Discuss the key components of prevention effectiveness studies that were covered in the Introduction to prevention effectiveness video.

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Discuss the key components of prevention effectiveness studies that were covered in the Introduction to prevention effectiveness video.

Describe the four common causes of chronic diseases.

Discuss the key components of prevention effectiveness studies that were covered in the Introduction to prevention effectiveness video.

Discuss effective preventive efforts for diabetes that must occur to yield health benefits.

Evidence-based Practice in Wound Cleansing

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Introduction

This essay defines the concept of evidence-based practice and discusses the importance of evidence-based practice for professional practice. The essay also selects an aspect of practice that is relevant to adult nursing, namely the use of water

vs.

saline for wound cleansing, provides a rationale for choosing that aspect within the context of evidence based practice, and, drawing on practice experience and examples of approbate evidence, discusses the extent to which the aspect of professional practice is informed by different types of evidence. In addition, the essay, with reference to the selected aspect of professional practice, discusses the factors that can hinder, or hinder the implementation of, evidence-based practice.

Evidence-based practice is usually taken to mean using “the current best evidence in making decisions about the care of individual patients” (see Sackett

et al.,

1996), with a more recent definition being, “Evidence-based practice requires that decisions about health care are based on best available, current, valid and relevant evidence. These decisions should be made by those receiving care, informed by the tacit and explicit knowledge of those providing care, within the context of available resources” (see Dawes

et al.,

2005).

The importance of evidence-based practice for professional practice

In terms of the importance of evidence-based practice for professional nursing practice, offering evidence-based assessments and treatments has become widespread across the nursing profession due to the need for the NHS to be seen to be accountable to their patients as part of the NHS Plan (see Griepp, 1992). In essence, in the context of the NHS Plan and the consequences of this for professional practice, the aim of evidence-based nursing practice is to treat the patient in the best possible way, as dictated by the most up-to-date evidence available, in a timely manner, in order to ensure the highest possible quality of care for that individual patient (Cluett and Bluff, 2000).

Within the framework of the NHS, the NHS Plan has meant many changes to nursing practice, including improvements in the delivery of service but mainly placing emphasis on the prompt delivery of evidence-based care and the pro-active involvement of the patient in their own care. As part of this change, which is a sea-change in the way in which the NHS has traditionally viewed care, nursing staff need to commit themselves to lifelong learning and professional development, within an evidence-based practice framework. This evidence-based framework dictates that nursing staff must use the current best evidence when making decisions about patient care, in order to conform to the dictates of their particular guidelines for professional practice.

This is especially pertinent considering the need to empower patients through involvement in patient care, under the dictates of the NHS Plan: as Playle and Keeley (1998) argue, patients are no longer passive receivers of care as the NHS now needs to be seen to be accountable to their patients. Offering evidence-based assessments and treatments fulfills the requirements to be accountable to patients through the use of up-to-date research to inform treatment practices, for example (see also Griepp, 1992).

Rationale for choosing the use of water

vs.

saline in wound cleansing

This section of the essay discusses an aspect of practice that is relevant to adult nursing, namely the use of water

vs.

saline for wound cleansing, and provides a rationale for choosing that aspect within the context of evidence-based practice. This aspect practice has been chosen as it is commonly found in nursing practice: many individuals present with wounds at all nursing levels, including A&E, community nursing and intensive care, amongst others. The issue thus has widespread importance in nursing practice across many different areas of practice.


An analysis of the extent to which the use of water



vs.



saline for wound cleansing is informed by different types of evidence

This section of the essay will now draw on my practice experience, and, using examples of appropriate evidence, will discuss the extent to which the use of water

vs.

saline for wound cleansing is informed by different types of evidence.

Cunliffe and Fawcett (2002) found that nurses are presented with a variety of wound cleansing options, from the products that can be used to cleanse wounds to the dressings that can be used. The work found that this makes it difficult for nurses to make decisions about patient treatment, which means that nursing staff, instead of looking to the literature for advice, turn to the RCN guidelines, which is not an ideal basis for evidence-based practice (Cunliffe and Fawcett, 2002).

Betts (2003) found that wound cleansing with water does not differ from wound cleansing with other substances, in terms of wound infection and wound healing (similarly to Gannon, 2007; Hall, 2007 and Griffiths

et al.,

2001). Fernandez and Griffiths (2008) conducted a systematic review of the literature on the use of water for wound cleansing and found that, whilst saline is usually favoured for wound cleansing, tap water is also a viable alternative, as it does not increase infection and there is some evidence that using tap water actually reduces the risk of infection, even in acute wounds. Their conclusion was that boiled tap water can be used as a wound cleansing agent (Fernandez and Griffiths, 2008), a conclusion also reached by Moscati

et al.

(2007), O’Neill (2002), Valente

et al.

(2003), Whaley (2004) and Riyat and Quinton (1997).

Thus, the evidence from the research conducted on this subject suggests, overwhelmingly, that tap water is a viable alternative to saline for wound cleansing. The RCN guidelines for wound cleansing still, however, state that saline should be used for wound cleansing. The next section will look at this discrepancy in detail.


The factors that facilitate or hinder the implementation of evidence-based practice in wound cleansing

This section makes reference to the selected aspect of professional practice in order to discuss the factors that facilitate or hinder the implementation of evidence-based practice. There are many structures designed to support evidence-based nursing practice, including research and development that translates in to best practice guidelines. However, whilst it is clear that nursing staff, under the dictates of the NHS Plan, need to work within an evidence-based care framework, there are no guidelines as to how research is best incorporated in to their practice, in terms of what research should be used or what questions should be asked of that research, and so nursing staff often end up following guidelines that are produced for them, by the NHS. These guidelines are based on current research, and so do provide evidence-based care for patients, in some sense, but following guidelines does not involve nursing staff being

directly

involved in evidence-based care.

As one of the main principles of evidence-based practice is that decisions about care should be based on the best currently available evidence from research, this situation is not ideal. Under a true evidence-based practice framework, nursing staff should be regularly undertaking literature searches themselves, to ensure that they themselves keep up to date with the research, and that they are aware of any new recommendations for nursing practice that are suggested by this research. They should then be implementing these new recommendations.

This, however, provides difficulties, in that nurses are bound, by their professional training, to provide the usual standards of care, with the possible implication that, should a nurse try a new treatment method on a patient, following their research on a subject, as part of the evidence-based framework, and this treatment is not successful, the nurse would have let the patient down, under the guidelines provided for their professional practice. This, thus, provides a dilemma for nursing staff, who are bound to work under an evidence-based framework, but who are – in practice – reliant on the timely provision of updates to treatment guidelines, which are based on an evidence-based framework but which have not been researched individually by the nursing staff.

For example, as has been seen, there are many research publications that show how water can be beneficial in cleansing wounds, but the current recommended practice from the RCN guidelines is that “irrigation of the wound with saline is usually sufficient” with the provided rationale for this being that, “cleansing traumatic wounds with saline was associated with a lower rate of clinical infection when compared to tap water (Angeras

et al.,

1992)”, the RCN guidelines do concede that no clinical trials have been performed comparing tap water and saline water in wound cleansing and, as such, that there is no

real

evidence-base for these recommendations.

Nursing staff working within an evidence-based framework could read the literature supporting water as an effective wound cleanser, and could base their treatment on this literature, which, whilst being within the scope of evidence-based practice, as recommended by the NHS Plan, would go against what they are recommended to do by their professional body. In the example discussed in this essay, therefore, the evidence as provided by the research has not yet been translated in to an up-to-date set of guidelines for nursing staff to follow. It seems, therefore, that patients are not being treated according to the best possible set of treatments according to the research, but, as the RCN guidelines state, there has, as yet, been no clinical trial of wound cleansing with water

vs.

saline, and so, even if the research suggests tap water is an effective, if not more effective wound cleanser than saline, until a clinical trial has been undertaken testing this, the recommendations for treatment will not change.

In this case, however, a clinical trial is extremely difficult to imagine, due to the temporary and highly individual nature of wounds, which makes it impossible to provide clinical trial conditions to test water

vs.

saline as wound cleansing agents. As such, even though the literature suggests that tap water is an effective, if not more effective, wound cleanser than saline, saline will still continue to be used, as this has been used historically, and because no clinical trial has been set up proving the effectiveness of tap water, meaning that tap water cannot be recommended as a wound cleanser, in that it is not recommended in the RCN guidelines for nursing staff.

Nursing staff are, however, under the evidence-based practice framework, able to apply, monitor and record wound cleansing using tap water. This approach allows nursing staff to approach the process of evidence-based practice in a series of steps (as recommended by Cluett and Bluff, 2000), within the guidelines provided by the RCN. The first step is defining the research question, based on evidence gained from treating patients in practice, which, in this case would be, “What is the best way to cleanse a patients wound, using tap water or saline?”. The next step would be to search for and to read all the relevant literature, and then to decide, on the basis of that literature, what the best treatment options are for the patient. This would, as has been seen, overwhelmingly suggest that tap water is the best treatment option, but the RCN guidelines would suggest that saline is the best treatment option. The nurse would thus be obliged to use saline but could apply, monitor and record wound cleansing using tap water, as part of the evidence-based framework they are encouraged to follow.

Evaluation of the care provided and the processes through which the care was decided upon and administered would constitute the third and final step of the evidence-based framework (as given by Cluett and Bluff, 2000), which would gather all the relevant information and then would evaluate the results of this treatment in terms of finding a better solution for wound cleansing. This step-by-step approach to evidence-based practice allows for gradual improvements in the delivery of patient care through a process of gathering evidence of best practice. As has been seen, however, often nursing staff are not encouraged to follow this pathway as they are obliged to be bound by the guidelines for treatment provided by their professional body, the RCN, which, in this case, recommends a treatment option that seems outdated, according to the current research.

Conclusion

As shown by the appraisal of evidence for the use of tap water

vs.

saline as a wound cleanser, evidence-based practice in a nurses working life can be hindered by their professional guidelines, which, in this case, have not been updated based on the findings of current research. Whilst evidence-based practice facilitates best treatment practice for patients (as dictated by the NHS Plan) through the step-by-step approach outlined by Cluett and Bluff (2000), in this case, this facilitation is not enabled through the failure of the RCN to update their guidelines.

Angeras M.H.

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Betts, J. (2003). Review: wound cleansing with water does not differ from no cleansing or cleansing with other solutions for rates of wound infection or healing.

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Cunliffe, P.J. and Fawcett, T.N. (2002). Wound cleansing: the evidence for the techniques and solutions used.

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Dawes, M.

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2005. Sicily statement on evidence-based practice.

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Fernandez, R. and Griffiths, R. (2008). Water for wound cleansing.

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Gannon, R. (2007). Wound cleansing: sterile water or saline?

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Goldenberg, M.A., 2006. On evidence and evidence-based medicine: a commentary on common criticisms.

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Griffiths, R.D.

et al.

(2001). Is tap water a safe alternative to normal saline for wound irrigation in the community setting?

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2004. Evidence-based medicine has come a long way.

BMJ


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Hall, S. (2007). A review of the effect of tap water

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normal saline on infection rates in acute traumatic wounds.

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Hinchiff, S.

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Nursing practice and health care

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LoBiondon-Wood, G. Haber, J. (2006) Nursing Research: Methods and Critical Appraisal for Evidence-Based Practice. St. Louis. Mosby.

Moscati, R.M.

et al.

(2007). A multicenter comparison of tap water

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saline for wound irrigation.

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O’Neill, D. (2002). Can tap water be used to irrigate wounds in A&E?

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Patel, S. and Beldon, P. (2003). Examining the literature on using tap water in wound cleansing.

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Riyat, M.S. and Quinton, D.N. (1997). Tap water as a wound cleansing agent in A&E.

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, pp.471-478.

Tuberculosis in Aboriginal People

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Introduction

Tuberculosis is caused by a bacterial infection triggered by Mycobacterium tuberculosis, generally from the lungs, though it was also transmitted until lately through the intake of infected milk and meat (Douglas, 2013, p. 155). Also, TB was regarded as a chronic condition as infection remained permanent until antibiotic therapy schemes developed after World War II (Douglas, 2013, p. 156).  In the past, TB was one of the deadliest epidemic diseases affecting the Aboriginal population (Douglas, 2013, p. 156). The chance of developing active TB is very small for most individuals in Canada. But, the levels of active TB among Indigenous individuals born in Canada are greater. In Inuit Nunangat’s TB incidence among Inuit was more than 300 times the prevalence of non-Indigenous Canadians born in 2016 (Government of Canada, 2019). In other words, a lot of Aboriginal people are affected by this disease. Furthermore, the TB incidence among First Nations residing on the reserve is more than 50 times greater than non-Indigenous Canadians born in Canada (Government of Canada, 2019). Since most of the Aboriginal people dealt with this epidemic illness there are factors that contribute to the prevalence of pulmonary tuberculosis, the pertinent nursing implications will provide interventions that can improve the facets of overall health and wellness of the Aboriginal peoples, tackling the available resources from the federal government to reduce and aim a total eradication of TB among the First Nations communities.


Contributory factors of Tuberculosis

TB was mainly ignored in the Aboriginal population and it was partially due to unawareness and in part to selfishness with Aboriginal people’s health care funding (Douglas, 2013, p. 158). This goes to show that TB became rampant as these people do not have the support that can help them prevent the occurrence of TB. Aside from lack of funding, there are other aspects that lead to the prevalence of TB among the Aboriginal population and these are; direct contact with individuals with unmanaged active TB, overpopulated area, inadequately ventilated housing, food insecurity, other conditions like diabetes or HIV and smoking (Government of Canada, 2019). Through this, it really made a great impact in the lives of Aboriginal people, their poor status made it even difficult for them to live a better life as they are still struggling in making a difference in their way of life. Moreover, because of the insufficient health care facilities, poverty, extremely crowded housing, and the remoteness of many groups, the illness continues undercurrents in the Aboriginal people (Douglas, 2013, p. 160). Because of these determinants of health, there are more possibilities that this illness will spread in the whole community as there is not much treatment and support given to the Aboriginal people. As per Lonnroth et al., (2010), some health determinants boost the amount and length of infection exposure, while others may decrease the immune system of an individual, reducing the probability of infection (as cited in Health Canada, 2012).


Treatments, Diagnosis and Nursing implications of TB

Until the 1970s, Sanatoria have been the recommended technique of treating TB. It was thought that the illness could be regulated and reduced more efficiently by isolating clients and managing the environments (Douglas, 2013, p. 157). As future psychiatric nurses, it is important that we educate the Aboriginal people about the signs and symptoms of an individual with tuberculosis such as coughing for more than two weeks, coughing up phlegm and sometimes blood, lack of energy and chill (Government of Canada, 2019). Through this, they will be more aware and have a better understanding of this sickness. Furthermore, it is vital for us to explain to them that TB is preventable and curable and there is diagnosis provided to further detect TB like tuberculin skin test, blood work, sputum testing and chest x-ray (Government of Canada, 2019). Moreover, when an individual has a TB infection, antibiotics may be provided to avoid TB from becoming active. This can take up to 9 months for the therapy. Taking all medicines correctly is very crucial (Government of Canada, 2014). They must be handled with antibiotics if they have TB illness to destroy all the germs and heal TB. Treatment generally requires 6 to 9 months to complete. TB medicine is generally provided by a qualified health care worker who watches every dose of medication that should be taken, this is known as Directly Observed Therapy (DOT) (Government of Canada, 2014). Through this, TB will be controlled and manage, as long as we educate the Indigenous people to be compliant with the treatment plan, they will have a better outcome. In addition, as nurses, when we work with Aboriginal people, we can teach them to speak about their own probability of TB with their healthcare provider, they should have knowledge about TB and know the disease symptoms and be conscious themselves and others (Government of Canada, 2014). If you have illness symptoms, you will be inspected as quickly as possible. The faster you find and treat tuberculosis, the less it can transmit to your friends and family, and the better opportunity you have for proper treatment option (Government of Canada, 2014). Furthermore, it is also good to share information about tuberculosis with your family, friends and to the community as TB can impact anyone, but with the right medications TB can be cured (Government of Canada, 2014). Through this, Aboriginal people will be well informed about this illness that may possibly affect them. Additionally, according to Dr. Banerji, the treatment for TB requires a lot of time so once you find out what is susceptible to TB in a patient, it sometimes requires to be handled over a lengthy period of time with three or four distinct antibiotics as it is a slow-growing organism. It can also be more difficult to do in the North, particularly if it includes patients returning to isolated nursing stations or shipping drugs to remote places (as cited in Hogan, 2019). With regards to this, there is a challenge to be treating Aboriginal people living in remote areas as there is always a delayed treatment.


Government programs and plans to lower the risk of TB



As per the First Nations Health Authority (n. d.), they supported methods that can help alter the prevalence of TB like lowering the risk of TB disease by culturally informed and community-driven measures in First Nations societies and ensuring comprehensive screening, diagnosis and testing of TB illness to minimize the transmission process. This means that, the organization is doing something that can improve the life of an individual affected by this illness. Moreover, encourage holistic therapy through community involvement, along with home health care, traditional medicine inclusion, social, spiritual and physical health. Developing community ability, empathy and commitment via practice and support of Wellness Champions: community members who provide assistance, education and sharing of stories to people impacted by TB and their societies (FNHA, n. d.). With regards to this, Aboriginal people do believe in a holistic approach of treatment as well as their traditional way of healing and due to these objectives, it will provide them more awareness and understanding on how to prevent and control TB. Also, cooperate on community-level TB disease treatment and prevention with First Nations, provincial and federal government health, nursing and medical experts. Work with excellence by incorporating monitoring, information collection and assessment as well as community knowledge from First Nations and Aboriginal education program growth, execution and assessment (FNHA, n. d.). This goes to show that the government is willing to do something that can reduce the occurrence and incidence of TB not only to the Aboriginal people, but also to other non-Aboriginal people affected by this disease. In addition, Aboriginal Affairs and Northern Development Canada (AANDC) continues to support First Nations, Inuit and Métis Aboriginal peoples and Northerners in their efforts to increase cultural well-being and economic stability; create safer, more stable societies (Health Canada and the Public Health Agency of Canada, 2014, p. 7). These programs and projects entail income support and facilities for citizens of limited income, the provision of culturally suitable prevention and protective services to First Nations children (Health Canada and the Public Health Agency of Canada, 2014, p. 8). In addition, Aboriginal people on-reserve populations will have access to safe and affordable housing (Health Canada and the Public Health Agency of Canada, 2014, p. 8). Furthermore, a distinctive collaboration strategy that brings together all levels of government, urban Aboriginal communities and the private and non-profit sectors to recognize urban Aboriginal peoples’ needs (Health Canada and the Public Health Agency of Canada, 2014, p. 8). This means that these projects focus on the improvement of the Indigenous population’s prevention and control of acquiring TB. These projects will definitely make a difference and it will help these people to have more possibilities and chance to take all the necessary support that will lead them to a better health care outcome.


Conclusion

Therefore, if the factors that contribute to the prevalence of TB will improve and manage, there will be a chance to lower the risk of Aboriginal people from acquiring this illness. The nursing implications and interventions will certainly guide these people to be more aware of TB and be more cautious to further prevent the incidence of getting and spreading TB. Lastly, with the support coming from the government and the programs created, time will come that the Aboriginal people’s rate for TB will reduce and they will gain more benefits and advantages to having better access in the health care system. As future psychiatric nurses, we played a vital role in the life of Aboriginal people as we will serve as their voices so that all the issues they are facing will be addressed and one of our goals is to provide a safe and secure environment free from any discrimination and judgment as well as maintaining a good quality of care.


References

Leukemia: An overview

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What Is Leukemia?

Leukemia is the general term used to describe four different disease-types called: Acute Myelogenous (AML), Acute Lymphocytic (ALL), Chronic Myleogenous (CML), and Chronic Lymphocytic (CLL). AML, the most common type of leukemia, is an attacking cancer of the bone marrow and blood. ALL, the most common in young children and adults over 50, is a cancer of the lymphocytes. CML is a cancer of the blood-producing cells of the bone marrow. CLL is a cancer of the lymphocytes.

What are the Symptoms of Leukemia?

The symptoms for leukemia depend on the type of leukemia. For AML, the symptoms are: fatigue, weakness, easy bruising or bleeding, weight loss, fever, bone or abdominal pain, difficulty breathing, frequent infections, swollen glands, and swollen or bleeding gums. For ALL, the symptoms are: fatigue, weakness, easy bruising or bleeding, weight loss, fever, bone or abdominal pain, dyspnea (difficulty breathing), frequent infections, swollen glands, and enlarged liver or spleen. For CML, the symptoms are: fatigue, excessive sweating, weight loss, and abdominal swelling or discomfort because of enlarged spleen. For CLL, the symptoms are: swelling of the lymph nodes in the neck, under the arms, or in the groin, discomfort or fullness in the upper left part of the abdomen because of enlarged spleen, fatigue, fever or infection, abnormal bleeding, and weight loss.

What is the Diagnosis?

The diagnosis for leukemia again depends on the type of leukemia. For AML, the tests that may be used to diagnosis a patient with AML are: blood tests, bone marrow biopsy, lumbar puncture, imaging tests, and subtypes. The tests that may be used to diagnose a patient with ALL is a little bit different. They are: blood tests, bone marrow biopsy, flow cytometry and cytochemistry, cytogenetics, lumbar puncture, and imaging tests. The tests for CML are: blood tests, bone marrow biopsy, cytogenetics, and imaging tests. The tests for CLL are: blood tests, bone marrow biopsy, flow cytometry and cytochemistry, and imaging tests. Some of the factors that may be considered by your doctor when choosing a diagnosis test are: age and medical condition, the type of cancer, severity of symptoms, and previous test results.

What are the Risk Factors?

A risk factor is anything that increases a person’s chance of developing cancer. Some can be controlled, while some others can’t. Most do not directly cause cancer. The risk factors that may raise your chances to get any one of those types of leukemia are: your age, if you smoked or if you are smoking, genetic disorders, high doses of radiation, if you had a previous chemotherapy treatment, race, viruses, gender, family history, and ethnicity.

What is the Treatment?

The treatment for each type of leukemia may depend on the classification, how healthy the person is, the patient’s stage, risk status, the subtype, morphology, and cytogenetics. Some of the kinds of treatments are: chemotherapy, induction, complete remission (CR), consolidation therapy, maintenance therapy, re-induction therapy, and central nervous system prophylaxis (preventive treatment), consolidation or intensification, Acute Promyelocytic Leukemia Treatment (APL), Imatinib, Dasatinib, Nilotinib, stem cell transplantation/bone marrow transplantation, Interferon, SCT, Hydroxyurea, and Biologic therapy.

What are the Side Effects of Cancer and Cancer Treatment?

Cancer and cancer treatment can cause a variety of side effects. Some of the side effects are: constipation, fatigue, hair loss, infection, mouth sores, nausea and vomiting, Neutropenia, skin problems, and Thromboc- ytopenia. Not all patients have side effects.

What about After Treatment?

After treatment, talk to your doctor about developing a follow-up care plan. People that are in remission should have regular follow-up examinations for a few years to see if there is any sign of relapse or late effects.

What are Some Questions to Ask the Doctor?

Some questions that you should ask the doctor are: “What is my Diagnosis?, What does this all mean?, What subtype of (ALL, AML, CML, and CLL) do I have?, What are the possible side effects of this treatment?, What clinical trials are open to me?, Do I need to start treatment right away?, How likely is it that my (ALL, AML, CML, or CLL) will go into remission?, How will the treatment affect my normal activities, including my ability to work or attend school?, What support services are available to me?, Can you recommend a leukemia specialist?, and Where is the best place for me to be treated?.”

What is the Classification for ALL Leukemia?

The doctors classify ALL based on the type of lymphocytes that are affected.

Health care and public health are often used interchangeably. Two such widely used terms are public health and health promotion.

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Health care and public health are often used interchangeably. Two such widely used terms are public health and health promotion.

The terms: health care and public health are often used interchangeably. Two such widely used terms are public health and health promotion.

Based on your understanding of the topic, create a report in a Microsoft Word document answering the following questions:

  • Define the terms public health and health promotion.
  • What are the similarities and differences between the two?
  • What specific health promotion activity was provided in your community during the past one year and what was the beneficial result?
  • How did Healthy People 2020 develop and what is the purpose and goals of this program?

Over the years, the public health care system has evolved due to the numerous legislative and regulatory influences. These efforts are being illustrated as legislative and regulatory pressures on the form and function of the delivery system.

Note: Click here to view a link to get a better understanding about the issues affecting the community and nation (Go to Policy and Advocacy > Congress and Federal Agencies > Legislation and Issues).

  • What current legislation has had the maximum impact on the way health care is provided?
  • What interest group(s) influenced the establishment of this legislation?

Mention an interest associated with a health care promotion or wellness program that, according to you, had the greatest impact on the people of the U.S. in the last three years. Provide a description of this program.

The description should include the following details:

  • What were the activities actually associated with the program?
  • How was it reported in the media?
  • What was it about this program that had an impact on you?
  • What population was involved? Why do you think the specified population was involved in the program?
  • What do you think can be done by society to promote this program?

Understanding of nursing as a discipline and profession.

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Understanding of nursing as a discipline and profession.

The following elements must be
addressed:
1. Definition of nursing
2. Historical overview of nursing in Canada
4. Societal factors that have shaped nursing in Canada
5. Nursing in Canada today and tomorrow
3. Nursing as a discipline and profession

Looking for the best essay writer? Click below to have a customized paper written as per your requirements.

Identify and describe the 5 core competencies for all healthcare professionals.

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Identify and describe the 5 core competencies for all healthcare professionals.

 

Transitions Due Dates

Student learning objectives:

Identify and describe the 5 core competencies for all healthcare professionals.
Identify and describe the 7 professional characteristics of Nursing as described by the ANA.
Discuss issues related to defining nursing
Explain the meaning of caring to nursing
Describe the relationship of theory to nursing and to critical nursing theories
Due in the dropbox

Develop a professional paper, using APA format with a minimum of three scholarly references (your text book may be one reference), fully addressing the following:

Use the emboldened words for your APA headings. i.e., for #1 below, use the heading “Five Core Competencies.” Your paper will be 4-5 double-spaced pages (not counting title page and reference page). Answer the following in a scholarly, APA paper:

1. Identify and describe the Five core competencies for all healthcare professionals.

2. Identify the listed professional characteristics of Nursing as described by the ANA in the textbook or ANA website Professional Standards

3. Consider the definition of nursing developed by the American Nurses Association (ANA), “the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations” (2004, p. 7). ANA Definition

Discuss the meaning of any 3 of the following terms found in this definition: Promotion of health, health, prevention of illness and injury, illness, injury, diagnosis, human response, treatment, advocacy.

4. List a minimum of five actions demonstrating how the nurse-patient relationship can make a difference when the nurse uses caring consciously.

From your list, provide one example illustrating how you’ve implemented this in your practice.

5. Reflecting on the four domains of a nursing philosophy (review chapter 2 of text) develop your own personal definition of nursing. The following are ideas to reflect on in the process of defining your own personal beliefs, you shouldn’t list and answer each one in your paper but include in a short overall summary statement of your nursing philosophy. (#5 should only be one paragraph -app 1/2 page)

What is your central belief about the individual person? What makes up a person, who they are and how they got to where they are?

What constitutes the environment? Does it include elements both external and internal? Give examples. Find out what internal/external environments are and how the person interacts with them. A good source for this information is Chitty and Black “Professional Nursing Concepts and Challenges” 6th edition, or Google search should give you direction on this

How do the individual and the environment interact? Think about how you view health. Chapter 5 of Finkelman or the Chitty book mentioned above will give you a basic understanding but you will need to expand upon this.

What is your view of health? What is health and how is illness related to health? Is health a continuum with absolutes at either end, is it a dichotomy: either good or bad? Is it a state that includes illness? Note that disease and illness is not the same thing. One can have a disease and not be ill, and one can be ill and not have a disease.

What is the central reason for the existence of nursing? Why are we, as nurses, here? Don’t think of this as a task based definition. Why do you get up every day and go to work? How do we do what we do every day?

Spend a little bit of time thinking about the questions provided and you will do fine!

Don’t look for a “right” answer, this is your personal philosophy/thoughts.
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Should continuing nursing education be mandatory for all nurses?

/in /by

Should continuing nursing education be mandatory for all nurses?

 

The essay should be in Bullet points only . My part is 5th one that is “
5. Relationship to ANA (American Nurses Association) Code of Ethics.”. Pls work with that . The small essay should be 1 page and
in Bullet point only !!! . yYou can go through following resources for this bullet point essay http://www.nursingworld.org/ Here is
CLC assignment Details In your CLC group, create a small essay, in which you compare the pros and cons of continuing nursing education
related to the following: 1. Impact on competency. 2. Impact on knowledge and attitudes. 3. Relationship to professional
certification. 4. Relationship to ANA Scope and Standards of Practice. 5. Relationship to ANA (American Nurses Association) Code
of Ethics. Take a position with your CLC group: Should continuing nursing education be mandatory for all nurses? Support your position
with rationale. A minimum of two scholarly sources are required for this assignment. Thanks
CLC assignment Details
In your CLC group, create a small essay, in which you compare the pros and cons of continuing nursing education related to the
following:
Impact on competency.
Impact on knowledge and attitudes.
Relationship to professional certification.
Relationship to ANA Scope and Standards of Practice.
Relationship to ANA (American Nurses Association) Code of Ethics.
Take a position with your CLC group: Should continuing nursing education be mandatory for all nurses? Support your position with
rationale.
A minimum of two scholarly sources are required for this assignment.
Resource:

http://www.nursingworld.org/

Do you believe that case management programs are more concerned with reducing costs or improving the quality of care? Please justify your position.

/in /by

Do you believe that case management programs are more concerned with reducing costs or improving the quality of care? Please justify your position.

 

Assignment Expectations
Case management programs are usually considered to be an element of the Quality Assurance Program.
However, some health care professionals believe that they may be more interested in managing costs rather
than quality of care. Considering this issue please respond to the following questions in a 4- to 6-page paper:
1. Do you believe that case management programs are more concerned with reducing costs or improving
the quality of care? Please justify your position.
2. Discuss the limitations of a typical case management program and their strengths.
3. Do you believe that case management programs will become a medical program necessity in the future?
Justify your position.
4. In your opinion, how important are “gatekeepers” to the case management process?

Case Studies in Geriatric Medicine

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In the united states, lower birth rates and increasing longevity has contributed to growing numbers of people 65 years old or older (Roberts, Ogunwole, Blakeslee, & Rabe, 2018). By 2050, it is predicted that at least ¼ of the united states population will be ≥ 65 years old (Roberts et al., 2018). Nearly all providers caring for adult populations will likely see increasing numbers of geriatric patients. This paper describes a case-based approach identifying and managing common geriatric syndromes and concerns that providers across all disciplines may encounter. The patients described have been assigned aliases and are part of Northwestern Medicine’s Home-Based Primary Care (HBPC) program. HBPC programs, targeting the highest need and highest-cost patients, have been shown to reduce Medicare costs and hospital admissions (Lindquist & Dresden, 2019). HBPC programs are different from traditional home care that typically focuses on acute problems. Rather, with HBPC, an interdisciplinary team of physicians, pharmacists, social workers, physical therapy and advanced practice providers collaborate to address a myriad of physiological, social and psychological elements for patients and caregivers to promote optimal well-being while allowing the patient to remain at home (Lindquist & Dresden, 2019)


Case Study #1

Providers may find themselves in a conundrum when trying to manage calls like these. Many providers would opt to bring the patient in for a visit or perhaps arrange for a home-care agency to send a nurse over. Either of these options may take some time before the patient is assisted. Fortunately, the APRN for the HBPC program was able to make a visit the following day. This patient did have a very confusing bag of medications that took the APRN sent for a home visit over 1 hour to straighten out.  For instance, she had an Advair Diskus as well as an Advair HFA, the same medication but two different preparations and appearances. Of the medications she had been sent home with, some were in pharmacy bottles and others in single-dose packages from the hospital. She also had multiple duplicates. She needed help to organize and understand her medications as well as placing all the like with like and fill her pillbox for the next 2 weeks. This patient had been holding on to several expired or discontinued medications. Emergency hospitalizations related to adverse drug events are a great health concern for the geriatric population and measures should be taken to assure that patients both understand and adhere to their medication regimens (Lindquist & Dresden, 2019).


Polypharmacy

Polypharmacy is defined as the use of multiple medications by a patient and is of concern for older adults who may have more chronic conditions being treated. Adverse drug reactions are suspected to account for 3-10% of all older adult hospitalizations (Saraf et al., 2016). The use of greater numbers of medications has been found to be an independent risk factor for adverse drug events (Saraf et al., 2016). Polypharmacy has been linked with falls and was an independent predictor of hip fractures (Jokanovic, Tan, Dooley, Kirkpatrick, & Bell, 2015). Patients may experience adverse drug events that are misinterpreted as a new medical condition leading to “prescribing cascade” of new medications to treat this condition (Rochon & Gurwitz, 2017). Multiple and complex medication regimens have been shown to increase medication nonadherence (Kucukdagli et al., 2019). Additionally, polypharmacy has been linked to functional decline, incontinence, cognitive impairment and poor nutrition (Jokanovic et al., 2015).

The most widely used criteria for medication appropriateness in older adults is Beers criteria (Panel et al., 2015). Providers prescribing to the geriatric population should be considerate some of the special concerns for this population. Anticholinergic medications may lead to delirium, memory problems, confusion, hallucinations or anticholinergic symptoms of dry mouth, constipation, urinary retention, hypotension and tachycardia (Panel et al., 2015).  NSAIDs are likely the most widely used inappropriate agent and may worsen renal function or lead to GI bleeding (Panel et al., 2015). Benzodiazepines are an independent risk factor for delirium, may increase risks of falls and fractures and should be avoided, especially with concurrent use with opiates as this can lead to respiratory depression and death (Lindquist & Dresden, 2019; Zaal et al., 2015). Antipsychotics such as Haldol and Zyprexa should be avoided unless the patient poses a risk to self or others, but can be used short-term in the treatment of delirium (Lindquist & Dresden, 2019). Antipsychotic medication increases mortality in older adults and providers should focus on behavior modification prior to prescribing medications (Lindquist & Dresden, 2019). For acute pain control, avoid morphine due to buildup of active metabolites in the presence of decreased renal clearance (Lindquist & Dresden, 2019). Dilaudid in small doses may be more appropriate for hospitalized geriatric patients requiring acute pain control (Lindquist & Dresden, 2019).

Providers should utilize guidelines for prescribing to the geriatric population (Lindquist & Dresden, 2019). Be sure to ask patients to bring ALL their medications in for visits as some may be on dangerous Over The Counter (OTC) medications or holding on to expired or discontinued medications (Lindquist & Dresden, 2019). A pharmacy consult may be helpful if polypharmacy is identified or for complex or concerning regimens (Lindquist & Dresden, 2019). Utilization of pillboxes and blister packs may improve adherence (Conn et al., 2015). Blister packs are available at some pharmacies for no additional charge and may be more accurate than caregiver filled pill boxes (Conn et al., 2015).

This patient is exhibiting concerning findings for frailty and functional decline. Frailty is characterized by a variety of elements including slowness, shrinking, exhaustion, inactivity, weakness, disability, malnutrition, and changes in cognition and mood (Fried et al., 2001). Frail patients have diminished physiological reserve leading to a higher incidence of disability, morbidity, institutionalization, falls and all-cause mortality (Fried et al., 2001).

Providers may have some concerns about sending Mr. Williams home. This patient would benefit from a multidisciplinary approach to address his needs. A social worker could assist with eligibility and costs of home assistance (Lindquist & Dresden, 2019). Physical and occupational therapy would be beneficial for home gait, balance, strength and function, while a dietitian could provide nutritional assessment and intervention (Lindquist & Dresden, 2019). He may benefit from home visits or perhaps placement in assisted living would be more appropriate. Since your time may be limited, referral to geriatrics for a geriatric assessment may be beneficial (Lindquist & Dresden, 2019). Geriatric appointments at Northwestern Medicine are over 1 hour and include consultation with our geriatric social worker. It may be a good idea to consider discussing goals of care with patient/ complete POLST form (Torke et al., 2019).

Northwestern Medicine also offers resources for additional evaluation. Some providers may consider admitting this patient for a social admission or for failure to thrive. Another, and possibly better choice, would be to send the patient to the Emergency Department (ED) at Northwestern Memorial for a geriatric assessment (Hwang et al., 2018; Lindquist & Dresden, 2019) The skilled geriatric nurses will administer a number of validated tests to assess for common geriatric conditions by evaluating cognitive function, delirium, functional status, falls risk and caregiver strain (Hwang et al., 2018). The comprehensive geriatric ED at Northwestern Memorial also includes access to 24-hour social work coverage and a Monday-Friday physical therapist. The interdisciplinary team evaluates the patient for safety in returning home arranges additional home services such as meals and household assistance. This program has been shown to reduce the need for hospitalization (Hwang et al., 2018; Lindquist & Dresden, 2019).


Case Study #3

Many providers may feel the best approach to this patient would be to send him into the ED for evaluation and treatment. This would likely cause increased burden and costs to his caregiver as he would need to travel by ambulance, an out-of-pocket cost for patients, other than those receiving Medicaid. It is also likely that this patient would subsequently be admitted from the ED, generating additional costs from inpatient admission and depleting scarce healthcare resources. This is a patient that benefited from the HBPC program and received a home evaluation by an APRN the following day. The APRN performed an exam and collected a CBC, BMP and UA and culture. On exam, the patient was not showing concerning signs of sepsis or other acute findings that would warrant admission. The patient was started on Cephalexin 500 mg by mouth every 8 hours while the labs were pending. The BMP and CBC were unremarkable. The urine culture was positive for Proteus mirabilis and susceptible to the antibiotic chosen. The patient was seen the following week for follow up by the HBPC APRN and found to be in stable condition with mentation and behaviors at his baseline.


Delirium

Mr. Edmond may be experiencing delirium in addition to his dementia. The Presence of delirium on admission is a strong indicator of increased functional decline during hospitalization (D’onofrio, Büla, Rubli, Butrogno, & Morin, 2018). Distinguishing delirium from dementia may be difficult and a patient may present with both. Delirium frequently occurs in people with dementia; however, having episodes of delirium does not always mean a person has dementia (Lindquist & Dresden, 2019).  The DSM-5 diagnostic criteria for delirium includes an acute and fluctuating disturbance in attention with a change in cognition (Lindquist & Dresden, 2019). The onset of delirium occurs within a short time, while dementia usually begins with relatively minor symptoms that gradually worsen over time (Lindquist & Dresden, 2019). The patient may have a significantly impaired ability to maintain focus and attention (Lindquist & Dresden, 2019). Delirium can often be linked to one or more physiological factors such as acute or chronic illness, metabolic disturbances such as low sodium, infections, surgery, and drug or alcohol-related problems (Lindquist & Dresden, 2019). Delirium may manifest in several clinical presentations.  Hyperactive delirium, perhaps the most easily identified type, this may include restlessness, agitation, mood changes or hallucinations, uncooperative behaviors (Lindquist & Dresden, 2019). Hypoactive delirium manifests as inactivity or reduced motor activity, drowsiness, sluggishness and dazed appearance (Lindquist & Dresden, 2019). Patients may have a mixed delirium, with manifestations of both hyperactive and hypoactive delirium (Lindquist & Dresden, 2019).

Obtaining a history from a confused or uncooperative patient may be difficult. Relatives or caregivers, if available, may be able to provide valuable information about potential causes such as recent infection, organ failure, drug or alcohol abuse, or depression (Lindquist & Dresden, 2019). A focused exam concentrating on vital signs, hydration, skin and potential infectious etiologies should be performed (Lindquist & Dresden, 2019). Simple tests like asking the patient to spell “lunch” or “world” backward may be useful in identifying inattention (Lindquist & Dresden, 2019). Delirium can be confirmed using either the Confusion Assessment Method (CAM) or the Brief Confusion Assessment Method (bCAM) (Lindquist & Dresden, 2019). Both assess the four elements of delirium, which include acute altered mental status, disorganized thinking, inattention, and altered consciousness (Lindquist & Dresden, 2019). Medications should be assessed, and drug levels evaluated for toxicity when possible (Lindquist & Dresden, 2019). A finger stick blood sugar, CBC, CMP, lactate, blood gas, liver function tests, ammonia level urine analysis and culture, chest x-ray, CT brain, EEG, lumbar puncture, EKG may be ordered indicated by history and exam (Lindquist & Dresden, 2019).

Interventions that may help reduce delirium include orientation to environment, clocks, calendars, windows with outdoor views and reorientation (Lindquist & Dresden, 2019). Visits from family and friends and provision of visual and hearing aids if needed, will aid in cognitive stimulation for patients, yet overstimulation should be avoided (Lindquist & Dresden, 2019). If possible, it is best to avoid procedures and medication administration during sleep hours. Early mobilization with PT and OT, limiting the use of restraints and sedatives have been shown to be useful for mitigating delirium (Lindquist & Dresden, 2019). Medications should be reviewed for potential culprits. Benzodiazepines, opioids, antihistamines and should all be used with caution or avoided. Medical complications such as dehydration, dihydropyridines (nifedipine, amlodipine), hypoxemia and infections may contribute to development of delirium and must be identified and treated (Lindquist & Dresden, 2019). Untreated pain may be an important contributor for delirium (Lindquist & Dresden, 2019).  Non-opioid and nonpharmacological pain control interventions should be used when possible and appropriate as these have least risk of potentiating delirium (Lindquist & Dresden, 2019).


Dementia

While delirium is often acute with a reversible cause, dementia is chronic, progressive and irreversible (Lindquist & Dresden, 2019). Dementia is a progressive loss of memory and other thinking capabilities due to reduction or damage of brain cells (Smits et al., 2015).  Dementia is not a specific disease but rather a set of symptoms associated with loss of mental capacity and social skills severe enough to affect daily living (Smits et al., 2015). There are several different types of dementia with varying etiologies. Alzheimer’s disease is the most common type of dementia in people 65 and older (Raz, Knoefel, & Bhaskar, 2016). While the exact cause is poorly understood, clumps of plaques and tangles of fibers composed of protein are found in the brains of Alzheimer’s patients on autopsy (Raz et al., 2016). Vascular dementia is the 2nd most common type of dementia and occurs secondary to damage to the blood vessels supplying the brain from vascular problems such as stroke (Raz et al., 2016). Lewy body dementia is a progressive dementia that occurs in Parkinson’s and Alzheimer’s disease and is characterized by the presence of abnormal clumps of protein found in the brain called Lewy bodies (Raz et al., 2016). Many patients with dementia have mixed dementia, or a combination of Alzheimer’s, Lewy body and vascular dementia (Raz et al., 2016).

Patients with dementia experience a myriad of psychological and cognitive changes such as personality changes, depression, anxiety, inappropriate behavior, paranoia, agitation, hallucinations, memory loss, trouble communication, reasoning, problem solving, completing tasks, planning, organizing and with coordination and motor functions (Smits et al., 2015).  Previously patients with dementia were often grouped together and identified as having “senile dementia.” It is now better understood that accurate diagnosis of the type of dementia is important for accurate treatment and prognosis (Bredesen et al., 2018).

Patients with dementia will often lose decision-making capacity and should identify a Health Care Power of Attorney (HPOA) (Austrom, Boustani, & LaMantia, 2018). Behavioral disturbances are common in dementia and should be routinely screened for during visits. Caregivers should be asked about hallucinations, delusions, aggression, apathy, wandering and other behavior problems (Austrom et al., 2018).  Underlying causes of behavioral disturbances in dementia include delirium, medication side effects, pain, depression, anxiety, sleep disorders and sensory deficits (Austrom et al., 2018). Pain is an important and often under-identified or treated condition that may exacerbate dementia symptoms (Austrom et al., 2018). It is important to explore nonpharmacological interventions prior to drug therapy as polypharmacy may contribute to worsening dementia symptoms and sleep disturbances (Austrom et al., 2018). Many patients with dementia will experience sleep disturbances (Austrom et al., 2018). Some general recommendations to promote adequate sleep include keeping the environment dark at night and bright during the day, reducing night-time noise and unessential night-time wake-ups, sleep hygiene education, establishing consistent sleep-wake schedules and controlling stimuli (Austrom et al., 2018).

Strange or unfamiliar environments or changes in daily routines may exacerbate symptoms; therefore, it is important for dementia patients have routines and to participate in regular activities and chores (Austrom et al., 2018). Eating problems are very common in dementia patients (Nifli, 2018). Patients tend to have a diminished sense of smell; therefore, supplements, appetite stimulants, increasing spices, flavor content, and texture in foods and assisted feeding have been used with varying degrees of success (Perna et al., 2019). Safety concerns are prominent for patients with dementia. In addition to lack of decision-making capacity, dementia patients are often unaware of their deficits and may engage in risky behaviors such as driving and cooking (Brims & Oliver, 2019). Patients are prone to wandering and may become lost in remote areas (Brims & Oliver, 2019).


Caregiver Burden

Caregivers of persons with dementia often experience significant role strain and burden (Liu et al., 2017). Caregiver burden can be assessed by the Modified Caregiver Strain Index, a validated tool (Lindquist & Dresden, 2019). Psychotherapy, support groups, and respite care have all been shown to improve caregiver well-being, reduce burden or reduce the intent institutionalize the patient (Austrom et al., 2018; Rausch, Caljouw, & van der Ploeg, 2017; Vandepitte, Putman, Van Den Noortgate, Verhaeghe, & Annemans, 2019).

Information technology innovations are emerging as useful tools to help improve safety, independence and function (Osvath, Kovacs, Boda-Jorg, Tenyi, & Fekete, 2018). Security cameras, motion detectors, water temperature sensors have been used to help promote safety while allowing for patient independence (Osvath et al., 2018).  Computer and tablet games allow for pastimes and promotion of cognitive processes (Osvath et al., 2018). Telemedicine, online support groups and web applications can provide disease information and interpersonal connections (Osvath et al., 2018).  Calendar apps, such as google calendar, can be set up to deliver automatic reminders such as time for medications or doctor’s appointments (Rover, 2018). Video calling, such as Face Time and Skype, allow for direct visualization between dementia patients and caregivers and can help reduce feelings of isolation (Rover, 2018). Voice-activated assistants, such as Alexa, can be programmed to deliver reminders, play music, read books and even answer questions like “what day is it?” when asked repeatedly (Rover, 2018). Spark memories radio allows for creation of playlists of music dating back to the 1930s (Rover, 2018)


Implications for Practice

Geriatric patient populations are growing in the united states and will likely be seen at some point by all providers practicing adult medicine. Providers should assess for and understand appropriate interventions for common geriatric syndromes such as polypharmacy, frailty, dementia and delirium and caregiver burden in order to provide patient-centered, age-specific care. Providers may consider referral for specialist comprehensive geriatric assessment and should choose an accredited geriatric emergency department when referring to emergency care.


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