an issue because the research is narrative in nature and inevitably filtered through the subjective impressions of the study designers. Researchers must be self-reflective about their biases but not to the point that it obscures the perspective of the respondents. They must also do all they can to ensure they do not unduly influence the responses.
Many recommend use of minimally invasive techniques including SEPS to treat and address problems related to chronic venous insufficiency (Kalra & Glovisczki, 2002). Multiple studies confirm the safety and efficacy of SEPS when used early, especially resulting from its low complication rates compared with other procedures including the formerly popular Linton procedures (Kalra & Gloiscki, 2002; Lee, et al. 2003; Tenbrook, et al., 2004; Bianchi, et al. 2003).
More randomized clinical trials are necessary however to answer additional questions related to the efficacy of new procedures including SEPS, though this procedures remains important for patients with advanced CVI secondary to PVI or with patients who do not demonstrate other complications including DVT (Kalra & Gloiscki, 2002; Bianchi, et al. 2003).
Wagner-Cox (2005) also notes that it is important for nurses to be considerate, knowledgeable and compassionate toward patients with acute and chronic illnesses, especially when caring for…
Baranoski, S. & Thimsen, K. (2003, Aug). "Oasis Skin and Wound Integumentary
Assessment Items: Applying the WOCN Guidance Document." Home Healthcare Nurse, 21(8): Supplement 3-13.
Baron, H.C., Wayne, M.G., Santiago, C.A. & Grossi, R. (2004, Sep-Oct). Vasc
Endovascular Surg. 38(5): 439-42.
New Practice Approaches Through Policy
One of the major current concerns in health care is the rapidly aging nature of the populations in Western societies today. This is, in general, attributed to developments in medical science and better information regarding personal health choices and activities. Despite this, however, it is also true that aging seldom brings with it a glowing sense of health. While many people today age better than ever before in human history, the elderly also tend to suffer from an increasing number of conditions, some of which leave them bed bound. Many of these bed bound residents, in addition to their initial conditions, also suffer related ailments such as pressure ulcers. These create not only great physical discomfort and emotional stress, but also great burdens on the health care system in terms of treating such ulcers. For this reason, it is suggested that policies should be created…
Leonard, R. (2001, Spring). Policy Considerations for Nursing Home Quality Improvement. Harvard Health Policy Review 2(1). Retrieved from: http://www.hcs.harvard.edu/~epihc/currentissue/spring2001/leonard.html
Mackie, S. And Dunnery, P. (2008). Clinical Policy: Pressure Ulcer Prevention and Care for Adults in Hospital. Retrieved from: http://www.nhstayside.scot.nhs.uk/about_nhstay/commitees/08_iaq/27012009/docs_024483.pdf
Niezgoda, J.A. And Mendez-Eastman, S. (2006, Feb.). The Effective Management of Pressure Ulcers. Advances in Skin & Wound Care: The Journal for Prevention and Healing 19(1). Retrieved from: http://www.nursingcenter.com/lnc/JournalArticle?Article_ID=636557&Journal_ID=54015&Issue_ID=636556
Rich, S.E., Margolis, D., Shardell, M., Hawkes, W.G., Miller, R.R., Amr, S., and Baumgarten, M. (2011, Jan.). Frequent manual repositioning and incidence of pressure ulcers among bedbound elderly hip fracture patients. Wound Repair Regen 19(1). Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3059225/
This is hardly used for detection of H. pylori alone but for ruling out the existence of other stomach maladies. It is quite expensive and requires a highly skilled physician.
Stool Antigen Test; this is when the stool is analyzed for detection of any foreign antigens or proteins that are associated with H. pylori infection. The stool is known to be very sensitive and can also be use to assess the infection status after the treatment has commenced. The disadvantage of this method is that it absolutely depends upon the participation and compliance of the patient, it is inconvenient to handle and the results are not immediate.
Urea breath test; it is used to detect the presence of H. pylori bacteria in the stomach. It can also be used to detect whether the treatment has worked, the problem with this test is that it is not always available (WebMD LLC,…
American Academy of Family Physicians (2002). Management of Helicobacter pylori Infection.
Retrieved May 12, 2011 from http://www.aafp.org/afp/2002/0401/p1327.html
Dennis Lee, (2011). Helicobacter Pylori. Retrieved May 12, 2011 from http://www.medicinenet.com/helicobacter_pylori/article.htm
Gastroenterological Society of Australia, (2006). Helicobacter Pylori. Retrieved May 12, 2011
Given the frequency of pressure ulcers, the strategies used in mitigating those wounds must be effective. Sherman reports that 61 ulcers in 50 patients got maggot therapy and 84 ulcers in 70 patients did not receive maggot therapy (instead, those wounds received traditional care). The results showed that "eighty percent of maggot-treated wounds were completely debrided" but only 48% of conventionally-treated wounds were "completely debrided" (Sherman, 208).
(Qualitative) Laura Jean van Veen presents a case in the Journal of ound, Ostomy and Continence Nursing; a 59-year-old woman (a Jehovah's itness) was seriously injured in an auto accident in Vancouver. In order to save her legs (her religion did not permit blood transfusions) the family asked for maggot therapy. After applying maggots weekly for 6 weeks, "…the patient [was] now free of infection" and had skin graft surgery (van Veen, 2008, 432).
(Qualitative) Another case study in the Journal of ound,…
Courtenay, M., Churdh, J.D.T., and Ryan, T.J. (2000). Larva therapy in wound management.
Journal of the Royal Society of Medicine, Vol. 93, 72-74.
Fenn-Smith, P. (2008). Case Study: Maggot Debridement Therapy. Wound Practice and Research, 16(4), 169-170.
Paul, Aaron G., Ahmad, Nazi W., Lee, H.L., Ariff, Ashraff M., Saranum, Masri, Naicker,
Osteomyelitis in the Diabetic Patient
Management OF OSTEOMYELITIS IN THE DIABETIC PATIENT
Osteomyelitis is an infection of the bone or bone marrow which is typically categorized as acute, subacute or chronic.1 It is characteristically defined according to the basis of the causative organism (pyogenic bacteria or mycobacteria) and the route, duration and physical location of the infection site.2 Infection modes usually take one of three forms: direct bone contamination from an open fracture, puncture wound, bone surgery, total joint replacement, or traumatic injury; extension of a soft tissue infection such as a vascular ulcer; or hematogenous (blood borne) spread from other infected areas of the body such as the tonsils, teeth or the upper respiratory system.2(p807) Bacteria such as Staphylococcus aureus, Pseudomonas, Klebsiella, Salmonella, and Escherichia coli are the most common causative agents of the disease, although viruses, parasites and fungi may also lead to the development of osteomyelitis.3
1. Stedman's Medical Dictionary. 27th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2000.
2. Butalia S, Palda V, Sargeant R, Detsky A, Mourad O. Does This Patient With Diabetes Have Osteomyelitis of the Lower Extremity?. JAMA: Journal of The American Medical Association [serial online]. February 20, 2008; 299(7):806-813. Available from: Academic Search Premier, Ipswich, MA. Accessed September 19, 2012.
3. Lavery L, Peters E, Armstrong D, Wendel C, Murdoch D, Lipsky B. Risk factors for developing osteomyelitis in patients with diabetic foot wounds. Diabetes Research & Clinical Practice [serial online]. March 2009; 83(3):347-352. Available from: Academic Search Premier, Ipswich, MA. Accessed September 19, 2012.
4. Turns M. The diabetic foot: an overview of assessment and complications. British Journal of Nursing [serial online]. August 12, 2011;:S19-S25. Available from: Academic Search Premier, Ipswich, MA. Accessed September 19, 2012.
Assessing the Abdomen
The chief complaint of JR is that his “stomach hurts” and he is experiencing diarrhea, from which he has been unable to obtain any relief. His pain in his abdomen started 3 days earlier and he has taken no medication for it. The pain is midrange, though it was very high today when it began. He ate but experienced nausea afterwards. JR is 47, suffers from hypertension, diabetes and had an issue of gastrointestinal bleeding four years ago. He is on a number of medications to address his high blood pressure and diabetes. He has no known drug allergies, no history of colon cancer. His father and mother both had hypertension; his father has type 2 diabetes; his mother suffered from Gastroesophageal reflux disease and high fatty concentration in the blood (hyperlipidemia).
JR occasionally imbibed alcohol. He is overweight at 248 lbs with a 5’10” height. He…
Arterial Ulcerations:Management of Arterial ulcerations in the diabetic patient
Arterial Ulcerations: Management of Arterial ulcerations in the diabetic Patient
There Approximately 10 per cent of all leg ulcers are arterial ulcers. The legs and feet are often start to feel very cold and then they may have a color that looks either white or blue, shiny appearance. Arterial leg ulcers normally can be certainly painful. Pain normally starts to escalate when the person's legs are elevated and resting. ith this condition, most have learned tha they can reduce that pain just by lying down on the bed. The gravity will then cause more blood to start flowing directly into the legs. Ulcers normally happen when the breaks in the legs do not heal properly. They may be escorted by irritation. A lot of the times they do not heal correctly thus causing them to become chronic. People that have arterial…
Anand SC, D.C. (2003). Health-related quality of life tools for venous-ulcerated patients. Br J. Nurs, 17(2), 34-56.
C:, W. (1995). Living with a venous leg ulcer: a descriptive study of patients' experiences. Journal of Advanced Nursing, 23(7), 23-30.
Franks PJM, M.C. (1998). Who suffers most from leg ulceration? Journal of Wound Care, 18(3), 383-385.
Stress Ulcer Prevention
The subject up for study in this report shall be whether stress ulcers in hospital patients induced by being bedridden can be mitigated or even prevented by turning the patient to a new position at least once every two hours. The amount of research on this subject is not pervasive and voluminous. However, some material about the subject does exist. Thus, a conclusion should be possible regarding whether patient-turning is a solution to prevent stress ulcers from forming in the first place. While it may not truly be a fix-all solution, the practice of turning patients at two hour intervals shows some promised based on evidence-based research and results.
Stress ulcers, otherwise commonly referred to as deep tissue injury (DTI) is a pressing and persistent issue in the medical field. This is especially true when speaking of patients that are bedridden for any significant amount of time…
Behrendt, R., Ghaznavi, A.M., Mahan, M., Craft, S., & Siddiqui, A. (2014).
CONTINUOUS BEDSIDE PRESSURE MAPPING AND RATES OF HOSPITAL-
ASSOCIATED PRESSURE ULCERS IN A MEDICAL INTENSIVE CARE
UNIT. American Journal Of Critical Care, 23(2), 127-133.
Practice Issue Evidence-Based Practice (EBP) Project in courses DNP program, asked
The practice issue I have chosen to explore is whether or not q2 hourly turning and positioning actually decreases the incidence of pressure ulcers in the elderly bed bound population in nursing homes. The conception that turning does help to relieve the pressure associated with these types of ulcers has been longstanding. Specifically, there is clinical evidence to indicate the fact that "Unrelieved pressure is a well-known clinical risk factor for ulcer development" (Salcido, 2004, p. 156). As such, the turning of patients at least every two hours has been carried on for quite some time in the nursing population, although there are some salient points of concern that need to be addressed with this issue.
One of the major things that individuals need to be aware of who take on such a practice is the fact that the…
Leeds, L. (2004). Importance of turning q2. www.denvernursingstar.com. Retrieved from http://denvernursingstar.com/specials/newsletter_view.asp?newsid=310&catid=85&active=0&mode=current&count=0
Salcido, R. (2004). Patient turning schedules, why and how often? Advances in Skin & Wound Care: The Journal for Prevention and Healing. 17(4), 156.
Wound, Ostomy & Continence Nurses Society. (2012). Patient turning and repositioning: current methods & challenges, a WOCN perspective. www.sageproducts.com. Retrieved from http://www.sageproducts.com/documents/pdf/education/studies_articles/sacral/WOCN%20White%20Paper_Aug2012.pdf
The digestive fluids that are secreted by the stomach glands aimed at breaking down solid food and to kill bacteria in the stomach are referred to as gastric juices. Gastric acid is produced by the gastric parietal cell located on the walls of the stomach. The region where the gastric juices are secreted into the lumen is the most acidic environment in the human body and is known as the secretory canaliculus (Schubert & Peura, 2008). The secretion of the gastric acid into the lumen occurs in response to a variety of messages from the paracrine, hormonal, and neurocrine inputs. Gastrin, produced by the G cells that are located in the pyloric mucosa of the stomach is the primary hormonal stimulation for gastric acid production. There are various inputs that will stimulate the parietal cells in order for them to secrete hydrogen ions that will flow into the gastric lumen,…
As a result, children and adolescents are at risk of delays and impairments in cognitive development" (Levy 2009). Such delays are far from inevitable, but they do underline the need to assure that Sarah 'keeps up' with her studies and that reasonable peer-appropriate learning goals may need to be met with the assistance of additional support in some instances.
Although not directly applicable to Sarah, immunizations with live viruses, including chickenpox, MMR (measles, mumps, rubella), and oral polio vaccines are not advised for children with lupus (Lupus, 2009, Children's Hospital of Boston). Sarah's parents may need to watch for is the possibility of symptoms in her sibling: "a form of lupus may occur at some point in about one out of twenty people whose siblings have lupus" and they may need to take this into consideration when contemplating a vaccination program if they ever have another child (Lehman 2002). Sarah's…
Lehman, Thomas J.A. (2002, Fall). Early diagnosis of SLE in childhood. Lupus News.
22.3. Retrieved June 29, 2009 at http://www.lupus.org/education/topics/early.html
Levy, Deborah, Stacy P. Ardoin, Laura E. Schanberg (2009). Neurocognitive
impairment in children and adolescents with SLE: Cognitive development in healthy children and adolescents. Nat Clin Pract Rheumatol CME. 5(2)
The assumption here is that ounselor burnout may be heightened as a result of the diversity of students who attend post seondary eduational institutions, and the variety of servies the 2-year postseondary ounselors must provide to these students. This assumption is ongruent with the findings of a study by Wilkerson and Bellini (2006) who advise, "Professional shool ounselors are asked to perform multiple duties as part of their daily work. Some of these duties math the desriptions set forth by national standards for shool ounseling programs, whereas others do not" (p. 440).
Consequently, shool ounselors are required to formulate deisions on a daily basis onerning the best way to perform their jobs (Wilkerson & Bellini). Not surprisingly, many shool ounselors are overwhelmed by these onstantly hanging working onditions and requirements, and a number of ounselors experiene high levels of stress as a result. Beause the onnetion between high levels of…
cited in Angerer, 2003). Unfortunately, it would seem that most helping professionals, including counselors, possess characteristics which predisposed them to this construct. For example, Lambie notes that, "Counselors may have increased susceptibility to burnout because of their training to be empathic which is essential to the formation of a therapeutic relationship. In fact, research has found counselor empathy to account for two thirds of the variance in supporting clients' positive behavioral change" (p. 32). The ability to remain empathic to the plights and challenges typically being experienced by students in community colleges is complicated by the enormous diversity that is increasingly characterizing these institutions, of course, but all helping professionals run the risk of becoming burned out while performing their responsibilities by virtue of their empathic sharing. In this regard, Lambie emphasizes that, "Empathy helps counselors understand the client's experience, but at the same time, a counselor may experience the emotional pain of multiple traumatized clients. Empathy is a double-edged sword; it is simultaneously your greatest asset and a point of real vulnerability; therefore, a fundamental skill of effective counselors, being empathic, may place counselors at high risk for burnout" (p. 33).
Citing the alarming results of a national survey of counselors that indicated that incidence may be almost 40%, Lambie also emphasizes that although all professions involve some degree of stress, counselors and other human service providers are at higher risk of burnout compared to other professionals. For example, this author notes that, "Counseling professionals are often in close contact with people who are in pain and distress. This continuous exposure to others' despair, combined with rare opportunities to share the benefits of clients' successes, heightens counselors' risk for burnout" (Lambie, p. 34). Other authorities confirm the incidence of burnout among educators, and cite even higher rates than the foregoing estimate. For instance, Cheek, Bradley and Lan (2003) report that, "Based on several international studies, approximately 60% to 70% of all teachers repeatedly show symptoms of stress, and a minimum of 30% of all educators show distinct symptoms of burnout" (p. 204). Indeed, a study by Lumsden (1998) determined that overall teacher morale was sufficiently severe that fully 40% of the educators who were surveyed indicated they would not choose teaching again as a career, and far more than half (57%) remained undecided at the time concerning ending their teaching career, were actively making plans to leave teaching, or would opt to leave the teaching field in the event a superior opportunity presented itself.
There are some other qualities that typify school counselors that may predispose them to becoming burned out over the course of time (some quicker than others, of course), but which may reasonably be expected to adversely effect the ability of school counselors to maintain their effectiveness in the workplace. For instance, Lambie concludes that, "Common counselor qualities of being selfless (i.e., putting others first), working long hours, and doing whatever it takes to help a client place them at higher susceptibility to burnout. As a result, counselors may themselves need assistance in dealing with the emotional pressures of their work" (p. 34).
Counselors and Characteristics of Burnout
agrees that ethics is an important part of effective leadership in the field of health care but there is no universally accepted understanding of what constitutes ethical leadership (Milton, 20004). The concept of ethical leadership has been addressed in the literature of a wide variety of fields associated with the health care profession but none have been able to clearly define its terms. The purpose of this paper will be to examine what ethical leadership means to me and how my personal viewpoints and attitudes have been affected by my background and experience.
Having been raised in an Irish family my Irish heritage is an important aspect in the formation of my ethical viewpoint. Although I have lived in the United States for nearly forty years, I cannot escape the lessons and values that I learned growing up in the Irish countryside. My family lived in an Irish…
Benner, P. (2000). The roles of embodiment, emotion and lifeworld for rationality and agency in nursing practice. Nursing Philosophy, 5-19.
Catanzaro, A.M. (2001). Increasing Nursing Students' Spiritual Sensitivity. Nurse Educator, 221-226.
Fry, S.T. (2002). Ethics in Nursing Practice: A Guide to Ethical Decision Making. Indianapolis, IN: Wiley-Blackwell.
Hussey, T. (1996). Nursing Ethics and Codes of Professional Conduct. Nursing Ethics, 250-258.
EBP Project: Will Every Two Hour Turning and Positioning Decrease Pressure Ulcers in the Eldery Bed Bound Population in Nursing Homes?
Practicum: Clinical rotations with preceptor; serving patients with acute, chronic and new medical issues.
One of the things I have discovered during my recent experiences with both academic and clinical education and an EBP project is that there are numerous and effective ways of learning, presenting, and communicating. Each method, however, has one critical thing in common -- it must be a two-way path and none are effective unless there is clear communicative understanding on the part of the receipient, patient, family or colleague. Aristotle, for instance, once commented that "For the things we have to learn before we can do them, we learn by doing them." Experiential learning targets certain brain chemicals and allows a more personal approach to the individual's own particular brain chemistry. Because the individual…
Beard, C., et.al. (2006). Experiential Learning: A Best Practice Handbook for Educators and Trainers. Kogan Press.
Hyrkas, K., et al. (2010. Leading Innovation and Change. Journal of Nursing Management. 18 (1): 1-3.
Moon, J. (2004). A Handbook of Reflective and Experiential Learning. New York: Routledge.
Tapscott, D. (1998). Growing Up Digital: The Rise of the Next Generation. New York: McGraw Hill.
placement practice I discovered a great deal about pressure ulcers that occur following perioperative care. I am normally community based and I treat patients that have been discharged from hospital that have developed pressure ulcers following an operation. During my complementary placement on a short stay ward I was involved in the care of patients through their perioperative period. I was amazed how quickly one patient developed a pressure ulcer. The experience and subsequent investigation produced several facts concerning the reasons why such ulcers develop, how to prevent them from occurring, treatment and the emotional, financial and physical hardships that having these ulcers produce in patients.
To evaluate my experience, I have chosen to use Driscoll's model of reflection. Driscoll's model was chosen because of the simple but reflective manner in which it concentrates on questions that are pertinent to the care of patients. The model is divided into three…
Driscoll's (2000) Model of Reflection www.nelsonthornes.com/.../reflection/Model_of_Reflection_Driscoll_2000.doc - United Kingdom
NHS Quality improvement Scotland, Tissue Viability, Best Practice Statement, march 2009, Prevention and management of pressure ulcers accessed at www.nhshealthquality.org/nhsqis/files/PUPREVMAN_BPS_MAR09.pdf [accessed on 21/03/2011]
NICE guidelines for pressure ulcer prevention accessed at http://www.nice.org.uk/nicemedia/live/1098/9180/9180.pdf [accessed on 15/03/2011]
National Institute for Health and Clinical Excellence, September, 2009 The Prevention and treatment of pressure ulcers, London, Royal College of Nursing,
Resources needed include manpower and positional aids mentioned previously in this report. Evaluation of the effectiveness of the change would be accomplished through data collection related to the frequency of pressure ulcer occurrence in patients and nurse compliance in the four hours supine positional rotation of patients. Questionnaires will also be administered to nursing staff in order to gain insight as to their attitudes, behaviors and perceived barriers to pressure ulcer prevention.
Phase V: Transplantation and Application
This study concludes that positional rotations of every four hours has been shown to be the most effective prevention of pressure ulcer formation in older patients in elderly care homes and further that that attitudes, behaviors and perceptions of barriers in the view of staff nurses predicts the effectiveness of the implementation of such a prevention program for pressure ulcer care. (Moore and Price, 2006)
Exact Nature of Practice Implications
____ Change the…
Moore, Z. And Price, P. (2004) Nurses' Attitudes, Behaviors, and Perceived Barriers Towards Pressure Ulcer Prevention Journal of Clinical Nursing 13, 2004.
Vanderwee, K.; Grypdonck, D.; Bacquer, De and Defloor, T. (2006) Effectiveness of Turning with Unequal Time Intervals on the Incidence of Pressure Ulcer lesions. JAN Original Research 10 July 2006.
Nursing: Utilization Review
MS Case Study Nurse Practice
When patients enter hospitals it is oftentimes they become more ill and sicker due to inappropriate care and professional ignorance. This is due mainly to the amount of hubris involved within the medical profession and a tendency to ignore empirical evidence as practiced to success. This approach underlines the most important aspects of healing and the medical profession itself.
The argument for continued improvement in the treatment of patients is best exemplified in the case of MS. His ill health has led to more problems and the approach by the nurse practitioner and her staff is critical to the ultimate survival of this young child who innocently trusted the advice of both his parents or caretakers that the medical staff would be able to treat him with the care and respect that every patient deserves when being encountered during a medical treatment or hospital stay.…
Arnold, M., & Barbul, A. (2006). Nutrition and wound healing. Plastic and reconstructive surgery, 117(7S), 42S-58S.
Bennett, G., Dealey, C., & Posnett, J. (2004). The cost of pressure ulcers in the UK. Age and ageing, 33(3), 230-235.
Campbell, N.C., Murray, E., Darbyshire, J., Emery, J., Farmer, A., Griffiths, F., ... & Kinmonth, A.L. (2007). Designing and evaluating complex interventions to improve health care. BMJ: British Medical Journal, 334(7591), 455.
Corbett, L.Q. (2012). Wound care nursing: professional issues and opportunities. Advances in Wound Care, 1(5), 189-193.
This could have been a significant factor, but researchers will never know because the information was never looked at, nor contained in the study. An additional weakness of the study was that the researchers had to rely entirely on information and data derived from hospital reports and patient charts rather than on direct contact with the individuals involved. This could be a considerable weakness to the study, but again it is not known whether it is a weakness or not because the information is not contained therein, which makes it a weakness.
One rationale that an observer might make in regards to the criticism of this particular study and the fact that it only looked at the records of the patients rather than talking to the patients themselves was that the study was only looking for the incidences of pressure ulcers.
The study did not offer specific solutions to the…
2003, p. 247).
The use of NSAID has been associated with increased risks of gastrointestinal bleeding in unselected patients, approximately five-fold for musculoskeletal pain and two fold for secondary prevention of cardiovascular disease with low-dose aspirin (Clinical Guideline 17: Dyspepsia 2004). Therefore, depending on the level of pain management required, a simple analgesic that can be used for pain management is paracetamol; this preparation does not cause bleeding of the stomach and it has been found to be highly effective in relieving mild to moderate pain; furthermore, it can be purchased without a prescription from chemists and supermarkets (Henderson & Wood 2000).
Discussion of Health Education Advice Required.
The U.K. Department of Health recommends the following educational advice and support for people suffering from gastrointestinal bleeding:
Patients and their relatives should be offered as much information as they want. GPs should ask what they would like to know, and give…
Barve, S., Hill, D., Marsano, L.L., Mcclain, C.J., & Mendez, C. (2003). "Diagnosis and Treatment of Alcoholic Liver Disease and Its Complications." Alcohol Research & Health 27(3):247.
Dyspepsia: Management of dyspepsia in adults in primary care. NICE Clinical Guideline 17. [Online]. Available: http://www.nice.org.uk/guidance/CG17/niceguidance/word/English .
Garcia, N., Jr., & Sanyal, a.J. (2001). "Portal hypertension." Clinics in Liver Disease, 5(2):509- 540.
Govoni, R., Mann, R.E., & Smart, R.G. (2003). "The Epidemiology of Alcoholic Liver Disease." Alcohol Research & Health 27(3):209.
c. What types of validity were used? Is the validity adequate?
Multiple trials, yes validity is adequate d. Are the instruments clearly described?
All instruments utilized in the study are clearly described.
e. Is interrater reliability described?
The journal article also does a good job of expressing what aspects do not effect interrater reliability
9. Data collection a. Is the data collection process clearly described?
All process have been clearly described and explained b. Is the training of data collectors clearly described?
This is not a completely accurate yes answer. The article does inform the reader that the data collectors are nurses with x amount of years in the field. However, numbers of years in the field do not insure that the nurses do the same things, in the same ways.
c. Are the data collection methods ethical?
Nothing appears to be un-ethical.
10. Data analysis a. Are data analysis…
Vanderwee, K., Grypdonck, M.H., Bacquer, D.D., & Defloor, T. (2005, March 1). The reliability of two observation methods of nonblanchable erythema, Grade 1 pressure ulcer. Applied Nursing Research, 19, pp.156-162.
Translation Evidence Into Nursing Health Care Practice. Chapter 6, "Translation Evidence Leadership" Article: Bakke, C.K. (2010). Clinical cost effectiveness guidelines prevent intravascular catheter-related infections patients' hemodialysis.
Briefly summarize your selected issue and propose new evidence-based practice strategies.
Pressure ulcers, commonly known as bedsores, are frequently observed in otherwise healthy bed-ridden patients in nursing homes. To promote wellness amongst this patient population, it has been suggested that regular turning and positioning of the patients by caregivers should be used to reduce their occurrence. Turning and positioning has long been used amongst healthcare practitioners for a variety of bed-ridden patients, usually at regimented intervals spanning 4-2 hours (Thomas 2001). Based upon the previous research conducted upon this population, the suggested shortened interval is 1-11/2 hours for repositioning of the patient (Thomas 2001).
Q2. Describe the theoretical basis for your strategies.
The theoretical basis for this initiative lies in the idea that passive…
Bluestein, D. & Javaheri, A. (2008). Pressure ulcers: Prevention, evaluation, and management.
American Family Physician, 78(10):1186-1194. Retrieved from:
Krapil, L.A. & Gray, M. (2008). Does regular repositioning prevent pressure ulcers?
Health and Nursing
eduction of bedsores through implementation of Hospital wide turntable
Does the implementation of a hospital-wide turntable team have a positive impact on the reduction of bedsores?
eduction of Bedsores
A pressure ulcer (PU) or bedsore can be defined as an injury to underlying tissue of the skin that occurs due to pressure or friction. In most cases, the injured tissue sores due to the pressure exerted over a prominent bone. PU has also been defined as areas of necrosis due to tissue compression amid the bony prominence and the extracorporeal surface for a prolonged time period (Gray & Krapfl, 2008). It is therefore apparent from these definitions that exposure to pressure for a lengthy time is the primary cause of bedsores.
To prevent or minimize bedsores therefore, it is imperative upon medical practitioners to put intervention measures in place that will reduce exposure to pressure. The human…
Gorecki, C., Brown, J.M. & Andrea, N.E. (2009) Impact of Pressure Ulcers on Quality of Life in Older Patients: A Systematic Review. Journal of American Geriatrics Society. DOI: 10.1111/j, 1532-5415.
Gray, M & Krapfl, L.A. (2005) Does regular repositioning prevent pressure ulcers? Journal of Wound, Ostomy and Continence Nursing. Vol.35, No.6, 571-577.
Ikechokwu, E.C., Idowu, O.A. & Anekwe, D.E. (2012) Prevalence and Factors Associated With Healing Outcomes of Hospitals-acquired Pressure Ulcers among Patients With Spinal Cord Injury. Journal of Public Health and Epidemiology.Vol. 4(2), p. 44-47.
Kaitani, T., Tokunaga, K., Matsui, N., Sananda, H. (2010) Risk factors related to the development of pressure ulcers in the critical care setting. Journal of Clinical Nursing. Vol.19, 414-421.
Helicobacter (genus) pylori (species), commonly known as H. pylori, is a bacterium that causes gastritis of the inner lining of the stomach in humans and is the most common cause of ulcers worldwide (Delaney, Moayyedi and Forman 536). Ingestion of contaminated food and water and person-to-person contact is the most likely means of acquiring H. pylori. Portals for entry are largely oral, as oral-oral and oral-fecal contact are the most common contamination methods. About 30% of the adult population in the United States are infected and is more common in crowded living conditions with poor sanitation (Malcolm et al. 137). Infected individuals typically carry the infection indefinitely unless they are treated with medications to eradicate the bacterium. Other than the human stomach, there appears to be no natural reservoir for this bacterium. One out of every six patients with H. pylori infection will develop ulcers of the duodenum…
Delaney, B., P. Moayyedi, and D. Forman. "Helicobacter Pylori Infection." Clin Evid.10 (2003): 535-48.
Hofman, P., et al. "Pathogenesis of Helicobacter Pylori Infection." Helicobacter 9 Suppl 1 (2004): 15-22.
Malcolm, C.A., et al. "Helicobacter Pylori in Children Is Strongly Associated with Poverty." Scott Med J. 49.4 (2004): 136-8.
McLoughlin, R., et al. "Therapy of Helicobacter Pylori." Helicobacter 9 Suppl 1 (2004): 42-8.
Against All Odds: Preventing Pressure Ulcers in High-isk Cardiac Surgery Patients
There are three authors of the article reviewed who represent several degrees, including one master's degree, and certifications. The authors are (Cooper, Jones, & Currie, 2015):
Danielle Nicole Cooper, N, BSN, CCN-CSC
Sarah Layton Jones, N, BSN, CCN
Linda Ann Currie, N, MSN, ACNS-BC, CCN-CSC
The Authors have credentials that include Adult Health Nurse Specialist-Board Certified (ACNS-BC) and Critical Care Nurse -- Cardiac Surgery Certificate (CCN-CSC) certificates.
The article is peer reviewed and appears in the Critical Care Nurse journal and was published in October, 2015. The article sites twenty-two different sources, most of which were published within the last five years.
The title of the article includes the phrase "Against All Odds," which honestly seems a bit dramatic. The Virginia Commonwealth University Medical Center (VCUMC) nursing staff implemented preventative measures to decrease rates of all hospital-acquired pressure ulcers,…
Cooper, D., Jones, S., & Currie, L. (2015). Against All Odds: Preventing Pressure Ulcers in High-Risk Cardiac Surgery Patients. American Association of Critical-Care Nurses, 75-82.
Hourly nursing rounding is regarded as one of the most suitable means for enhancing patient satisfaction and clinical outcomes. This process can be described as a proactive, systematic nurse-centered evidence-based intervention to predict and deal with the various needs in hospitalized patients. There is sufficient evidence to demonstrate that effective hourly nursing rounding can enhance patient safety, promote team communication, and enhance the capability of staff to offer efficient patient care. Therefore, this approach would be a suitable method to help reduce falls, prevent ulcers, and call light use and result in enhanced patient satisfaction through evidence-based practices. The adoption of this method in the organization to improve patient satisfaction and clinical outcomes would require the development of a comprehensive implementation plan and participation from all key stakeholders.
Method of Obtaining Necessary Approval
The adoption of hourly nursing rounding in the healthcare facility to enhance patient satisfaction and clinical outcomes…
Brosey, L.A. & March, K.S. (2014, September 16). Effectiveness of Structured Hourly Nurse Rounding on Patient Satisfaction and Clinical Outcomes. Journal of Nursing Care Quality, 00(00), 1-7.
Forde, J.C. (2014, April 9). Intentional Rounding: A Review of Literature. Nursing Standard, 38(32), 37-42.
Negarandeh, R., Bahabadi, A.H. & Mamaghani, J.A. (2014, December). Impact of Regular Nursing Rounds on Patient Satisfaction with Nursing Care. Asian Nursing Research, 8(4), 282-285.
Timothy, H. (2015, June 2). Hourly Rounding is an Effective Patient Safety Strategy. Retrieved from American Sentinel University website: http://www.americansentinel.edu/blog/2015/06/02/hourly-rounding-is-an-effective-patient-safety-strategy/
ursing Annotated Bibliography
This article categorizes diabetes as an epidemic that can responds well with the adjunctive treatment of HBOT. The authors use two clinical case studies in their literature review of how oxygen plays a part in the healing of lower extremity diabetic ulcers. They argue for the necessity of further study and research into HBOT because of its efficacy and the potential to drastically lower medical costs for diabetic patients, whose numbers continue to increase steadily. There is a very clear focus on the costs of diabetic treatments on a global scale in relation to the number of diabetic patients worldwide, as part of the authors' strategy to advocate the widespread use of HBOT. Charts and color photographs contextualized the text and make the research more concrete in the mind of the reader, especially the photographs of diabetic amputees who have not had…
Neal, M.S. (2001). Benefits of hyperbaric oxygen therapy for diabetic foot lesions. Journal of Wound Care, 10(1), 507 -- 509.
This article provides a quantitative explanation for the presence of lower extremity ulcers and wounds in diabetic patients. The article additional explains how HBOT elevate the presence of circulating stem cells in diabetic patients. Their research aims to prove how HBOT stimulates the vasculogenic stem cell mobilization in the bone marrow of diabetics, which then are used to heal skin wounds. The authors explain their experience with these types of patients and HBOT treatments because at the hospital where they all work, HBOT is standard operating procedure for the qualifying patients in they study. This is another example of a highly statistical article with the presence of charts and graphs, even digital images of blood samples from the participants both in color and in black and white. Images have the potential to bring the reader closer to the content of the text. Their research shows that HBOT increases important agents in diabetics' bone marrow that lead to increased circulation and healing properties.
Thom, MD, PhD, S.R., Milovanova, MD, PhD, T.N., Yang, MD, M., Bhopale, PhD, V.M., Sorokina, E.M., Uzun, MD, G., Malay, D.S., Troiano, M.A., Hardy, MD, K.R., Lambert, MD, D.S., Logue, MD, C.J., & Margolis, MD, PhD, D.J. (2011). Vasculonic stem cell mobilization and wound recruitment in diabetic patients: Increased cell number and intracellular regulatory protein content associated with hyperbaric oxygen therapy. Wound Rep Reg, 19(2011), 149 -- 161.
Bedsore prevention was not given priority in the 'benchmarks' used to grade nursing effectiveness and insufficient care and attention was devoted to ensuring that nurses followed standardized preventative procedures. Nurses themselves cited many perceived barriers to being able to take full precautions, including a lack of time, having to work long shifts and being over-tired, and a lack of emphasis on such routine patient care overall.
An important implication of this study is that nursing knowledge does not automatically translate into effective nursing practice. It also shows that an intellectual awareness of the seriousness of a health problem such as bedsores likewise does not cause a behavioral change unless there are radical changes in the nursing environment as a whole, and implementation must be supported on a holistic level. Overburdened nurses face obstacles that prevent adequate oversight of patients and inhibit the administration routine, essential care, such as the patient…
Moore Z, Price P. (2004). Nurses' attitudes, behaviors and perceived barriers towards pressure ulcer prevention. Journal of Clinical Nursing, 13 (8):942 -- 952.
Retrieved December 17, 2010. doi: 10.1111/j.1365-2702.2004.00972.x.
Patient Satisfaction Scorecard
This dashboard page reviews and specifies how satisfied patients attending the hospital were, or were not, based on the service they received at the hospital. The data breaks down into specific areas of concern for patients in terms of the service they received.
There are 24 categories for patient input as to the quality of service they received. The hospital sent out 1,232 surveys and 954 people (former and presumably present patients) responded to the survey (450 males and 504 females; 250 new patients and 704 returning patients). The ages reflect a very diverse community of patients, including: 19 that were 10 years of age or younger; 57 between 11 and 20; 124 were between 21 and 30 years of age; 219 were between 31 and 40; 172 were between 41-50; 153 were between 51-60; 113 were between 60 and 70; and…
One of the immediate things that nurses and other healthcare professions do when a new patient arrives is to give that person aspirin. This was done 100% of the time in January, 2009. And 87% of the patients received aspirin (prescribed at discharge). Patients with heart trouble were given ACEI or ARB for their left ventricle systolic dysfunction (90% of the patients) and counseling for people who smoke cigarettes was given 67% of the patients in 2009. The list is quite long but of particular interest is influenza vaccination (75% of patients received it), blood cultures were taken for 78% of the patients, and 76% of patients that had undergone colorectal surgery received "immediate postoperative normothermia."
As to the how this hospital's core measures stack up on a national basis, the barometer graph on the lower right side of this dashboard shows that this hospital meets national averages 80% of the time.
Overall Summary: When a hospital goes to the trouble of presenting specific data regarding how it serves its patients -- and this should be required / expected in today's healthcare environment -- any potential or past patient can easily see the thoroughness therein.
The objective of this work is to provide viable research techniques to use in order to help a child and her family. This report represents a summary of Alicia Thomas, a nine-year-old African-American 4th grader with a series of legitimate medical as well as possibly psychosomatic physiological and psychological concerns. The young lady has been specifically diagnosed as having a duodenal ulcer with the inherent gastrointestinal symptoms including vomiting and intermittent pain. The pain has been linked to increased absenteeism from school, four hospitalizations, adverse sleeplessness, nightmare experiences with detail of dismemberment and professed fears of death for herself and for her family members.
The family consisted of eight total children and an intact parental situation but of these members, there has also been a history of mental retardation, depression and one sibling who has since deceased but in life was a main care provider. There is also…
Annunziata, Jane. (n.d.). "Play Therapy With A 6-Year-old With Jane Annunziata, PsyD." Retrieved May 10, 2005, from http://www.apa.org
College of Agricultural Sciences (1999). Cognitive Development/Play-Overview. College of Agricultural Sciences, Penn State University. Retrieved May 10, 2005, from http://www.penpages.psu.edu/penpages_reference/28507/2850764.htmL
Ferguson, E.D. (1989). "Adlerian Therapy: An Introduction." Vancouver, British Columbia, Canada: Adlerian Psychology Association of British Columbia.
Wikopedia. (n.d.). Post-traumatic stress disorder. Retrieved May 10, 2005, from http://en.wikipedia.org/wiki/Post-traumatic_stress_disorder
Diabetic Vascular Disease state caused by the deficiency of a chemical in the body called insulin which is a hormone is called Diabetes. There are two forms of diabetes. In the type-one diabetes no insulin is formed and people require insulin injections for existence. This was once thought it would affect only children, but now it can occur at any age. The type2 diabetes is due to the resistance of the body towards the effects of insulin. This also includes insulin which is insufficient. ut in this type there is some amount of insulin produced. In both the types the blood glucose levels is increased. When compared to people without diabetes, people with diabetes are prone to certain problems. These problems occur in the nerves (neuropathy), kidney (nephropathy) and eye (retinopathy). These people are prone to early heart attacks and stroked due to the hardening of the arteries (arteriosclerosis). With…
Diabetes Basics-About Diabetics," Retrieved from www.orthop.washington.edu/faculty/Hirsch/diabetesAccessed on March 3, 2004
Diabetes & Vascular Disease Research" retrieved from www.medstv.unimelb.edu.au/Research/DCVDR/. Accessed on March 3, 2004
Haptoglobin: A major susceptibility gene for diabetic vascular complications," retrieved from www.pulsus.com/europe/07_02/szaf_ed.htm. Accessed on March 3, 2004
Pathophysiology of Diabetes" retrieved at http://www.dhss.state.mo.us/diabetes/manual/DMOverview.pdf. Accessed on March 3, 2004
OGANIZATIONAL SYSTEMS & QUALITY LEADESHIP
Organizational Systems and Quality Leadership
Efforts to measure and improve the quality of nursing care provided to patients began with Florence Nightingale, who measured patient outcomes and worked towards the improvement of hospital conditions. ecently, studies linking nurses to patient outcomes have been given significant focus within healthcare. Efforts to measure the indicators of the quality of care dispensed by nurses have led to the phrase "nursing sensitive indicators," which has become a buzzword in healthcare. These are "outcomes from patient care that reflect the nursing care provided" (Kelly, Vottero, & Christie-McAuliffe, 2014). These indicators reflect the structure, nursing care process, and nursing care outcomes (American Nurses Association, 2014). Structural indicators include nursing staff supply, skill level of nurses and certification. The process indicators include patient assessment measures of nursing interventions while outcome indicators include all patient experiences such as falls, pressure ulcers, and readmissions…
American Nurses Association. (2013). Code of Ethics for Nurses with Interpretive Statements. Retrieved 2014, from Nursing World: http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf
American Nurses Association. (2014). Nursing-Sensitive Indicators. Retrieved 2014, from Nursing World: http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/PatientSafetyQuality/Research-Measurement/The-National-Database/Nursing-Sensitive-Indicators_1
ANA. (2014). ANA Indicator History. Retrieved 2014, from Nursing World:
Search the U.S. Department of Health and Human Services National Guideline Clearinghouse website at http://www.guideline.gov / for a quality guideline that pertains to the area of nursing in which you are interested. Describe the guideline and how the information could be used in a process improvement project. Reference the website.
Quality Guideline: Pressure ulcer prevention. In: Evidence-based geriatric nursing protocols for best practice at http://www.guideline.gov/content.aspx?id=43935.
With the elderly segment of the merican population growing more rapidly than any other, there are going to be a number of age-related infirmities that will require informed healthcare services in the future. This quality guideline sets forth best evidence-based practices for the prevention and care of pressure ulcers and skin tears for the clinical specialties of nursing, family practice and geriatrics with intended users including advanced practice nurses and nurses. The stated guideline objectives are to provide a standard of practice protocol for: (a)…
Agency for Healthcare Research and Quality. (2014). CUSP Toolkit. Retrieved May 11, 2014 from http://www.ahrq.gov/professionals/education/curriculum-tools/cusptoolkit/index.html
Safety in the workplace is everyone's responsibility and preventing the spread of increasingly resistant infectious agents represents a timely and valuable enterprise. One straightforward method that has been used to good effect to help coordinate the actions of all healthcare practitioners is the Comprehensive Unit-based Safety Program (CUSP) toolkit. This training program for healthcare providers is intended to promote teamwork and improve communication levels in ways that reduce the risk of infection and improve the safety of healthcare delivery systems.
One practice area that the CUSP toolkit can be used to plan a process improvement project in my workplace is through a reduction in patient falls. Currently, patients are allowed to fall up to three times before a fall flag was placed on their bed alerting healthcare providers of the patient's potential fall risk and placing a notice on the electronic and hard-copy medical records to this effect. In some cases, patients have been severely injured (in fact, one patient even died after his surgical wound became infected when it was contaminated by the contents of his colostomy bag that ruptured when he fell on it) before an medical record and fall flag alerts were posted. The current system requires improvement in order to reduce the prevalence of falls in this tertiary healthcare facility. Implementing the principles of the CUSP toolkit would provide a consistent approach to risk management for patients that are at risk of falling during the in-patient stay, including identifying better ways to conduct assessments and the number of falls that should be allowed before an alert is posted.
After spending a semester in the Newborn Intensive Care Unit (NICU) as a student nurse in training, I can report that I have learned a great deal about the vital issues and practices that are involved in the intensive care unit for newborns, and about the duties and responsibilities of a nurse in that area of healthcare. Part of my training involved treating wounds and the therapeutic communication that is involved in wound care; also, I became well familiarized with the family centric care that is part and parcel of the NICU.
Family Centered Care at the NICU
hat can be more important for a family that has just been on the emotional roller coaster of giving birth prematurely to a new member of the family than being made to feel welcomed and to be treated with a great deal of professionalism and respect? There are a number…
Auckland District Health Board (2010). Car seats for babies / Information for parents. Retrieved May 2, 2013, from http://www.abhd.govt.nz.
Auckland District Health Board (2010). Establishing and Maintaining Breast Milk Supply /
Information for parents. Retrieved May 2, 2013, from http://www.abhd.govt.nz.
Aukland District Health Board (2010). Meconium and Newborn Babies / Information for Parents. Retrieved May 2, 2013, from http://www.abhd.govt.nz.