Discuss the Factors That Contribute to the Unequal Access to Health Care and Escalation of the Health Care Cost, Making Specific Reference to Trinidad and Tobago. Suggest Recommendation That May Assist in Alleviating These Challenges

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Discuss the Factors That Contribute to the Unequal Access to Health Care and Escalation of the Health Care Cost, Making Specific Reference to Trinidad and Tobago. Suggest Recommendation That May Assist in Alleviating These Challenges

 

Introduction This essay focuses on the comparing and contrasting the functionalist, conflict and symbolic interaction perspective on the health care system in Trinidad and Tobago and its problems. Functionalists note that health is essential to the preservation of the human species and organized social life. One way societies contain the negative effects of health problems and disease is through institutionalizing illness in a sick role. Conflict theorists note that some people achieve better health than others because they have access to those resources that contribute to good health and recovery should they become ill. And finally, symbolic Interactionist theorists view sickness as a condition to which we attach socially devised meanings. For example, an increasing number of behaviors that earlier generations defined as immoral or sinful are coming to be seen as forms of sickness the medicalization of deviance. The ministry of health is in the business of promoting wellness and ensuring the availability of quality health care to the people of Trinidad and Tobago in an affordable, sustainable and equitable manner. Although some advances were made, problems and inadequacies in the delivery of health care persisted. In addition, the Health Sector Reform Programme was developed with the aim of decentralizing the health services. The government of Trinidad and Tobago takes into account the WHO definition of health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. (WHO, 1986). Health care therefore, is the prevention, treatment, and management of illness and the preservation of mental and physical well-being through the services offered by the medical and allied health professions. In an attempt to address the problems the government of Trinidad and Tobago via the ministry of health implemented, the plan to decentralize the health services which was cultivated by strengthening the policy-making, planning and management capacity of the health sector; Separating the provision of services from financing and regulatory responsibilities; Shifting public expenditures and influencing the redirection of private expenditures to high priority problems and cost-effective solutions; Establishing new administrative and employment structures, which encourage accountability, increase autonomy and appropriate incentives to improve productivity and efficiency; Educing preventable morbidity and mortality through promoting lifestyle changes and other social interventions. (Ministry of Health, 2000). Functionalism is based around a number of key concepts. Firstly, society is viewed as a system a collection of interdependent parts, with a tendency toward equilibrium. Secondly, there are functional requirements that must be met in a society for its survival (such as reproduction of the population). Thirdly, phenomena are seen to exist because they serve a function (Holmwood, 2005:87). Conflict Theory states that the society or organization functions so that each individual participant and its groups struggle to maximize their benefits, which inevitably contributes to social change such as changes in politics and revolutions. The essence of conflict theory is best epitomized by the classic ‘pyramid structure’ in which an elite dictates terms to the larger masses. All major institutions, laws, and traditions in the society are designed to support those who have traditionally been in power, or the groups that are perceived to be superior in the society according to this theory. This can also be expanded to include any society’s ‘morality’ and by extension their definition of deviance. Anything that challenges the control of the elite will likely be considered ‘deviant’ or ‘morally reprehensible.’ The theory can be applied on either the macro level (like the US government) or the micro level (a church organization or school club). Symbolic Interactionism: Herbert Blumer (1969),…; Introduction This essay focuses on the comparing and contrasting the functionalist, conflict and symbolic interaction perspective on the health care system in Trinidad and Tobago and its problems. Functionalists note that health is essential to the preservation of the human species and organized social life. One way societies contain the negative effects of health problems and disease is through institutionalizing illness in a sick role. Conflict theorists note that some people achieve better health than others because they have access to those resources that contribute to good health and recovery should they become ill. And finally, symbolic Interactionist theorists view sickness as a condition to which we attach socially devised meanings. For example, an increasing number of behaviors that earlier generations defined as immoral or sinful are coming to be seen as forms of sickness the medicalization of deviance. The ministry of health is in the business of promoting wellness and ensuring the availability of quality health care to the people of Trinidad and Tobago in an affordable, sustainable and equitable manner. Although some advances were made, problems and inadequacies in the delivery of health care persisted. In addition, the Health Sector Reform Programme was developed with the aim of decentralizing the health services. The government of Trinidad and Tobago takes into account the WHO definition of health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. (WHO, 1986). Health care therefore, is the prevention, treatment, and management of illness and the preservation of mental and physical well-being through the services offered by the medical and allied health professions. In an attempt to address the problems the government of Trinidad and Tobago via the ministry of health implemented, the plan to decentralize the health services which was cultivated by strengthening the policy-making, planning and management capacity of the health sector; Separating the provision of services from financing and regulatory responsibilities; Shifting public expenditures and influencing the redirection of private expenditures to high priority problems and cost-effective solutions; Establishing new administrative and employment structures, which encourage accountability, increase autonomy and appropriate incentives to improve productivity and efficiency; Educing preventable morbidity and mortality through promoting lifestyle changes and other social interventions. (Ministry of Health, 2000). Functionalism is based around a number of key concepts. Firstly, society is viewed as a system a collection of interdependent parts, with a tendency toward equilibrium. Secondly, there are functional requirements that must be met in a society for its survival (such as reproduction of the population). Thirdly, phenomena are seen to exist because they serve a function (Holmwood, 2005:87). Conflict Theory states that the society or organization functions so that each individual participant and its groups struggle to maximize their benefits, which inevitably contributes to social change such as changes in politics and revolutions. The essence of conflict theory is best epitomized by the classic ‘pyramid structure’ in which an elite dictates terms to the larger masses. All major institutions, laws, and traditions in the society are designed to support those who have traditionally been in power, or the groups that are perceived to be superior in the society according to this theory. This can also be expanded to include any society’s ‘morality’ and by extension their definition of deviance. Anything that challenges the control of the elite will likely be considered ‘deviant’ or ‘morally reprehensible.’ The theory can be applied on either the macro level (like the US government) or the micro level (a church organization or school club). Symbolic Interactionism: Herbert Blumer (1969),…

After reviewing your assessment of the organization’s approach to addressing recent health care legislation and related evaluation of the strategic response commonly employed, leadership has asked you to develop an in-depth analysis of the strengths, weaknesses, opportunities, and threats (SWOT) facing the organization that can be used to support strategic planning.

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After reviewing your assessment of the organization’s approach to addressing recent health care legislation and related evaluation of the strategic response commonly employed, leadership has asked you to develop an in-depth analysis of the strengths, weaknesses, opportunities, and threats (SWOT) facing the organization that can be used to support strategic planning.

Prepare a report of 5–7 pages with a minimum of 5 relevant scholarly or professional peer-reviewed references within the last 5 years that includes the following information:

Perform a formal SWOT analysis, and identify and explain at least 5–7 elements in each category: Strengths, Weaknesses, Opportunities and Threats.
Determine which stakeholder groups have the most influence on each of the elements identified in the formal SWOT analysis, and provide an explanation of the rationale to support your identification and how they impact the organization’s strategic plan.
Project the likely organizational and operational outcomes that are possible if changes are made based on the SWOT analysis, and provide an explanation of the rationale supporting your projections.
Predict the future viability of the organization if no changes are made based on the SWOT analysis, and provide an explanation of the rationale supporting your projections.
Formulate at least 5 strategic recommendations that the organization should consider pursuing to effectively compete in the health care marketplace.

Professional Boundaries for Nurse

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Professional Boundaries for Nurse

The Australian & Midwifery Council defines professional boundaries as limits which separate the therapeutic behaviour that could reduce the benefit of nursing care to patients, families and communities. The nurse need to be aware of the boundaries when providing therapeutic cares which is consumer centred to clients. When a therapeutic relationship is moved to establish into a friendship or social relationship then the professional boundaries are transgression. The relationship can turn into non-therapeutic and potentially harmful to both the nurse and client (Ruth,Katie&Debra, 2009). A boundary creates a sense of legitimate control in a relationship, where the nurse is responsible to set and maintain personal and professional boundaries by allowing safe therapeutic connection with clients. In this case, the nurse has breached the professional boundaries.

Teaching Plan for Patient Recovering from Surgery

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The primary focus of this paper is to create, implement, and review a teaching plan to be provided to a patient who has recently undergone surgery and subsequently entered the recovery phase. The patient subject of this paper, who will be referred to as ‘GW’, is a 48-year-old male who has recently undergone major spinal surgery; an anterior cervical disk fusion as well as a cervical vertebrectomy. Postoperative recovery is a multifaceted process, a major component of which is reaching a reasonable level of functionality. This teaching plan will emphasize recovery of mobility through physical therapy, coping mechanisms, and nurse interventions. This paper begins with the topic and why this particular plan was chosen for this patient, provide a detailed assessment of the patient’s situation and why education is needed, followed by the implementation and tools used to carry out the plan, and finally an evaluation of the plan after the fact.

Topic for educational need

For an adult to function in day-to-day life, mobility is a necessity. When mobility is compromised due to trauma, surgical or otherwise, day-to-day functionality suffers greatly. The patient, GW, is having a difficult time with his recovery after spinal surgery, both physically and emotionally, and if things don’t improve, activities of daily living such as walking to the kitchen to prepare a meal, bathing, or going to the store will be incredibly difficult tasks for GW upon discharge. That being said, recovering as much mobility as possible, as soon as possible, should be a primary focus of the patient and healthcare staff alike. When mobility is impaired during surgical recovery, staff should emphasize the importance of a progressive increase in movement, daily physical therapy, and coping methods for barriers that arise. Pain, hopelessness, alterations in self-image, and depression can be significant barriers to a return to functionality after surgery. GW has himself made statements regarding a lack of hope for the situation. Beliefs that he will again end up in the hospital soon after his discharge and that his recovery will be too long and difficult were expressed. The student nurse decided that education needed to take place in order to show the patient both the benefits from early, continued mobilization, and the negative effects of staying in bed. Deep vein thrombosis, pulmonary embolism, higher risk for falls, pneumonia, and longer hospital stays are all concerns that nurses should consider and educate patients on when they hear patients refusing to ambulate (Rebar, Ignatavicius, & Workman, 2017).

Assessment of patient

Upon first contact between GW and the student nurse, the student learned GW had been admitted to the hospital following a severe bout of pain, and was subsequently diagnosed with Degenerative Disk Disease, cervicalgia, upper right extremity radiculitis, and neck compression. GW had been suffering with chronic pain for some time and was using a single-point cane at home to ambulate, however, he began to experience increasingly potent symptoms that decreased his mobility further and forced him to switch to using a walker. After seeking help, GW underwent surgery; ACDF with vertebrectomy, which was aimed at alleviating his pain and increasing his mobility. The student nurse met with GW one day after surgery, where GW expressed to the student that while he was initially hopeful the surgery would help him, he felt it may not have helped him at all. The student nurse asked GW why he felt that way, to which he responded “I just keep ending up in here.” Based on these statements, it would seem that GW suffers from hopelessness and is having difficulty coping with his current state, both of which are significant barriers to recovery. During the first half of the day, GW worked with the staff and student to ambulate around the nurse’s station and made an effort to participate in his scheduled care. However, throughout second half of the day the student nurse observed GW becoming agitated with staff when asked to use an incentive spirometer, and again when encouraged to walk around the unit again, followed by isolating himself in his room while asking not to be disturbed. Because of the severity and recency of his surgery, GW may merely need time to properly cope with his situation, but time is short.

Method of implementation

For many recovering patients, the sooner they mobilize, the better. In the case of this patient, the student nurse strongly believes the teaching plan needed to be implemented immediately. A paper published by the Physician-Patient Alliance for Health and Safety stated that “given the well-documented positive effects on patient care, it makes sense that ambulation should be a clinical priority” (PPAHS, 2017). Ambulation and regaining mobility is not a “wait and see” part of recovery, it requires immediate action from the staff and patient alike. Participation and willingness from the patient are crucial, as even skilled staff cannot force recovery. In the case of GW, the student nurse felt that one of the best ways to reach the patient would be to start simply by conversing and build from there. The student nurse started by asking basic questions to identify barriers, past experiences, coping mechanisms used, and goals the patient could set for himself. Afterwards, the patient was willing to walk around the unit with the student and PT, making several trips around the nurse’s station. Upon returning to his room, and given some time to rest, the student nurse continued to speak with GW about his condition, and encouraged him to continue to ambulate as much as he could, with resting periods between, so long as his physician and primary nurse agreed.

Teaching tools

Beyond conversation and formulation of coping strategies, the student nurse believes that media, written information, and medical studies that the patient can relate to are all important tools. There has been extensive study into the effects of progressively increasing mobility soon after surgery and the benefits that come with it. There is no small number of online articles quoting or based on these studies, many of which contain advice from qualified physicians and physical therapists. Helping GW access and read through some of them may very well help educate him on the benefits of early mobilization, and detrimental effects of being sedentary after surgery. One such article states that “therapeutic exercise before and after surgery might augment the postoperative outcomes by improving functional status and reducing the complication and mortality rate” and “postoperative exercise should be initiated as soon as possible after surgery according to fast-track or enhanced recovery after surgery principles” (Hoogeboom, Dronkers, Hulzebos, & Meeteren, 2014).


Evaluation

Over the course of the teaching plan, several techniques were used in order to educate and see improvements in the patient’s overall understanding and willingness to work on the mobility aspect of his recovery. During a question-and-answer phase, the student nurse asked several questions in an effort to better get to know the patient’s feelings. The student nurse asked why GW felt the way he did, to which GW responded that he was “tired of coming back to the hospital” and that “if I’m just going to end up back here then I don’t know what the point of all this is.” The student nurse took this as an opportunity to explain how not partaking in physical activity at intervals recommended by the physician and ignoring components of recovery could easily prolong a hospital stay and quite possibly land someone back into the hospital soon after discharge from something such as a fall at home or deep vein thrombosis due to prolonged sitting. Next, the student nurse worked with the patient to identify coping strategies that he can use to provide outlets and respite from the difficult time ahead of him. Spending time with his wife, watching TV, going to a local sports bar with his friends to watch a game, and going to visit his daughter were all healthy opportunities to relieve stress and focus on something else. The student nurse also suggested simple breathing exercises, positive thinking, and rewards for progress as additional methods to cope. Finally, the student nurse asked GW for a verbal return demonstration of several of the things they had gone over that day. In the end, if this plan was to be revised, the inclusion of more teaching aids (i.e. brochures and prepared articles), a longer preparation time, and more time spent getting to know the patient would very likely be included. One of the largest hurdles when carrying out this plan was not knowing the patient well enough and, due to the limited amount of time, there wasn’t much of an opportunity to remedy this. The last thing the student nurse would consider changing is the level of patient involvement during the education phase. Because education is individualized, it would be beneficial to have the patient tell the student nurse what their most effective medium for learning is, be it visual, auditory, or physical. Strong positive reinforcement, educational information, teaching aids, and forming effective coping strategies are all part of effectively educating a patient for the good of their continued recovery.

References

  • Rebar, C., Ignatavicius, D., Workman, M. L. (2017).

    Medical-surgical nursing

    . [CoursePoint]. Retrieved from https://coursepoint.vitalsource.com/#/books/9780323461580/
  • PPAHS. (2017).

    Patient ambulation a key metric to improved health.

    Retrieved from http://www.ppahs.org/wp-content/uploads/2017/02/PPAHS-Patient-Ambulation-a-Key-Metric.pdf
  • Hoogeboom, T., Dronkers, J., Hulzebos, E., Meeteren, N. (2014).

    Merits of exercise therapy before and after major surgery

    . Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4072442/

Analyze the role of community/public health nursing and community partnerships as they apply to the participating family’s community.

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Analyze the role of community/public health nursing and community partnerships as they apply to the participating family’s community.

Signature Assignment: Community and Public Health Nursing Reflection

Complete a reflection of this week’s Community Assessment activity and the Week 2 Windshield Survey activity in which you:
Analyze the role of community/public health nursing and community partnerships as they apply to the participating family’s community.
Analyze the influence of cultural diversity and vulnerable populations as they apply to the participating family’s community.
Analyze the epidemiological influences within the participating family’s community in comparison to state-level data over the past five years.
Analyze at least three community nursing diagnoses that relate to the participating family’s community.( South Trenton NJ)
Select one Healthy People 2020 Leading Health Indicator (LHI) that relates to your participating family’s community( South Trenton NJ). Based on your selected LHI topic:
Analyze at least one nursing intervention for each diagnosis (identified above) that could have a positive effect on the community.
Analyze the health partnership(s) that could assist in implementing the nursing interventions in the community.
Create a plan for how nurses can advocate for the community, including how to involve the community in the change plan.
Include goals of the plan, actions that will be taken to reach goals, resources, and a timeline.
Include at least three peer-reviewed references (you may not use your course textbooks or Electronic Reserve Reading articles) to support your analyses.
Format your reflection according APA guidelines.
THE COMMUNITY BEING ANALYZED IS SOUTH TRENTON NJ. FAMILY MEMBER IS A SINGLE HISPANIC MOTHER OF A YOUNG BOY AGE 4

For this written assignment, select one recent (within the last two years) evidence-based article from a peer reviewed nursing journal that describes a “best practice” in an area of nursing you are interested in.

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Nursing pediatric care Description For this written assignment, select one recent (within the last two years) evidence-based article from a peer reviewed nursing journal that describes a “best practice” in an area of nursing you are interested in. For example, if you would like to be a pediatric nurse, select an article that discusses a best practice in pediatric care. Cite the article and provide a brief overview of how the results or findings were obtained. Then describe the “best practice.” Conclude your discussion by explaining whether you thought the research findings supported the conclusions and the best practice. This assignment must be no more than 3 pages long. It should include all of the required elements. Use APA Editorial format and attach a copy of the article.

Principles Of Infection Prevention And Control Catheter Associated Nursing Essay

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The evaluation and focus on the infection control among the hospitals has been under the monitoring of many Health Organizations and government. The issue on the infection prevention and control usually arise in the nursing practices and centers in the way on how they handle the patients. Eventually, aside from the needles or injections and hand contacts, the diseases and other infections can be transmitted or found to be associated with the urinary catheter. As identified by the Hong Kong Department of Health (2010), there should be preventive measures for the four major concerns – “surgical site infection, intravascular catheter associated with the bloodstream infection, ventilator-associated pneumonia and catheter-associated urinary tract infection”. To be familiar with the method, the urinary catheter is used to drain the bladder via the patient’s urethra. Due to the incapability of the patient to go to the bathroom that is most likely appeared after the operation, the method allows the patient to urine freely without messing the bed. However, this procedure is usually done by the clinicians or nurses to ensure that the catheter is held at place and will not fall or hurt the patient. Within this process, the infection is possible. As it believed, the infection can be prevented and controlled if there are standards that can be set in the nursing care of Hong Kong.

The purpose of the paper is to investigate the infection control based on urinary catheter and the associated nursing practices. In order to gather all the information, there are objectives that need to consider. First is to discuss the background of the case based on the clinical practice implemented in the settings. Second is to critically evaluate the nursing care dealing with the infection prevention and control particularly in Hong Kong through comparing the practices from those of the neighboring or developed countries like US. And third is to formulate the appropriate recommendation based on the investigation.

Background of the Case

The area of practice has been based on nursing care dealing to the principles of infection prevention and control. As working in acute female Urology ward, this will be realized through a critical evaluation of infection control on urinary catheterization found within Urology ward. In my work area, both clinical and emergency urology cases are found. Emergency cases include acute retention of urine, renal stone, acute pyelonephritis and heamaturia etc. Also there are cases that include renal stone, tumour of bladder, carcinoma of kidney, neurogenic bladder for operation etc. Therefore, insertion of urinary catheter is extremely common in my work area. Actually it is not a pure Urology ward. General surgical emergency and clinical cases, like abdominal pain, intestinal obstruction, gall stone, hernia, would be admitted to my ward. The ratio of nurse to patient is about 1:6 on week day and even 1:7 on weekend. This manpower distribution is very common in public hospital in Hong Kong. Hence, the workload in my work place is heavy. There is a need to comprehensively discuss infection control practices based on urinary catheter cases determining of best practices and recommendations from within Urology ward experience. Infection control effectiveness is essential in this evaluation to understand promptly the care for patients with urinary catheters.

Discussions

According to McConnell (2001), urinary tract infections (UTIs) account for 35% to 40% of nosocomial infections in the USA each year. In Hong Kong, as recorded in 2010, the situation with the central line-related bloodstream infection associated with the catheter and haemodialysis results in the 44.61% and is in fifth rank in the global health situation (Lam, 2010). Among the most common nosocomial infections in the elderly are UTIs caused by urinary catheterization. Saint and Lipsky (1999 cited in Madeo and Roodhouse 2009) estimates that 8.5-10.0% of all patients who have indwelling catheters develop catheter-associated urinary tract infection (CAUTI) and contributes to enhance morbidity and mortality. Glynn et al (1997 cited in Madeo and Roodhouse 2009) indicated that the overall rate of catheterization in acute care was 26.3%, with a range of 12-40% dependent on specialty. According to The Hospital Infection Society 2007 (cited in Madeo and Roodhouse 2009), there was recorded up to 31% of inpatients had a urinary catheter. Based on the study of Chow and his associates (2010), there are 65% among the 75 participants they studied in Hong Kong that had bacteraemia episodes due to catheter-related infection. This situation is considered as the major cause for the catheter loss, and has been associated with the morbidity and mortality among the haemodialysis patients (Chow, et al., 2010).

There is a suggestion that, since the use of urinary catheterization is very common; staff may develop “catheter apathy” by viewing the complications as a consequence of the procedure that is harmless, acceptable and easy to treat (Tew et al (2005 cited in Madeo and Roodhouse 2009). The management of urinary catheterization among the patients is monitored by the nurses (Chenoweth, 2010; Chow et. al., 2010). Therefore, I assume that the implementation of best practice encompassing infection prevention evidence will decrease associated risks and help to prevent serious complications such as blood stream infection.

Pomfret (2000) have asserted that urinary catheterization is a common procedure for both community and hospital patients, nurses make many of the decisions with regards to the catheter selection and the subsequent catheter care. The nurses can use the necessary information to help the patients to form their own decisions such as determining what type of catheterization that can be appropriate to their situation. Actually, there are two main types of catheter that can be used namely intermittent catheter and indwelling catheter. Intermittent catheter is where the catheter is temporarily inserted into the bladder and removed once the bladder is empty, while indwelling catheter, where the catheter remains in place for many weeks (Urinary Catheterization). In relation to all aspects of catheter care, it is recommended that nurses have a formal update for at least five years, and more often if appropriate or required to aid them in the type and size of catheters can be used among the patients. This is a recommended practice in order to gain competency in catheterization (RCN, 2008). This may lead in choosing the optimum catheter material and size that emphasizes towards the precise catheter care. In addition, Pomfret (2000) argued that without proper attention coming from the nurses and management there might be serious problems that are associated in catheterization.

Based on Doherty’s (2006) findings, the issues on the urinary catheter in connection with the nursing care should be kept in the priority of the clinical settings and have an infection control guideline. Although Doherty’s study is focused on the male catheterization, I admire the same principle that he promoted in the nursing environment. The same thing goes for the female ward that I’m working into and because of the concentration of the nursing practice in terms of the infection prevention and control; the nursing task will be more focus in providing the quality of health care.

The importance of nursing care responsibility is to provide the best and possible practices in order to follow infection control standards for catheterization. The safety precautions that nurses should need to know can be introduced to help them apply it in their performances. In general, the nursing idea promotes that the knowledge of catheterization and most embody the fundamentals of nursing practice primarily in prevention of the infection and through the control management. In addition, the professional nursing practice should be flexible at all times in order to provide the nursing care during the call of emergency. Based on my experience, the infection control practice should be firstly sought and introduced in the nursing practitioner and be part of the entire team to achieve the desirable outcome in the quality of health care.

As stated by the Hong Kong Department of Health (2010), there are four major infections that present in every health care setting. Therefore, the proper hand hygiene is one important infection prevention and control practice. Supervised hand hygiene can prevent the spread of infection as well as the use of personal protective equipment like gloves prior to the insertion and removal of catheter (RCN, 2008). This practice is essential to prevent transmission of infection due to urinary catheterization. In the nursing care area, the preventive actions should be administered to prevent the transmission of an infectious agent and include salient elements through transmission (Saint et al 2002). In the ward setting, catheter practices varies on the level of care given to the patient and with that fact, the risk in infection is high because of the lack of standard practices.

Creating the guidelines concern with the infection prevention and control is possible through the aid of the nursing professional’s catheter knowledge and the evidence-based practices (Pearson, et al., 2007). As the first step, the hand washing practice will provide opportunities for nursing care to be effective in the Urological practice in the ward particularly in placing an emphasis on the safety of the patients’ subject for the use of catheter. Through the simple hand washing technique, the infection prevention can be introduced while at the same time and the maximizing effects of nursing care in the female ward. If the practice applied, there would be a better control with the infection that is related in the catheter insertion or removal (Brown et al 2005).

There can be ample need to ensure that there is safe, effective and ethical infection prevention and control measurements and served it as an important component of nursing care. The hand washing and other prevention practice standards has been evidence-based and outline practice expectations for every nurses involved of specific roles and practice care setting. Infection control guide and standards provide a path to information, skill, decision and attitude that has been needed to the practice of safe urine catheterization (WHO, 2009). There describe what each nurse is accountable and responsible for in infection control practice. Public protection can be achieved when nurses practice according to the formulated standards that will work appropriately in their clinical environment. Knowledge of clinical infection control practices is continually growing and changing. While the principles of infection control do not change, specific clinical practices may evolve as a result of new evidence. For this reason, hand washing practice standard provide broad statements and does not include specific clinical practice information (Saint and Chenoweth 2003). Because of the benefits that can be gained in the hand hygiene, we can apply this to nursing practice and focusing on the catheterization nursing practice.

Truly, infection control is a vital form of quality management for urinary catheter application from wherein health care skills are well suited to addressing catheterization quantity issues thereunto. The infection prevention and control on urinary catheterization can allow effective base of catheter quality process upon focusing adverse event and assess function of prevention of the infection (Simmons and Kritchevsky, 2002). Through the continuous practice and monitoring, the compliance with policies and procedures can be ensure and help the nurses to provide infection control in the future problems. There can be examples of appropriate quality indicators that include percentage of the registered nurses hand washing compliance (US Department of Health 2003).

Critical Evaluation

Bad Practice in my work area

In my work place, shower bath is offered to bedridden patients, even patients with urinary catheter but twice a week only due to limited manpower. Poor personal hygiene may lead to urinary tract infection (Chenoweth, 2010), and as I have seen, many patients are suffering in the infection that caused by the catheter. Many bedridden patients are experiencing many health problems as well as sanitation which increase the chance of urinary tract infection, especially in female, and it is expected to increase if the proper perineal cleansing is not performed thoroughly.

It is a routine to empty drainage bag every 4 hours or whenever necessary. This procedure breaks the closed drainage system. Micro-organisms are present at the inlet and outlet tap, making the micro-organisms to enter the drainage system during opened. Apparently, in the current situation of the health care settings, this procedure is overlooked by the ward managers. However, if I suggested that the catheter should be changed more often, it will definitely cost the patient. Therefore, as a solution, the nurses should perform the task by wearing the gloves, doing the procedure within the fastest time, and if possible apply solutions to the inlet/outlet taps like hot water or concentrated alcohol to prevent the movement of the micro organisms. Maki and Tambyah (2001 cited in Madeo 2009) indicated that there are two recognized pathways through which bacteria can gain entry to the bladder of a catheterized patient: the periurethral pathway and the intra-luminal pathway. The periurethral pathway involves the migration of micro-organism into the bladder between the inner side of the urethral wall and the outside of the catheter. The intra-luminal route involves the upward movement of micro-organism inside the catheter drainage system as a result of contamination of the urinary drainage bag, either through the outflow tap or as a result of tubing disconnection. The intra-luminal pathway is thought to be the most common for bacterial entry (Madeo 2009).

In order to clean the perineal area during urinary catheterization and daily perineal swabbing is my ward practice; the 0.9% sodium chloride is recommended to clean the meatus during urinary catheterization, however there is no advantage in using any specific antiseptic solution as a cleansing agent (Madeo 2009). In addition to the study of Madeo (2009), Mucous membranes may be irritated by the use of antiseptic agents, making this painful for the patient. This espoused by the study of Wilson (2001) and concluded that antiseptic solutions present no additional benefit. In addition to the infection risks associated with urinary catheterization, patients can experience trauma and pain. Therefore, it is imperative that the procedure is done by competent and trained healthcare professionals (Madeo 2009). Although insertion of urinary catheter is done by professional registered / enrolled nurse in my work place, they might neglect the importance of aseptic technique. They might not follow protocol strictly or skip some key points such as the standard in cleaning the area in performing urinary catheter insertion when there is a heavy workload.

Minor staff (health care assistance) is lack of knowledge and experience to manage the urinary catheter, especially in cleaning the perineal area of the female patients. In my observation, health care assistances would not clamp the urinary catheter to prevent back flow of urine, when turning patients in bed because of the tendency that the position of the catheter might be affected. Pratt et al (2001) indicated that if downward flow of urine cannot be maintained, the tubing should be clamped for a short period till the correct drainage can be resumed. Occasionally, health care assistance would place the drainage bag above bladder level when the patient is sitting out of bed. But, the incorrect positioning of the drainage bag would assist the transfer of bacteria to the bladder. Therefore, bacteria could be transported distances of 0.9-1.2m in rising air bubbles, often generated when the tubing is kinked and column of urine is formed (Roberts et al 1965 cited in Wilson 2001).

Good practices in my work area

An observational study by Mulhall et al (1993 cited in Madeo 2009) revealed that disconnection of the urinary catheter and drainage bag happened in 11% of catheter care procedures, and that incorrect emptying of urinary bags was also a common problem. There was use of individual cleaned urinary collection container to avoid cross infection in my work area. Our staff uses 70% alcohol to swab the outlet of drainage bag before and after emptying urine bag. Pratt et al (2001 cited in Madeo 2009) stated that the drainage port should be cleaned with an alcohol swab and the urine drained into a single use receiver avoiding contact between the drainage outlet and the receiver. Then the tap should be cleaned with a new alcohol swab. Small bottles of alcohol based hand rub (pocket size) are distributed to every staff. Also, dispenser for alcohol-based hand rub is attached to the frame of each patient’s bed. Staff wear clean individual gloves to empty urinary collection bag for each patient and use alcohol based hand rub to disinfect their hands (if hands are not visibly soiled) after removing the gloves. Compared to handwashing, alcohol-based hand rub has been shown to be more effective in decreasing the number of viable bacteria and viruses on hands, require less time to use, cause less hand dryness and hand irritation with repeated use and can be made more accessible at the point of care (Boyce et al cited in Soule and Memish 2007). Boyce et al (cited in Soule and Memish 2007) also recommended to use an alcohol-bases hand rub for routinely decontaminating hands (if hands are not visibly soiled) in the following situations: before inserting indwelling urinary catheters, after contact with body fluids, mucus membranes, non-intact skin, and wound dressings if hands are not visibly soiled, after removing gloves. When the urinary bag is emptied, care should be taken to ensure that bacteria are not introduced on to the tap by contact with a contaminated receiver or container. Urinary containers should be decontaminated in a bedpan washer or autoclaved after each use (Wilson 2001). Urinary containers are routinely decontaminated in a bedpan washer between uses in my work area.

Giving of leaflets about prevention urinary catheter associated infection is routinely given to patient with urinary catheter. Staff would explain the skill of managing urinary catheter, e.g. avoid kinking, stretching and disconnection of catheter, proper positioning of urine bag. Also, video of managing urinary catheter would be shown to patients, in order to reinforce the importance of infection control. Roe (1990 cited in Wilson 2001) revealed that encouraging patients to care for their own urinary catheters can reduce the risk of cross infection in hospital. The long-term catheterized patients in the hospital can benefit from education on how to manage the catheter and decrease the risk of introducing bacteria. In my work place, nurses would further explain the skill of managing urinary catheter, e.g. avoid kinking, stretching and disconnection of catheter, proper positioning of urine bag.

Recommendations

Upon reviewing the nursing practices in my workplace, I firstly recommend in maintaining the level of awareness of the nurses in the infections and how can it be transferred. In this way, we can start to change the bad nursing practices while at the same time, strengthening the good practices. For better personal hygiene, provide shower bath for bedridden patients daily. Advise ambulatory patients to have bathing or shower every day in order to prevent the bacteria that might produce infection. In addition, empty drainage bag daily, or whenever necessary to minimizes micro-organism from entering the close drainage system. Empty the bag as infrequently as possible (Wilson 2001). It is advised to use saline or soap and water, instead of salvon, to clean the perineal area during catheterization and daily swabbing. Wilson (2001) suggested that it is impossible to remove the perineal flora thoroughly prior to the procedure, but the number of bacteria may be reduced by cleansing with saline, or soap and water.

Ideally, regular talk or seminar should be held to reinforce the importance of infection control and hand washing. Wong (cited in Abrutyn 2001) described that hospital personnel and others who take care of urinary catheter should be given periodic in-service training focusing on the correct techniques and potential complication of urinary catheterization. Education is an important factor for improving compliance with guidelines and prevention measures. All health care workers need to know about the risk of infection and the route of transmission of pathogens. There has to be regular audits for nurses and health care assistance on hand hygiene and urinary catheter insertion, e.g. every half year, should be carried out to ensure proper standard (Abrutyn 2001). Thus, posters focusing hand washing can be posted in ward to reinforce important of infection control. Regular infection control seminars are important to the health care assistances and the new comers.

Conclusion

Based on the evaluation on the nursing practice in the female ward, an assessment of bad and good practices has been made and created a great impact to future of the nursing practice. It is not enough to be aware of the infection related to the patient’s catheter, what we need is the application of the standards towards infection prevention and control. Through the recommendations presented, the nursing practice might gain its confidence again.

The patients have undergone immediate catheterization might acquire infection if not recognized and controlled properly. Therefore, the simple standards in managing and preventing the infection might be present in the overall catheterization process. Also, such risk factors as identified to be associated with infections and through the careful hand washing as a compliance of nurses in the care setting, there is an assurance that the role of nurses do not only denotes the quality of health care but also the function in promoting the safety and cleanliness.

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The Important of Healthy Eating

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What is the importance of healthy eating?

Depending on where you live, you might start your day with eating food first before doing an activity. Food is the most important thing in our lives besides water. Moreover, healthy eating means eating a variety of food that gives you the nutrients you need to maintain your health, feel good, and have energy. These nutrients include protein, carbohydrate, fat, water, vitamin, and minerals.


Nutrition

is important for everyone. Other than nutrition, metabolism is also related with healthy eating. Metabolism is an energy that is used to burn fat or calories you take everyday. Each of us has different types of metabolism; high metabolism or low metabolism. For people who are in high metabolism, they do not have worry about the amount of calories that they are taking. This is because, when we have high metabolism, the energy will burn the calories in our body fast. However, for a person that has low metabolism, they must worry about the total of calories that they are taking, if it doesn’t burn fast it will become fat in our body. When combined with being physically active and maintaining a healthy weight, eating well is an excellent way to help your body stay strong and healthy. However, many people do not care about the types, variety, and amounts of food they are taking every day. Nowadays, the population of people eating unhealthy food is more than people who are eating healthy food. The population is significantly different and increase from year to year. This statement proved by the summary of Consumer Food Service Market Research 2011 in Malaysia.

Recovering from the economic crisis in 2008-2009, Malaysians spent more on eating out in 2011. More customers were willing to pay for an expensive food, in full-service restaurants, café or fast food outlets. Customers did not mind paying for an irregular treat for themselves or their family members. Operators offered food in unusual parts of the day, food preparation to consumers who do not mind spending as a group (Market Research on Food Service, 2011). Based on this research, we know that many people in this state do not care too much about the health of food they are taking every day. Some of them are willing to buy fast food and

junk food

for their family, without thinking of the importance of health or the side effect that their family will face in the future.

Unhealthy Food

There is a lot of unhealthy food available. McDonald’s, KFC’s, Pizza Hut’s, Kenny Roger’s, and many more brands are becoming top choices for people who are hungry. Other than fast food restaurant, junk food, canned food or snacks may also be included in the unhealthy food category.

Unhealthy foods exist when consumers demand food that can be prepared in a short time. This is why many food restaurants exist today. Besides, eating unhealthy food style can happen when many people choose fast food as a main course when they are in a hurry. This style also still largely applied to community within key cities such as Kuala Lumpur, the Klang Valley area, Johor Bahru and main city in this country. Some of them have argued that, fast food is more convenient for people who have hectic lives. Even though, the global trend of an increasing number of consumers ordering take away food, most channels in Malaysia saw the opposite more when people were dining out instead of ordering take away. A combination of a few factors led to this phenomenon. Busier work schedules meant that consumers had less incentive to cook at home. Thus, they opted to eat out instead. Young people tend to spend more on eating out. Those who enter the workforce gain financial independence, and are willing to spend more on food at slightly higher priced on full service restaurants or cafeteria.

The great quantity of consumer food service outlets, which open early and have late closing hours in city centers, meant that consumers could choose different outlets in which to eat at special times of the day. However, people should be aware when taking fast food. This is because, fast food or even junk food contains many preservative ingredients. Such as, MSG, more salt content, more Sugar content, food additives and fat content. The preservative used to maintain the shelf life of the product. So, either it is live to eat or eat to live? We are decided what we want to eat today. These trends were incorrect because many people do not know what types of food that they are taking. The nutrient inside fast food is not enough for human nutrition. People should take nutrient based on what they need and not eating food based on what they want. The situation makes people enjoy their eating life style without thinking the effect on their future.

Furthermore, life today is not like how it was before. Along time ago, people ate foods that were pasture with balanced quantity of nutrient value. Not with chemicals, preservatives, artificial colors and flavors which are known as Fast foods. Year ago, woman do not work outside, but they only just stay at home and prepared a food to their family. Today, many women choose to work outside to help their husband support their family finances. Based on this situation, many teenagers or children learn to eat outside when their parents do not have enough time to prepare a food for them. Therefore, this is how these trends may be happen. A large amount of people who eat junk food more frequently do not know it has a bad affect on their body, which can be avoided if they use more healthy alternatives. Hence, there are many reasons to try to make healthier choices. Eating junk food as a primary method of sustenance will lead to diseases and illness because your body is being deprived from its needed nutrients. While, by eating well you are strengthening your body and giving it proper nutrients to defend it in a time of infection we are supposedly not get to postpone hunger because our stomach is always worked to process food into our bodies in order to produce energy.

In our life, health is the most important thing. Eating also related to our body, when we are eating well, the rate of our health is also well balanced. That is how healthy eating plays a role in our lives. Furthermore, diseases likes

obesity

, diabetes, hypertension, cancer and other chronic diseases are highly related to fast food and junk food. It has more calories on average per meal than healthy food does, leading to greater weight gain and illness. Several people have a problem that they do not want to face, which is weight gain. Especially women, they do not want their body out of shape, which can be issue when they meet up with their friends. It is important to watch carefully what you eat, particularly at fast food restaurants or either ordering junk food while you are in hurry. Therefore, knowing the nutritional content of food that we are taking is very important. Healthy foods such as fruits, vegetables, whole grain, lean meat and fish, provides a balanced amount of nutrients. They are by definition nutrient rich with vitamins, minerals and fiber that benefit our body. Eating a balance of foods that contain full nutrients such as, carbohydrate, protein and fat every day will help keep your blood glucose to normal. We also need to try to balance the need for nutrition and calories each day. The healthy eating is required in order to build and repair cells and body tissues.

In addition, both unhealthy and healthy foods are reassembling in preparation time and they have a like rate. Nevertheless, we must observe it on nutrient content on food that we are taking. For junk food, it contains less or sometimes no proteins, vitamins and fiber. This is different from healthy food, that contains high proteins, high vitamins contain and fiber. Healthy food is very important to have a good life and better communication for many reasons. First, for those who eat healthy food, they have capability to do hard work. Second, if a person eats food that contains vitamins, proteins, iron and other important nutrients, he/she will be free from diseases, and can enjoy their lives. Moreover, everyone definitely likes to meet those who have a good health, so a person who is healthy, he/she have friends. For example, a person who looks weak and does not live healthy lifestyle will feel lonely, and they will not happy. Therefore, if you want good looking, clever mind and make friends, you should eat healthy. A good mind can be developing if people eat healthy food, and this necessary for children. Besides having a good life and communication for people at any age, healthy food is the perfect kind of food for children in many ways. It is necessary for proper growth and development during childhood. Parents can offer a wide variety of nutrients to make sure that their kids get what they need to be equal with every physical level of their life. Otherwise, children who are healthy eating with balanced food are less likely to suffer from harmful diseases such as over fitness or obesity.

In Malaysia, there is a general survey carried out with the specific purpose to decide the prevalence of overweight and obesity amongst children and adolescents. However, several less significant scale studies have been reported (J., 1996). The reported an occurrence of 8% overweight between primary schoolchildren in Selangor (Ismail & Tan, 1998). The report show that an obesity commonness of 6.6% among 7-year-olds while 13.8% prevalence was children who are in 10-year-olds (Fatimah et al., 2001). About 8.7% fatness in children residing in Kuala Lumpur as compared to 5.7% in Kota Bahru. In a recent survey of 11,500 schoolchildren aged among 6-12 years from four regions in Peninsular Malaysia, revealed a commonness of 6% obesity in both sexes with small differences between urban and rural children (Ismail et al. 2003). Among 5,995 kids aged 7 to 10 years in all primary schools in Kuala Lumpur reported a commonness of overweight of 9.7% among boys and 7.1% among girls,(WHO 1995). In marked gap, the other reported a prevalence of less than 2% among 3,000 rural children (Khor & Tee, 1997). It should be note, however, that all the above studies were report using different cut-offs / criterion for significant overweight. The end result not strictly similar a more recent survey carried out among young people of both sexes aged 12 to 17 years in four region of Peninsular Malaysia and the Miri region of Sarawak report 19% of overweight using the,(WHO, 1995) BMI-for-age cut-off of above 85th percentile (Poh et al. 2004).

Conclusion

Finally, as a conclusion, good nutrition is essential for good health and eating nutritional food can help prevent common ailments, as well as more life threatening illness and diseases. Medical scientists now believe that a third of all cancers and most cases of heart disease are related to poor diet balance. There are many advantages of healthy eating compared to eating fast food or junk food. As a consumer, we must decide which types of food we need to take. Therefore, we are recommended refer to the food pyramid when we are setting up our meals. Make sure that food that we are taking enough of nutrients contain like vitamin, fiber, carbohydrate, water and others. Even we are in hurry, we must remember that fast food might contain lot of food additives, preservative and more contents of salt and sugar, which is can make our healthy level decrease. We also may become sick and not happier than our life before. So, watch out when taking unhealthy food than healthy food. Parents also play an important role for their children, they must being observe when they are children taking a food. For a better way, parent should cook for their children if they have time. Children may also involve in getting diseases such as obesity and gain weight. It is important for parents to watch carefully what your children eat for proper growth through their childhood lifestyle. Other than that, parents should not teach their children eat fast food when they are outing. Lastly, why did not we choose eat fruits such as banana or an apple instead of eating and drinking can drink or potato crisp. For that reason, in our life we must always remember that healthy eating is important in our life. This fact related with what an Indian-born American physician and writer say, ‘Life is like a tree, and its root is consciousness. Therefore, once we tend the root, the tree as a whole will be healthy’. (Deepak Chopra, 1977)

Psychiatric Nursing Care Plan and Process Recording

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Psychiatric Nursing Care Plan and Process Recording

use documents and just fill them in.
This is for a Psychiatric Nursing

DSM V Psychiatric Diagnosis:

Social Issues or Current Stressors:

Client’s understanding of the reason for hospitalization (Client’s words from interview or chart):

What precipitated the current hospitalization? (From the medical record)

List all prior psychiatric treatments and/or hospitalizations:

List what you consider to be the client’s current problems or needs in order of priority.

Description of the client (age, gender, physical appearance, and diagnosis)

Description of student’s stage of relationship with the client (prior interactions, developing trust, etc.)

Goals for the interaction (at least two). What you hope will occur for the patient as result.
1.

2.

• BE SURE TO COMPLETE THE SELF-ANALYSIS AFTER THE PATIENT INTERACTION. (See last page of this assignment)
NURSE: Actual verbal and non-verbal communication CLIENT: Actual verbal and non-verbal communication INTROSPECTION
Student’s personal thoughts and feelings
ANALYSIS
1. Name of communication technique used
2. Is it therapeutic or non-therapeutic?
3. Was it effective? Why or why not?

1.

2.

3.

1.

2.

3.

4.

NURSE: Actual verbal and non-verbal communication CLIENT: Actual verbal and non-verbal communication INTROSPECTION
Student’s personal thoughts and feelings
ANALYSIS
1. Name of communication technique used
2. Is it therapeutic or non-therapeutic?
3. Was it effective? Why or why not?

1.

2.

3.

1.

2.

3.

Mental Status Examination
Mental Status From admission Psychiatric Assessment on ____________ (Provide date of initial assessment) Student assessment on ______ (Date)
Appearance – Describe overall impression, posture, clothes, grooming, apparent age
Motor Activity – Note mannerisms, gestures, combative, rigid, twitching, psychomotor retardation, alert, lethargic
Orientation – Ask name, where they are, the date, why they are here (person, place, time, situation)
Speech – Describe rate (rapid, pressured, slow), tone (soft, angry) volume, articulation (clear, slurred), language (aphasia); unusual style (rhyming, neologisms)
General Attitude – Note if cooperative, hostile, defensive, seductive, evasive, ingratiating
Mood – Ask “How would you describe your mood right now?”(emotional state: sad, happy, depressed, elated, anxious)
Affect – Describe apparent emotional state (sad, happy, full or restricted, flat, labile, appropriate or inappropriate)
Attention – Describe ability to concentrate and stay focused on the interview and answer questions; ask to spell WORLD backwards

Memory – Tell client you want to test memory: name 3 unrelated objects and ask the client to repeat them back (immediate memory); after 5 minutes, ask the client to again name the 3 objects (recent memory); remote (ability to recall early personal history)
Form of thought – Describe if thoughts are circumstantial, flight ideas, evasiveness, loosening associations, perseveration, blocking, etc.
Content of thoughts, suicidal or homicidal ideation – Note any preoccupations, phobias, obsessions, rituals. Ask if having thoughts that someone is trying to hurt them, or that people are against them, or talking about them; do they think they have special powers or abilities? Ask directly about thoughts to hurt self or others and, if yes, ask about a plan.
Perceptions – Ask if see or hear things that others do not see or hear; misperceptions, illusions, hallucinations.
Judgment – Ask what would do if found a sealed envelope that was addressed and stamped; or what would do if someone yelled “Fire” in a movie theatre

Insight – Ask how they think being in the hospital will be helpful, or what do they expect to gain from being in the hospital (ability to understand illness)
Intellectual Functioning- Fund of knowledge: Ask the client to name 5 countries in Europe; or name 5 cities in the U.S. Abstract thinking: Ask meaning of proverb: “People in glass houses shouldn’t throw stones”; or “How are an apple and a peach similar?”

Current Medications (Copy this page for each medication)
Medication, Classification, Dosage Action and target symptoms Nursing implications for assessment, observation and client teaching
Generic name

creation of a colostomy

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The client who has undergone creation of a colostomy has a nursing diagnosis of Disturbed body image.

The nurse would evaluate that the client is making the most significant progress toward identified goals if the client:
The client who has undergone creation of a colostomy has a nursing diagnosis of Disturbed body image. The nurse would evaluate that the client is making the most significant progress toward identified goals if the client:

1. Watches the nurse empty the colostomy bag
2. Looks at the ostomy site
3. Reads the ostomy product literature
4. Practices cutting the ostomy appliance