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Chronic wounds represent a devastating health care problem with significant clinical, physical and social implications. Evidence suggests that consistent, meticulous and skilled care provides the primary means by which successful wound care and healing is promoted. The occurrence of wounds has plagued humankind throughout recorded history and remains a major source of morbidity and mortality in several disciplines of clinical medicine. Within this thesis, an effort will be made to address the basics of appropriate and potentially successful nursing in wound care and the promotion of healing. Section 1 will provide introductory information on the problem of wound care. In Section 2, the relevant literature will be reviewed while Section 3 will present the research methodology used within the thesis. In Section 4, the results of the thesis will be provided, offering a framework that can be used for insuring that the essential basics in wound care are…
Allman, R.M. (1989). Pressure ulcers among the elderly. New England Journal of Medicine, 320,850.
Allman R.M., Larade C.A. & Noel, L.B. (1986). Pressure sores among hospitalized patients. Annals of Internal Medicine,105, 337-342.
American Hospital Association (2003). Curative Health Services. Found at http://www.curative.com
Anonymous (1997). Wound dressing prices holding steady. Hospital Materials Management, 22(6), 1-10.
In this regard, the documentation should include the four main assessment components; which are, nutrition, wound etiology, wound appearance and pain (Assessment and Documentation Issues in Wound Care).
In other words a careful written as well as visual record should be kept of all the possible factors and variables relating to the patient's condition and to the progression or otherwise of the healing process.
There are two further reasons that are important to note with regard to the issue of documentation. These are, firstly, that thorough documentation serves as a legal record of the quality of care and wound management; and secondly, it also provides invaluable information relating to the environment and surroundings that impact the healing process. As one study notes, "….we have seen that the environment of the patient may cause profound difficulties in wound healing. Identifying and understanding these co-morbidities will help you bring in important interventions…
Assessment and Documentation Issues in Wound Care. Retrieved from http://www.vnaa.org/vnaa/g/?h=html/wound_center_march
Flanagan M. Barriers to the implementation of best practice in wound care. Wounds UK.
Retrieved from http://www.woundsinternational.com/pdf/content_87.pdf
Phases of Wound Healing. Retrieved from http://www.clinimed.co.uk/Wound -
This highlights the seriousness of the need for proper wound care in long-term care facilities, demonstrating the extent to which the nurse must define and provide oversight to standards in this area.
What steps should be taken to ensure proper wound care?
The first and most important aspect of ensuring that wound care is attended with proficiency is the provision of comprehensive training for nurse professionals. There are an array of strategies which can be applied to help hasten the process of healing or which can have the impact of lessening the likelihood or severity of recurrence. Indeed, the study by O'Meara et al. (2000) recognizes that such high risk individuals as diabetics are particularly vulnerable to recurrence and that 'secondary wound care' is a central part of reducing this likelihood. Accordingly, O'Meara et al. indicate that "the prevention and treatment of chronic wounds includes many strategies, including the use…
American Academy of Dermatology (AAD). (2009). Causes of Aging Skin. Aging Skin Net. Online at http://www.skincarephysicians.com/agingskinnet/basicfacts.html
Ayello, E.A.; Baranoski, S.; Cuddigan, J. & Sibbald, R.G. (2007). Wound Debridement. Wound Care Essentials: Practice and Principles; Lippincott, Williams & Wilkins.
Braun, R.P.; Vecchietti, J.L.; Thomas, L.; Prins, C.; French, L.E.; Gewirtzman, a.J.; Saurat, J. & Saloman, D. (2005). Telemedical Wound Care Using a New Generation of Mobile Telephones. Arch Dermatol, 141(2), 254-258.
Gardner, a. & Gardner, G. (2004). A trial of nurse practitioner scope of practices. Journal of Advanced Nursing, 49(2), 135-145.
Certification for wound care are available but wound care is not typically addressed as an area of specialization for nurses. There is a corresponding lack of wound care training for nurses in key fields including those who work with diabetics. Research shows that proper wound care can minimize complications related to lack of mobility including bed sores, and reduce the rates of amputations. Comprehensive wound care training is therefore essential for nurses working with the elderly, diabetics, and burn victims.
Second, organizational issues stymie effective wound care interventions. One of the organizational issues cited most frequently in the literature is a lack of standardization of wound care procedures. A lack of standardization is one of the most often-cited reason for the ineffective implementation of wound care treatment, as nurses with varying levels of training employ wound care strategies sporadically and without guidance. Dressing, re-dressing, use of antimicrobial agents, and environmental…
Chronic Wound Care: Nursing Assessment
Chronic Wound Care: Nursing Assessment and Intervention
Chronic Wound Care: Nursing Assessment and Intervention
Chronic wounds are a challenge for both the clinician and the patient. For the nurse, issues of chronic wound care include the type of wound, the condition of the patient, and presence of infections, possible antibiotic therapy, and patient education on chronic wound care management. For the patient, issues revolve around how the patient will provide for their own long-term chronic wound care, compliance, cosmetic issues, effects on quality of life, potential self-esteem issues, and other factors related to the overall health of the patient. The following paper discusses the topic of chronic wound care for the nurse and for the patient. A nursing assessment for chronic wound care is provided using two approaches: the NANDA diagnostic approach, and the PICO process. In order to properly illustrate the issue,…
Beckert, S., Konigsrainer, A., & Coerper, S. (2007). The physiology of wound healing. Therapeutische Umshau, 467-472.
Bryant, R., & Nix, D. (2007). Acute and chronic wounds: current management concepts . St. Louis: Mosby, Inc.
Buluta, H., Hisara, F., & Guler Demir, S. (2010). Evaluation of mentorship programme in nursing education: A pilot study in Turkey. Nurse Education Today, Available online 1 April 2010, ISSN 0260-6917, DOI: 10.1016/j.nedt.2010.01.019.
e Laat, E., Scholte op Reimer, W., & van Achterberg, T. (2005). Pressure ulcers: diagnostics and interventions aimed at wound-related complaints: a review of the literature. Journal of Clinical Nursing, 464-472.
Clinical Pactice Guideline - Sugical Infection Issue
Sugical Infection Issue
Clinical Pactice Summay:
National Collaboating Centee fo Women's and Childen's Health. (2008, Octobe; eaffimed in 2011). Sugical site infection: pevention and teatment of sugical site infection. Lodnon (UK): National Institute fo Health and Clinical Excellence (NICE).142 p. [256 efeences].
Scope and Pupose
The scope and pupose of the clinical pactice guideline entitled "Sugical site infection: pevention and teatment of sugical site infection, is to povide guidance fo sugical site infections (SSI). A sugical site infection is a wound that occus when an invasive sugical pocedue has taken place. The sugical site infection guideline does not addess management of the opeating theate envionment and envionmental factos, no does the sugical site infection guideline addess pophylaxis and management of antibiotic-esistant bacteia. Anesthetic factos elating to the sugical site infection (SSI) ae also not addessed by the sugical site infection guideline.
references]. Retrieved from http://www.nice.org.uk/guidance/CG74 . [Original document contains cost analyses].
Preventing and treating surgical site infections. Understanding NICE guidance. Information for other people who use NHS services. (2008, October). London (UK). National Institute for Health and Clinical Evidence. (Clinical guideline; no. 74). Retrieved from
As standard procedure warranted in this case, her obstetrician injected her with varicella zoster specific immunoglobulin. The injection did occur too late, but this is a special case warranting attention and was a prophylactic to protect the baby. A few days later the N developed chickenpox anyway. The reasons why the vaccine did not take could have been the fact that the N had already been exposed, and the situation is referred to as "breakthrough varicella," (National Centre for Immunisation, 2009, p. 3). Breakthrough varicella is a mild form of the infection, and yet is still contagious. Varicella vaccine should not be given to the baby until it is twelve months of age, but it may not be necessary at all due to the potential in vitro exposure to the varicella zoster virus. Infants "should receive no specific treatment or vaccination after exposure to Varicella zoster virus (VZV) but…
Centers for Disease Control and Prevention (2014). Preventing varicella in health care settings. Retrieved online: http://www.cdc.gov/chickenpox/hcp/healthcare-setting.html
Cheprasov, A. (2014). The spread of disease. Retrieved online: http://education-portal.com/academy/lesson/the-spread-of-disease-endemic-epidemic-pandemic.html#lesson
Children, Youth, and Women's Health Service (n.d.). Chickenpox. Retrieved online: http://www.health.wa.gov.au/docreg/Education/Diseases/Communicable/Virus/HP8873_chickenpox.pdf
"Descriptive Epidemiology," (2014). Retrieved online: http://www.med.uottawa.ca/SIM/data/Epidemiology_rates_e.htm
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.
com). A certain amount of errors is to be expected, but there should not be so many that it demonstrates a certain level of skewedness about the model in its entirety. Thus, if the NHI model is the one which is selected, then it needs to be tested against a range of different scenarios. The following demonstrate some truly relevant what-ifs: what if the doctors only move half the projected volume; what if medicare slashes rates; what if competitors open a comparable program (dgapartners.com).
There are a range of factors which can change or adjust once a healthcare facility opens their doors for business. And as much as this facility is attempting to engage in a solid humanitarian effort, at the end of the day, it's still a business and people need to get paid. Thus, before engaging in further developmental activities, one needs to determine in what ways the…
Brakatu Ofori-Adjei, a. (2007). Microfinance: An Alternative Means of Healthcare Financing for the Poor. Ghana Medical Journal, 193-194.
Burnstein, L., Harris, R., & Love, L. (2012, August 30). Top Four Legal Issues to Consider When Opening an Urgent Care Center. Retrieved from Mondaq.com: http://www.mondaq.com/unitedstates/x/194082/Healthcare/Estate+planning+is+important+step
Burnstein, M., Harris, R.L., & Love, L. (2012, August 20). Top Four Legal Issues to Consider When Opening an Urgent Care Center. Retrieved from Mondaq.com:
The penalties for being out of compliance when OSHA comes knocking should be enough to motivate any healthcare facility to devise a plan to make sure that they are in compliance with OSHA's regulations. The startling thing is that it took an initiative like NEP to wake these facilities up and get them thinking about being compliant. Since they deal with people and their well being on an everyday basis, these are things that they should have been doing all along and not just because there is an increased probability of getting into trouble by OSHA.
Harris, S. (2012). OSHA in Health Care: Out of Sight & Out of Mind? etreived from http://ohsonline.com/articles/2012/04/01/osha-in-health-care.aspx
Healthcare workers. (2012). etrieved from http://www.cdc.gov/niosh/topics/healthcare/
New OSHA inspection initiative focuses on healthcare. (2011). etrieved from http://www.puresafety.com/public/workingwell/?p=1209#.UAa4aFJ6EM
Occupational Safety and Health Administration ("OSHA") Targets Nursing and esidential
Care Facilities. (2012). etrieved from http://www.hancocklaw.com/p/OSHA_Newsletter_212_May_H1768037.PDF
Prepare Your Facility…
Harris, S. (2012). OSHA in Health Care: Out of Sight & Out of Mind? Retreived from http://ohsonline.com/articles/2012/04/01/osha-in-health-care.aspx
Healthcare workers. (2012). Retrieved from http://www.cdc.gov/niosh/topics/healthcare/
New OSHA inspection initiative focuses on healthcare. (2011). Retrieved from http://www.puresafety.com/public/workingwell/?p=1209#.UAa4aFJ6REM
Occupational Safety and Health Administration ("OSHA") Targets Nursing and Residential
Aaron, H.J. 1994. Thinking About Medical Costs. Health Affairs, 13, 5 (winter): 8-13 in Hong, G-S and Kim, S.Y. (2000). Out-of-Pocket Health Care Expenditure Patterns and Financial Burden across the Life Cycle Stages. Journal of Consumer Affairs. 34. 2.
Acs, G. And John S. 1995. Trends in Out-of-Pocket Spending on Health Care, 1980-1992. Monthly Labor eview, 35-45 in Hong, G-S and Kim, S.Y. (2000). Out-of-Pocket Health Care Expenditure Patterns and Financial Burden across the Life Cycle Stages. Journal of Consumer Affairs. 34. 2.
Cote, J. And Latham, C. (2003). Exchanges between Healthcare Providers and Insurers: A Case Study. Journal of Managerial Issues. 15, 2.
Health, United States. (2003). Chartbook on trends in the health of Americans. HHS, Centers for Disease Control and Prevention (CDC). National Center for Health Statistics in Lesnik, J. (2006). Community Health Centers: Health Care as it Could Be. Journal of Law and Health. 19, 1..…
Aaron, H.J. 1994. Thinking About Medical Costs. Health Affairs, 13, 5 (winter): 8-13 in Hong, G-S and Kim, S.Y. (2000). Out-of-Pocket Health Care Expenditure Patterns and Financial Burden across the Life Cycle Stages. Journal of Consumer Affairs. 34. 2.
Acs, G. And John S. 1995. Trends in Out-of-Pocket Spending on Health Care, 1980-1992. Monthly Labor Review, 35-45 in Hong, G-S and Kim, S.Y. (2000). Out-of-Pocket Health Care Expenditure Patterns and Financial Burden across the Life Cycle Stages. Journal of Consumer Affairs. 34. 2.
Cote, J. And Latham, C. (2003). Exchanges between Healthcare Providers and Insurers: A Case Study. Journal of Managerial Issues. 15, 2.
Health, United States. (2003). Chartbook on trends in the health of Americans. HHS, Centers for Disease Control and Prevention (CDC). National Center for Health Statistics in Lesnik, J. (2006). Community Health Centers: Health Care as it Could Be. Journal of Law and Health. 19, 1..
Health Care Past, Current, And Future
The health of any nation should be a top priority for leaders and elected political representatives, but in the United States it took several centuries for the nation to begin to come to terms with providing health care for its citizens. This paper covers the gradual implementation of health care services and doctor training facilities in the U.S., and also covers the recent attempt by President Barack Obama to reform a chaotic, poor-functional and expensive health care system. Thesis: It is a scandal of massive proportions that a well-functioning, citizen-friendly universal health care system cannot be instituted in America, the world's most democratic superpower. Until the divisive and toxic political climate can be reformed, there is no chance of major reforms -- or for universal health care coverage -- in these United States.
Past Health Care Services -- Early America
Health care in colonial…
Daly, John. (2005). Professional Nursing: Concepts, Issues, and Challenges. New York:
Springer Publishing Company.
Gorsky, Martin. (2010). Good Health for America? History Today, 60(2), 1-6.
McCarthy, Robert L., and Schafermeyer, Kenneth W. (2007). Introduction to Health Care
When considering the ever-changing and highly competitive economic landscape of the modern world; governments, businesses and institutions must remain diligent in their care and compassion for their citizens and staff members. With the current exponential growth and advancement of technology and the computerization of business and learning, voters, workers and consumers have become much more connected to the organizations they patronize (Kurzweil). Accordingly, these important groups are faced with the continuous task of finding new ways to understand and subsequently accommodate the needs of their followers, while simultaneously securing lucrative business models and job environments. One of the most important needs presented in all demographics is reliable healthcare. Thus, with the inelasticity in the demand for healthcare, countries need to determine an applicable system, whereby citizens can have access to the medical services they will inevitably need. Collective access to healthcare represents the main problem in field of…
Blumenschein, K. And M. Johannesson. "Economic Evaluation in Healthcare. A Brief History and Future Directions." Journal of Pharmacoeconomics 10.2 (1996): 114-122.
Cox, Malcolm, et al. "Health Care Economics, Financing, Organization and Delivery." Family Medicine January 2004: 20-30.
Hamburger, Tom and Kim Geiger. "Healthcare Insurers Get Upper Hand." The Los Angeles Times 24 August 2009.
Jeremiah Hurley. "An Overview of the Normative Economics of the Health Sector." Journal of Health Economics 1.1 (2000): 55-118.
S. Department of Health and Human Services, 2011). Furthermore, subpart C explains the privileges and the protections of confidentiality that is attached to the patient's record along with much exception (U.S. Department of Health and Human Services, 2011).
The penalty for anyone who breaks confidentiality is imperative. In "November, 23, 2009" was increased to $11,000 (U.S. Department of Health and Human Services, 2011). This goes for anyone in the medical field or has access to this information. A person has to follow HIPAA precisely or face a huge fine. If one thought of this ahead of time, whether or not they own a business, then no issues would arise legally. However, sometimes this does occur, especially for those who want to harm another person, yet in the medical field the goal is not to do this to any individual, regardless, otherwise he or she could face losing their license in…
U.S. Department of Health and Human Services Civil Rights. (2011). Your health information privacy rights. Retrieved May 3, 2011, from U.S. Department of Health and Human
Services Civil Rights:
U.S. Department of Health and Human Services. (2011). Health information privacy. Retrieved May 3, 2011, from U.S. Department of Health and Human Services:
While it may not be just to hold an organization liable, absolutely, for every instance of employee negligence, there is a rationale for imposing such liability in many cases. For example, many types of industries entail potential danger to others that are inherent to the industry.
Individual workers are not likely to be capable of compensating victims of their negligence, but the employer benefits and profits financially by engaging in the particular industry. Therefore, the employer should not necessarily escape liability for compensating all harm caused by their activities, regardless of fault in particular instances.
10.A nurse is responsible for making an inquiry if there is uncertainty about the accuracy of a physician's medication order in a patient's record. Explain the process a nurse should use to evaluate whether or not to make an inquiry into the accuracy of the physician's medication order.
Like other highly trained professionals, experienced nurses…
Abrams, N., Buckner, M.D. (1989) Medical Ethics: A Clinical Textbook and Reference for the Health Care Professionals. Cambridge, MA: MIT Press
Caplan, a.L., Engelhardt, H.T., McCartney, J.J. Eds. (1981) Concepts of Health and Disease: Interdisciplinary Perspectives. Reading, MA: Addison-Wesley
Starr, P. (1984) the Social Transformation of American Medicine.
New York: Basic Books
Workarounds in Healthcare Facilities
Workarounds refer to the alternative methods "of accomplishing an activity when the usual system / process is not working well" (Pennsylvania Patient Safety Advisory, 2013). In as much as workarounds may temporarily solve existing problems, they also indicate inefficiencies and deficiencies in the current system. Workarounds may at times be effective and more convenient, compared to the system in existence, but a regular use of the same could endanger both the safety of patients and the facility's reputation. A workaround can, therefore, be termed as an at-risk behavior that does not yield concrete long-term solutions to existing problems. Therefore, "workarounds perceived as necessary by the user for patient care, efficiency or safety, may be beneficial, neutral, or dangerous for patients' safety" (Koppel, Wetterneck, Telles & Karsh, 2008, p. 1).
A description of Workarounds in a Selected Facility
Workarounds can take a variety of forms. For instance,…
Flanagan, M.E., Saleem, J. J., Millitello, L.G., Russ, A.L. & Doebbeling, B.N. (2013). Paper- and Computer-Based Workarounds to Electronic Health Record Use at Three Benchmark Institutions. Journal of the American Medical Informatics Association, 20(e1): e59-66.
Intel (2013). Workarounds in Healthcare, a Risky Trend. Retrieved from http://www.intel.com/content/www/us/en/healthcare-it/workarounds-in-healthcare-risky-trend.html
Koppel, R., Wetterneck, T., Telles, J.L. & Karsh, B. (2008). Workarounds to Barcode Medication Administration Systems: Their Occurrences, Causes, and Threats to Patient Safety. Journal of the American Medical Informatics Association, 15(4), 408-423.
Merrill, M. (2009). Using Pen and Paper Workarounds Could Boost EMR Efficiency. Retrieved from http://www.healthcareitnews.com/news/using-pen-and-paper-workarounds-could-boost-emr-efficiency
As the module suggests, "Each wound that is encountered and considered for repair must be addressed independently," ("Wound considerations"). This is true whether the injury is an acute one, or whether there is a procedure involved. Generally, however, suturing can take place in an outpatient care clinic regardless of whether there was an acute injury or not. It depends a lot on the nature of the injury, and the nature of the procedure, though. Generalizing about situations like injuries and procedures is unnecessary, unproductive, and potentially dangerous. Each would certainly requires an evaluation of the situational and patient variables. The age and overall health condition of the patient, and the age of the wound are all taken into consideration when there has been an acute injury; the type of the wound also needs to be taken into consideration when there was an injury. Acute injury patients might not be…
Khan, M., Bann, S., Darzi, A. & Butler, P. (2003). Use of suturing as a measure of technical competence. Annals of Plastic Surgery 50(3):304-309.
Queen's University School of Medicine Module
Ratner, D., Nelson, B.R. & Johnson, T.M. (1994). Basic suture materials and suturing techniques. Seminars in Dermatology 13(1): 20-26.
qualities of chronic wounds serves as a useful selection of literature for those health professionals that are expected to treat and care patients with this type of condition. The purpose of their article was to further explain and ultimately gain a more thorough understanding of what patients may be subjectively feeling when suffering from chronic wounds. The article used a literature review and administered a study to help clear up some of the more mysterious aspects of those suffering from chronic wounds.
Before introducing their study, the authors provided ample background about chronic wounds by giving some precise and useful definition of terms. The problem was essentially framed in a manner that helped determined the scope of the research, its aims and its methodology. This part of the article is the most useful part of the submission due its clear and concise arguments.
To help determine or reject some of…
Bietz, J. & Goldberg, E. (2005). The Lived Experience of Having a Chronic Wound: A Phenomenological Study. Dermatology Nursing, Aug 2005, 17 (4), p 272-284.
Opening an Outpatient Wound Clinic
Categories in udget (Fixed and Variable Expenses)
udgeting for the outpatient wound clinic includes both fixed and variable expenses. Fixed costs are reported in the work of Swansburg (1997) to be unrelated to volume and to remain constant, as there are increases and decreases in volume over a time-period. Fixed costs are reported to include such as:
(1) Depreciation of equipment and buildings;
(3) Fringe benefits;
Interest on loans or bonds; and (6) Taxes. (Swansburg, 1997)
Variable costs do however "relate to volume and census. They include such items as meals and linen." (Swansburg, 1997) it is reported that supplies are usually volume responsive, meaning that total costs increase or decrease according to use." (Swansburg, 1997)
Direct and Indirect Costs
Direct and indirect costs of making the provision of service of product and are costs that are not "directly related to…
Swansburg, Russell C. (1997) Budgeting and Financial Management for Nurse Managers. 1 Jan 1997. Business and Economics. Retrieved from: http://books.google.com/books?id=TlyldEaLWyoC&dq=outpatient+wound+clinic:+cost+accounting+and+fixed,+variable+expenses&source=gbs_navlinks_s
Capital Expenditure (nd) Tax Guide. Retrieved from: http://taxguide.completetax.com/text/Q13_2612.asp
Caplan, Dennis (nd) Management Accounting: Concepts and Techniques. Part 2: Microeconomic Foundations of Management Accounting. College of Business. Oregon State University. Retrieved from: http://classes.bus.oregonstate.edu/fall-06/ba422/Management%20Accounting%20Chapter%205.htm
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?
Success in several high-profile areas, such as stroke prevention, acute coronary intervention, or nosocomial infection have the benefits of focusing the organization on a task which can bring tangible results, measured in clinically-relevant ways.
Specific Program for our Institution
This memo recommends that we choose five treatment areas, and implement specific quality improvement programs for each one. The focus on each should include procedures which are important to the overall quality of this institution's morbidity and mortality results. Given the hospital's focus on acute care, the following procedures might be candidates for quality improvement programs:
Ischemic stroke treatment
ACS treatment (acute coronary syndrome).
Trauma in the ER related to gunshot wounds.
Maternal ward delivery performance
Nosocomial infection reduction.
In each case, the procedures should proceed as outlined above: (1) an identification of the problem, (2) identification of best practices as demonstrated in peer-reviewed clinical trials, (3) adoption of the best…
CancerCenter. (2007). Cancer Treatment Centers of America. Retrieved November 23, 2007, from CCA: www.cancercenter.com
Civitarese, L.A. (1999). Congestive Heart Failure Clinical Outcomes Study in a Private Community Medical Group. Journal of American Board of Family Practice, 467-472.
Dana Farber. (2005). Dana-Farber attains nation's highest honor for nursing excellence; first cancer center in New England to earn Magnet recognition. Boston: Dana Farber Cancer Institute.
Katzan, I.L. (2003). Quality Improvement and Tissue-Type Plasminogen Activator for Acute Ischemic Stroke. JAHA, 799-800.
Methicillin-esistant Staphylococci (MSA), most common Healthcare Associated Infections
The PICOT question to be discussed is: For adult patients using catheters, does the use of sterilization practices reduce the future risk of health associated infections like MSA compared with standard procedure in one week?
The answer is yes.
The support given to answer the question will be based on peer-reviewed journals and scientific literature. A summary of the evidence will be availed in a chart plus a conclusion that summarizes evidence used will also be given.
Methicillin-resistant Staphylococcus aureus (MSA) bacteria is resistant to several antibiotics. A significant proportion of MSA infections in the community are on the skin. It results in alarming infections of the bloodstream, surgical site infections and pneumonia in health facilities. Studies have revealed that one person in every three individuals have staph in the nose - most of the time they don't show any illnesses (General…
General Information About MRSA in the Community. (n.d.). Retrieved February 21, 2015, from http://www.cdc.gov/mrsa/community/index.html
Sydnor, E., & Perl, T. (2011). Hospital Epidemiology and Infection Control in Acute-Care Settings. Clinical Microbiology Reviews,24(1), 141-173. Retrieved February 21, 2015, from http://cmr.asm.org/content/24/1/141.full
Nursing Health Care Informatics
"…At the beginning of the 21st century, nursing informatics has become a part of our professional activities…[and has] advanced the field of nursing by bridging the gap from nursing as an art to nursing as a science…" (Saba, 2001, 177).
Nursing Health Care informatics relate to and address technology and other cutting edge issues of great interest in the healthcare field. According to the AMIA, Nursing Informatics is the "…science and practice (that) integrates nursing, its information and knowledge, with management of information and communication technologies to promote the health of people, families, and communities worldwide." New and relevant knowledge presented in the genre of informatics helps to empower nurses and other healthcare practitioners to deliver the most effective patient-center care possible. This paper presents several informatics in the belief that applying healthcare technologies and practices that are genuinely progressive and helpful to today's nurse is…
AMIA (2009) Working Group Nursing Informatics. Retrieved March 9, 2014, from http://www.amia.org .
An, J.Y., Hayman, L.L., Panniers, T., and Carty, B. (2007). Theory Development in Nursing
And Healthcare Informatics. A Model explaining and Predicting Information and Communication Technology Acceptance by Healthcare Consumers. Advances in Nursing Science, 30(3), E37-E49.
Cipriano, P.F. (2011). The Future of Nursing and Health IT. Nursing Economics, 29(5).
Specifically, deficient cae may esult in a child's being vulneable as a consequence of a low intinsic level of self-esteem and self-woth (Pake, Baett, and Hickie, 1992). It is clea that a numbe of factos ae likely to affect the teenaged individual esulting in depession and it is citically noted that this depession must necessaily be addessed, teated and esolved. The client in this instance has bodeline low blood pessue which should be monitoed seveal times each week and futhemoe the body mass index (BMI) of this individual is excessively low indicating that this patient needs to be counseled in egads to thei diet both in tems of quality and quantity of foods consumed.
Logsdon, Cynthia J.(nd) Depession in Adolescent Gils: Sceening and Teatment Stategies fo Pimay Cae Povides Jounal of the Ameican Medical Women's Association Volume 59, No 2.
Lemay, Edwad P. And Ashmoe, Richad D. (2005) the…
reference: Studies of occupational and recreational choice. Social Psychology Quarterly, 49, 11-18.
The red and swollen appearance could be an on-site reaction to the administered medication. A change of type of antibiotic medication may be necessary.
Question 5: Simon begins to complain of chest tightness he is beginning to get distressed what may be occurring and what interventions need to be undertaken.
An asthma attack partially brought on by the psychological stress of the surgery and being in the hospital, combined with the physical trauma is likely. Simon, physician permitting, should be allowed with assistance to treat his asthma in the usual fashion, after screening for potentially more serious conditions that can manifest in chest tightness, such as a cardiac condition.
Question 6: You notice that Simon has become disoriented and is complaining of a headache what may be occurring and what interventions need to be undertaken?
Signs and symptoms of a concussion, the result of head trauma, are not always immediately…
Fractures of the tibia and fibula." (2008). Chapter 21: Practical Plastic Surgery. Retrieved 23 May 2008 at http://www.practicalplasticsurgery.org/docs/Practical_21.pdf
Interdisciplinary Care Providers
CABG or coronary artery bypass graft surgery is advised for individuals suffering from CHD (coronary heart disease), for alleviating symptoms, prolonging lifespan, and improving QOL (quality of life) (Bayoumi, 2015). Improvements in mechanical ventilation-supported cardiac operation patient management continues to be a major focus area for better optimizing clinical results. The FTE (fast-track extubation) theory applied in case of cardiac operation patients is growing in popularity, in a bid to offer more economical and superior-quality healthcare. A large number of research works have established that prompt extubation (i.e., between 6 and 8 hours after surgery) may be a safe step, whilst decreasing admission and resource use expenses (Cheng, Karski & Peniston, 1996). In spite of the aforementioned advantages, prompt extubation is not consistently performed, underscoring the need to adopt a protocolized strategy for decreasing setbacks and variations and linked to weaning mechanical ventilation. Time-guided extubation protocols’ benefits have been…
Ruth E. Mathias and a.E. Benjamin (2003) report that social workers are becoming increasingly concerned about elder abuse in long-term care settings (p. 174). A study conducted by these social scientists/authors, reveals that Medicaid related agency care demonstrates no harmful or increase in the abuse suffered by elderly people receiving care through private agencies, but that there is little social worker oversight, and because of that, reports and information supporting that fact can be misleading at this point in time (p. 174). Mathias and Benjamin reported, too, that direct care provided by family members was proven to be less abusive to the elderly than services rendered by state and private providers (p. 174).
The most concentrated areas of consumer complaints reported was the difficulty in scheduling services, language barriers, and high care-giver/assistant turnover (p. 174). These are areas of concern, because the elderly are often suffering levels of dementia that…
Litwin, H., & Zoabi, S. (2004). A Multivariate Examination of Explanations for the Occurrence of Elder Abuse. Social Work Research, 28(3), 133+. Retrieved July 31, 2008, from Questia database: http://www.questia.com/PM.qst?a=o&d=5007316778
Matthias, R.E., & Benjamin, a. (2003). Abuse and Neglect of Clients in Agency-Based and Consumer-Directed Home Care. Health and Social Work, 28(3), 174+. Retrieved July 31, 2008, from Questia database: http://www.questia.com/PM.qst?a=o&d=5001999500
Thorslund, M., & Parker, M.G. (1994). Elder Care in the Priorities Discussion. The Hastings Center Report, 24(5), 29+. Retrieved July 31, 2008, from Questia database: http://www.questia.com/PM.qst?a=o&d=5002212664
cultural diversity issues and its impact on nursing professionals' practice. It assesses a client hailing from a different culture, and employs information derived from the assessment determining and reflecting on health practices and beliefs of the client's culture. Lastly, nurses' role in the care of patients hailing from diverse backgrounds care is analyzed, and a conclusion is drawn.
Client Interview Data
Client's health beliefs in relation to cultural diversity
The client comes from a family-focused background, in which she plays the role of chief household organizer and attends to her family and their needs. She believes one ought to lead a life of a good and virtuous individual, and support one's family, particularly in times of need. In her opinion, sickness must be tended to, for preserving life. She believes in healthcare professionals and services they offer, for leading a healthy life. She is comfortable having healthcare professionals take care…
American Nurses Association. (1998). Discrimination and Racism in Health Care. Silver Spring, MD: American Nurses Association.
Anderson, L. (2012, October 10). Cultural Competence in the Nursing Practice. Retrieved from Nurse Together: http://www.nursetogether.com/cultural-competence-nursing-practice
Coe, S. (2013, January 15). Cultural Competency in the Nursing Profession. Retrieved from Nurse Together: http://www.nursetogether.com/cultural-competency-nursing-profession
Graue, M., Dunning, T., Hausken, M. F., & Rokne, B. (2013). Challenges in managing elderly people with diabetes in primary care settings in Norway. Scand J Prim Health Care, 31(4), 241-247.
Healthcare Administration -- New York State Care Act
The New York State Care (Caregiver Advise, ecord and Enable) Act was implemented into law in April this year. The development and enactment of this law is geared toward having a positive effect on caregivers who assist patients and family members recover in the aftermath of hospital admission. The legislation ensures patients in healthcare facilities can assign a family caregiver and the facility provides the designated caregiver instruction and illustrations of medical tasks they are likely to offer their loved ones at home. However, the implementation of this initiative across hospitals such as Winthrop Hospital has been characterized by several challenges that could hinder its effectiveness if not addressed.
New York State Care Act and its Importance/Benefit
There are approximately 2.8 million New Yorkers who offer unpaid care to their loved ones at any given time as well as nearly 1.6 million…
Dianoski, T. (2014, November 18). How the New Caregiver Advise, Record, Enable (CARE) Act Affects Hospitals and Health Plans. Retrieved August 11, 2016, from https://gomohealth.com/2014/care-act-hospitals-health-plans/
Kansas Department for Aging and Disability Services. (2015). The Kansas Caregiver Advise, Record, Enable (CARE) Act (HB 2058 and SB 265). Retrieved from Kansas Government website: https://www.kdads.ks.gov/docs/default-source/CSP/HCBS/HCBS-2015-Spring-Summit/Presentations/the-kansas-caregiver-advise-record-enable -(care)-act-presentation.pdf?sfvrsn=0
Kriss, E. (2015, June 1). AARP: Millions of NY Family Caregivers in Line for Help as Lawmakers Pass CARE Act. Retrieved August 11, 2016, from http://states.aarp.org/aarp-millions-of-ny-family-caregivers-in-line-for-help-as-lawmakers-pass-care-act/
Mitchell, G. (2013, April). Selecting the Best Theory to Implement Planned Change. Nursing Management, 20(1), 32-37.
Evidence and Expert Interview
SMAT Goals - Evidence and Expert Interview
I chose goals in the areas of leadership development and organizational planning because I believe these are pivotal skills for a nurse to have in order to be an effective member of a healthcare team. My SMAT goals are as follows:
SMAT Goal 1: Leadership Development
To implement a process of increasing communication between field staff and case managers to increase patient meeting nursing goals to 80% by July 2014.
SMAT Goal 2: Organizational Planning
As a nurse administrator of a home health agency, it is my goal to incorporate a time management-mentoring project for all nurses to balance a healthy work-life balance by March 1, 2015.
SMAT Goal 1: Leadership Development
Staggers, N., Gassert, C.A., and Curran, C. (2002). esults of a Delphi study to determine informatics competencies for nurses at four levels of practice. Nursing…
Staggers, N., Gassert, C.A., and Curran, C. (2002). Results of a Delphi study to determine informatics competencies for nurses at four levels of practice. Nursing Research, Nov/Dec. Retrieved http://nursing-informatics.com/niassess/NIcompetencies_Staggers.pdf
Spear, S.J. (2005). Fixing Health Care from the Inside, Harvard Business Review. Retrieved http://hbr.org/2005/09/fixing-health-care-from-the-inside-today/ar/1
The Lean Healthcare Exchange. Retrieved http://www.leanhealthcareexchange.com/
Incidence rates of obesity are rising globally, with tremendous impacts to the cost and nature of healthcare intervention. As measured as body mass index (BMI) of 25 or over, being overweight affects as many as 67% of all American adults, while up to 40% can be classified as obese with a BMI of 30 or more. About 5% of Americans are classified as morbidly obese with a BMI of 40 or more. Obesity affects persons from all demographic groups, and has been on the rise in all demographic groups, even though some groups have higher rates of obesity than others. As many as 10% of all children worldwide are either obese or overweight. Being overweight and being obese are associated with a number of health conditions including cardiovascular disease, hypertension, and diabetes. Moreover, obesity may cause psychological and social issues ranging from depression and anxiety to stigma and prejudice, with…
Camden, S.G. (2009). Obesity: An emerging concern for patients and nurses. OJIN 14(1).
PTSD & SPIITUALITY
Health care and spirituality have long been linked and involved with each other. This involvement and linkage goes far beyond the stereotypical "faith healers" that have become the butt of many jokes. Indeed, faith is used by many to get through struggles and challenges of many kinds. Post-traumatic stress disorder (PTSD) is no different in this regard. While medication and therapy are the more commonly cited ways to address and treat PTSD, faith-based options are also quite common. These spiritual methods are easy to apply in the patient care sphere given that many hospitals are religiously based and/or are willing to tailor a patient's emotional and mental care based on their specific faith. While there can be some pushback when religious and spiritual values are suggested as part of a care program, the use of these values can absolutely be beneficial to a person's mental well-being…
Bormann, J., Liu, L., Thorp, S., & Lang, A. (2012). Spiritual Wellbeing Mediates PTSD
Change in Veterans with Military-Related PTSD. International Journal Of
Behavioral Medicine, 19(4), 496-502. doi:10.1007/s12529-011-9186-1
Currier, J.M., Drescher, K.D., & Harris, J. (2014). Spiritual functioning among veterans seeking residential treatment for PTSD: A matched control group study. Spirituality In Clinical Practice, 1(1), 3-15. doi:10.1037/scp
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,
Assessment of the Situation
As a case manager for patient in this case scenario there are at least four easily identifiable healthcare issues associated with the discharge of patient; 1. Patient safety related to second floor placement of apartment and navigation of two flights of stairs with walker while using pain medication and recovery time needed for hip replacement 2. Patient safety with regard to size and condition of apartment with limited room to navigate with walker, cluttered space and rug placement all of which are barriers to proper use of walker and ambulation an essential aspect of recovery, 3. The potential for patient non-compliance with new medication regimen for diabetes and dietary plan for weight and glucose control 4. Patient well being with regard to isolation and the inability to follow normal routines such as helping in bakery (two flights down) eating in bakery and interacting with…
Borg, C., Hallberg, I., & Blomqvist, K. (2006). Life satisfaction among older people (65+) with reduced self-care capacity: the relationship to social, health and financial aspects. Journal Of Clinical Nursing, 15(5), 607-618.
Byers-Lang, R.E., & McCall, R.A. (1993). Peer support groups: Rehabilitation in action. RE:View, 25(1), 32-36.
French, D.D., Bass, E., Bradham, D.D., Campbell, R.R., & Rubenstein, a. Z. (2008). Rehospitalization After Hip Fracture: Predictors and Prognosis from a National Veterans Study. Journal Of The American Geriatrics Society, 56(4), 705-710. doi:10.1111/j.1532-5415.2007.01479.x
Lin, P., Hung, S., Liao, M., Sheen, S., & Jong, S. (2006). Care needs and level of care difficulty related to hip fractures in geriatric populations during the post-discharge transition period. The Journal Of Nursing Research: JNR, 14(4), 251-260.
(Sussman and Bates-Jensen, 2007)
Assessment data is reported to enable the clear communication among clinicians about the wound and in making the provision for "continuity in the plan of care" as well as allowing for "evaluation of treatment modalities." (Sussman and Bates-Jensen, 2007) Wounds that are classified as red, yellow and black are those that require examination of deep tissue involvement. (Sussman and Bates-Jensen, 2007) The wound must be monitored during the healing process since monitoring provides the means of "checking the wound on a regular and frequent basis for "signs and symptoms that should trigger a full reassessment, such as increased wound exudate or bruising of the adjacent or periwound skin. Included in monitoring is the "gross evaluation for signs and symptoms of wound complications, such as erthema (change in color) or periwound skin and pus, which is indicative of infection." (Sussman and Bates-Jensen, 2007) Included as well should…
Aseptic Technique (2008) Aseptic Technique. Section G. NHS Foundation Trust. Online available at: http://www.cht.nhs.uk/fileadmin/departments/infection_control/policies/Section_G_-_Aseptic_Technique_Issue_2.pdf
Burney, R.E. et al. (1997) Core Outcomes Measures for Inguinal Hernia Repair. Journal of the American College of Surgeons. Vol. 185, Issue 6. Online available at: http://www.journalacs.org/article/S1072-7515%2897%2900108-7/abstract
Issues in Wound Care: Appropriate Use of Dressings. Report from a Wound Academy Expert Forum. Sponsored by the Molnlycke Health Care Wound Academy. September 2007. Online available at: http://www.molnlycke.com/Global/Wound_Care_Products/UK/Wound%20Academy/IssuesAppropriateusefinalSept07.pdf
Khan, Y. And Fitzgerald, P. And Walton, M. (1997) Assessment of the postoperative visit after routine inguinal hernia repair: A prospective randomized trial. Journal of Pediatric Surgery. Vol. 32, Issue 6. June 1997. Online available at: http://www.jpedsurg.org/article/S0022-3468%2897%2990644-8/abstract
Medical Case Study
Florence (F) is a 43-year-old woman who is two days post-operative, following an appendectomy. She has a history of arthritis, and currently takes 10mg of prednisone daily. She is allergic to penicillin. She weighs 46 kg (101.5 lbs.) and is 168cm tall (5'6"). This puts her slightly underweight for her age and height, at least 18-25 pounds (Height and Weight Chart, 2010). While doing a route in dressing change, nurse notice a yellow discharge emanating from the wound.
Identify and discuss the importance of obtaining information during a nursing admission in relation to post- operative assessment. In modern healthcare, a nurse must first and foremost try to understand and utilize a systematic and synergistic model of data collection and assessment. Human beings are complex creatures, and the more data one has, the easier it will be to ensure that a proper diagnosis is made. A systematic assessment…
Height and Weight Chart. (2010). HealthCheck Systems. Retrieved from:
Prednisone and Other Corticosteroids: Balance the Risks and Benefits. (2011). The Mayo
Clinic. Retrieved from: http://www.mayoclinic.com/health/steroids/HQ01431
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.
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.
Nurses are considered the backbone of the medical care-giver community. Good quality patient care centers on having a competent educated nursing labor force. There is a wealth of empirical evidence that has demonstrated Baccalaureate (BSN) nurses are associated with fewer medication errors, lower mortality rates, and greater overall positive patient outcomes than nurses at lower levels of educational achievement. For example, Brady, Malone, and Fleming (2009) performed an extensive literature review and found that BSN nurses made fewer medication errors than their less educated counterparts. Aiken and associates (2003) found a strong link between N education level and patient outcomes. Their findings indicated that for every ten percent increase in the proportion of BSN nurses in a surgical unit there was a four percent decrease in the risk of death to patients. In a large study of nearly 47,000 patients conducted at the University Toronto it was found that hospital…
Aiken, L.H., Clarke, S.P., Cheung, R.B., Sloane, D.M., & Silber, J.H. (2003). Educational levels of hospital nurses and surgical patient mortality. Journal of the American Medical Association, 290, 1617-1623.
Brady, A.M., Malone, A.M., & Fleming, S. (2009). A literature review of the individual and systems factors that contribute to medication errors in nursing practice. Journal of Nursing Management, 17(6), 679-697.
Friese, C.R, Lake, E.T., Aiken, L.H., Silber, J.H. & Sochalski, J. (2008). Hospital nurse practice environments and outcomes for surgical oncology patients. Health Services Research, 43(4), 1145-1163.
Profetto-McGrath, J. (2003). The relationship of critical thinking skills and critical thinking dispositions of baccalaureate nursing students. Journal of Advanced Nursing, 43(6), 569- 577.
As with many pharmaceutical products manufacturers, the extent of supply chain and quality performance has a direct effect on distribution, profitability and services performance as well (tevenson, 2012).
Beginning with supply chain management, J&J has an intensively level of supplier audits they expect each supplier to pass and also randomly be able to manage as they provide materials, components and subassemblies to the company (Wechsler, 2011). upplier audits form the interlinking process to Quality Management, another strategic operations management initiative in the comp[any as well. J&J also uses these supplier audits to ensure alignment to the Collaborative, Planning, Forecasting & Replenishment (CPFR) processes which are critical to their success in anticipating global demand for products by business unit (Weill, Ross, 2005). upply chain management is the unifying operations management strategy that keeping the entire value chain and quality levels of J&J aligned to corporate objectives and standards (Weill, Ross, 2005)…
Sources: (Connolly, 2007) (Hook, 2010) (SAP Practice on Life Sciences Supply Chains) (J&J Investor Relations, 2012)
J&J has a strong focus on operations management strategies, techniques and frameworks as the company is heavily reliant on them to continually meet federal and international compliance requirements for their products (Wechsler, 2011). The focus on supply chain integration to quality management is critical for any business' supply chain to execute the many processes and transactions necessary to grow a business (Stevenson, 2012). For J&J the highly regulated nature of the product quality levels for their products make the integration of these two areas essential for their continued profitability and growth.
Christine Connolly. (2007). Sensor trends in processing and packaging of foods and pharmaceuticals. Sensor Review, 27(2), 103.
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.
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.
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
Clinical Problem: Diabetes Mellitus in Rural Settings
Mid-range nursing theories can be extremely useful in understanding specific clinical issues. These theories are less broad and all-encompassing than so-called grand theories of nursing such as Jean Watson’s Theory of Human Caring and seek to offer a more technical and practical approach to applying theory in daily practice (Alligood, 2018). This paper will specifically examine the application of Kristen Swanson’s Theory of Caring to the treatment of patients suffering from diabetes mellitus living in rural settings without adequate access to healthcare. Virtually all nursing theories are composed of four essential core definitions, that of person, environment, health, and nursing itself. Swanson’s theory, however, specifically focuses on nursing, which Swanson defines as a very specific type of caring.
Although obesity is increasing across the nation, obesity is often particularly rife in rural settings with limited access to healthcare and healthy foods.…
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/
It provides health-related advice on its website that all readers can benefit from, not simply those who use its services. As well as reaching out to the wider population of patients, it honors those within its fold who serve the organization with nights such as its "Celebrating Our Talent" ceremony designed to honor organizational members who have shown excellence in their duties (Boyd 2012).
The climate at the organization stresses valuing employees as well as clients, and serving the needs of its employees is included in the organization's statements of its critical functions. This acknowledges the need for caregivers to be cared for as well as patients. There is also a commitment to technological change to facilitate care: the organization was praised in 2003 for completely reconfiguring the way in which it kept track of patient data, switching to an entirely online system, to comply with changes in regulation and…
Boyd, Tracey. (2012). VNSNY home care agency praises nursing talent. VNSNY. Retrieved:
Mission and vision. (2013). VNSNY. Retrieved:
The National Association of Clinical Nurse Specialists - The NACNS was founded in 1995, specifically to enhance and promote the unique and high-value contributions that clinical nurses make to the health and well-being of individuals, families, groups, and communities in their particular branch of healthcare. They also have a foundation, scholarship programs, a journal and discussion portal, various levels of conferences, scholarship programs, honors and awards, and the ability for advanced certification. A Clinical Nurse Specialist is a licensed N who has graduate preparation (MA or PhD) in nursing specifically as a Clinical Nurse Specialist. This field of healthcare goes beyond the duties of an LPN or N, or even charge nurse, and deals with either advanced levels of clinical specialization, or broader, community and national health concerns. The field requires a rather significant academic bent, and the association is designed to support and enhance that paradigm focus (CNS -…
About ENA. (2010, January). Retrieved October 2010, from Emergency Nurses Association: http://www.ena.org/about/Pages/Default.aspx
About the ACNM. (2010, February). Retrieved from American College of Nurse-Midwives: http://www.midwife.org/members.cfm
CNS - Who We Are and What We Do. (2010, January). Retrieved October 2010, from National Association of Clinical Nurse Specialists: http://www.nacns.org/AboutNACNS/MissionStatement/tabid/57/Default.aspx
Kozier, B., Erb, G. & Blais, K. (1997), Professional nursing practice (3rd edition),
Studies suggest that more computerized order entry of medications helps reduce errors by limiting interpretation errors due to handwriting (Meadows, 2003). Thus more order entry is involving computers to protect patients. A culture that supports safety and safe practices has also been adopted to provide nursing staff and patients information about drug therapy and medication to ensure that everyone is aware of the need for safe practices when utilizing and dispensing medications.
Describe the strategies used to ensure nursing practice is performed within legal requirements and ethical frameworks
Nurses now "live and work in a world where there is no single reality but many coexisting realities among which they must choose" (Johnston, 1999:1). Given that through more and more nurses are forced to make legal and ethical decisions and take steps that will determine the best processes to adopt to ensure that moral and legal processes are adopted and followed.…
Campbell, D.W. & Sigsby, L.M. (1995). "Nursing interventions classification: A content analysis of nursing activities in public schools." Journal of Community Health Nursing, 12(4): 229.
Caretto, V.A. & McCormick, C.S. (1991). "Community as Client: A Hand's on experience for baccalaureate nursing students." Journal of Community Health Nursing, 8(3): 179.
Johnston, M.J. (1999). Bioethics: A nursing perspective. Sydney: Harcourt Saunders.
Lumby, J. & Picone, D. (2000). Clinical challenges: Focus on nursing. St. Leanords:
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,
Hip dysplasia in children [...] nursing care and considerations of the child with congenital or developmental hip dysplasia. Hip dysplasia occurs actually quite commonly in infants and children all over the world. There are some special considerations nurses should use when caring for these patients, including recognizing the early symptoms of hip dysplasia in infants and children, and fully understanding the treatment necessary to help the family cope with the disease. Treating and diagnosing children is often much more difficult than diagnosing and treating older patients who can communicate more effectively, so the nurse must be patient, cognizant, and highly aware of the disease, its indicators, and its treatment.
Hip dysplasia in infants and children used to be known by two terms, developmental dysplasia of the hip (DDH), or congenital dislocation of the hip (CDH). However, today, most professionals refer to the condition as DDH. Hip dysplasia occurs when the…
Author not Available. (2004). Developmental hip dysplasia in children. Retrieved from the Drugs.com Web site: http://www.drugs.com/CG/DEVELOPMENTAL_HIP_DYSPLASIA_IN_CHILDREN.html13 Sept. 2004.
Berant, Moshe. (1999). Developmental dysplasia of the hip: A new approach to incidence. Pediatrics; 1 Jan. 1999.
D'Alessandro, Donna, M.D. And Huth, Lindsay. (2002). DDH (Developmental dysplasia of the hip). Retrieved from the Virtual Children's Hospital Web site: http://www.vh.org/pediatric/patient/pediatrics/cqqa/ddh.html13 Sept. 2004.
Dietz, Frederick R. (1999). Screening for developmental dysplasia of the hip. American Family Physician; 1 July 1999.
However, when ad-hoc methods meant to maintain the former conflict with protocols necessary to ensure the latter, the consequences can be compounded by the anaerobic environment under the dressing that promotes more rapid bacterial infection instead of protecting the wound site from external bacterial contamination (Fitzpatrick 1997).
Protocol Compliance Issues in Antisepsis of Intravenous Dressings: Wound dressings are provided in sterile packages and when applied with proper care and adherence to antisepsis protocol, help ensure that wound sites are protected from bacterial infection. However, when protocols are violated, whether accidentally, through oversight, or negligently, wound dressings represent significant vulnerabilities to infection via external contamination. Sometimes, techniques and procedures that are meant to solve other problems introduce increased risks to the antiseptic integrity of the wound site. For example, it is common practice to increase the absorbency of sterile gauze pads by simply doubling them over in half. While this does…
Fitzpatrick, J. (1997) Annual Review of Nursing Research. New York: Springer Publishing Co.
Nursing Link: The Nation's Nursing Community Online Library; (2007) Intravenous Therapy - Tips and Techniques. Retrieved February 26, 2008 from NursingLink website, at http://www.nursinglink.com/training/articles/350-iv-therapy-tips-techniques
Starr, P. (1982) the Social Transformation of American Medicine. New York: Basic Books.
Taylor, C., Lillis, C., LeMone, P. (2005) Fundamentals of Nursing: The Art and Science of Nursing Care. Philadelphia: Lippincott, Williams, and Wilkins.
International Trade and Kinetic Concepts Inc. (KCI) International
This report will focus on San Antonio, Texas-based Kinetic Concepts, Incorporated (KCI) and how they have successfully moved into the international medical technology market through their second largest business unit KCI International (KCII). In this extremely competitive global economy, medical technology manufactures and service providers have been continually searching for new opportunities that could lead to a reduction in overall production costs while at the same time providing viable opportunities to increase revenues and profits. educing the labor force was the trend of choice in the 1990's. This labor reduction trend entailed major layoffs, downsizing and corporate re-structuring methodologies, plant output reduction or complete facility closings. In other words, these methodologies meant that a company would implement a process that strategically reduced production costs by cutting labor only and therefore boosting the company's common stock through a 'smoke and mirror' profit increase.…
Kinetic Concepts, Inc. Home Page. (2004, April 12). Kinetic Concepts, Inc. Retrieved April 12, 2004, at http://www.kci1.com/
Kinetic Concepts, Inc. Annual Report (2002). SEC Version. 2002 10 K. Annual Report.
Yahoo Finance. (2004, April 12). Kinetic Concepts Inc. (KCI). Retrieved April 12, 04, at http://finance.yahoo.com/q?s=KCI&d=t
This will give her a good idea of the level of understanding the patient has and then she can tailor her teachings to fit the patient's level of understanding.
It is also a good idea for the nurse to give the patient as much printed information on the topic as she can because the patient can always use these materials as a reference in case the nurse is not readily available. If he teaching is about following a menu plan that will assist the patient in a speedy recovery, the nurse can have the patient keep a food journal of what he ate for a week or so and they can go over it together to determine what is working and what isn't. The same goes for the patient needing to be educated on any type of physical activities he must perform in order to improve and maintain his health.…
Baker, Lois K. And Denyes, Mary J. (2008). Predictors of self-care in adolescents with cystic fibrosis: A test of Orem's theories of self-care and self-care deficit. Journal of Pediatric Nursing, 23(1), 37-48.
Cleary, Michelle and Freeman, Adele. (2006). Enhancing nurse care partnerships: A self-
directed learning approach. Nurse Education in Practice, 6, 224-231.
Griswold-Pierce, Anne and Smith, Jennifer A. (2008). The ethics curriculum for doctor of nursing practice programs. Journal of Professional Nursing, 24(5), 270-274.
Specifically focused on products for each phase of a persons' life, this business segment is the most mainstream in terms of promotional strategies. Skin Care, OTC and Nutritionals have successfully given JNJ a permanent marketing strategy for selling to women in the 25-34 and 25-45 segments, two of the fastest growing demographic markets for these products.
The biggest challenge for JNJ is the ability to quickly develop and launch products across all of their business units. This is the most challenging task internally for the entire company to coordinate on, specifically in the area of pharmaceuticals where Federal Drug Administration (FDA) guidelines and the need for compliance are very high.
The costs of producing a new drug can be well over $800M according to AM esearch (2004). An analysis of each phase of the development of a new drug is shown in the following graphic from PhMA (2005).…
AMR Research (2006) - Pharmaceutical and Life Sciences Industry Overview. AMR Research Alert. Monday June 5, 2006. Hussain Moorai and Roddy Martin.
Credit Suisse (2006) - Johnson and Johnson Research Brief. January 24, 2007.New York, NY.
Life Science Analytics (2007) - Life Science Analytics Johnson & Johnson Pipeline Report. January 3, 2007. Boston, MA
PhRMA (2005) - Pharmaceutical Research and Manufacturers of America (PhRMA) Conference Proceedings. Accessed from the Internet on February 10, 2007 at http://www.phrma.org/innovation/
Contact Dermatitis to Metal: Case Study
Contact dermatitis on the hands can be caused by a number of distinct mechanisms (Usatine & iojas, 2010). The type most amenable to treatment is dermatitis caused by environmental irritants. Other possible causes include allergic and atopic dermatitis, each arising from different mechanisms. The patient under consideration here has been diagnosed with contact dermatitis due to metal exposure and is concerned about a possible link between the eczema and rhinitis. This report will examine the pathophysiology of contact dermatitis and whether there could be any relationship between the patient's dermatitis and rhinitis.
Irritant Contact Dermatitis
Irritant contact dermatitis is caused by exposing the skin to harmful substances (Usatine & iojas, 2010). A wound or injury can compromise the ability of the skin to maintain an effective barrier against noxious substances, resulting in skin trauma. A single or chronic exposure can lead to local…
Alavi, A., Skotnicki, S., Sussman, G., & Sibbald, R.G. (2012). Diagnosis and treatment of hand dermatitis. Advances in Skin & Wound Care, 25(8), 371-381.
McFadden, J.P., Puangpet, P., Basketter, D.A., Dearman, R.J., & Kimber, I. (2013). Why does allergic contact dermatitis exist? British Journal of Dermatology, 168(4), 692-699.
Spergel, J.M. (2010). From atopic dermatitis to asthma: The atopic march. Annals of Allergy, Asthma, & Immunology, 105, 99-106.
Usatine, R.P. & Riojas, M. (2010). Diagnosis and management of contact dermatitis. American Family Physician, 82(3), 249-255.
EClinicaWorks at ikers Island
ikers Island is a correctional facility that currently utilizes eClinicalWorks, which has emerged as a leader in medical software solutions. This paper examines the use of this electronic health records software at this correctional facility in relation to hospitalized inmates. The author includes an overview of how this software is run by Corizon Health and how the correctional facility works with Bellevue Hospital, which also has eClinicalWorks. The discussion includes an evaluation of how this software has been characterized by a workflow challenge that hinders effective workflows. The use of paper documentation by hospital staff because of inability of this software to visualize findings, discharge instructions or recommendations is discussed. This is followed by discussion of a proposed innovation and how it can be implemented using a project management approach. The final sections discuss strategies for going live and ongoing maintenance of the proposed innovation.
Corizon Health Website. (2015). About Corizon Health. Retrieved 26 November, 2015 from: http://www.corizonhealth.com/S=0/About-Corizon/Who-We-Are-History-and-Today
Miller, R.H. (2012, March). Satisfying Patient-Consumer Principles for Health Information Exchange: Evidence From California Case Studies. Health Affairs, 31(3), 537-547.
Pantaleoni et al. (2015, February 11). Successful Physician Training Program for Large Scale EMR Implementation. Applied Clinical Informatics, 2015(6), 80-95.
Stazesky, R., Hughes, J. & Venters, H. (2012, April). Implementation of an Electronic Health Record in the New York City Jail System. Retrieved April 18, 2016, from http://www.cochs.org/files/hieconf/implementation-ecw-new-york.pdf
Introduction to Johnson and Johnson
For a company to be successful, it must continuously build and nurture long-term relationships with its strategic shareholders. Shareholders is anyone who has an interest in an organization ((Noe et al., 2016). They include employees, governments, competitors, suppliers, competitors and customers. One such company is Johnson and Johnson (J&J). It has emerged as one of the most successful company globally because of its values dubbed "Our Credo” (Team, Directors and Governance, 2019).J&J is also among the Fortune 500 companies.
This paper will focus on various dimensions of the J&J Company. It is divided into three distinct sections. That is organizational structure, organizational strategy and human resource management. So, J&J organization structure will be explored, the various strategies that the company has pursed over the years will be elaborated and finally J&J human resource management practices will be discussed. Other sections in the paper include organizational…
Fractures and Causes
A fracture is a broken bone or a break of any size on the bone (Giza 2009, Vorvick 2009, Parmet 2010). The cause is the application or exertion of physical force, which is stronger than the bone itself. Fractures are common occurrences and experience. The average person is said to experience two fractures in his lifetime. The risk depends partly on age. It is quite common in childhood although fractures during childhood are, as a rule, less serious than those in adulthood. This is because bones become more brittle with age. Fractures result from injuries, osteoporosis, tumors near the bone, and prolonged walking or running. The severity depends on the location and extent of damage to the bone and surrounding tissues. Unless treated promptly, complications may develop. Recuperation depends on the person's age and health and the type of fracture. Healing may take a few weeks if…
Better Health 2004, 'Bone fracture,' Better Health Channel [Online] Available at http://hnb, dgs, vuc, giv, ay/dsonline/dsarticles.nsf/pages/Bone-fractures?OpenDocument
Giza, E reviewer 2009, 'Understanding fractures -- basic information,' Web MD [Online]
Available at http://www.webmd.com/a-to-z-guides/understanding-fractures-basic-information
Gould, L 2006, 'Fractures,' Education Resources and Information [Online] Available at http://www.radiology.med.sc.edu/presentations/FRACTRES.ppt
Healthcare -- Floor Plan
Renovation of an existing facility into a walk-in health clinic would be a complex, expensive task. It would involve careful planning, numerous stakeholders, land, building, renovations, driveway and parking, contracts, furnishings, equipment and supplies. Budget planning would be critical. Having completed this task, I would change several key aspects of my plan.
If this is a new facility or a renovation
I selected renovation of an existing facility, which is a walk-in health clinic. The floorplan follows:
(Smartdraw, LLC, 2016)
Reason you selected the facility
I chose this facility because it is an increasingly common and modern structure for providing outpatient medical care in a community
ho are your stakeholders for this project
The stakeholders for this project are: providers; patients; payers; and in certain circumstances, the patients' employers (Duke University School of Medicine - Department of Community and Family Medicine, 2016). In addition, due to…
Berry, T. (n.d.). Estimating realistic startup costs. Retrieved from articles.bplans.com: http://articles.bplans.com/estimating-realistic-start-up-costs/
Duke University School of Medicine - Department of Community and Family Medicine. (2016). Who are the Stakeholders in Healthcare? Retrieved from patientsafety.duhs.duke.edu: http://patientsafetyed.duhs.duke.edu/module_a/introduction/stakeholders.html
Medical Device Depot, Inc. (2016). Brewer Millennium series surgeon chair. Retrieved from www.medicaldevicedepot.com: https://www.medicaldevicedepot.com/Brewer-Millennium-Series-Surgeon-Chair-p/21340b.htm
Medical Device Depot, Inc. (2016). Clinton classic series chrome base exam stool with round footring. Retrieved from www.meicaldevicedepot.com: https://www.medicaldevicedepot.com/Clinton-Classic-Series-Chrome-Base-Stool-p/2102.htm
Contact information: 1-877-MDA-6789
Date interviewed: November 8, 2012
Company name: MD Anderson Cancer Center
Highest degree earned: LPN
College or University where the degree was earned: Houston Community College
What is your title and what are your main responsibilities?
I am a nurse. My main responsibilities are: measuring vital signs, administering medications, keeping the patient clean, handling wound care, maintaining patient records, and observing the patient.
What are some of the specific skills you need in order to perform your job?
The biggest skill I need is the ability to communicate with my patients. Through communication I can learn if they are in pain, if they have any needs, and assess their conditions. I also need a thorough understanding of biology and anatomy.
Describe what you do during a typical day?
During a typical day I work on a specific floor and am in charge of handling a set…