Pharmacology and the Prevention of Medication Errors

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INTRODUCTION

For many patients, the disturbing part of being in the hospital has to do with relying on other people for your care and what treatment you are given. The medications that are given are a significant part of this fear. I can only envision what it must be like for patients to have an unfamiliar person come in and start managing the drugs that are given. What would be particularly frightening could be the adverse reactions triggered by taking them.

It is very realistic that a patient might have a fear of experiencing adverse side effects from a medication. A large number of Americans die needlessly each year due to medication errors. This should drive the desire of every healthcare professional to prevent medication errors from happening. Let us examine some of the problems and trends that exist in medication errors and how to help eliminate them.

THE IMPORTANCE OF PREVENTING MEDICATION ERRORS IN HEALTHCARE

Medication errors occur when the healthcare professional, patient, or the consumer makes a mistake. “Adverse drug events (ADEs) account for more than 3.5 million physician office visits and 1 million emergency department visits each year” (Silva & Krishnamurthy, 2016). The reporting of medication errors is vastly understated.

Healthcare professionals have a professional and legal responsibility to make sure that the patient is receiving the right medication and dose every time that a medication is given. Nurses, in particular, are required to assess a patient’s necessity for a drug, evaluate the response to it and then manage it safely and correctly.

SAFETY AND QUALITY ISSUES INVOLVED IN MEDICATION ADMINISTRATION

A nurse has spent many years in training, learning and understanding the role of medication to help and assist a patient in a safe environment. The patient has faith and trust that the medication that they will be taking is going to do them well and not harm.

Some of the most common errors occur because prescriptions are not legible, drug names get confused, there are drug interactions, and when there is poorly written documentation. When a nurse receives, a poorly written prescription it can cause serious injury because the wrong drug amount or name of the drug is given.

Another big problem that occurs in the nursing field today is that most nurses have poor concentrations due to their workload. If time allows they can call back the doctor to clarify an illegible order, versus arriving at their own assumptions. In addition, during the rush of the day healthcare professionals can make medication errors by misplacing decimal points and misreading zeros.

Effective communication can affect the patient’s safety, for example, poorly communicated side effects for a certain medication can cause patient harm. Good effective communication can help prevent injuries, medication errors, delays in treatment, perinatal deaths, wrong site surgery, and patient falls (Nursing that works newsletter, 2007).

The pharmacy is another place where medication errors occur. These errors mainly are a result of overstressed and overworked pharmacists. The number of medications that Americans are taking has increased drastically and our pharmacies are not able to keep up with the demand. The problem of pharmacy errors is only going to continue to get worse and worse as the number of prescriptions that are being written increases and pharmacists are asked to continue to work longer hours and at a faster pace. Pharmacists are making errors in filling the prescriptions due to exhaustion like many in the healthcare profession.

CONTINUOUS QUALITY IMPROVEMENT IN MEDICATION SAFETY

It is important that healthcare professionals and healthcare organizations continue to improve medication safety through continuous quality improvement program and initiatives. Quality improvement programs that concentrate on medication safety management and recognizing medication safety dangers and prevention of medication miscalculations. Healthcare organizations need to continue to have medication error reporting systems and the presence of safety protocols for specific medications. Programs that are successful in reducing the number of medication errors need to publish the results so that the healthcare community can use those programs and strategies in their organization. It would make sense that a centralized organization be established that could be tasked with creating and overseeing safety programs to help reduce medication-related errors.

At a minimum, the following components of continuous quality improvement programs need to be in place at all healthcare organizations. They should be required to maintain adequate health professionals on staff including pharmacists and nurses. They need to improve workflow and work patterns, adopt medication reconciliation strategies that are effective, use proper and effective technology systems, and cultivate a culture of accountability that would also value quality improvement.

TOOLS IN TECHNOLOGY TO PREVENT MEDICATION ERRORS

A number of new and emerging technologies are in use today that can help to prevent medication errors. I have noticed that there are still some doctor orders that are handwritten. Consequently, these handwritten prescriptions can be very hard to read, much less correctly deciphered into suitable medication doses. Electronically transmitting every medication prescriptions to the pharmacy would greatly reduce a large part of the problems associated with poorly written prescriptions.

Computers, Wi-Fi, the internet have continued to develop and all prescription orders need to take advantage of this medium. With the growth of wireless networks and mobile platforms, such as the IPAD, healthcare professional could order all prescriptions readily and efficiently. Prescriptions electronically transmitted reduce errors and give the healthcare professional one more stratagem to reduce medication errors. The proper and effective use of electronic devices can greatly reduce the number of errors made.

In addition to these efforts, there are new and emerging technologies that are being developed and worked on to help reduce the number of medication errors. There are automated dispensing machines that automatically dispense the correct drug and dose. In addition, barcoding is being introduced that can also help to eliminate handwritten issues and translation prescription-related errors. Computerized medication administration records can synchronize data throughout an organization and help properly record and then to track any missed prescriptions. If an organization interfaces the pharmacy, the computerized prescriber order entry system, and the admission system then all of the information is accessible by all personnel.

HEALTHCARE TEAM COLLABORATION AND COMMUNICATION

It takes a lot of collaboration and interaction between healthcare professionals to care for a patient. When healthcare professionals are not communicating properly, patient safety is at stake. Some of the problems that arise are missing information, misinterpretation of information, or overlooking a change in the patient status. The lack of communication can cause server harm and injury to a patient.

Effective teams and teamwork is a result of collaboration, trust, and respect. There must be proper communication between all members of the team in order for medication errors to be minimized and eliminated. An effective approach to a patient’s care involves each member of the team working together to achieve an overall care plan for the patient.

Good communication will always encourage teamwork and help to prevent medication errors. Proper communication along with technological improvements can lay the groundwork for there to be a more effective clinical practice. Hospitals and healthcare organizations need to provide training programs that will help to encourage and teach healthcare professionals how to have effective communication and collaboration. By addressing this issue, healthcare organizations have a chance to improve team collaboration and communication and improve patient safety and care.

WHAT DOES NURSING LITERATURE SAY ABOUT THE MEDICATION ERRORS

Research has indicated that interruptions to the administration of medications are the number one cause of medication errors (Pelegrin, 2018). A nurse can be interrupted a number of times during their routines of medication administration. It is important that a nurse learn how to handle distractions in a way that the quality of care for the patient is not undermined. A better understanding of how disruptions in a nurse’s daily work schedule can affect their medical decision-making. Technology can play an important role in helping to reduce the number of interruptions that a nurse experience, by enhancing communication, tools, and workload. Also understanding why disturbances happen will also lead to creating effective strategies to help the healthcare professional manage disruptions and then reduce the number of medication errors.

IMPORTANCE OF MEDICATION ERRORS TO NURSING PROFESSION

Nurses spend a large part of their time distributing medications. Precise and safe medication administration rest on a nurses’ understanding of each drug, making appropriate judgments when required, and critical thinking skills. Nurses have a critical role in distributing medicines to patients by following the six rights of drug administration. These six rights are Right medication, Right route, Right time, Right patient, Right dosage, and Right documentation. Following these six rights can help to eliminate medication error. Nurses are the last line of defense in the healthcare field that can help avoid medication errors so they need to be able to perform this task without any interruptions. It is important to take the time required to guarantee patient safety and to diminish interruptions throughout the process.

CONCLUSION

One of the primary goals of the healthcare industry should be to reduce the number of medication errors and improve patient safety. In the fast-paced healthcare setting, distributing medications is a high-risk task. Medication errors can occur during any phase of the medication distribution process. Technology is one of the main tools that can be used today to improve overall patient care, safety, and patient outcomes. It is important that health care organizations continue to have a quality improvement in the overall administration of medications. Communication and team collaboration are important factors in the reduction of medication errors. More research is required concerning the role of technology in the administration of medication and the role that disruptions can have with the distribution of medications.

References

  • Brianna A. da Silva & Mahesh Krishnamurthy (2016) The alarming reality of medication error: a patient case and review of Pennsylvania and National data, Journal of Community Hospital Internal Medicine Perspectives, 6:4, Retrieved from https://doi.org/10.3402/jchimp.v6.31758
  • Friesen, M. A. Hughes, R. G. Zorn, M. (2007). Nursing that works newsletter.

    Communication:


    Patient Safety and the Nursing Work Environment,

    13, 11-12. Retrieved from http://web.a.ebscohost.com.bakerezproxy.palnet.info/ehost/pdfviewer/pdfviewer?vid=4&sid=6188af0e-dfae-4852-a9ba-d4f8d021002f%40sessionmgr4006
  • Hayes, C., Jackson, D., Davidson, P. M., & Power, T. (2015, November 09). Medication errors in hospitals: A literature review of disruptions to nursing practice during medication administration. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1111/jocn.12944
  • O’Daniel M, Rosenstein AH. Professional Communication and Team Collaboration. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 33. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2637/
  • Pelegrin, G. (2018). Medication Errors in Hospitals: An Analysis. [online] Pharmacytimes.com. Available at: https://www.pharmacytimes.com/publications/issue/2004/2004-10/2004-10-4616 [Accessed 10 Oct. 2018].

Elective Induction of Labor

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Labor induction has become increasingly more popular in recent years. In 1990, 9.6% of mothers chose to induce their labor, and the number of induced labors peaked in 2010 when 23.8% of mother’s chose to induce their labor (Kriebs, 2015). Families and healthcare professionals can choose to induce labor for a variety of reasons. A woman may choose to induce labor to better accommodate the family’s needs, for example, or a doctor may induce labor to manage a mother or a baby’s severe health conditions. This paper will evaluate the position statement from The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) regarding the induction of labor.

The induction of labor is the use of pharmacologic and/or mechanical methods to initiate labor (as cited in AWHONN, 2019), but one cannot look at labor induction without also considering the complexities associated with labor and fetal development. The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) advocates against elective labor prior to 39 weeks gestation (as cited in AWHONN, 2019).  After 39 weeks gestation, however, the AWHONN notes that women are able and encouraged to make well informed decisions about the induction of labor, but only after they understand the process of induction, the risks and benefits associated with the methods used to induce labor, the available alternatives to induction, and the risks and benefits of allowing labor to progress spontaneously (AWHONN, 2019). Labor, after all, is a complex event with many possible complications, and the possibility of complications is only exacerbated when the mother is not adequately informed or when the individual labor is not adequately evaluated. It is important to inform the mother, for example, that the elective induction of labor can have harmful effects on both the mother and the newborn. A child requires 40 weeks gestation to be fully developed and equipped to survive, and when the family elects to induce labor before 40 weeks gestation, the child may not be fully developed and ready to be born. Since a nurse is a patient’s advocate, it is important to consider a nurse’s role in supporting and informing a mother as she decides whether she ought to electively induce labor. The nurse certainly supports the mother in her decision, but it is essential that the nurse also inform the mother of the potential complications she and her child may experience.

This topic is relatable to pregnant mothers due to its rapidly increasing popularity. The rate of inductions has more than doubled in frequency since 1990 (as cited in AWOHNN, 2019). The frequency of inductions has increased due to medical advancements that have increased medically necessary inductions, but inductions have also become more popular for elective reasons. Medical indications for an induction of labor include various medical conditions the mother or fetus may possess. Conditions such as preeclampsia, gestational hypertension, comorbidities, and cardiac conditions are among the conditions that may require doctors to induce labor (Kriebs, 2015).  Elective induction of labor occurs after 39 weeks of labor and includes reasons such as a doctor being out of town on the due date, a family’s ability to be in town at a certain date, or even the planning of maternity leave around one’s work schedule (Kriebs, 2015). Medically indicated inductions are done for the safety of the mother and the baby; elective inductions are completed mainly out of convenience for the mother, child, and family.  AWHONN supports medically induced labors at any point when a healthcare professional feels an induction is the best solution to a health problem (2019). The AWHONN position statement specifically relates to the elective decision a family makes to induce the mother before her term date. Overall, there is a vast increase in the popularity of inductions, and it is a point of discussion in a significant number of pregnancies.

While it is important to consider the recent increase in induced labor and the variety of factors that have caused its increase, one cannot adequately consider the trends and the accuracy of the position statement from The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) regarding the induction of labor without also considering patient safety. Jan Kriebs notes that, “labor induction should only be undertaken when there are specific indications for interrupting the moral processes of pregnancy” (Kriebs, 2015, p 130). Indications for the induction of labor can relate to maternal, fetal, and placental complications (Kriebs, 2015). The discovery that inducing labor prematurely was correlated with adverse pregnancy outcomes lead  to a slight decrease in inductions among women, particularly in non-Hispanic white women between the ages of 20 and 39 (Kriebs, 2015). The Joint Commission subsequently introduced a Core Performance Measure that addressed the induction of labor prior to 39 weeks, which played a significant role in this decline (Kriebs, 2015).

Clearly, then, informing mothers of the potential consequences of prematurely inducing labor is essential in decreasing the number of negative outcomes for the baby and the mother. Kriebs notes that it is very important for women and their families to know clear and precise information about early delivery and to be engaged and informed on the need for prenatal education (Kriebs, 2015). Kriebs notes, for example, that “A survey found that 24% of women considered 34 to 36 weeks to be full term, and more than 50% believed it was safe to deliver a baby at that gestation” (Kriebs, 2015, p. 132). That is not accurate, and the adverse consequences of that misinformation can easily be avoided by simply providing mothers with accurate and comprehensive information.  A fetus that has only had 34 to 36 weeks to develop simply is not as developmentally ready to survive outside of the womb as a fetus who has had 40 weeks to develop. Childbirth education classes also reduced the incidence of early induction as well, for they inform parents about fetal development and the potential complications a mother and newborn might endure by having a premature child (Kriebs, 2015).

Education is certainly helpful and educational initiatives have been effective in decreasing premature inductions, but many institutional safety initiatives have also been shown to decrease the incidence of labor inductions. Institutions are responsible for having clear protocols for the indications of induction of labor, the dose, the route of administration, and the timing of doses for any medication they use to induce a mother (Kriebs, 2015). Just as a parent’s prenatal education is important, the education the healthcare staff receives is very important as well. A healthcare provider is often not present with his or her patient, but the nurse or nursing staff is present when he or she is not. As a nurse, the use of inducting agents such as oxytocin should be understood (Kriebs, 2015). The nurse often is one-on-one with the patient and is responsible for monitoring the patient and for administering the inducing agents and the cervical ripening agents, so nurses should have appropriate knowledge of the drugs they use. The most important aspect of labor induction according to Jan Kriebs is the cohesive effort between the family, the physician or midwife, and the nurses to ensure the safety of the patient is their priority (2015).

Kriebs’ artical relates to the AWHONN position statement discussed earlier because both articles stress the risks of inductions when the induction of the mother is not medically necessary. The AWHONN statement states that the mother is not able to have an elective induction prior to 39 weeks’ gestation (AWHONN, 2019).  The article written by Jan Kriebs stresses the importance of educating patients and medical staff about the risks of inducing labor (2015). Both of these articles indicate that the education provided by the healthcare team are the most crucial aspects of minimizing the unintended consequences of premature labor inductions. Labor is a process that is meant to be natural to the body. A woman should go into labor when both her body and the baby are ready, and the best indicator of that readiness is to naturally allow the body to enter into labor on its own unless there is a medical reason to induce earlier.

The Joint Commission establishes many rules and regulations a hospital must follow to ensure patient safety. One goal that is applicable to the induction of labor is the importance of accurate patient identification. The Joint Commission states at least two patient identifiers should be used to insure the correct patient prior to providing cares, treatments, and services to that patient (2018). Wrong patient errors happen too often in healthcare settings. This goal is crucial since the nurse is ultimately the individual responsible for administering agents that induce labor such as oxytocin, and administering those agents to the wrong patient could severely jeopardize the health and well-being of a mother and her child. Oxytocin is used to stimulate contractions and therefore initiate labor. If a nurse does not ensure that she is administering the correct medication to the correct patient, a number of unfortunate outcomes could occur. For example, the nurse could induce labor in the wrong patient.  The Joint Commission states acceptable patient identifiers include the individual’s name, assigned identification number, telephone number, or other person-specific identification methods (2018). If a nurse does not ensure she follows this rule, a number of unforeseeable outcomes could occur, and patient safety would be compromised.

Overall, AWHONN established this position statement to ensure the safety of women and their children. The AWHONN position statement centers around the idea that a woman cannot electively decide to induce her labor until she is 39 weeks gestation (AWHONN, 2019). Once a woman reaches 39-week gestation, she must fully understand all aspects of elective labor inductions, including the potential complications she may face due to the induction (AWHONN, 2019).  Jan Kriebs’ article supports the AWHONN position statement and further underscores the importance of patient safety, especially by educating patients and medical staff.  Kreibs stresses the importance of educating the patient and the family about the importance of waiting until 40 weeks gestation or when the child is fully mature and ready to be born. The Joint Commission goal of accurate patient identification further underscores the importance of patient safety, for it calls attention to the importance of accurate patient identification when administering medications that induce labor (2018). This topic is crucial because the administration of these medications to the wrong patient could have devastating effects. Overall, the correlation between the AWHONN position statement, the research article written by Jan Kreibs, and the goal stated by the Joint Commission demonstrate the importance of limiting the induction of labor to ensure patient safety and the importance of following clear information and safety protocols to avoid unnecessary and premature induction of labor.

References

  • Kriebs, J. M. (2015). Patient Safety During Induction of Labor.

    Journal of Perinatal & Neonatal Nursing

    ,

    29

    (2), 130–137. https://doi-org.methodistlibrary.idm.oclc.org /10.1097/JPN.000000000000009

Telemedicine And Remote Patient Monitoring Health And Social Care Essay

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Telehealth is the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration.

Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.

Telehealth is an expansion of telemedicine, and unlike telemedicine which more narrowly focuses on the curative aspect, it encompasses preventative, promotive and curative aspects.

One of the most significant increases in telehealth usage is the home monitoring of conditions by patients.

Telemedicine uses Information and Communication Technologies to overcome geographical barriers, and increase access to health care services. This is particularly beneficial for rural and underserved communities in developing countries – groups that traditionally suffer from lack of access to health care.

Uses of telehealth

Clinical uses

Non-clinical uses

Transmission of medical images for diagnosis (Store and forward telehealth)

Distance education including continuing medical education, grand rounds, and patient education

Groups or individuals exchanging health services or education live via videoconference (Real-time telehealth)

Administrative uses including meetings among telehealth networks, supervision, and presentations

Transmission of medical data for diagnosis or disease management (Remote patient monitoring)

Research on telehealth

Advice on prevention of diseases and promotion of good health by patient monitoring and followup

Online information and health data management

Health advice by telephone in emergent cases (Teletriage)

Healthcare system integration

Asset identification, listing, and patient to asset matching, and movement

Overall healthcare system management

Patient movement and remote admission

Modes of telehealth:

There are 3 modes of Telehealth:

Store and forward telehelath

Real-time telehealth

Remote patient monitoring

1. Store-and-forward telehealth:

In store-and-forward telehealth, digital images, video, audio, observations of daily living and clinical data are captured and stored on the client computer or mobile device, then at a convenient time they are transmitted securely to a clinic at another location where they are studied by relevant specialists. The opinion of the specialist is then transmitted back.

2. Real-time telehealth:

In real-time telehealth, a telecommunications link allows instantaneous interaction. Videoconferencing equipment is one of the most common forms of real-time telemedicine. Peripheral devices can also be attached to computers or the video-conferencing equipment which can aid in an interactive examination.

3. Remote patient monitoring:

In remote monitoring, the patient has a central system that feeds information from sensors and monitoring equipment, e.g. blood pressure monitors and blood glucose meters, to an external monitoring center. This could be done in either real time or the data could be stored and then forwarded. Examples of remote monitoring include Home-based nocturnal dialysis, Cardiac and multi-parameter monitoring of remote ICUs, Disease management including COPD, Chronic Heart Failure, Diabetes, Coagulation, Arthritis, Depression, Obesity, etc…

Pros of telemedicine:

1. Convenience: Through video, Web chat, or phone, workers can follow-up on a prescription or diagnosis with a physician they’ve been seeing for years if that physician indeed provides telehealth services or with a new doctor in their network. The goal of telehealth is to create an experience that closely mirrors a traditional doctor visit.

2. Less time in the waiting room: Telemedicine eliminates waiting time in ER. It takes a couple of minutes to register and put your health history in and then patients are ready to get the healthcare they need.

3. Cost-efficiency: An increasing number of doctors are charging less for a telemedicine consultation than they would for an in-person visit. Telemedicine can also reduce travel expenses. This is especially true for those living in rural communities. Rural families who would normally travel hours out of their way to access key health services can do it from the comfort of their couch.

4. Expedited transmission of MRIs or X-rays for a second opinion: E-mailing an MRI or X-ray to a specialist for a second opinion is another benefit of telemedicine. It can improve communication between patients and their medical practitioners.

5. Privacy assurance: Telemedicine complies with HIPAA laws, which aim to prevent private or secure medical documents from being leaked.

Cones of telemedicine:

1. Electronic glitches: Technology is only as reliable as the electrical current that keeps it running. Inclement weather and other annoyances can cause a power outage or disrupt an internet connection, complicating online consultation with a doctor. Workers should keep that in mind prior to scheduling online visits.

2. Physician resistance: The bulk of resistance comes from doctors struggling to comfortably use the new technology. At the same time, when they think about how they might begin to use this to better manage patients with chronic illnesses or be able to expand access to rural areas in particular.

3. Inadequate assessment. While having the ability to interface with your primary care physician or dentist is a major plus, certain non-verbal cues might still slip through the cracks. There are no limits on how you can use telemedicine, but of course one of the cons is you cannot personally touch or feel the patient.

Benefits and uses:

Improved Access – Telemedicine has been used to bring healthcare services to patients in distant locations. Not only does telemedicine improve access to patients but it also allows physicians and health facilities to expand their reach, beyond their own offices

Cost Efficiencies – Reducing or containing the cost of healthcare is one of the most important reasons for funding and adopting telehealth technologies. Telemedicine has been shown to reduce the cost of healthcare and increase efficiency through better management of chronic diseases, shared health professional staffing, reduced travel times, and fewer or shorter hospital stays.

Improved Quality – Quality of healthcare services delivered via telemedicine are as good those given in traditional in-person consultations. In some specialties, particularly in mental health and ICU care, telemedicine delivers a superior product, with greater outcomes and patient satisfaction.

Patient Demand – Consumers want telemedicine. The greatest impact of telemedicine is on the patient, their family and their community. Using telemedicine technologies reduces travel time and related stresses for the patient

U.S. licensing and regulatory issues:

Restrictive licensure laws in the United States require a practitioner to obtain a full license to deliver telemedicine care across state lines. Typically, states with restrictive licensure laws also have several exceptions (varying from state to state) that may release an out-of-state practitioner from the additional burden of obtaining such a license. A number of States require practitioners who seek compensation to frequently deliver interstate care to acquire a full license.

Regulations concerning the practice of telemedicine vary from state to state. Physicians who will be prescribing over the Internet to patients should mandate strict controls on their practice to insure that they stay compliant with the various State Medical Board Regulations concerning Internet Prescribing.

Transtheoretical Model (TTM) to Promote Exercise in Overweight Women

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Journal Article

The overweight and obesity epidemic has become one of the major health concerns across the world. According to the data of the World Health Organization (WHO), there were approximately 1.9 billion overweight and approximately 600 million obese adults in the world in 2014.

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Obesity can lead to major health concerns down the road including type 2 diabetes, hypertension, dyslipidemia, and can affect the length and quality of life. Studies have shown that in Turkey physical activity has not yet become a life style and there is a need for education and motivation to encourage the population to achieve a regular, active exercising habits.  The Transtheoretical Model (TTM) is widely used today to improve the process of health behavior change and to achieve the most effective health behavior change.

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The TTM has been shown to be very effective in promoting exercise. The goal of this study was to assess how TTM based education could facilitate exercise in overweight women. There were two hypotheses in the study, first was that the TTM-based education and follow-up would enable the women in the experimental group to progress in their stages of exercise behavior change. The second hypothesis was that TTM-based education and follow-up would improve the mean process of change, self- efficacy and decisional balance for exercise scores of the women in the experimental group.

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The study was a pretest-posttest, controlled, semi-experimental study conducted between January of 2011 and January of 2013. The population in the study was made up of women overweight women with a BMI of 25- 29.9 and were between the ages of 20-45.  Fifty five women were placed in the control group and anther fifty five women were selected for the experimental group. Women were included in the sample group through improbable randomization and individuals were included in the experimental and control groups in sequence, one to each of the groups.

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Data collection included a personal information questionnaire consisting of socio-demographic questions. A brief questionnaire for stages of exercise change consisted of five questions to reveal the individuals stage of change, either precontemplation, contemplation, preparation, action or maintenance. The process of change scale for exercise was a five point scale to determine how experiences affect the exercising habits of people. A self-efficiency scale was used to assess the perceived beliefs of individual’s exercise efficiency using six questions of a five point scale. To determine the cognitive and motivational factors in making decisions about exercise behavior the decisional balance scale for exercise was used, discussing the pros and cons of exercising. The overall score of the scale is obtained by subtracting the total score of perceived cons from the total score of perceived pros.

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Home visits were preformed to collect data. The data of the experimental group was collected before the education (pretest), immediately after the conclusion of the education (second test) and 6 months after the education (posttest). The data of the control group was collected at baseline and month 6.

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Pedometers were provided to the women to assess their activity based on the daily amount of steps. Height and weight were also important factors measured in the beginning of the study. Those who were in the experimental group attended a ten week education session and six months later had a follow up visit. The control group did not receive any kind of educational session. The duration, number and contents of the education given to the women in the experimental group were decided on according to their stages of change.

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Women in the precontemplation stage received at least five educational sessions while women in the maintenance stage only received one or two education sessions. By administering the TTM-specific questionnaires and scales to the women before each education, their stages of exercise change and processes of change were determined.

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During the six month follow up, participants were phoned three separate times to discuss any questions, motivate them on their action, record their average daily steps, and any weight loss. Educational exercise brochures were given to participants based on their stage of change. An exercise CD was given to any participants in the preparation, action, or maintenance stage. The CD included movements to warm up and cool down, losing weight with the help of objects such as a plastic bottle, chair and pillow at home, becoming fit, weight lifting and movements to improve the strength of the heart and respiration system.

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The data was statistically analyzed using a t-test, McNemar test, one-way ANOVA and x2 test. The education and exercise brochures given to the women in the experimental group were also given to the women in the control group after the administration of posttests.

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There was no statistical significance between the experimental and control group based on their socio demographics and their TTM scores were similar between the two groups. At the pretest measurements, 9.1 % of the women were either in the action or maintenance stage. When the post measurements were taken, the percentage of women in the action or maintenance stage went up to 54.5%. A statistically significant difference was found in the experimental group between pretest and posttest with respect to their stages of change (p<0.001); no such difference was found in the control group (p>0.05).

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Only twelve women in the experimental group did not progress to a new stage of change. The mean scores of Processes of Change Scale for Exercise and Self-Efficacy Scale were low in the experimental group during pretest but improved with repeating tests. Their mean overall scores of Decisional Balance Scale for Exercise and mean pros of exercise improved as tests were repeated and the mean scores of cons of exercise decreased over time. The mean score of the processes of exercise change of the control group was low at pretest, it increased at posttest and the difference between the measurements was significant (p<0.001).

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The control groups mean score for self-efficacy of exercise and decisional balance did not change. Women in the experimental group increased their average number of steps per day from their mean pretest steps. Their BMI values also decreased from their pretest value. The mean scores of the experimental group were higher in all scales compared to the control group and the difference between the groups was significant (p<0.001).

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It has been reported that TTM based education helps enable progression in the stages of exercise change. This study showed that 78.1 % of women showed change in the direction of progress after their TTM based education. This suggests that the TTM based education was effective helping the women in the experimental group improve their physical activity. This result confirms the hypothesis that “TTM-based education and follow-up enables women to progress in their stages of exercise behavior change.”

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In the experimental group the women’s self-efficiency scores increased as they progressed from precontemplation to the maintenance stage. Many other domestic and foreign studies confirm that perceived self- efficacy increases as progress is made from the precontemplation stage to the maintenance stage.

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The education provided and the six month follow up was effective in helping improve self-efficacy scores in the women in the experimental group. From the study it was conclude that all the women in the experimental group were aware of the benefits of exercising, but as they progressed through the stages they became more aware of the cons preventing them from exercising.

The TTM based education and follow up concluded that the women made progress in their stages of exercise change by the end of the study. It also increased the mean process of change, self- efficacy and decisional balance for exercise scores of the women.

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Both hypotheses were verified from this study. The women in the experimental group also increased their mean daily steps, engagement in physical activity, and decreased their BMI values. From these results we can see how important it is to promote TTM based education to overweight clients, before they reach obesity and follow ups should be performed to help keep them on track and accountable. TTM based education might not only be able to increase clients’ stage of exercise, but could be used to help increase consumption of fruits, vegetables, and whole grains. Studies should be done to try out different eating behaviors to determine if TTM based education can be used to help clients reach a healthy diet. From the study, it can be concluded that TTM based education was effective in this study and multiple studies have shown similar results.

References

  1. Baysal H, Hacialioglu, N. The Effect of Transtheoretical Model-Based Education and Follow-up on Providing Overweight Women with Exercise Behavior.

    International Journal of Caring Sciences

    . 2017;10(2):897-904.

Causes and Effects of Obesity

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This paper is to inform one how important it is to be educated on the causes and affects of obesity. It will answer how one can catch the early signs of obesity and detect the symptoms in themselves or others. There are many causes for obesity and it is important to know these causes so that one can prevent the disease from affecting their lives. Obesity can affect ones social, psychological, health, and health and wellness lives. Obesity can be a fatal disease causing many deaths not only in America but around the world. Obese people have many disadvantages in life. Some can not get health insurance if they are too overweight, they make on average, less money than people who are not obese. Preventing obesity in society can save many lives around the world. Physical education, healthy eating habits and regular exercise can be a key prevention of obesity. The teaching system around America needs to take a stronger role in the health and prevention of this disease, but the key people in ones life in preventing obesity is the parents. Parents play a key role in a child’s life, they must regulate what their children eat and the activities they participate in each day. Preventing obesity is not a one day job, it is a long process and a lifestyle. Obesity

Obesity is a growing problem in our world and is one of the most rapidly growing diseases in children, teens and adults. Obesity has many definitions and many ways in which it can be interpreted. There are also many signs and symptoms of obesity which give doctors and parents time to prevent the fatal disease. Many things cause obesity in children, teens and adults and the effects can be deadly. People need to start noticing signs and take action for, not only themselves, but for their children as well, for a happier, healthier, and more normal life.

Obesity is a growing concern in our world and in some cases can be predicted in infants. There are patterns amongst infants that show signs of obesity. Infants that grow faster than others have a greater risk of becoming obese than infants that do not grow as fast. Fast growing children, whether it be in height or weight gain, are more likely to be overweight later on in life. There is no set evidence that infants who grow faster become obese but faster growing infants do eat more food. Growth is driven by a childs appetite and dietary intake is a main risk factor in obesity. Studies have shown that the older the obese child is, the more likely that child is to become obese as an adult. Studies have proven that 25-80 percent of obese children become obese as adults (Lissau, 2007).

Obesity is a very harmful disease that can be prevented, but will require a lot of work from the whole family. Childhood obesity is defined as having a body mass index equal to or more than the eighty fifth percentile of the age and gender (Whitaker, Wright, Pepe, Seidel, Heights 2008). Obesity is an imbalance between energy expenditure and dietary energy intake. Many people in society often have mistaken obesity and being overweight as the same thing. Being overweight means that the body mass index is over twenty five, and being obese means the body mass index is over 30. The only similarity between being overweight and obese is the fact that both can harm a person’s health. Weight gain occurs when you take in more calories than your body uses during a certain time period. If the food you eat provides more calories than your body needs, then the calories that are left over transfer into fat. There are three stages to childhood obesity: late fetal development with overweight at birth, during the rebound period at five and six years old, and during the adolescence. (Whitaker, Wright, Pepe, Seidel, Heights). It is important to catch obesity early in these stages or it may become more difficult.

There are many reasons as to why kids around the world are obese. Diet, physical activity, and familial psychosocial environment are three risk factors for childhood obesity. A cause for obesity can be early infant weight gain. This is a risk factor for childhood and adult obesity (Cole 2007). Smoking while pregnant reduces the birth weight of an infant but it increases post natal weight gain which is a cause of obesity. (Cole 2007). When a child gains a lot of weight early on, it is a sign that they will become obese rather than gaining weight at a steady pace.

In an issue of Acta Paediatrica, it shows that watching television, having obese parents, and having a high birth weight increases the chance for obesity (Elanson-Albertsson & Zetterstrom, 2005). In most cases it is not the child’s fault that they are overweight but the parents of that child. The parents are the strongest factor for childhood obesity and both parents are equally effective. The lifestyle a parent gives their kid is a major factor as to how one will grow up. If a parent does not enforce exercise and physical activity they are more likely to become obese.

Eating habits are a large factor in whether or not a child becomes obese. If the parent does not control the foods they eat and how much they eat the risk of obesity rises. Some parents buy a lot of

junk food

for the house and when children are hungry they will be more likely to choose junk food rather than a healthy snack. It is twenty-five to thirty percent more likely that children with obese parents will become obese themselves. When children grow up in an environment with bad eating habits they are thirty-three percent more likely to become obese as young teenagers (Cole 2007).

Eating habits do not just come from parents, but can be caused by emotions as well. As a teenager there are many different situations that can occur in life, these may be new experiences or changes that a teenager can experience. Their changes and experiences can really cause a change in emotions, especially when a teenager is going through puberty. Some teenagers overeat because they are depressed, angry, or even because they are bored. Adolescents who suffer from depression are at a greater risk of becoming obese, and staying obese. Women usually tend to be more emotional and as teenagers they are going through many new experiences that can cause these emotions. A study shows that women at ages six to twelve are three times more obese now than they were thirty years ago.

Two main factors to consider when decreasing the chances for obesity are dieting and activity. These help balance each others energy and help people live a healthier lifestyle. A way to protect children from obesity is to breast feed them. A formula fed baby has a higher risk of being obese. “Two alternatives to explain recent obesity trends are programming of appetite has changed, and appetite in some children is up regulated. And Programming of appetite is unchanged, but hungry children now get overweight due to the obesogenic environment.” (Cole, 2006 pg 3).

The San Jose study focused on decreasing the amount of time spent in front of the television, and they increased the amount of physical activity in children and saw a decrease in obesity and the chances for obesity in the children. When the children watched less television the intake of sugar and carbonated beverages decreased. The children ate more fruits and vegetables throughout the day, when they spent time watching T.V. The children that were studied also had a change in their attitudes. The children seemed happier and more willing to do physical activities in there everyday lives. They also had an increase in there social lives and found they were more will to make new friends and it was easier to expand the groups of friends they had. (Lissau, 2007).

Mossberg conducted a study in 1989 involving a number of obese children. After forty years Mossberg did a follow up with those children and found that a large number were still obese. Mossberg also found that these adults had a normal food intake and this shows that methods for reducing obesity and being overweight should be started at a young age. It is much harder to reduce obesity in adults than to start when one sees the first signs of obesity in children.

Another main cause of obesity is environmental factors. In the world today the environment really has a huge impact on people’s lives especially when it comes to teenagers. In the modern world, technology has really come a long ways; so children and teenagers are relying more on technology to keep them entertained. This can be harmful to their health. Teenagers today are spending a lot more time interacting with technology than they should. These sedentary behaviors include video games, television, movies, and internet. Children who watch television and videos have been found to have a higher body mass index. By watching television and playing video games, the energy balance in a person decreases the energy expenditure, reduces resting metabolic rate, and increases energy intake. Also, many people eat while watching TV and are not doing any physical activity to work off what they eat. This allows the food to sit and turn to fat, increasing the chances of obesity. There are many commercials on television that advertise fast food and restaurants making it more likely for a person to go buy these foods rather than cook a healthy meal (Nowicka 2007). Television viewing has been linked to obesity, smoking, poor fitness and raised cholesterol in adulthood. Reducing television viewing and increasing physical activity may not be enough to reduce the chances of obesity. Gender, age, ethnicity and body mass index are variables in how much they are related to sedentary behavior.

Most children and teenagers also tend to eat out at fast food restaurants more often than they should. In result of this, they have less control over how much fat, sugar, and salts are in the foods they are eating. Fast food restaurants are also staying open even later than before. With these restaurants staying open late it really accommodates the food cravings that teenagers may have no matter what time of the day it may be. These fast food restaurants also encourage super-sizing your meals for a better deal, which adds more unnecessary calories and it proves to be cheaper. Children experience money now as an important part of life so if it appears that super sizing a meal will save some money they are going to feel that it is a better deal even though in the end it is really harmful to their health. Fast food restaurants are very common choices for families because they are so busy that do not have time to sit down and eat a home cooked meal so they stop and get something quick. With this busy schedule it creates a change in the eating habits that the children had before they got their license or got more involved.

Hilde Bruch was one of the first people to say that obesity was not just related to body mass index and weight. It affects many psychological aspects of a person such as psychiatric health, psychiatric disorders, social maladjustment, and conflicts and tension in relations to the family of that person (Elanson-Albertsson & Zetterstrom, 2005). The psychological complications of obesity are most related to teenagers. Research has shown just how important it is to teenagers to maintain a physical appearance, athletic skills, and be accepted with what one wears (Lissau, 2007). People who are obese are proven to have friends who are also obese. It is also proven that obese people do not make as much money as people who are “skinny” or not obese. They have a lower self esteem and have a harder time developing relationships with other people (Lissau).

Young teenage girls in our society today are obsessed with their body image. This obsession can come from many different sources. Teenage girls may feel pressure from peers about their physical appearance because each person has different features that make them who they are. Often time’s people feel jealous because there is always someone in school that they wish they could look like. Girls become very competitive when it comes to the way that they present themselves and it can be a challenge if they feel someone has a better body. Not only is there pressure from peers that cause an obsession in body appearance, but the celebrities they see on television, or in movies have an impact as well. These women shown in the media are portrayed as what everyone should look like.

In the United States, the amount of obese teenage women almost doubles that of obese men. Studies have shown that more than one-third of women are obese. Girls spend more time talking on the phone and listening to music while boys spend more time watching television and playing video games. Boys are also involved in more physical activity at all ages. Decreasing sedentary behavior in children can be just as effective as increasing the physical activity in a person (Nowicka, 2007).

The school environment is a key place to start with obesity prevention. The schooling systems, especially in America, have low priority on healthy eating. Schools lack food and healthy meal support and the staff is unmotivated to add extra activities and lectures about nutrition. There is little supervision to what students are eating. In the United States vending machines are located in roughly 98 percent of the schools. (Lissau 2007) Removing vending machines will help decrease the chances of having junk food and carbonated drinks.

Schools need to start preventing obesity by bringing activities to the children and making them a requirement. The only time children in school are not sitting down is during breaks or during physical education. In most cases a physical education class is less than an hour and only a few times a week. The length of time should be increased each week and the amount of times the breaks occur should be increased as well. Also, many students are enrolled in after school day care programs and by putting more physical activity into after school events would decrease the chance for obesity (Lissau).

Physical activity has a major impact on body composition and metabolism making it a key treatment and prevention of obesity. It increases energy expenditure maintains lean body mass, and increases mobilization as well as burning body fat. Physical activity also has other benefits. One must have physical activity for normal growth, development of cardio respiratory endurance, muscle strength, flexibility, motor skills, and agility. Activities such as: walking, jumping, and weight lifting help bone development as well. Physical activity in children and adolescence has not just been proven to be a good thing. It also has some downfalls as well. Changes in energy expenditure or energy intake can occur at critical times in development in infants or adolescence and it can result in energy imbalance.

Physical activity can have a different impact on different groups, such as male and female, ethnic groups, active and inactive. Different individuals will be impacted differently. World Health Organization recommends a minimum of thirty minutes a day of moderate physical activity. Moderate physical activity is defined as activity that requires three to six times as much energy as the energy needed in a resting state ( Nowicka, 2006). For children and adolescence, World Heath Organization recommends an additional twenty minutes of vigorous physical activity at least three times a week. Vigorous physical activity requires more than six METs, such as jogging and running at least 8.0 km per hour (Nowicka, 2006). Nordic Nutrition Recommendations recommends an hour of activity should include moderate and physical intensity but it can be divided out throughout the day (Nowicka).

A study conducted by the National Weight Registry shows how maintaining a healthy diet and physical activity affects overweight and obese people. They studied successful and unsuccessful weight loss treatments. Ones dietary intake and the amount of physical activity are the main weight maintainers in adults and children. Adults maintain weight easier with more physical activity than children need. Having a low fat intake works better than physical activity for maintaining weight in children. The study also showed that the heavier and younger the subject was, the more weight that was lost. Boys also had a tendency to lose more weight than females in the long term weight maintenance.

Catching the early signs of obesity gives one the opportunity to prevent the disease. Managing obesity is based on lifestyles where physical activity and behavior is a key target. Physical activity is a key treatment and prevention to obesity and should be a main focus of children and adolescence. Obesity is also decreased by sleeping longer, high education of your parents, and having more siblings ( Elanson-Albertsson & Zetterstrom, 2005).

It is important to have a variety of activity each day. Getting only one form of activity each day will only work certain muscles in the body. A popular form of activity for obese patients has been resistance training. Resistance training helps improve musculoskeletal fitness. Working various muscles is a key solution to decreasing body fat and lowering the amount of obesity in the world. Physical education classes may be the only way some children get any activity throughout the day. Physical education teachers are very important role models for children and it is important for them to stress the importance of physical activity (Nowicka, 2006).

The table below shows how a child can get in the suggested one hour of physical activity each day. If one gets in an hour a day it can be a major factor to prevent obesity in the world. Limiting time spent watching television and playing video games has reduced the amount of overweight children. There are many ways to get in one hour of physical activity each day. Walking to school and then home from school is a great way to exercise for twenty to thirty minutes. Also, cleaning a room in the house allows you to be moving and bending over. Climbing stairs is a great way to get in physical activity, walking to a friends rather than driving, going shopping and walking the do g. Avoiding rides to school, watching television, and avoiding playing video games will help accomplish ones goal of completing the one hour recommended amount of exercise each day (Nowicka, 2006).

Two examples of how everyday activities can be accumulated during a common day

Example 1.


How can a child accumulate 1 h of everyday activities

  • Walks to school- 10 min
  • Plays during breaks- 20 min
  • Walks home from school- 10 min
  • Cleans room- 10 min
  • Walks to meet friends- 10 min


Total 60 min

Example 2.


How can a child accumulate 1 h of everyday activities

  • Rides bike to school- 5 min
  • Walks and talks during breaks- 20 min
  • Rides bike home from school- 5 min
  • Goes shopping- 10 min
  • Walks the dog- 20 min


Total 60 min

In the Untied States 15.5% of teenagers are overweight. Being overweight as a teenager can lead to three different diseases as an adult these can be type two diabetes, sleep apnea, and heart attack. A heart attack is not as common as the other two, but can still be dangerous. The first disease is type two diabetes. This is a disease that affects the metabolism when a person eats sugar, which is the body’s main source of fuel. If a person has type two diabetes, it is very difficult for their body to keep a normal glucose level. If this disease is not treated correctly it could be life threatening. As of right now there is no cure for type 2 diabetes, but there are many things that can be done to help control it. A person can eat healthier foods, and add some type of exercise to their daily routine. It is best to get this under control as a teenager, because as a teenager it is easier to change a person’s lifestyle, and it will be more effective in the future. A disease can be very harmful a person in the future.

Sleep apnea is another disease that is a major risk in a person’s life and can cause early death due to obesity. Sleep apnea is a serious breathing disorder which can cause a person to stop breathing for short periods of time during sleep, and cause drowsiness during the day. Obesity also causes blood pressure to rise, and because of the high blood pressure it causes the heart to over work, and weakens the heart muscle. This causes the blood vessels to harden, which creates a greater chance of getting a blood clot increase, which makes it more likely to have a stroke or heart attack.

Even though there are medical situations that can harm a person as a result from obesity; there are some beneficial medical treatments. Gastric bypass surgery is an option for many people to lose the weight fast. Many people these days are turning to gastric bypass surgery. Gastric bypass surgery is a permanent treatment to help obese people lose a certain amount of weight. This surgery is more common for adults, but some doctors feel that it could be helpful for teenagers as well. Gastric bypass surgery makes the stomach smaller, and allows food to bypass the small intestine. It helps a person feel full faster than usual, and results in fewer calories being absorbed, which leads to weight loss.

A study was held where Leptin was infused in rats when they were born and they grew up to be leaner adults. Leptin is a hormone that regulates the body weight and metabolism. Although this raises ethical issues, giving newborns a shot of leptin when born will set them up for a more lean future. This may seem dramatic when there are healthy and natural ways of preventing obesity.

Different organs of the body have drives or cravings for different types of food. The brain has the highest energy requirement of any of the organs. The total consumption of the brain is forty percent of newborn infants and twenty five percent in children and ten percent in adults. Because America has so many types of food available, the choice of fat and carbohydrates are around forty five percent each. ( Elanson-Albertsson & Zetterstrom, 2005). Foods that are high in fat and sucrose are more satisfying than other types of foods and it is easier to overeat and become obese. Sucrose that is in a fluid has more potential to trigger your appetite than sucrose in a solid food (Elanson-Albertsson & Zetterstrom, 2005).

Obesity is an imbalance between energy expenditure and dietary energy intake. There are many variables that cause obesity in our society and there are many affects that go along with this disease. Preventing obesity must be started at a young age and parents must take action in giving their child a healthier lifestyle. Teens must avoid the pressures of society and be smart about the health choices they make. In order to make progress in preventing obesity schools need to educate the children more about its causes and its deadly affects, but most importantly how to prevent it. Keeping a healthy diet and regular exercise decreases ones chance of obesity and will help one live a healthier and happier life.

References

Cole, 2007,

Early causes of child obesity and implications for preventions,

2-4, Retrieved April 12th 2008, http://web.ebscohost.com/ehost/pdf?vid=6&hid=108&sid=5536f511-b9fc-4551-9d4a-44b312dac852%40sessionmgr106

Cole, Bellizzi, Flegal, Dietz, 2000,

Establishing a standard definition for child overweight and obesity worldwide: international survey,



Retrieved April 11, 2008, http://www.bmj.com/cgi/reprint/320/7244/1240

Deforche, De Bourdeaudhuij, tanghe, debode, hills, bouckaert, 2004,

Role of physical activity and eating behaviour in weight control after treatment in severely obese children and adolescents


,

Retrieved April 12th, 2008, http://web.ebscohost.com/ehost/pdf?vid=11&hid=114&sid=adeb569d-7792-42b8-a6e3-94f22e8572f1%40sessionmgr104

Erlanson-Albertsson and Zetterstrom,

The global obesity epidemic: Snacking and obesity may start with free meals during infant feeding

, 1523-1531, Retrieved April 18th, 2008, http://web.ebscohost.com/ehost/pdf?vid=14&hid=113&sid=5536f511-b9fc-4551-9d4a-44b312dac852%40sessionmgr106

Lissau, 2007,

Prevention of overweight in the school arena

, Retrieved April 12th, 2008, http://web.ebscohost.com/ehost/pdf?vid=16&hid=114&sid=adeb569d-7792-42b8-a6e3-94f22e8572f1%40sessionmgr104

Nowicka,

Dietitians and exercise professionals in a childhood obesity treatment team

, 23-29, Retrieved April 18th, 2008, http://web.ebscohost.com/ehost/pdf?vid=21&hid=116&sid=5536f511-b9fc-4551-9d4a-44b312dac852%40sessionmgr106

Nowicka,

Physical activity-key issues in treatment of childhood obesity

, 39-45, retrieved April 11th 2008, http://web.ebscohost.com/ehost/detail?vid=10&hid=8&sid=5536f511-b9fc-4551-9d4a-44b312dac852%40sessionmgr106

Schwartz and Brownell,

Actions Necessary to Prevent Childhood Obesity: Creating the Climate for Change

, 78-87, Retrieved April 12, 2008, http://web.ebscohost.com/ehost/pdf?vid=28&hid=116&sid=5536f511-b9fc-4551-9d4a-44b312dac852%40sessionmgr106

Whitaker, Wright, Pepe, Seidel, Heights, 2008,

Predicting Obesity in Young Adulthood from Childhood and Parental Obesity

, Retrieved April 11, 2008, https://content.nejm.org/cgi/content/full/337/13/869.

Yaussi,

The Obesity Epidemic

, 105-108, Retrieved April 13th, 2008, http://web.ebscohost.com/ehost/pdf?vid=32&hid=16&sid=5536f511-b9fc-4551-9d4a-44b312dac852%40sessionmgr106

Case Study on Palliative Care: Example Answers

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Carol is a 48 year old woman who lives with her husband Dean and three children. Carols three children, Josephine (15 years), Harry (12 years) and Sarah (8 years) are aware their mother has cancer, but have not been told of the development of secondary disease or the implications this carries. The family run a small general store in an outer suburb of Perth. Carol was diagnosed with breast cancer three years ago, originally undergoing a right lumpectomy with adjuvant chemotherapy. Last year Carol was diagnosed with bone secondaries. Since that time she has been receiving tamoxifen and attending the oncology clinic for follow-up. The community palliative care nurse visits Carol once a month to monitor her progress and provide emotional support.

While visiting Carol the nurse notes that she appears to be in considerable discomfort, though she denies any pain. On questioning Dean, the nurse learns that Carol has been found crying and holding her hip, but refuses to seek medical attention.


Why do you think Carol is reluctant to seek medical attention and acknowledge her pain?


ANSWER:

Carol is reluctant to seek the medical attention because she is fed up with the medical checkups and also she receives no positive improvement in her health so she herself concluded to not to waste the money on her health and let them safe for her three children (Matthews, 2008).


As Carol begins to receive palliative care, which members of the palliative care team do you think need to be involved in her care? Briefly describe the role of each.


ANSWER:

The family members of Carol play an important role in the team of palliative care and especially the role of Dean was very crucial because he is the person who could fill the strength in Carol to fight against this dangerous disease ( Foley, 2001).

Investigations of Carol’s pain revealed bony secondaries. She was offered a course of radiotherapy, but refused as this would mean going to the city (55km away) every day, and she would be away from the shop at the busiest time of the year. Carol agreed to recommencing chemotherapy, and was commenced on regular panadeine forte (two every four hours) for her pain. Carol has been troubled by nausea and vomiting after each course of chemotherapy. On a follow up visit five days after Carol’s last chemotherapy, the community nurse discovers that Carol is constantly nauseated, vomiting several times a day and unable to keep any fluids down.


Identify the possible causes of Carol’s nausea and vomiting.


ANSWER:

Chemotherapy involves the killing of cancerous cells from the patient’s body thus due to these heavier operations on Carol’s body would make her uneasy and thus she has nausea and vomiting (Ferrell, 2006).


Describe the management strategies for the various probable cause(s) of Carol’s nausea and vomiting.


ANSWER:

Management strategies should be in order to give her strict instructions to be away from strong odours, not to lay flat after eating, have some light exercise after eating, to eat in smaller amounts and most importantly keep her mind relaxed and try to forget about the chemotherapy (Hesketh, 2005).

On a follow-up visit, the community nurse discovers that Carol is only achieving two hours pain relief after her tablets and is taking them more frequently, but is reluctant to consider changing to stronger medication.


Identify the appropriate steps for assessing Carol’s pain.


ANSWER:

She should be checked to take medicines on her own i.e. someone from her family should take the responsibility to fetch her with medicines; also management should maintain a regular chart of the total amount of daily doses and the time span of pain she have(McMann, 2009).

After consultation with the general practitioner, the community nurse discusses changing Carol’s analgesia to something stronger. Carol is very reluctant as she feels she will only become addicted to ‘hard drugs’ if she uses them now. Carol expresses concerns about having this type of medication in the house with young children around.


What are the possible reasons for Carol’s reluctance to change her medication, and how could this be overcome?


ANSWER:

Carol main reason for reluctance was that she wants to be with her family also she wants to save money as she could not afford the hospital’s expenses and hence she wants the whole medication to be done at her home. This can be overcome if and only if the management gives some relaxation in the expenses (Visel, 2006).

Carol reluctantly agrees to a trial of oral morphine, initially in short-acting form until the dose is titrated. She is commenced on 10mg of oral morphine 4th hourly.


What education should the nurse give Carol about commencing and taking morphine?


ANSWER:

The nurse should tell her to handle some pain and extend the period of taking the morphine from 2 hours interval to 4 hours interval so that she could develop some resistive powers in herself (Bruera, 2003).


When should Carol be considered for conversion to controlled (slow) release morphine, and how would the dose be calculated for this?


ANSWER:

As soon as Carol feels that she has generated enough resistive power then the controlled doses of morphine should be given and the period should be increased rose to the power of 2 i.e. 2, 4, 8, 16 and finally it should be stopped (Bruera, 2003).


Identify adjuvant medication that may be helpful in Carol’s case.


ANSWER:

Herceptin drug can be used as the adjuvant medication because it interferes with growth of cancer cells and slows their growth and spread in the body (Knox, 2004).

Carol is reluctantly taking morphine 30mg every four hours and Naprosyn 500mg b.d. for her pain. When visiting Carol one day the community nurse finds Carol vomiting and complaining of catching a ‘gastro’ bug from one of the children. On questioning Carol states she has had small frequent amounts of diarrhoea for 5-6 days, and has not had a normal bowel motion for two weeks. Carol is notably dry, complains of thirst, has a coated tongue, and a distended abdomen.


What nursing investigations would you carry out?


ANSWER:

The infection is been spreading in her family due to the contact of virus released by the vomiting of the Carol. Hence personal hygiene should be maintained (Yarbro, 2005).


What nursing strategies would you implement to relieve Carol’s symptoms?


ANSWER:

For relieving Carol’s symptoms the basic nursing strategies should ensure that the toiletry area should properly cleaned using diluted bleach, she must wash her hand after using the toilet, her clothes must be washed in warm water, and lastly the nurse should suggest her the BRAT food i.e. Banana Rice Applesauce and Toast as the main food from time to time and drink as much liquid as she discharges in her stools (Yarbro, 2005).

Carol’s appetite has decreased and she is eating only very small amounts of food. She is not nauseous. Dean is finding it hard to accept that Carol doesn’t need food and worries that without food Carol will die.


What will you tell Dean about Carol’s loss of appetite?


ANSWER:

We will tell him not to panic because this loss of appetite is only due to the gastro effects and it will be removed as soon as the medicines perform their proper function (Ko, 2008).


What strategies can you use to help Carol increase her intake?


ANSWER:

After giving her enough liquid food we will ask Carol to perform light exercises which could help her to burn more calories and so she will feel a good hunger for receiving a good nutrition (Ko, 2008).

Carol has become increasingly bedbound and is spending many hours sleeping, and at times becomes restless. She has refused all further chemotherapy and blood tests and is aware her time is limited. Carol has told Dean that she would like to die at home.


What do you need to consider to ensure that Carol can be cared for at home (eg. equipment, care needs etc)?


ANSWER:

The main consideration would be based on finding ways so that she must not get any complication in terms of medical facility. Hence important equipments must be installed with a good experienced nurse who remains with Carol in her house for 24 hours (Keir, 2002).

The community nurse is called late at night because Carol has become semi-conscious, but is calling out and very restless. On arrival the nurse finds Carol agitated and restless in bed, with an increased respiratory rate, an obvious frown and unable to respond to questions. On questioning Dean states that he was unable to administer her last two doses of morphine slow release tablets. Carol has not taken fluids for several days, nor passed urine for eighteen hours.


Identify the possible cause(s) for Carol’s restlessness and suggest treatments.


ANSWER:

Carol’s restlessness is only due to improper metabolism of her body so she should be given liquids as much as she could take and finally she must be made to discharge the urine (smith, 2006).

The community nurse suggests insertion of a subcutaneous butterfly needle to administer Carol’s morphine for pain control. Dean becomes distressed, questioning the need for morphine when his wife is almost unconscious. He accuses the nurse of trying to “hurry things along”.


What is an appropriate nursing response to Dean’s concerns?


ANSWER:

Nurse should send Dean outside the room and tell him to keep patience and keep faith, she will do the appropriate nursing of Carol (Kearny, 2006).

Carol remains unconscious for several days. Josephine expresses concern that her mother has not had any fluids for several days and questions whether she should be admitted to hospital so intravenous fluids could be commenced. Josephine questions if it is cruel to let her mother die of dehydration?


What explanation could the nurse give in response to Josephine’s concerns?


ANSWER:

Nurse should give condolence to Josephine and not to worry because she will take care of her mother in every aspects of medical concern (Alexander, 2000).


What nursing actions will ensure that Carol is comfortable despite no oral intake?


ANSWER:

The basic nursing action that a nurse should check Carol’s pulse rate and blood pressure, if everything is normal then there it is ensured that Carol is comfortable despite of having no oral intake (Alexander, 2000).

Dean approaches the palliative care nurse for assistance the next day. He states the children, in particular Sarah, are asking questions he doesn’t know how to answer. Sarah asks detailed questions about what will happen to Carol before and after she dies, and appears to have a morbid interest in the details of death.


Identify strategies to assist children dealing with death.


ANSWER:

While assisting children dealing with death the children of small age should be taken away from the house and make them busy in some games while elder children should understand itself how to manage with the condition (Schaefer, 2002).

Carol died at 4.30 p.m. on a Sunday afternoon, with Dean, the three children and her mother by her side. Her death was described by the palliative care nurse as peaceful, but her dying as a struggle.


What bereavement follow up could be put in place for this family?


ANSWER:

Carol was a strong fighter and she fights with her disease with silence and lots of courage, this death would keep soul free from the struggles that she had faced during her illness. God bless her soul Amen (Schaefer, 2002).

Decreasing Infection Rates with Chlorhexidine Baths in Intensive Care Units

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Decreasing Infection Rates with Chlorhexidine Baths in Intensive Care Units


Abstract

Clinical Problem: Patients in intensive care units are very ill and susceptible to infection. Patients in intensive care units often have medical devices inserted into their bodies (Foley catheters, central lines, ventilation tubes, etc.) which are access points for infection. If a patient acquires an infection while in the hospital, it can result in increased costs, increased length of stay, and possibly death.

Objective: The purpose of this paper is to discuss the most effective bathing method in reducing infection rates in intensive care units, whether it be with chlorhexidine antimicrobial methods, or with plain soap and water. PubMed, CINAHL, and the Agency for Healthcare Research and Quality (AHRQ) were accessed to find three randomized controlled trials (RCTs) and a clinical practice guideline regarding reduction in hospital-acquired infections. Key search terms that were used include intensive care unit, chlorhexidine, hospital-acquired infection, catheter-associated urinary tract infection, central-line associated blood stream infection, infection prevention, and infection risk. The publication years searched were 2015 to 2019.

Results: The literature reviewed for this paper and the three randomized controlled trials demonstrated a reduction in infection rates in intensive care units with the use of chlorhexidine for bathing compared to alternative methods such as soap and water. The clinical practice guideline from the Centers for Disease Control and Prevention (2011) also recommends daily use of chlorhexidine wash for bathing to reduce infection rates.

Conclusion: Patients in intensive care units, who are at an increased risk of infection that received baths with antimicrobial chlorhexidine, compared to those who received non-antimicrobial baths, experienced lower infection rates. Some studies showed a significant difference between the two bathing methods, while others only showed minor differences. More extensive research is needed in order to determine if chlorhexidine significantly decreases the rate of infections in intensive care units.


Decreasing Infection Rates with Chlorhexidine Baths in Intensive Care Units

According to The Centers for Disease Control and Prevention, close to 1.7 million patients acquire hospital-acquired infection (HAIs) annually, and greater than 98,000 patients die from these HAIs (Haque, Sartelli, McKimm & Abu Bakar, 2018). Patients in intensive care units are more susceptible to infection because of underlying illness, impaired immunity, risk of aseptic mistakes during invasive monitoring, and because these patients often have medical devices inserted into the body (Foley catheters, central lines, breathing tubes, etc), which are access points for infection (Kolpa, Walaszek, Gniadek, Wolak & Dobros, 2015). With infection and mortality rates rising, it is essential to determine the most effective bathing method for patients in intensive care units. Common bathing methods include antimicrobial solutions such as chlorhexidine, and non-antimicrobial solutions, such as plain soap and water.

The purpose of this paper is to determine, among intensive care unit patients requiring nursing-delivered baths, how does bathing with chlorhexidine compared to non-chlorhexidine (ex. soap and water) decrease the rate of hospital-acquired infections.


Literature Search

PubMed, CINAHL and the Agency for Healthcare Research and Quality (AHRQ) were accessed to find three randomized controlled trials (RCTs) and one clinical practice guideline regarding reduction in hospital-acquired infections. Key search terms that were used include intensive care unit, chlorhexidine, hospital-acquired infection, catheter-associated urinary tract infection, central-line associated blood stream infection, infection prevention, and infection risk. The publication years searched were 2015 to 2019.


Literature Review

Three randomized controlled trials (RCTs) and one clinical guideline were used to evaluate how chlorhexidine bathing compares to non-chlorhexidine bathing when it comes to reducing infection rates in intensive care units (see Table 1). The purpose of the RCT by Pallotto et al. (2019) was to evaluate whether daily bathing with 4% chlorhexidine gluconate (CHG) was more effective than washing with standard soap in preventing hospital-acquired infections (HAIs). The trial included individuals who were admitted to the intensive care unit (N=446), who were then randomly divided into two groups. Patients in the intervention group (n=226) received daily bathing with 4% CHG. The patients in the control group (n=223) received daily bathing with standard soap. All patients were evaluated for the incidence of bloodstream infections (BSI), central-line associated BSI (CLASBI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infections (CAUTI). The results of the study showed that 15% of the individuals in the intervention group and 25.6% of the individuals in the control group suffered from at least one hospital-acquired infection. Results also showed that the incidence of bloodstream infections was significantly reduced (p=0.027) in the intervention group. Strengths of this study include the use of randomized assignment and the fact that infectious disease specialists were blinded to the intervention status. One weakness of this study is that it does not directly state what other interventions are being used to prevent infection; for example, are the nurses using proper sterile technique when accessing central-lines, etc.

Swan et al. (2016) conducted a RCT to evaluate whether bathing every other day with chlorhexidine compared to daily bathing with soap and water decreases the risk of hospital-acquired infection. The trial included all patients in a surgical ICU from July 2012 to May 2013 with an anticipated stay of 48 hours or more (N=325). These patients were randomized using Microsoft Excel into two groups, the intervention group who were bathed every other day with chlorhexidine, and the control group, who were bathed every day with soap and water. The results of the study showed that 35 patients in the control group developed HAIs, while only 18 in the intervention group developed HAIs (p=0.049). Strengths of this study include the large sample size (N=325), randomized assignment into either the intervention or control group, description of eligibility criteria, blind investigators, and explanation of why some participants did not complete the study. The major weakness of this study is that it was a single-center, meaning it only included the surgical ICU at a single hospital.

Noto et al. (2015) designed a RCT to determine if daily bathing with chlorhexidine decreased the incidence of healthcare-associated infections (HAIs) compared to bathing with non-antimicrobial cloths. This trial included 9,340 patients in 5 intensive care units from July 2012-Juy 2013. The intervention group (n=4488) received daily chlorhexidine baths, while the control group (n=4852) received baths with non-antimicrobial cloths. Bathing treatments were performed for 10 weeks, followed by a 2-week washout period, before crossing over to the alternate bathing treatment. Each group crossed over 3 times during the length of the study. The results of this study showed that during the chlorhexidine period, 55 infections occurred (4 central line associated, 21 catheter associated, 17 ventilator associated pneumonia, and 13 c. difficile), and during the control period, 60 infections occurred (4 central line associated, 32 catheter associated, 8 ventilator associated, and 16 c. difficile). The rate of the primary outcome was 2.86 per 1000 days during chlorhexidine bathing and 2.90 per 1000 days during control bathing (

P

=.95). What these results show is that daily bathing with chlorhexidine did not necessarily reduce the incidence of healthcare-associated infections. What can be concluded from this study, is that the use of chlorhexidine might help prevent certain type of HAIs, such as catheter-associated (21 vs 32). The main strength of this study is the very large sample size. Weaknesses of this study include the inability to blind staff administering the baths and also the fact that it is a single-center study.

The clinical practice guideline published by The Centers for Disease Control and Prevention is concordant with the literature search performed. The guideline states that daily skin cleansing with chlorhexidine is recommended and supported. Even though there is evidence that chlorhexidine reduces infection rates, it is still not ranked as a Category IC recommendation, meaning that it is required by state or federal regulations, rules, or standards and it is not standard practice among all healthcare institutions.


Synthesis

Pallotto et al. (2019) demonstrated that the incidence of hospital-acquired infections was significantly reduced using daily chlorhexidine bathing methods (p=0.027). Additionally, Swan et al. (2016) reported a reduction in the development of hospital-acquired infections (p=0.049) with the use of bathing every other day with chlorhexidine compared to daily bathing with soap and water. Noto et al. (2015) demonstrated reduced infection rates in certain categories of hospital-acquired infections with the use of chlorhexidine bathing, but did not demonstrate a significant difference in overall occurrence of hospital-acquired infections (P=0.95).

The research shows that, in general, bathing with chlorhexidine does reduce the incidence of hospital-acquired infections in intensive care units. Because there are other considerations when it comes to infection prevention (ex. hand washing, sterile instruments, proper sterile technique, etc.), it is extremely difficult to pinpoint which interventions are causing and preventing infections. For example, a patient might develop an infection while receiving chlorhexidine baths, but there is no way to ensure that the infection was not caused by poor practice. What needs to be known is that bathing with chlorhexidine does not replace other modes of preventing infection. Because of this, additional research is needed to determine best bathing practice for not only intensive care unit patients, but for all hospitalized patients.


Clinical Recommendations

The clinical guideline published by the Centers for Disease Control and Prevention states that patients in intensive care units should be bathed daily with chlorhexidine, especially those patients who have central lines. The guideline also states that chlorhexidine bathing cannot be the only method of infection prevention; it must be used in conjunction with other precautions (ex. hand washing, sterile technique, proper skin preparation, protocols for insertion and removal of central lines, etc.). Most research is supportive that chlorhexidine does reduce hospital-acquired infection rates in intensive care units, but supplemental research is needed to rule out why some patients are still developing infections while receiving the chlorhexidine baths, maybe there is a better method? Overall, research demonstrates that chlorhexidine bathing is still a developing idea in order to improve patient outcomes, reduce healthcare costs, reduce length of stay, and decrease mortality rates from hospital-acquired infections.


References

  • Centers for Disease Control and Prevention (2011). Guidelines for the prevention of intravascular catheter-related infections. Retrieved from https://www.cdc.gov/infectioncontrol/guidelines/bsi/index.html
  • Haque, M., Sartelli, M., McKimm, J., & Abu Bakar, M. (2018). Health care-associated infections – an overview.

    Infection and Drug Resistance, 11

    , 2321-2333. doi:10.2147/IDR.S177247
  • Kolpa, M., Walaszek, M., Gniadek, A., Wolak, Z., & Dobros, W. (2015). Incidence, microbiological profile and risk factors of healthcare-associated infections in intensive care units: A 10 year observation in a provincial hospital in southern Poland.

    Int J Environ Res Public Health, 15

    (1), 112. doi:3390/ijerph15010112
  • Pallotto, C., Fiorio, M., De Angelis, V., Ripoli, A., Franciosini, C., Quondam Girolamo, L., Volpi, F., Iorio, P., Francisci, D., Tascini, C., & Baldelli, F. (2019). Daily bathing with 4% chlorhexidine gluconate in the intensive care settings: a randomized controlled trial.

    Clinical Microbiology and Infection, 25

    (6), 705-710. doi:10.1016/j.cmi.2018.09.012
  • Swan, J.T., Ashton, C.M., Bui, L.N., Pham, V.P., Shirkey, B.A., Blackshear, J.E., Bersamin, J.B., Pomer, R.M., Johnson, M.L., Magtoto, A.D., Butler, M.O., Tran, S.K., Sanchez, L.R., Patel, J.G., Ochoa, R.A., Hai, S.A., Denison, K.I., Graviss, E.A., & Wray, N.P. (2016). Effect of chlorhexidine bathing every other day on prevention of hospital-acquired infections in the surgical ICU: A single-center, randomized controlled trial.

    Critical Care Medicine, 44

    (10), 1822-1832. doi:10.1097/CCM.0000000000001820
  • Noto, M.J., Domenico, H.J., Byrne, D.W., Talbot, T., Rice, T.W., Bernard, G.R., & Wheeler, A.P. (2015). Chlorhexidine bathing and healthcare-associated infections: A randomized clinical trial.

    JAMA, 313

    (4), 369-378. doi:10.1001/jama.2014.18400

Table 1


Literature Review


Reference

(in APA without indention)


Purpose
Design and Measures

(relevant to project topic)
Sample

(total size (N=?), control/intervention size (n=?), demographics relevant to project topic)



Outcomes / statistics

(include significant findings related to the PICOT topic & include

p

-values or confidence intervals)

Pallotto et al. (2019) To determine whether daily bathing with chlorhexidine compared to bathing with soap and water would decrease hospital-acquired infection rates in intensive care units. Design:  RCT

Measures:

  • Number of patients who developed HAIs
  • Total size (N=449)
  • Control group (n=223)
  • Intervention group (n=226)
  • Thirty-four of the 226 individuals (15%) in the intervention group suffered from at least one HAI, while 57 (25.6%) individuals in the control group suffered from at least one HAI (p=0.008).
  • The incidence of all bloodstream infections was significantly reduced in the intervention group (9.2 vs 22.6), (p=0.027)
Swan et al. (2016) To evaluate whether bathing every other day with chlorhexidine compared to daily bathing with soap and water decreases the rate of hospital-acquired infections. Design:  RCT

Measures:

  • Number of patients who developed HAIs


  • Total size (N=325)
  • Adults >18 admitted to ICU expected to stay for 48 hours or longer; Braden Scale Score >9
  • Thirty-five patients in the control group (soap and water) developed HAIs, while 18 in the intervention group developed HAIs (p=0.049)
Noto et al. (2015) Determine if daily bathing with chlorhexidine decreased incidence of HAIs compared to non-antimicrobial methods. Design: RCT

Measures:

  • Number of patients who developed HAIs


  • Total size (N=9,340)
  • Intervention group (n=4488)
  • Control group (n=4852)
  • All patients admitted to cardiovascular, neurological, surgical, and trauma ICUs were included
  • Patients were excluded if they had an allergy to chlorhexidine, were admitted with burns, or if the physician thought bathing would be unsafe.
  • During the chlorhexidine period, 55 infections occurred (4 central line associated, 21 catheter associated, 17 ventilator associated, 13 c. diff). During the control period, 60 infections occurred (4 central line, 32 catheter associated, 8 ventilator associated, 16 c. diff).
  • Rate of primary outcome was 2.86 per 1000 days during chlorhexidine bathing and 2.90 per 1000 days during control bathing (P=0.95)

explain the ways in which the findings might be used in nursing practice, and address any ethical considerations associated with the conduct of the study.

/in /by

explain the ways in which the findings might be used in nursing practice, and address any ethical considerations associated with the conduct of the study.

 

Select either the qualitative OR quantitative study method for this assignment. The study method should connect to the practice problem of interest identified in Topic 1. This could be one of the previously selected articles from your literature review or a new peer-reviewed article.

In an essay of 1000-1,250 words, summarize the study, explain the ways in which the findings might be used in nursing practice, and address any ethical considerations associated with the conduct of the study.

Refer to the resource “Research Summary and Ethical Considerations Guidelines” for suggested headings for your paper.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

My topic chosen is family presence allowed during any type of patient care provided at any level.
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Metaparadigm concepts such as person/client, nursing, health, and environment

/in /by

Metaparadigm concepts such as person/client, nursing, health, and environment

Formulate a professional nursing philosophy based upon the role and responsibilities of the advanced nurse.

Introduction

The purpose of this Assignment is for you to present your views, values, and beliefs about the four concepts of the nursing metaparadigm (i.e., person, nursing, health, and environment) and their interrelationship to one another as they guide your currentnursing practice. The process of identifying a personal nursing philosophy of advanced nursing practice and continuously examining, affirming, and validating this philosophy through caring for patients, families, communities, populations, and/or systems can foster professional and personal growth that builds advanced practice expertise.

Directions

In this Assignment, you will develop the first draft of your personal philosophy of advanced practice nursing. You will continue to work on this document throughout the course, with new drafts reflecting your growing sophistication as you reflect on each week’s lesson.

A philosophical statement includes these elements:

An introduction that presents your thought processes used to articulate a philosophy of advanced practice nursing. Note that APA does not use a heading for the introduction, because it is assumed that the first few paragraphs of a manuscript are the introduction.
Valued personal concepts, such as:
Metaparadigm concepts such as person/client, nursing, health, and environment
Additional concepts you may find valuable to advanced practice, such as IOM Future of Nursing, accountability, interprofessional collaborative practice, social justice, and professionalism
Definition of each concept selected
Relationships between and among concepts within your personal philosophy as applied to your current practice. A diagram with should be used to graphically depict these interrelationships.

Organization of Your Paper

Your final paper is to be written in APA format (including organization, documentation, and references) and be no more than two pages in length. The paper should include a title page and reference list, however, these pages are not included in the final page count.

Course materials, except textbook, may be used and must be supplemented by current literature from peer-reviewed nursing journals no older than 5 years.

Additional resources to support this Assignment include:

Reflection: Readings
IOM Future of Nursing
Interprofessional collaborative practice

Before finalizing your work, you should:

Minimum requirement of at least 5 sources of support
be sure to read the Assignment description carefully (as displayed above);
consult the Grading Rubric (under the Course Resources) to make sure you have included everything necessary; and
utilize spelling and grammar check to minimize errors.

Your writing Assignment should:

follow the conventions of Standard English (correct grammar, punctuation, etc.);
be well ordered, logical, and unified, as well as original and insightful;
display superior content, organization, style, and mechanics; and
use APA 6th Edition

Identify and clarify an ethical dilemma facing your chosen discipline (i.e., health education, health care management, or environmental health). To achieve this, you will be expected to gather and evaluate relevant information (e.g., peer reviewed and credible sources) pertaining to the dilemma you’ve chosen to make the focus of your case assignment.

/in /by

Identify and clarify an ethical dilemma facing your chosen discipline (i.e., health education, health care management, or environmental health). To achieve this, you will be expected to gather and evaluate relevant information (e.g., peer reviewed and credible sources) pertaining to the dilemma you’ve chosen to make the focus of your case assignment.

 

American Nursing Association (2014). Short Ethics Definitions. Retrieved fromhttp://nursingworld.org/MainMenuCategories/EthicsStandards/Resources

Carnevale, F. (2009, Mar.). A Conceptual and Moral Analysis of Suffering, Nursing Ethics. 16(2), 173.

Deshpande, S.P. (2009, Dec.). A Study of Ethical Decision Making by Physicians and Nurses in Hospitals.Journal of Business Ethics. (90)3, 387-397.

Foster, C., Herring, J., Melham, K., & Hope, T. (2011). The double effect effect. Cambridge Quarterly of Healthcare Ethics, 20(1), 56-72.

Goldworth, A. (2008, Oct.). Deception and the Principle of Double Effect. Cambridge Quarterly of Healthcare Ethics, 17(4), 471-473.

Lippert-Rasmussen, K. (2010). Scanlon on the doctrine of double effect. Social Theory and Practice, 36(4), 541-564.

Murray, John S, PhD, RN, U.S.A.F., N.C. (2010). Moral courage in healthcare: Acting ethically even in the presence of risk. Online Journal of Issues in Nursing, 15(3), 9-1G,2G,3G,4G,5G,6G,7G,8G,9G.

The goal of the Session Long Project is to identify and evaluate the ethical principles used in resolving ethical dilemmas, and to apply the principles to specific ethical issues that may have professional, sociological, economic, legal, and possible political implications.

Tasks for Module 1: (Critical thinking Assignment)

Identify and clarify an ethical dilemma facing your chosen discipline (i.e., health education, health care management, or environmental health). To achieve this, you will be expected to gather and evaluate relevant information (e.g., peer reviewed and credible sources) pertaining to the dilemma you’ve chosen to make the focus of your case assignment.
Identify and briefly discuss the competing ethical positions that accompany the issue and the applicable ethical theories and principles.

SLP Assignment Expectations

Limit your responses to three pages, not including title and reference pages, and be sure to properly cite all references within the text of your assignment and listed at the end.
Please support your discussions with scholarly support (3-5 references). Be sure to properly cite all references.
Apply critical thinking skills to your response- specifically to #2 above.