Summarize how informatics has assisted in improving health care safety in your organization and areas where growth is still needed.

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Summarize how informatics has assisted in improving health care safety in your organization and areas where growth is still needed.

The Effects of “To Err Is Human” in Nursing Practice

The 1999 landmark study titled “To Err Is Human: Building a Safer Health System” highlighted the unacceptably high incidence of U.S. medical errors and put forth recommendations to improve patient safety. Since its publication, the recommendations in “To Err Is Human’” have guided significant changes in nursing practice in the United States.

In this Discussion, you will review these recommendations and consider the role of health information technology in helping address concerns presented in the report.

To prepare:

Review the summary of “To Err Is Human” presented in the Plawecki and Amrhein article found in this week’s Learning Resources.
Consider the following statement:
“The most significant barrier to improving patient safety identified in “To Err Is Human”is a “lack of awareness of the extent to which errors occur daily in all health care settings and organizations (Wakefield, 2008).”

Review “The Quality Chasm Series: Implications for Nursing” focusing on Table 3: “Simple Rules for the 21st Century Health Care System.” Consider your current organization or one with which you are familiar. Reflect on one of the rules where the “current rule” is still in operation in the organization and consider another instance in which the organization has effectively transitioned to the new rule.
Post on or before Day 3 your thoughts on how the development of information technology has helped address the concerns about patient safety raised in the “To Err Is Human” report. Summarize how informatics has assisted in improving health care safety in your organization and areas where growth is still needed.

Reference:

Wakefield, M. K. (2008). The Quality Chasm series: Implications for nursing. In R. G. Hughes (Ed.), Patient safety and quality: An evidence-based handbook for nurses (Vol. 1, pp. 47–66). Rockville, MD: U. S. Department of Health and Human Services. Retrieved from https://www.ahrq.gov/qual/nurseshdbk/docs/WakefieldM_QCSIN.pdf

Readings

American Nurses Association. (2015). Nursing informatics: Scope & standards of practice (2nd ed.). Silver Springs, MD: Author.
“Introduction”
This portion of the text introduces nursing informatics and outlines the functions of the scope and standards.

McGonigle, D., & Mastrian, K. G. (2012). Nursing informatics and the foundation of knowledge (Laureate Education, Inc., custom ed.). Burlington, MA: Jones & Bartlett Learning.
Chapter 1, “Nursing Science and the Foundation of Knowledge”
This chapter defines nursing science and details its relation to nursing roles and nursing informatics. The chapter also serves as an introduction to the foundation of knowledge model used throughout the text.

Chapter 2, “Introduction to Information, Information Science, and Information Systems “
In this chapter, the authors highlight the importance of information systems. The authors specify the qualities that enable information systems to meet the needs of the health care industry.

Wakefield, M. K. (2008). The Quality Chasm series: Implications for nursing. In R. G. Hughes (Ed.), Patient safety and quality: An evidence-based handbook for nurses(Vol. 1, pp. 47–66). Rockville, MD: U. S. Department of Health and Human Services.
Pages 1–12
These 12 pages highlight the issues raised by the Quality Chasm Series and examine their long-term implications for nursing. The text reviews external drivers of safety and quality, design principles for safe systems, and guidelines for health care redesign.

Cipriano, P. F., & Murphy, J. (2011). Nursing informatics. The future of nursing and health IT: The quality elixir. Nursing Economic$, 29(5), 282, 286–289.
Retrieved from the Walden Library databases.

In this article, the authors focus on how nurses can use health information technology to help transform health care using the recommendations included in the 2010 Institute of Medicine report “The Future of Nursing, Leading Change, Advancing Health.” The author also discusses the 2011 National Strategy for Quality Improvement in Health Care.

Plawecki, L. H., & Amrhein, D. W. (2009). Clearing the err. Journal of Gerontological Nursing, 35(11), 26–29.
Retrieved from the Walden Library databases.

This article presents a summary of the Institute of Medicine report “To Err Is Human: Building a Safer Health System.” The authors provide an overview of what has been accomplished in the decade following the IOM report, focusing in particular on health information technology.

Media

Laureate Education, Inc. (Executive Producer). (2012e). Introduction to nursing informatics. Baltimore, MD: Author.

Importance of Implementing Electronic Health Record Systems

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The government has an important role to play in improving health care quality, reforming payment processes, and reducing barriers of electronic health record (EHR) implementation. This is especially important since “U.S. health care costs [are] at 17 percent of the gross national product and rising and forty-six million Americans [are] uninsured” (Wager, Lee, & Glaser, 2013, p. 189). Some of these increased health care costs are due to medical errors and medication errors. The landmark study

To Err is Human: Building a Safer Health System

, reported “that as many as 98,000 people die in any given year from medical errors that occur in hospitals” (Institute of Medicine, 2000). In order to decrease health care costs, the government needs to invest in the public health with early disease prevention, improve health care quality by decreasing medical errors, ensure health care organizations are meaningful users of their EHR systems, and reform the health care payment system.

One way the government can help improve health care quality is through the investment in public health initiatives. “Public health promotes the welfare of the entire population, ensures its security and protects it from the spread of infectious disease and environmental hazards, and helps to ensure access to safe and quality care to benefit the population” (Minnesota Department of Health, n.d.). Early prevention of health care issues can improve the overall health of the community and help decrease health care spending in the long run. If the public health departments are allocated the funds for adequate health care technology, they will better be able to track the trends of the health care issues faced in their communities and be able to better treat and serve their patients. For example, if the health department had quality health care data that showed a majority of their patient population had complications due to

diabetes

, they could focus their efforts on education and prevention of diabetes related illnesses and complications.

Another role of the government to help improve health care quality is to help determine ways to prevent and decrease medical errors.

To Err is Human: Building a Safer Health System

recommends that the government “create sufficient pressure to make errors costly to health care organizations and providers, so they are compelled to take action to improve safety” (Institute of Medicine, 2000). One approach organizations and independent providers can utilize to help decrease medical errors is through the adoption of an electronic health record system. To help encourage the adoption of the EHR the government enacted the Health Information Technology Economic and Clinical Health (HITECH) Act and established the Medicare and Medicaid EHR Incentive Programs. Not only did these programs provide organizations with incentives for the adoption of EHR systems, but they also meant organizations can incur penalties if they fail to meet meaningful use requirements of the EHR system. An organization acquiring an EHR is not enough, they must actually utilize the system in a way that helps improve efficiency, decrease medical errors, and helps to improve patient outcomes and overall quality of care.

The use of an EHR can help improve overall patient safety and help decrease medical cost. Most EHR systems utilize some type of clinical decision support, which can assist the health care provider in providing safer health care for patients. The clinical decision support can help improve overall health care quality because it includes “safety features such as allergy alerts, drug-drug, drug-food, and drug-disease interaction checks, can suggest safe medication dose ranges and intervals, [and] can guide users in implementing clinical practice guidelines and care pathways” (Connelly, 2019). To help improve health care quality, the government should require that all institutions utilize this safety feature.  The clinical decision software is not only best for the patient and their safety, but it can help reduce health care spending by alerting physicians of duplicate orders. For example, a provider may order for a patient to be given a pneumonia vaccine not knowing the patient had already been immunized. If the provider isn’t utilizing a clinical decision support system the patient could receive the vaccine again and have to incur that charge again, but the use of the system would notify the provider that this is a duplicate test and is not necessary.

To ensure quality health care is provided to everyone, the government should assist all health care organizations and independent health care providers in implementing an electronic health record. “The cost of EHR implementations can range from $15,000 to $50,000 per provider” (Wager, Lee, & Glaser, 2013, p. 142) and not all health care organizations or private medical offices can incur this cost. The US Federal government attempted to offset some of this burden by funding Regional Extension Centers (RECs) to assist small rural practices that lack IT expertise in the selection and implementation of an EHR. However, the development of the RECs has not been sufficient as many places still lack a functional EHR system. One way to combat the problem many organizations face with EHR implementation would be for the government to develop a comprehensive system that health care organizations could buy at a fraction of the cost, as long as they met predetermined quality care outcomes. This government developed EHR would not only assure all patients were receiving safe quality care since the providers would have timely access to patient information, but it would be easier for the government to obtain health care data and statistics to easily measure population health outcomes.

The utilization of electronic health records is not enough to combat the rising costs of health care. Reform to the payment process is also needed. Historically, payment has been primarily on a fee-for-service basis. With fee-for-service payment “providers are rewarded for volume and for conducting procedures that are often more complex, when simpler, lower-cost, better methods may be more appropriate” (Wager, Lee, & Glaser, 2013, p. 189). This type of payment does not prioritize patients’ best interest and leads to increased spending with a higher risk for error. Additionally, payment process reform is needed as “most third-party payment systems provide little incentive for a health care organization to improve safety, nor do they recognize and reward safety or quality” (Institute of Medicine, 2000). Patient safety should be first and foremost and the payment process design should prioritize good patient outcomes. One way to ensure that patient safety and quality healthcare is at the forefront is by the utilization of pay for performance (P4P). P4P programs make payments to HCOs and providers based on performance measures such as: “clinical quality and safety, efficiency, patient experience, and health information technology adoption” (Wager, Lee, & Glaser, 2013, p. 193). The P4P model ensures that patients receive quality health care while also helping to cut down the rising health care cost by making providers practice in a more efficient manner.

Source:

Case Study of Diabetes Mellitus and Community Health Nurse

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This paper is going to illustrate a case study, which has been chosen during the two weeks of clinical practicum. It will present the medical history of the patient, focus on current health status and discuss the main responsibilities of community health nurse.

H.S is a 74 years old Emirati, female, married and has 3 daughters and 5 sons. She has been referred to health home care setting on 24/2/2011. The patient’s past medical history included mild intermittent asthma, irritable bowel syndrome, acute gastritis, esophageal reflux, acquired hypothyroidism, generalized anxiety disorder, essential hypertension, diabetes mellitus type-1, chronic diastolic failure, blurred vision and impaired hearing. The patient has allergies from dust and medication like penicillin. Her surgical history was significant for cholecystectomy. Also, she had grafting surgery that done to repair the wound at right forearm which resulted from road traffic accident. Current medications include montelukast (singulair); 10mg orally once daily, steroids 500mg orally once per day, insulin 34 units in the morning and 32 units on evening, and cozaar 50mg once daily. Currently, the patient is suffering from uncontrolled diabetes. The fasting blood glucose ranged from 239-455 mg/dl and the past prandial glucose and bed time glucose ranged from 240-598 mg/dl. This assignment will shed light on one of the chronic disease which the patient has, diabetes, including pathophysiology, sign and symptoms, risk factors, epidemiology, diagnosis and treatment. In addition, it will illustrate the community health nurse roles regarding diabetic patient.

Diabetes mellitus is a worldwide epidemic disease. It is a metabolic disorder manifested by elevation of blood glucose level due to an absolute shortage of insulin production and action (American Diabetes Association, 2004). The two main classification of diabetes are type 1, this type represents insulin dependent diabetes, and type 2, non-insulin dependent diabetes (Meetoo & Allen, 2010). Additional types of diabetes mellitus include gestational diabetes, maturity once diabetes of the young, diabetes resulted from cystic fibrosis, and cushing’s syndrome diabetes (Meetoo & Allen, 2010).

As our patient is suffering from diabetes type-1, the nurse must understand the pathophysiology of this type in order to provide optimal care. Type-1 diabetes is found to be a result of an autoimmune mediated damaging of B-cells, pancreatic cells responsible for insulin production. Destruction of these cells will lead to insulin deficiency, which will result in increase of blood glucose and glycosuria. Mainly it is symptomatic disorder unlike type-2 diabetes (Meetoo & Allen, 2010). Type-2 diabetes is considered silent killer; most people with such disease are unaware because it is asymptomatic in many cases. It is characterized by abnormal insulin production, insulin resistance, and alteration in glucagon synthesis (Casey, 2011). Elevation in blood glucose caused by limitation of insulin in transporting glucose into the cells for energy synthesis. High glucose level enhances insulin production. So that, people with this type of diabetes often characterized by excessive insulin production (Casey, 2010). Diabetes’ symptoms might slightly vary according to the type.

Hyperglycemia manifested by a number of symptoms such as polyuria, polydipsia, weight loss, in some cases associated with polyghagia; feeling hungry as a result of cellular starvation, and blurred vision. Polyuria occurs when the amount of glucose filtration by the kidney overwhelms reabsorption mechanism (American Diabetes Association, 2004). Fatigue may be presented due to metabolic changes (Casey, 2011). These symptoms could not be severe in type-2 diabetes as much as type-1 (Casey, 2011).

Uncontrolled diabetes like in H.S case might lead to unpleasant consequences. These complications include retinopathy with loss of vision, nephropathy; which results in renal failure, peripheral nephropathy with high risk of foot ulcer and cardiovascular symptoms (American Diabetes Association, 2004).

There are many risk factors that lead to hyperglycemia. Some of these factors are non-modifiable such as heredity and race factors. Other modifiable factors include obesity, lack of exercise, impaired glucose tolerance, cardiovascular disorder, and high level of triglycerides (Rodbard et al, 2007).

Diabetes mellitus accounts for high epidemic percentage throughout the world. The total number of people with diabetes was significantly increased from 124 million in 1997 to 221 million in 2010 (Meetoo & Allen, 2010). From a global thought, the highest three countries estimated to have the highest number of people with diabetes in 2000 and 2030 are India, China, and the United State of America. The most affected groups are people between 45-64 years old (Meetoo & Allen, 2010). The risk of death for people with diabetes mellitus is twice that among individuals without diabetes of similar age (Rodbard et al, 2007). If patient diagnosed before age 40 years, the average reduction in life expectancy is 12 years for men and 19 years for women (Rodbard et al, 2007).

There are a number of diagnostic procedures that have been used to determine the blood glucose level. These strategies include observation the symptoms of diabetes such as polyuria, polydipsia, and weight loss (Rodbard et al, 2007). In addition, diabetic patient could be identified with fasting plasma glucose concentration more than or equal 126mg/dl or plasma glucose concentration more than or equal 200 mg/dl in normal status. These measurements taken by using a 75-g oral glucose tolerance test (Rodbard et al, 2007).

Applying appropriate intervention for patient with chronic disease like diabetes is an essential strategy to prevent any complications that might result from unstable condition (Pimouguet, Goff, Thiebaut, Dartigues & Halmer, 2011). The aims of diabetes treatment are to control blood glucose level to reduce the risk of long term complications and to help the patient with diabetes to live normal healthy life (Meetoo & Allen, 2010). The choice of treatment depends on the type of diabetes. For instance, patient with type 1 and some cases with type 2, insulin is an appropriate treatment in maintaining nearly normal level of blood glucose (Meetoo & Allen, 2010). Unlike type-2 diabetes, in which management processes are based mainly on life style modifications. For example, regular food intake, regular exercise, weight management and limited alcohol intake. Also, oral anti-diabetic agents are used to maintain normal level of blood glucose and to enhance the action of pancreatic cells (Meetoo & Allen, 2010). Furthermore, one of the most effective methods which are essential for patients with type-2 diabetes or for people who are at high risk is regular monitoring of blood glucose level .This method helps to prevent acquiring diabetes for people who are at increased risk of hyperglycemia or for those who have poor glycemic control (Grant, 2010).

The role of the nurse in delivering community health care is considered an essential part in managing patient’s condition at home sitting. As nurses working in community care, a number of responsibilities are involved in care of patient with diabetes including assessment and providing optimal intervention (Carey & Courtenay, 2008). The nurse is considered the only professional who has a complete knowledge about patient’s medical status (O’Reilly, 2005). Effective assessment will enable the nurse to create appropriate plan regarding patient’s condition and provide best care (World Health Organization, 2001). For optimal care, the community nurse should has enough knowledge regarding patient’s health disorder include functional limitations, patient’s medical history, prognosis, physical assessment for all body systems and behavioral status (O’Reilly, 2005). In addition, it is important to assess other factors that could affect patient’s health such as safety of living environment, types of daily living activities, medication awareness and compliance, equipment availability such as oxygen, intravenous therapy, and parenteral nutrition (Smeltzer, Bare, Hinkle & Cheever, 2008). For diabetic patient, the nurse is responsible to assess specific factors that might interfere with glycemic control. One of these factors is age- related changes such as physiological functions. For instance, loss of taste and olfactory functions may lead to malnutrition intake. So, that will lead to abnormal metabolism and blood glucose maintenance (O’Reilly, 2005). Dehydration is also one of the complication that might occur due to loss of thirst perception which affected by age factor. The nurse must evaluate the condition carefully in order to meet the needs (O’Reilly, 2005). Also, the nurse must assess for the presence of neuropathies, because it increase the risk of fall and infection (Smeltzer, Bare, Hinkle & Cheever, 2008). Furthermore, visual deficits and retinopathy must be assessed because the patient may be at risk of taking medication inaccurately and become unable to perform regular blood glucose test (O’Reilly, 2005). The nurse should ensure that the patient is aware about all medications and being compliance with. Also, identification and investigation of any complications are very crucial to protect the patient from life threatening condition (Diabetes Specialist Nurses, 2007). If the patient has diabetic foot, the nurse should assess the wound, regular dressing must be done and monitor for any further complications (Smeltzer, Bare, Hinkle & Cheever, 2008). Moreover, accurate documentation is necessary to ensure patients need correctly (O’Reilly, 2005).


Diabetes mellitus requires regular self care behaviors

. Nurse is responsible to teach the patient about appropriate self management (Smeltzer, Bare, Hinkle & Cheever, 2008). Physical and emotional stress could affect glycemic control negatively, so patients must learn how to balance among such factors. They should learn daily self care skills to prevent instability of blood glucose. In addition, patients must be aware about good nutrition by following a calorie- controlled diet (Smeltzer, Bare, Hinkle & Cheever, 2008). They should know that they might need additional meals and snacks during various exercises or at bedtime to prevent hypoglycemia. Also, patients must have knowledge regarding medications side effects and disease progression. Patients and family members should be taught about the symptoms of both hyperglycemia and hypoglycemia in order to be able to provide a required care (Smeltzer, Bare, Hinkle & Cheever, 2008).

In conclusion, this essay has discussed a case study that has been chosen during the clinical practicum time. Mainly, it focused on one of current health problem in which the patient is suffering from, diabetes mellitus. It discussed the pathophysiology of the two types of diabetes, type-1 and type-2. Diabetes is characterized by a number of symptoms such as polyuria, polydipsia, weight loss, and polyghagia. There are many risk factors might cause diabetes such as obesity and sedentary life style. This paper has also presented statistical information regarding diabetes disorder throughout the world, it found that India is the highest country that account for the highest number of people with diabetes. Moreover, there are various diagnostic methods that are used to identify and investigate patients with diabetes or who are at high risk. Treatment strategies are varying with different types of diabetes. Type-1 is insulin dependent diabetes while type-2 is non-insulin dependent. Diabetes mellitus is considered a chronic disease that required regular appropriate care at home sitting. Community health nurse has a number of responsibilities regarding diabetic patients care include effective assessment and providing teaching plan that help the patient to maintain controlled blood sugar level. Finally, diabetic patients should be aware about daily self care.

Analyse the video “Crossing professional boundaries as a registered nurse

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Analyse the video “Crossing professional boundaries as a registered nurse

Analyse the video “Crossing professional boundaries as a registered nurse”,( https://youtu.be/x-bOgRUJv4g )
and identify as many professional practice anomalies as possible. From the list below, choose one area of professional practice that you identified in the video as being disregarded by the nurse in the video.
Using a wide range of quality literature, critically discuss in detail the chosen professional practice area in relation to the anomalies from the video and demonstrate how these anomalies may impact negatively on both the patient’s care and the nurse’s professional image. (1500 words)
PROFESSIONAL PRACTICE IN NURSING. (choose one only)
1. ?Therapeutic relationships (patient centered care) ?
2. Professional behavior’s, attitudes & presentation ?
3. Demonstrating respect and maintaining dignity for patients (Code of Ethics) ?
4. Professional communication & collaboration. ?
Part 2
• Choose 2 literary sources that you felt were valuable to this paper. Write an annotated bibliography of 250 words for each source (i.e. two annotated bibliographies) and attach to the back of your paper. Write one short paragraph explaining why you believe that these 2 literary sources were valuable to this piece of assessment. (500 word), (2 literary sources that was used discuss part 1) and can I also get those 2 literature source (i.e. journals that was used to write the annotated bibliography)
Use a separate page for the reference list. Alphabetical order; no numbering. ?(I need reference in detail with all information’s and I need references for the past 5 years and literature that is relevant and up to date)
• Bullet points and numbering is not appropriate format for this essay. ?
• Line spacing: at least 1.5; Font size: 12; Font type: Arial. ?
• Minimum of reference 15-20 quality sources to allow you to write a critical discussion for this paper. These should be highest available quality reference should be in detail with all website address, page number and in APA 6 style.

Effective treatments for Post-Traumatic Stress Disorder (PTSD)

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Abstract

This special assignment intends to study the effects of combat operations in the mental health of American combat soldiers and veterans. More specifically, the assignment will explore how combat operations contribute to Post Traumatic Stress Disorder (PTSD) on American soldiers along with exploring effective treatments. Comer (2015) defines PTSD as a traumatic incident in which an individual witnesses the death of other people, is at risk of death, suffers severe injury, and/or experiences sexual abuse or violation. The Diagnostic and Statistical Manual of Mental Disorders (5th ed.); American Psychiatric Association [APA], (2013), which researchers and clinicians commonly accept as the official standard to diagnose mental health issues, officially recognizes PTSD as a serious mental health disorder.

APA

(2013) diagnosis criteria include individually experiencing or witnessing the traumatic event in others, learning that the incident has happened to a significant family member or friend, and continuous exposure to aversive particulars of traumatic events.


Overview of the Disorder

Symptoms of PTSD include frequent, spontaneous, flashbacks, disturbing upsetting recollections, and dreams of the traumatic event (APA, 2013). PTSD brings along consequences that cause distress in social, occupational, or any other areas of functioning. According to APA (2013), an individual with PTSD may avoid stimuli linked to the traumatic incident, may have difficulties remembering important features of the event, have alterations in cognition and mood, could exhibit insistent negative belief about self, and experiences minimum interest in participating in activities he uses to enjoy. Additionally, individuals with PTSD are associated with reckless or self-destructive behaviors such as alcohol/drug abuse, suicidal ideation, and suicide attempts.

Learning about PTSD is important because it addresses an issue that not only affects the USAF; it also affects the American population in general. As combat veterans complete their military careers, they are transferring to a society in which they may feel unwelcome, rejected, and disconnected. Along with exposure to traumatic events in the field, they are now facing other life stressing events in society, which can increase their anxiety and disconnection. As a result, they might turn to less than helpful ways to cope with stress. Hence, it is important to recognize PTSD or related symptoms in veterans to offer adequate mental health services. Ignoring the issues at hand could be much more costly than confronting the situation. Hence, the mental health community should be mindful in protecting our interests by looking out for the mental health of the American warriors. Recognizing the relationship between combat operations and PTSD can help in developing courses of action to prevent, identifying, and treating those individuals affected.

In addition to PTSD dynamics, one should be mindful about the elevated level of stress that returning veterans might confront (Brenner et al., 2008). Stress can prompt individuals to seek for coping mechanisms that not always are the most appropriate ones. According to Brenner et al. (2008), as individuals search for ways to diminish stress, they can go astray in adopting risky behaviors. Hence, individuals can begin or increase consumption of illegal substances, affecting their mental health. Brenner et al. (2008) maintains that soldiers are more prone to engage in risky behaviors, such as attempting or committing suicide.

The authors associate three suicide risk factors with combat operations. Habituation to pain (continuous exposure to fear, physical or emotional pain, increases tolerance, and decreases response) is a risk factor that contributes to substance abuse. Brenner et al. (2008) suggest that combat veterans experience habituation to pain in combat zones, which contributes to increments in pain tolerance and decreasing responsiveness to emotions after completion of tours. Concerning burdensomeness, veterans report diminishing self-value and confronting difficulties transitioning to civilian life. Combat veterans report a sense of failed belongingness. They recognize the inability to connect with people not in the military, choosing to separate and staying away from society. Brenner et al. (2008) conclude that exposure to combat operations and military training increase the susceptibility to risky and suicidal behavior.


Current Research

Numerous studies, such as Markowitz (2007) and Castro (2014) suggest that American combat veterans are at a much higher risk to suffer from PTSD. Most studies focus on the American soldier male population; little information is available addressing the female soldiers. Nonetheless, the military has been transitioning in such manner that female soldiers are also at risk of exposure to combat field operations (Vogt et al., 2011). The Iraqi military captured Jessica Lynch during OIF in 2003, the first American female prisoner of war (Holland, 2006). Currently, significant amounts of female soldiers, more than previous times, are vulnerable to experiencing PTSD while performing duties in the military (Vogt, et al., 2011). The inclusion of females in combat support roles calls for further research to find correlations between their combat field exposures and PTSD.

According to Comer (2015), during previous USAF combat operations like, soldiers experienced what clinicians identified as shell shock (World War I) and combat fatigue during War World II. Among other symptoms, shell shock and combat fatigue include extreme anxiety, depression, irritability, social detachment, and suicidal ideation. After Vietnam War, mental health providers learned that the effects of combat operations transcended the battlefield and the consequences follow soldiers beyond their tour of duty; hence, manifesting as psychological symptoms (Comer, 2015). He maintains that among Vietnam veterans, as much as 29% experienced PTSD. Additionally, the author indicates that an additional 10% of those veterans are currently troubled with PTSD symptoms like flashback, nightmares, and unwanted memories and thoughts. Comer (2015) indicates that the amount of soldiers presently suffering from PTSD as result of OIF and OEF is 20%, 45% reported witnessing traumatic events on others, and another 10% has suffered injuries requiring hospitalization. With such an alarming number of veterans suffering or being at risk to develop PTSD, it is imperative to adopt measures to treat those veterans in need.

Different studies, such as Vogt et al. (2011) and Castro (2014) suggest that combat operations contribute to PTSD. Markowitz (2007) maintains that the duration and intensity of combat operations are good predictors for PTSD. His study documents successful treatment of a combat veteran who did not receive PTSD management for about 60 years. The article wakes conscience that untreated PTSD will persist, even as long as 60 years or longer if not treated. According to Markowitz (2007), about 20% of individuals experiencing traumatic events will develop PTSD. Although PTSD diagnosis is more common today, this is not a new phenomenon. People mention it more frequently now due to recent military operations in the Middle East (Iraq/Afghanistan). The United States engaged in combat operations with Iraq during OIF in 2003. Subsequently, the USAF maneuvers extended to Afghanistan in support of OEF. Although the number of American military personnel in both countries is reducing over time, its military presence is still evident, adding to the susceptibility of traumatic events (Sherman, Larsen, & Borden, 2015).

Bryan, Cukrowicz, West, and Morrow (2010) contradict the previous finding that habituation, burdensomeness, and failed belongingness are main contributors to suicidal ideation. Bryan et al. (2010) maintain that perceived burdensomeness and thwarted belongingness do not play a big role in acquiring the capacity to suicidal ideation. This report indicates that combat operation contains a small variance in acquiring the capacity for suicide. Further research can focus on investigating other factors contributing to such risky behaviors. This research also contains limitations found in self-report studies.

Bush, Skopp, McCann, and Luxton (2012) research explores stressing events from the context of protective factors against suicide. Bush et al. (2012) refer to them as posttraumatic growth (PTG). PTG includes positive changes that help individuals reorganize priorities, values, spiritual standing, compassion, and empathy. The study supports the prediction that higher PTG scores translates into less amount of suicides. Such interpretation is vital to combat statistics indicating that veterans likelihood of suicide is double than nonveterans (Bush, Skopp, McCann, & Luxton, 2012). Limitations in this study include collecting self-reported data before consultation with mental health providers, and the unavailability of official diagnoses at the end of the study. Future research can focus on exploring the complex relationships concerning combat operations, PTG, and PTSD.

Barrera, Graham, Dunn, and Teng (2013) identify PTSD as the most common mental health issue (21-23%) affecting combat OIF/OEF veterans. Their study supports the initial anticipation that suicidal ideation in veterans with PTSD (12.9%) is higher than suicidal ideation in veterans without PTSD diagnosis. Additionally, OIF/OEF veterans with higher levels of combat experience are at much higher risk for developing PTSD or comorbid panic, in comparison to other mental health disorders. A limitation in this report is that participants received diagnoses during routine evaluations and unavailability of medical records at the end, precluding verification of diagnoses. Future research can study “prevalence of panic disorder and co-occurring PTSD in other samples of returning veterans” (Barrera et al., 2013).

Castro (2014) documents a significant amount of mental health concerns with OIF/OEF veterans. His data includes 118,000 active duty veterans with a PTSD diagnosis. His figures include another 50,000 soldiers wounded in action, leaving room for possible additions to those already diagnosed. Castro (2014) estimates that about 7.6 – 8.7 % of soldiers returning from combat will develop PTSD in comparison to 1.4 – 3.0 % of the ones in non-combat status. Similar to Castro’s findings (2014), McDevitt-Murphy, Williams, Murphy, Monahan, and Bracken-Minor (2015) highlight the mental health issues surrounding returning combat veterans. McDevitt-Murphy et al. (2015) identify heavy drinking as an increased risk for soldiers to deal with traumatic events. Combat operations increase risks for PTSD and PTSD increases the likelihood of alcohol misuse. The study by Hahn, Tirabassi, Simons, and Simons (2015) continue seeking relationships between combat operations and PTSD. Hahn et al. (2015) measure military sexual trauma (MST) and negative urgency (reckless behaviors) to forecast PTSD and succeeding alcohol issues among OIF/OEF combat veterans. Their study maintains that although combat exposure and MST contributes to PTSD, negative urgency is more significant in developing PTSD. This study contains cross-sectional limitations and data is unable to sustain causal evidence. As PTSD symptoms affect combat soldiers, the consequences can also affect their spouses. Renshaw, Rodrigues, and Jones (2008) investigate how does PTSD in combat veterans affects their marriages. The initial hypothesis implies a correlation between veterans’ PTSD symptoms and marriage dissatisfaction. This study accounts for about 10% PTSD cases in returning veterans, in contrast to another study accounting for 20% (Markowitz, 2007).


Evidenced-Based Treatments

Cognitive Behavioral Therapy or CBT is stated to be one of the most influential types of counseling for treating PTSD. CBT helps military clients to recognize the correlation between thoughts, emotions and behavior patterns. CBT also allows military clients to replace negative or distressing thoughts/images with more direct positive beliefs. The two forms of CBT that are popularly utilized among clinicians are exposure therapy and cognitive processing therapy (Schumm, Pukay-Martin and Gore, 2017).

Exposure therapy includes the desensitizing of oneself relating to the trauma by repeatedly processing the traumatic events until oneself feels less overpowered by them. Typically, most military clients refrain from talking about these traumatic events which actuality can help create empowerment. A clinician would process with a military client about relaxation and breathing techniques to help calm down the body and mind. Sometimes these techniques can be overbearing which can result in the military client to feel threatened by re-traumatizing the event. It is very important for a military client to have open channels with their clinician whenever they feel these unwanted feelings and/or thoughts (Kengne, Fossaert, Girard and Menelas, 2018).

Cognitive processing therapy or CPT deescalates the power of negative memories by stimulating the negative memory while importing new information that is conflicting with assumptions surrounding the memory. For instance, a clinician may process with a military client about a combat trauma with a belief that it was their fault but in actuality, they were only following direct orders from an officer during a mission. CPT informs PTSD symptoms, promotes understanding about thoughts and feelings, promotes more positive beliefs, and develops new techniques that launch intuition into actions (Galovski, Harik, Blain, Farmer Turner and Houle, 2016).

Eye movement desensitization and reprocessing or EMDR therapy was established in 1989 and discovered by Dr. Francine Shapiro. The EMDR therapy works on an eight-phase treatment outline that allows military clients to process trauma, learn appropriate coping skills and allow them to naturally heal accordingly (Ironson, Frued, Strauss and Williams, 2002). EMDR therapy allows military clients to find their “safe place” while explaining upsetting memories during “back and forth” eye movements (bilateral stimulation), tapping/snapping and body scans.  EMDR therapy allows military clients to process upsetting memories, thoughts, and feelings related to the trauma at a much faster pace. EMDR therapy typically involves one/three months of weekly 50-90 minute sessions. Some studies have shown that many military clients start to notice improvement after a few sessions which will allow military clients to quickly return back to post and future deployments (Ironson, et al. 2002).

Complementary and Alternative Medicine or CAM interventions are very effective relaxation, mindfulness, and yoga techniques utilized for PTSD. CAM interventions primarily target the autonomic nervous system (ANS). The ANS includes the sympathetic and parasympathetic nervous system. Essentially, CAM interventions can help regulate and find ways to help maintain composure for the body and mind during distressing times (Lake, 2014).


Micro

The micro practice is based upon the concentration of problem-solving in situations surrounding the client. Social workers are responsible for solving the problem through the resources of systematic development. Through the micro approach, the social worker is primarily focused on the person. Social workers often practice rapport as a micro skill which is about dissolving resistance and to allow clients to make steady changes. Social workers are also responsible for building alliances with clients to help better understand them (Forenza and Eckert, 2018).


Macro

With social planning and community organization as a macro approach, social workers often work within communities and organizations on how to solve social problems that range from local issues to international issues that may arise. Under this macro practice, social workers are typically taught all the different types of social planning that can be analytical, political or both on social problems that are affecting the community daily (Forenza and Eckert, 2018).


Mezzo

Engagement is often utilized by social workers as a mezzo level approach especially during group therapy (Forenza and Eckert, 2018).  For example, social workers will often keep PTSD veterans steady active to help them learn whatever new material (coping skills, house-keeping skills, etc.) that are brought up during group discussion. Having group therapy with PTSD veterans allows them to interact in different ways into developing healthy personal beliefs, appropriate social skills, and values and to be consistent with change. It will also allow PTSD veterans to develop long-lasting friendships with each other.


Conclusion

The United States Armed Forces (USAF) main objective is to defend our land, whether domestically or internationally, and this requires a significant amount of risks that expose our troops to obvious traumatic events. Since defending our interests is an ongoing battle by itself, our soldiers will be continually vulnerable to experiencing PTSD. Hence, the mental health community should be mindful in protecting our interests by looking out for the mental health of the American warriors. Exploring the relationships between combat operations and PTSD can help in developing courses of action to prevent, identifying, and treating those individuals affected.


References

  • American Psychiatric Association. (2013).

    Diagnostic and statistical manual of mental disorders

    (5th ed.). Washington, DC: Author.
  • Barrera, T. L., Graham, D. P., Dunn, N., & Teng, E. J. (n.d.). Correction to Barrera, Graham, Dunn, and Teng (2013 … Retrieved from https://www.researchgate.net/publication/263923283_Correction_to_Barrera_Graham_Dunn_and_Teng_2013
  • Brad, Eckert, & Caitlin. (2017, November 13). Social Worker Identity: A Profession in Context. Retrieved from https://academic.oup.com/sw/article/63/1/17/4621303
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    Journal of Mental Health Counseling,

    3093), 211-225. doi:10.17744/mehc.30.3.n6418tm72231j606
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    Journal of Clinical Psychology, 66

    (10), 1044-1056. doi:10.1002/jclp.20703
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    PsychEXTRA Dataset.

    doi:10.1037/e555092012-018
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    European Journal of Psychotraumatology,

    5(1), doi:10.3402/ejpt.v5.24713
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    Abnormal psychology

    (9th ed.). New York: Worth Publishers.
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  • Kengne, S. A. K., Fossaert, M., Girard, B., & Menelas, B.-A. J. (2018). Action-Centered Exposure Therapy (ACET): A New Approach to the Use of Virtual Reality to the Care of People with Post-Traumatic Stress Disorder. Behavioral Sciences (2076-328X), 8(8), 76. https://doi-org.ezproxy.net.ucf.edu/10.3390/bs8080076
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  • Sherman, M. D., Larsen, J., & Borden, L. M. (2015). Broadening the focus in supporting reintegrating Iraq and Afghanistan veterans: Six key domains of functioning.

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    Journal of Abnormal Psychology, 120

    (4), 797-806. doi:10.1037/a0023452

Fresno Co. establishes a $350 petty cash fund on January 1. On January 8- the fund shows $140 in cash along with receipts for the following…

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Fresno Co. establishes a $350 petty cash fund on January 1. On January 8, the fund shows $140 in cash along with receipts for the following expenditures: postage, $67; transportation-in, $35; delivery expenses, $52; and miscellaneous expenses, $56. Fresno uses the perpetual system in accounting for merchandise inventory. Prepare journal entries for the following

Hand Hygiene Skills Development

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4KNIP418



– Knowledge and Skills for Adult Nursing Assignment 1- Hand Washing

When providing healthcare, hands are the key pathway of germ transmission

(WHO 2009)


[1]

,

effective hand hygiene will decrease the amount of preventable Healthcare/Hospital Associated Infections (HCAI) and consequently an overall reduction in patient mortality. This demonstrates that hand hygiene is vital within a healthcare setting and thus this assignment will discuss my application of this important skill in clinical practice. The National Institute for Health and Care Excellence states that one in 16 people being treated in an NHS hospital picks up a hospital acquired infection such as meticillin-resistant staphylococcus (MRSA).

[2]
In this essay I will aim to highlight the process and steps taken when performing hand hygiene, why I performed this skill, when and where and why this skill should be applied. Finally, I will reflect upon how this skill has informed my future practice.

The trust that I have been working in has created a hand hygiene policy which was strictly followed by all healthcare professionals. Within this policy is a ‘five moments for hand hygiene at the point of care’, adapted from the

World Health Organisation (WHO) World Alliance for Patient Safety (2006)

brochure, which provides information on when hand hygiene should take place. For the duration of my placement, the five moments that I carried out hand hygiene, as advised by the policy, mainly included but was not limited to the following instances: prior to patient contact, prior to carrying out an aseptic task, regardless of whether or not gloves have been worn, after body fluid exposure, mucous membrane and non-intact skin, after patient contact and lastly, after having contact with patient surroundings.

[3]
Furthermore, the five moments for decontaminating the hands through the use of alcohol hand rub included: prior to or after leaving the ward, moving from a contaminated body site to a clean body site during patient care, after removing gloves, prior to handling food and finally, prior to handling medicine.

[4]

In the case that hands were not visibly soiled, I decontaminated my hands by rubbing them with an alcohol-based gel, as this is the preferred method for performing routine hygienic hand antisepsis.

[5]
To begin with, I applied a palm full of the alcohol-based gel, covering the entire palm, I then rubbed my hands together with my palms facing each other. After that I placed my right palm over the left dorsum of my hand whilst interlacing the fingers and repeated this on the left hand. I then went on to rubbing the gel on the back of my fingers facing opposing palms whilst interlocking my fingers. The next step was rotationally rubbing the left thumb grasped in the right palm and vice versa. The final step was rotationally rubbing with clasped fingers on the right hand in the left palm, and vice versa. This process should last for 20-30 seconds. Once my hands were completely dry and the alcohol gel evaporated I was able to carry out tasks safely.

However, if my hands were not visibly dirty, I washed my hands with soap and water. The first step I took was wetting my hands with water, after that I applied soap ensuring that there was enough soap that covered the entire surface of my hand. I then used the same process that I carried out when using the alcohol rub. However, the final steps involved in washing hands with soap included rotationally rubbing the left thumb whilst clasping the right palm, and then repeating this on the right thumb. I then rinsed my hands with water and dried them thoroughly using a single use towel. Finally, to ensure that I do not contaminate my hands I used the towel to turn off the faucet. *490

In this section I will discuss evidence that supports the approach I used when undertaking hand hygiene during clinical practice, why the skill is fundamental to patient care, and finally a discussion of professional values and the way in which they impacted the way that I carried out the skill in practice.

To begin with, the National Institute for Clinical Excellence (NICE) undertook research to explore various means that will prevent health care associated infections (HCAI) in NHS hospitals in England, this including hand hygiene. Regarding the choice of agent for decontaminating my hands, research suggests that handwashing using liquid soap and water, or the use of ABHR will remove transient microorganisms and meet acceptable hand hygiene standards.

[6]

[7]
Furthermore,

M. Lindsay Grayson et al (2009)

laboratory study proved that hand hygiene through the use of soap and water or ABHR is highly effective in reducing influenza.

[8]
Furthermore,

A Gupta, P Della-Latta, B Todd, et al (2004)

studies found that ABHR was preferred over handwashing due to its efficacy, availability and acceptability of healthcare workers. Although, hand washing is required due to evidence portraying that ABHR is ineffective in removing organic matter and some microorganisms.

[9]

Laboratory studies conducted by NICE supports the technique that I used when decontaminating my hands, they proved that paper towels efficiently dry hands whilst successfully removing bacteria.

[10]

[11]
As well as this, the hands and wrists must be fully exposed to the hand hygiene agents and not just the palms, which overall decreased carriage of microorganisms.

[12]

The foundation of nursing is to provide safe and effective care; hand hygiene is a fundamental skill to patient care and not carrying out hand hygiene would be violating our duty of care. This is because hand hygiene enhances patient safety, as well as minimising the risk of patients acquiring an infection during episodes of health care.

Pittet, Allegranzi and Joyce (2009)

, state that ineffective hand hygiene from nurses has the potential to infect not only their patients, but also their family members.

[13]
Furthermore, this skill is fundamental to patient care as evidence suggests tat it is the most effective way to prevent pneumonia and diarrheal diseases, which amounts to 3.5 million deaths per year worldwide

(Institute of Medicine 2000)

.

[14]

Professional values from the Nursing and Midwifery council (NMC) as well as St George’s trust values influenced the way in which that I carried out this skill during practice.  The NMC code outlines professional standards that nurses are required to uphold, one example is to “always practice in line with the best available evidence”.

[15]
This impacted the way that I carried out hand hygiene because I ensured that the technique, decontaminating agent and moments for hand decontamination was carried out in accordance with evidence-based guidelines in St George’s hospital policies and hand washing posters. Another example within the code is to “Be aware of, and reduce as far as possible, any potential for harm associated with your practice”. In order to achieve this, I stuck to the recommended hand hygiene practices regarding the control and prevention of infection. In addition to this, the moments that I carried out hand hygiene acted in accordance with this value as I took “all reasonable personal precautions necessary to avoid any potential health risk to ~ people receiving care”.

[16]

St. George’s Healthcare NHS Trust has set out values in their ‘living our values’ policy which states that all staff members are required to “adhere to the hand hygiene policy”.

[17]
Furthermore, the hand hygiene policy states that all staff must “ensure effective prevention and control procedures are incorporated into their daily practice”

[18]

In this section, I will be acknowledging the way in which this experience has impacted my own practice, determine whether or not I will use the same approach and my professional approach of the skill. To begin with, I have come to the realisation that I was more confident to care for patients after I decontaminated my hands properly, this is because I felt more comfortable as I was not worried about cross contamination. Furthermore, from my experience I noticed that patients were more willing and comfortable to allow me to carry out care episodes if I decontaminated my hands in front of them.

From my experience, I believe that I will use the same approach in my next placement including, the same technique, when to use certain decontaminating agents and the moments for hand hygiene.  However, I will take into consideration additional aspects when carrying out this skill. For example, I will perform hand hygiene in front of patients. Another difference that I will make is to shorten the duration of washing my hands, this is based off of

NICE Journal of Hospital Infection (2014)

research suggested that different durations of hand washing did not significantly affect the reduction of bacterial presence.

[19]
Despite this, I will follow the

World Alliance for Patient Safety – (2009)

which states that decontamination through the use of ABHR should take 20-30 seconds and 40-60 seconds for handwashing.

[20]

Coming from a Muslim background, I believe hand hygiene to be significant as my religion reiterates cleanliness and hygiene. Having this religious belief allows me to be more open and willing to carry out hand hygiene accurately, whereas

Leventhal and Cameron


(1987), Seto (1995) and Naikoba and Hayward (2001)

study demonstrated that healthcare workers handwashing compliance rates equated to 12%.

[21]

To conclude, it is imperative that nurses maintain hand hygiene in order to prevent and control infection amongst patients, their families and healthcare workers. As discussed before, effective hand hygiene will decrease the amount of preventable Healthcare/Hospital Associated Infections (HCAI) and consequently an overall reduction in patient mortality, reiterating the importance of this skill. This assignment outlined the skill of hand hygiene, discussed the process of performing hand hygiene, why I performed this skill, the five points of hand hygiene, why this skill should be applied and my reflection upon the way in which this skill has informed my future practice.


Reference list


[1]
World Health Organisation (WHO) – Hand hygiene: Why, how and when? (06/2009)


[2]
NICE (2014)


[3]
H.P.LovedayaJ.A.WilsonaR.J.PrattaM.GolsorkhiaA.TingleaA.BakaJ.BrowneaJ.PrietobM.Wilcoxc – Journal of Hospital Infection, 2014


[4]
Mehdi Lead Nurse in Infection Control, 2011


[5]
Steere – Handwashing Practices for the Prevention of Nosocomial Infections 1975


[6]
Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force – Infect Control Hosp Epidemiol, 23 (Suppl. 12) (2002)


[7]
National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England – RJ Pratt, CM Pellowe, JA Wilson (2007)


[8]
Efficacy of soap and water and alcohol-based hand-rub preparations against live H1N1 influenza virus on the hands of human volunteers – ML Grayson, S Melvani, J Druce, et al (2009)


[9]
Outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit linked to artificial nails – A Gupta, P Della-Latta, B Todd, et al (2004)


[10]
Effects of 4 hand-drying methods for removing bacteria from washed hands: a randomized trial – Mayo Clin Proc (2000)


[11]
Efficiency of hand drying for removing bacteria from washed hands: comparison of paper towel drying with warm air drying – Infect Control Hosp Epidemiol, (2005)


[12]
National Clinical Guideline Centre

Infection: prevention and control of healthcare-associated infections in primary and community care: partial update of NICE Clinical Guideline 2. NICE Clinical Guidelines – Royal College of Physicians, London (2012)


[13]
The importance of nurses hand hygiene Maria Malliarou,  RN, BSc, MSc, PhD, Pavlos Sarafis, RN, BSc, MSc, PhD , Sofia Zyga, RN, BSc, MSc, PhD, Theodoros C Constantinidis, MD, PhD – (2013)


[14]
To Err Is Human – Institute of Medicine (2000)


[15]
Nursing and Midwifery code – (10/18)


[16]
Nursing and Midwifery code – (10/18)


[17]
St George’s Healthcare NHS Trust – Living our Values: Theatre standards (14)


[18]
ST George’s Healthcare NHS Trust – Hand Hygiene Policy (01/14)


[19]
NICE – National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England (2014)


[20]
World Alliance for Patient Safety. WHO guidelines on hand hygiene in health care 2009


[21]
Bischoff W., Reynolds T., Sessler C., Edmond M. & Wenzel R. (2000) Hand‐washing compliance by health care workers: impact of introducing an accessible, alcohol based hand antiseptic. Internal Medicine 160(7), 201–214.

Nurse Burnout Clinical Practice Discussion

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Nurse Burnout Clinical Practice Discussion




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I need to answer this discussions in a 200 words discussion from this PowerPoint link. You are all asked to make comments on another group’s project. This should be a lively discussion around the research process and the use of evidence to answer clinical questions. Be sure to include what you learned from the presentation and how it impacts clinical practice. I also encourage you all to ask questions of each other to gain a deeper understanding of the topic

Nurse Burnout Clinical Practice Discussion


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Nurse Burnout During a Pandemic Gaylene Galbreath Terria Jackson Manoucheka Louis Lidia Metayer Luz Rodriguez Chamberlain University School of Nursing Introduction Nurses working during a pandemic can cause nurse burnout. The photo (COVID-19 Frontline Health Worker) by UN Women/Pathumporn Thongking. 2020 (https://www.flickr.com/photos/unwomenasiapacific/49749364163/in/photostream/) (Mudallal, 2017) The photo (Nursing in a pandemic) by OSEI[]KOFI. 2020 (https://commons.wikimedia.org/wiki/File:Nursing_in_a_pandemic.jpg_) Influences on the Nursing Profession ● Negative consequences with mental health ● Increased anxiety disorders, posttraumatic stress disorder (PTSD). ● Increased risk for social isolation ● Increased risk for alcohol and tobacco abuse ● Increased sick leave (Sampaio, 2020) This photo of (Burnout Bullying Matches…) by Pixaby. 2017 (https://pixabay.com/vectors/burnout-bullying-matches-fire-2326686/) Identification of The Problem Two main problems that has occured because of a burnout are: ● The well-being of a nurse and their mental health ● The effects on patient care such as: – Medication errors – Patient dissatisfaction (Mudallal, 2017) Impact on Nursing Practice ● A burnout could cause a decrease in a nurses performance level – Minimal nurse and patient interactions – Medication errors could occur – Lack of motivation (Mudallal, 2017) Research Process ➢ Identifying main problem and impact on nursing practice ➢ CINHAL and Google Scholar database ➢ Analyzing and interpreting published research studies ➢ Following required guidelines for topic searched Research Process, Continued ➢ Strength/ Success ➢ Barriers encountered ➢ What is still needed Clinical Issue in Research •Adversity of Covid 19 burdened nurses socially, mentally, and physically. •Nurses presented with elevated stress levels, anxiety, and depression. •Besides, nurses’ depression, anxiety, and stress score (DASS) showed the standard deviation of 3.8, 4, and 4.5. •Also, the low quality and quantity of PPE further exacerbated the problem. •The research suggests an adjustment of the modifiable factors. (Sampaio, 2020) Validity •According to CIAP, the study has evidence at II. •However, using snowball sampling weaken the evidence. •Ethically, the researchers obtained permits from two universities. •And, abided by the 1964 Helsinki’s guideline. •Besides, all the authors are Ph.D. holders. •Therefore, the research is valid in statistical and clinical significance. Recommended Practice Change ● Nurse Burnout Clinical Practice Discussion
Hospitals should embark on the implementation of health and wellness support programs. ●Health and wellness programs will help offer the nurses space to vent and share their struggles of working in a pandemic. ●Increasing the number of healthcare workers ●The feasibility of increasing the number of healthcare workers may be low, given that even retired nurses have gone back to work due to the pandemic. Suggestions for Implementation ●Effective implementation of a program ensures that it has a high chance of success. ●Implementing health and wellness programs should start immediately, although all stakeholders should be in on it. ●After shifts, nurses should be able to get to the health and wellness support group whose meeting place will be within the hospital. ●Psychologists, therapists, and psychiatrists should be present to take care of the nurses’ mental health needs ●Although less feasible, the increasing patient-nurse ratio could be implemented by looking for student nurses and taking them on board. Conclusion In reality a burnout can impact the health of a nurse in many ways. For example, a nurse can have anxiety, an increased risk for social isolation, and increased numbers of call – outs from work. Research that was conducted has been devoted to the understanding of the factors that led to a burnout and the effects it places on individuals and their health. Nurses should integrate strategies that promotes adequate rest and time away from the job. By working with nursing leadership, nurses should have mandatory breaks while at work. The break would allow for the nurses to regroup and gather their thoughts. References Hofmeyer, A., Taylor, R., & Kennedy, K. (2020). Fostering compassion and reducing burnout: How can health system leaders respond in the Covid-19 pandemic and beyond? Nurse education today, 94, 104502. https://doi.org/10.1016/j.nedt.2020.104502 Mudallal, R. H., Othman, W. M., & Al Hassan, N. F. (2017). Nurses’ Burnout: The Influence of Leader Empowering Behaviors, Work Conditions, and Demographic Traits. Inquiry: a journal of medical care organization, provision, and financing, 54, 46958017724944. https://doi.org/10.1177/0046958017724944 References Continued Sampaio, F., Sequeira, C., & Teixeira, L. (2020). Nurses’ mental health during the Covid-19 outbreak: A cross-sectional study. Journal of occupational and environmental medicine, 62(10), 783-787. https://journals.lww.com/joem/Fulltext/2020/10000/Nurses Mental_Health_During_the_Covid_19.2.aspx COVID-19 Frontline Health Worker (2020). UN Woman/Pathumporn Thongking. https://www.flickr.com/photos/unwomenasiapacific/49749364163/in/photostream/ Nursing in a pandemic (2020). Wikimedia Common. https://commons.wikimedia.org/wiki/File:Nursing_in_a_pandemic.jpg Nurse Burnout During a Pandemic Gaylene Galbreath Terria Jackson Manoucheka Louis Lidia Metayer Luz Rodriguez Chamberlain University School of Nursing Introduction Nurses working during a pandemic can cause nurse burnout. The photo (COVID-19 Frontline Health Worker) by UN Women/Pathumporn Thongking. 2020 (https://www.flickr.com/photos/unwomenasiapacific/49749364163/in/photostream/) (Mudallal, 2017) The photo (Nursing in a pandemic) by OSEI[]KOFI. 2020 (https://commons.wikimedia.org/wiki/File:Nursing_in_a_pandemic.jpg_) Influences on the Nursing Profession ● Negative consequences with mental health ● Increased anxiety disorders, posttraumatic stress disorder (PTSD). ● Increased risk for social isolation ● Increased risk for alcohol and tobacco abuse ● Increased sick leave (Sampaio, 2020) This photo of (Burnout Bullying Matches…) by Pixaby. 2017 (https://pixabay.com/vectors/burnout-bullying-matches-fire-2326686/) Identification of The Problem Two main problems that has occured because of a burnout are: ● The well-being of a nurse and their mental health ● The effects on patient care such as: – Medication errors – Patient dissatisfaction (Mudallal, 2017) Impact on Nursing Practice ● A burnout could cause a decrease in a nurses performance level – Minimal nurse and patient interactions – Medication errors could occur – Lack of motivation (Mudallal, 2017) Research Process ➢ Identifying main problem and impact on nursing practice ➢ CINHAL and Google Scholar database ➢ Analyzing and interpreting published research studies ➢ Following required guidelines for topic searched Research Process, Continued ➢ Strength/ Success ➢ Barriers encountered ➢ What is still needed Clinical Issue in Research •Adversity of Covid 19 burdened nurses socially, mentally, and physically. •Nurses presented with elevated stress levels, anxiety, and depression. •Besides, nurses’ depression, anxiety, and stress score (DASS) showed the standard deviation of 3.8, 4, and 4.5. •Also, the low quality and quantity of PPE further exacerbated the problem. •The research suggests an adjustment of the modifiable factors. (Sampaio, 2020) Validity •According to CIAP, the study has evidence at II. •However, using snowball sampling weaken the evidence. •Ethically, the researchers obtained permits from two universities. •And, abided by the 1964 Helsinki’s guideline. •Besides, all the authors are Ph.D. holders. •Therefore, the research is valid in statistical and clinical significance. Recommended Practice Change ●Hospitals should embark on the implementation of health and wellness support programs. ●Health and wellness programs will help offer the nurses space to vent and share their struggles of working in a pandemic. ●Increasing the number of healthcare workers ●The feasibility of increasing the number of healthcare workers may be low, given that even retired nurses have gone back to work due to the pandemic. Suggestions for Implementation ●Effective implementation of a program ensures that it has a high chance of success. ●Implementing health and wellness programs should start immediately, although all stakeholders should be in on it. ●After shifts, nurses should be able to get to the health and wellness support group whose meeting place will be within the hospital. ●Psychologists, therapists, and psychiatrists should be present to take care of the nurses’ mental health needs ●Although less feasible, the increasing patient-nurse ratio could be implemented by looking for student nurses and taking them on board. Conclusion In reality a burnout can impact the health of a nurse in many ways. For example, a nurse can have anxiety, an increased risk for social isolation, and increased numbers of call – outs from work. Research that was conducted has been devoted to the understanding of the factors that led to a burnout and the effects it places on individuals and their health. Nurses should integrate strategies that promotes adequate rest and time away from the job. By working with nursing leadership, nurses should have mandatory breaks while at work. The break would allow for the nurses to regroup and gather their thoughts. References Hofmeyer, A., Taylor, R., & Kennedy, K. (2020). Fostering compassion and reducing burnout: How can health system leaders respond in the Covid-19 pandemic and beyond? Nurse education today, 94, 104502. https://doi.org/10.1016/j.nedt.2020.104502 Mudallal, R. H., Othman, W. M., & Al Hassan, N. F. (2017). Nurses’ Burnout: The Influence of Leader Empowering Behaviors, Work Conditions, and Demographic Traits. Inquiry: a journal of medical care organization, provision, and financing, 54, 46958017724944. https://doi.org/10.1177/0046958017724944 References Continued Sampaio, F., Sequeira, C., & Teixeira, L. (2020). Nurses’ mental health during the Covid-19 outbreak: A cross-sectional study. Journal of occupational and environmental medicine, 62(10), 783-787. https://journals.lww.com/joem/Fulltext/2020/10000/Nurses Mental_Health_During_the_Covid_19.2.aspx COVID-19 Frontline Health Worker (2020). UN Woman/Pathumporn Thongking. https://www.flickr.com/photos/unwomenasiapacific/49749364163/in/photostream/ Nursing in a pandemic (2020). Wikimedia Common. https://commons.wikimedia.org/wiki/File:Nursing_in_a_pandemic.jpg …

Nurse Burnout Clinical Practice Discussion

Risk Factors Schizophrenia

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The Effect of Perinatal Risk Factors on the Incidence of Schizophrenia

Background

Developing schizophrenia is dependent on different factors. A person who could possibly develop the illness later in life is faintly unusual in terms of cognitive skills, motor functioning, and social behavior as compared to his or her peers. This states that indicators exist as to whether a person will be vulnerable into being a schizophrenic later in life, as dictated by certain abnormalities that can be observed (Mortensen, 1999 and Dean, 2003).

Most of the causes being held accountable for the development of schizophrenia can be traced back to genetic or biological factors and environmental exposure that operated early in life of the individual (Dean, 2003, Khasshan, 2008, Mednick, 1970, and Mortenen, 1999).

Evidences regarding the effects of obstetric complications, prenatal illness, misuse of drugs, migration and travel, urbanization, and various life experiences on the onset of schizophrenia in later years in life have been noted. These were even incorporated and represented in causation models that encompass psychological, genetic, environmental, and social elements. These evidences can be used as models for clinical and research purposes of determining the risk of schizophrenia, as they cover a wide range of causative agents (Dalman, 1999 and Dean, 2003).

It has been a challenge for researchers to understand the cause of schizophrenia, the etiology of which has brought about several hypotheses (Dean, 2003). Different risk factors affect the incidence of the illness, two of which will be given more attention in this paper. A number of epidemiological studies have indicated an increased risk of developing schizophrenia among people who were exposed to maternal infections such as rubella virus and influenza virus in utero (Westergaard, 1999). Other studies have shown that children who were born during inclement weather have an increased risk of developing schizophrenia. These are supported by researches conducted on a population basis (Mortensen, 1999).

Purpose

As stated by the study conducted by Mortensen and others (1999), the location and the season of birth of an individual might be important in the development of schizophrenia. Aside from family history, these environmental factors can be associated with the onset of the disorder. Prevalence studies of Westergaard and others (1999) also showed that exposure to prenatal infections might be a factor in the development of schizophrenia later in life. There is, however, a poor evidence of a strong association between development of schizophrenia and exposure to influenza viral infection. This lead the group into determining whether or not prenatal exposure to rubella would indeed be a factor for schizophrenia development. This is in accordance with previous researches that rubella viral infection might be a significant cause for the illness. With all these research supports as foundation for a prospective study, this paper aims to give a sound explanation on how certain factors might affect the possible development of schizophrenia later in life. This study will focus on two possible causative agents as parameters.

The main purpose of this study is to determine if being born in severe weather, such as extreme hot or cold temperatures, or being exposed to the rubella virus in utero is linked to developing schizophrenia later in life.

Research Hypothesis

We hypothesized that there would be an increase in the incidence of early adult onset schizophrenia among those exposed to the rubella virus in utero and those born in winter months.

Literature Review

Several studies have been conducted on risk factors for schizophrenia. One study examined the outcome in 70 individuals whose mothers had rubella infections during pregnancy. Rubella is known to cause severe developmental problems in exposed fetuses. These individuals’ risk of having schizophrenia by the time they reached the mean age of 22 years was five times higher than normal

It has been proposed that environmental factors may also be important in determining risk for schizophrenia. A study done by Mortensen and others (1999) showed that the place and season of birth account for many more cases of schizophrenia than family history of the disease, and family history has been the best-established risk factor. The group’s study found out that the risk for schizophrenia was highest for births in February and March and lowest for births in August and September. Another study conducted by Mortensen and others (1999) concluded that schizophrenia was positively associated with birth in late winter.

On the other hand, Hultman and others (1999) emphasized the evidences shown by neuropathological researches that the aberrations caused by pathogen invasion disrupt proper brain development. This in turn contributes to the onset of schizophrenia that might even be developed earlier in life than expected. This proposed hypothesis can be associated with the link between obstetric complications and schizophrenia, as both are dependent on risks brought about by prenatal infections, which in turn are connected with neurodevelopment of an individual.

Theoretical Framework

The physiological framework of this study is based on the notion that conditions during pregnancy have an effect on the fetus’ psychological development, specifically, the impact of season of birth and exposure to the rubella virus.

The prenatal conditions of an individual have a direct effect on the person’s future genetic and phenotypic make-up. The most important contribution of the obstetric development lies on the possible alterations on the genes of the individual. Exposure to such abnormalities has a considerable intervention with the normal functioning of the brain (Khasshan, 2008). This means that exposure to infections such as rubella virus has a meaningful link to schizophrenia development of the individual exposed to the pathogen in its prenatal stage.

This is serves as one of the backbones of this study, as it is the foundational basis whether the link between congenital exposure to rubella and schizophrenia onset has reliable evidence.

After the study which dwells more on the biological or genetic factors, the study will consider the environmental elements that can also be potential risk factors for the disorder. It has been established that the over-all make-up of an individual lies on genetic and environmental factors. The second part or backbone of the study concerns the environmental exposure effects as dictated by season of birth. This can be of importance since extreme weathers might affect a mother psychologically and physically, thereby creating an impact on the life inside her womb. Being born on extreme hot and cold weather can hence be linked to the development of schizophrenia later in life of an individual (Mortensen and others, 1999).

Significance and Need for the Study

The proposed study is important due to the health and psychological concerns of schizophrenia. Being a disorder which affects the entire lifestyle of the affected individual, it is of great significance to research about the etiology of the disease (Dean, 2003).

Prenatal exposure to rubella viral infection might be a cause of the onset of schizophrenia, as well as the environmental effect of being born on an extreme season. Knowledge on these prenatal risk factors can contribute additional information on how to prevent schizophrenia development in an individual.

References:

Dean, K., Bramon, E., Murray, R., (2003). The cause of schizophrenia:neurodevelopment and other risk factors.

Journal of Psychiatric Practice.

9(6), 442-454.

Dalman, C., Allebeck, P., Cullberg, J., Grunewald, C., Koster, M. (1999). Obstretric complications and the risk of schizophrenia: A longitudinal study of a national birth cohort.

The Journal of the American Medical Association,

281,p. 2170.

Hultman, C.M., et al. (1999). Prenatal and perinatal risk factors for schizophrenia, affective psychosis, and reactive psychosis of early onset: case-control study.

British Medical Journal,

(318), p 421.

Khasshan, A., Abel, K., McNamee, R., Pedersen, M., Webb. Baker, P., et al. (2008). Higher Risk of Offspring Schizophrenia Following Antenatal Maternal Exposure to Severe Adverse Life Events.

Archives of General Psychiatry

, 66(2), 146-152.

Mednick, S. (1970). Breakdown in individual at high risk for schizophrenia: possible predispositional perinatal factors.

Mental Hygiene

, 54(1), 50-63.

Mortensen, P., Pedersen, C., Westergaad, T., Wohlfahrt, J., Ewald, H., et al. (1999). Effects of family history and place and season of birth on the risk of schizophrenia.

The Journal of the American Medical Association

, (281), p. 1254.

Ross, R. G., et al. (1996). Early expression of smooth-pursuit eye movement abnormalities in children of schizophrenic parents.

Journal


of the American Academy of Child and


Adolescent Psychiatry

, (35), p. 941.

Sorensen, H., Mortensen, E., Reinisch, J., Mednick, S. (2004). Association between prenatal exposure to analgesic and risk of schizophrenia,

British Journal of Psychiatry

, 185, 366-371.

Westergaard, T., Mortensen, P., Pedersen, C., Wohfahrt, J., Melbye, M. (1999). Exposure to prenatal and childhood infections and the risk of schizophrenia.

Archives of General Psychiatry

, (56), p. 993-998.

A numbered list of at least five propositions or assumption statements that clearly connect the concepts described.

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A numbered list of at least five propositions or assumption statements that clearly connect the concepts described.

      • List of Propositions: A numbered list of at least five propositions or assumption statements that clearly connect the concepts described.

        • A numbered list of at least five propositions or assumption statements that clearly connect the concepts described. A numbered list of at least five propositions or assumption statements that clearly connect the concepts described.

>>>>This part of the homework is connected to the previous work “Two Practice-Specific Concepts: Identification, discussion, and documentation from the literature of your perspective on at least two concepts specific to your own practice.”

he paper should be thoroughly researched and well documented, with relevant material from the nursing theorists presented incorporated into the paper. The current APA Manual is to be used throughout the paper. Sources should focus on references from nursing theory but may also include conceptual and theoretical material from other professional domains.

Please use the same references you used for the previous work.