Analyze the role of nurses as change agents in facilitating the adoption of new technology.

Analyze the role of nurses as change agents in facilitating the adoption of new technology.

Adoption of New Technology Systems
As a nurse, you can have a great impact on the success or failure of the adoption of EHRs. It is important for nurses to understand their role as change agents and the ways they can influence others when addressing the challenges of changing to a drastically different way of doing things.
Everett Rogers, a pioneer in the field of the diffusion of innovations, identified five qualities that determine individual attitudes towards adopting new technology (2003). He theorized that individuals are concerned with:
• Relative advantage: The individual adopting the new innovation must see how it will be an improvement over the old way of doing things.
• Compatibility with existing values and practices: The adopter must understand how the new innovation aligns with current practices.
• Simplicity: The adopter must believe he or she can easily master the new technology; the more difficult learning the new system appears, the greater the resistance that will occur.
• Trialability: The adopter should have the opportunity to ‘play around’ with the new technology and explore its capabilities.
• Observable results: The adopter must have evidence that the proposed innovation has been successful in other situations.
Note: You are not required to purchase Rogers’ book or pursue further information regarding his list of five qualities. The information provided here is sufficient to complete this Assignment.
For this Assignment, you assume the role of a nurse facilitator in a small hospital in upstate New York. You have been part of a team preparing for the implementation of a new electronic health records system. Decisions as to the program that will be used have been finalized, and you are now tasked with preparing the nurses for the new system. There has been an undercurrent of resistance expressed by nurses, and you must respond to their concerns. You have a meeting scheduled with the nurses 1 week prior to the training on the new EHR system. Consider how you can use the five qualities outlined by Rogers (2003) to assist in preparing the nurses for the upcoming implementation.
To prepare:
• Review articles about successful implementations of EHRs.
• Consider how you would present the new EHR system to the nurses to win their approval.
• Reflect on the five qualities outlined by Rogers. How would addressing each of those areas improve the likelihood of success?
To complete:
Write a 3- to 5-page paper (double space) which includes the following:
• Using Rogers’ (2003) theory as a foundation, outline how you would approach the meeting with the nurses. Be specific as to the types of information or activities you could provide to address each area and include how you would respond to resistance.
• Analyze the role of nurses as change agents in facilitating the adoption of new technology

This assignment does require title page, headers and reference pages.

References
Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York, NY: Free Press.
Please use 4 more academic references

Thx
Daniel

Hashimoto Thyroiditis: Causes- Treatment and History


Neysha L. Gonzalez


Hashimoto Thyroiditis

Hashimoto’s Thyroiditis is a common form of Thyroiditis and disorder in the United States. Not many people know about its existence until they have acquired the disorder. It is considered a condition where your immune system attacks your thyroid. An individual’s thyroid is located on the side of the neck right below the Adam’s apple. It can easily be located and felt on those who have this condition. Thyroid is a gland located in your endocrine system along with other glands, which are said to create hormones and control your metabolic system. The ability of not creating thyroid hormones can result in hypothyroidism. Hashimoto Thyroiditis can be diagnosed and can bring about some common signs that can be picked up easily. Complications, along with risk factors can occur, so knowing the basic about the disorder can help any individual live through it as it is a life time disease. There are several causes, effects, and symptoms of Hashimoto Thyroiditis.


History

The name “Hashimoto” comes from the founder who was known to be a Japanese surgeon. Hashimoto can lead to dyspnea and even dysphagia due to the pressure felt on the neck area. The founder had diagnosed four patients with a thyroid disease called Struma Lymphomatosa (DeGroot & Amino, 2013). Struma Lymphomatosa was uncommon, but as the years have gone by many cases have appeared. Diagnosis was made by the surgeon and it was not until the patient came in, that they would be diagnosed with Hashimoto. Studies were done on animals, in particular rabbits and they studied the immunization of the extracts of the rabbit thyroid. Researchers concluded that rabbit thyroid had some sort of similarity to that of Hashimoto thyroiditis (DeGoot & Amino, 2013).


Signs and Symptoms

There are various characteristics used to distinguish Hashimoto Thyroiditis. It is beneficial to recognize these signs and symptoms as soon as possible in order to start treatment that an individual might need. Goiter may develop when your immune cells attacks your thyroid tissues, inflammation and an enlarged thyroid may occur (Milas, 2014). Swelling around the neck is considered the primary sign of a goiter. When it first starts to occur, the pain may be non-existence. However, if no treatment is administered, an individual might feel some pressure in the lower part of the neck. The neck area may feel a bit sensitive to the touch and discomfort may start to develop, which may extend to other parts of the body that is close to the area.

Additionally, if still un-treated, the swelling may then cause a difficulty in swallowing and breathing and depending on the individual, other symptoms such as hoarseness or other voice changes that do not go away, may come about due to the effect of the previous symptoms (Milas, 2014). Symptoms can be different for every individual. If you develop hypothyroidism some symptoms that may be associated with this disorder includes weight loss or weight gain, fatigue, muscle soreness, or even dry skin, nail, and hair. An individual’s hair may lose its shine and even cause a bit of hair loss in parts of their scalp. These symptoms may not be easy to detect, and one may see this as a normal occurrence.  For that reason, it is always good to have a basic knowledge about Hashimoto in order to detect the disease and look for help (Milas, 2014).


Risk Factors

Women are at higher risk of getting Hashimoto due to sex hormones. Studies show that it is 5 to 10 times more likely in woman than in men (Chen, Lin, Cheng, Sung, & Kao, 2013).  Having regular check-ups with your doctor is the best way to prevent the disease from getting worse. Middle aged individuals have a high likelihood of getting Hashimoto disease (Chen et al., 2013).  No studies have shown the reason why this occurs, but middle aged individuals are advised to keep alert on the signs and symptoms that are faced within this condition.  If an individual’s family has a history of thyroid or even some type of autoimmune diseases such as, type 1 diabetes or even lupus, then they might be at a high risk (Chen et al., 2013).

Additionally, individuals who are exposed to excessive environmental radiation can develop this condition as well.  Studies has shown that the development of Hashimoto can have negative effects on some types of cancers. The autoimmunity of the thyroid hormone is the cause of this association. Types of cancers that can develop due to this condition include lung, breast, and thyroid cancer (Chen et al., 2013). Chen et al. (2013) stated that studies are still being conducted in order to examine the different conditions individuals living with this disease may face with their lives. Researchers are focusing more on women because they are at a higher risk.

There is no major cause on what may trigger Hashimoto’s disease. According to Chen et al. (2013) your immune system is said to create antibodies which harms their thyroid gland. Various research has been conducted in order to find answers, but nothing has been proven to be true (Chen et al., 2013). Some scientists consider the possibility of a virus or even a bacteria being the reason behind this condition. Others conclude that it is a genetic defect that might have been the cause and so nothing can be done in order to prevent the condition (Chen et al., 2013).


Diagnosis

Hashimoto Thyroiditis can be diagnosed through various blood work. When blood tests are done, they tend to measure the thyroid gland function. The main objective upon these blood test is to search for antibodies against the proteins which are found in the thyroid gland (Lee, 2013). The blood work can either be done at the provider’s office or even at a commercial facility. One or two tubes of blood is all that is needed in order to diagnose whether or not there is a chance of having Hashimoto.

Some diagnostic blood tests that may be performed would be he TSH (Thyroid-stimulating hormone, T4, or the Anti-thyroid antibody test. The TSH test is said to be the first one performed because it is considered the most accurate measure of thyroid activity. T4 can measure the amount of thyroid hormone within your blood and the Anti-thyroid antibody tests looks for the autoantibodies within the body’s tissue (Lee, 2013). Hashimoto can also be diagnosed through a physical examination or even a medical history. This disorder can be diagnosed by asking of questions and the regular checkups to the doctor’s office can bring about the probability of diagnosing this disorder. During a physical examination, nodules could be found by your care provider who may palpate your thyroid gland and do further investigation to rule out this particular disorder (Lee, 2013). Blood work may then be requested in order to confirm if the patient has Hashimoto Thyroiditis.

Ultrasound for detecting Hashimoto Thyroiditis has been a useful tool. It helps doctors evaluate the disorder itself with high resolution. This type of testing is low in cost, widely available, is not painful, and it does not utilize ionizing radiation. (Chaudhary & Bano, 2013). Patients are put in a supine position and a high frequency instrument is utilized to detect any mass. The instrument is moved around the neck in a slow circular motion. The imaging of the thyroid gland is done in both color and gray-scale in order to get a better visualization of the gland and possible masses that might be present (Chaudhary & Bano, 2013).


Treatment

Hashimoto can be controlled by a medication called levothyroxine sodium. The individual would have to take this pill every day for the rest of their life. This pill replaces the hormones that the thyroid can no longer supplement.  Each individual’s dose intake is different because it depends on various factors. Some factors that are taken into consideration are the patient’s age, weight, and even the severity of the condition has on the patient (Schori-Ahmed, 2003). According to Schori-Ahmed (2003), the doctor may start off the patient with a low dose for about two to four weeks. By doing this they are keeping a close watch on the TSH levels to see if they have settled back to normal. If it has not, then a higher dose may be given to the patient (Schori-Ahmed, 2003). For the elderly and those who may have cardiovascular disease, it is important to take into consideration what pills they take as some side effects may occur due to overtreatment (Schori-Ahmed, 2003). A thyroidectomy can also be done if the condition worsens with time. It is commonly performed on individuals who developed Graves’ disease or thyroid cancer. This may result in taking thyroid medications for life (Schori-Ahmed, 2003).


Complications

If the condition is not treated on a timely manner, various complications may occur. Hashimoto is the cause of hypothyroidism and is one of the main cause for goiter, which is when your thyroid gland is enlarged. This happens when your thyroid gland is regularly aroused to release hormones. Goiter can be palpated or a times even seen by the human eye if big enough. It may give an individual difficulty breathing and even swallowing (Wint & Boskey, 2012). People who have hypothyroidism may be linked to developing heart problems. This is due to the high levels of low-density lipoprotein cholesterol. If untreated an enlarged heart may occur which may cause heart failure eventually (Wint & Boskey, 2012). Depression and loss of sexual desire can occur due to this disease for both men and woman.  If untreated, Hashimoto can cause Myxedema, which is not seen much, but can be life-threatening to those who do get it. Myxedema is the swelling of the skin and can be triggered by exposure to cold, stress and even infections (Wint & Boskey, 2012). Women may have birth defects such as heart, kidney, and even brain problems in the infant (Wint & Boskey, 2012).

Hashimoto Thyroiditis can be a serious disease if left untreated. Having regular check-ups can be beneficial when taking into consideration the complications it may have if not treated right away. If an individual experiences any sort of sign such as inflammation, difficulty swallowing, or feels some type of symptom such as fatigue and weight loss, immediate action should be taken. Various complications can develop if an individual does not seek for help right away, which can affect both your loved ones and yourself in both the short and even long run. There are various tests that can be completed in order to see if an individual has Hashimoto Thyroiditis. Blood work, ultrasounds, and even palpation around the neck area can help diagnose this disease. Hashimoto Thyroiditis cant be cured but it can be treated if diagnosed on time.


References

Chen, Y., Lin, C., Cheng, F. T., Sung, F., & Kao, C. (2013). Cancer risk in patients with Hashimoto’s thyroiditis: a nationwide cohort study. British Journal Of Cancer, 109(9), 2496-2501. doi:10.1038/bjc.2013.597

Chaudhary, V., & Bano, S. (2013). Thyroid ultrasound. Indian Journal of Endocrinology and Metabolism, 17(2), 219-227. http://doi.org/10.4103/2230-8210.109667

DeGroot, L., & Amino, N. (2013). Hashimoto’s Thyroiditis. Kuma Hospital, Center for Excellence in Thyroid Care. Retrieved February 28, 2017, from http://www.thyroidmanager.org/chapter/hashimotos-thyroiditis

Lee, S. (2013). Hashimoto’s Disease | NIDDK. Retrieved February 20, 2017, from https://www.niddk.nih.gov/health-information/endocrine-diseases/hashimotos-disease

Milas, K. (2014). Symptoms of Hashimoto’s Thyroiditis. Endocrineweb. Retrieved February 20, 2017, from https://www.endocrineweb.com/conditions/hashimotos-thyroiditis/symptoms-hashimotos-thyroiditis

Schori-Ahmed, D. (2003). Thyroid disease. Rn, 66(6), 38-44.

Wint, C., & Boskey, E. (2012). Hashimoto’s Disease. Healthline. Retrieved February 25, 2017, from http://www.healthline.com/health/chronic-thyroiditis-hashimotos-disease

Evidence-based Medicine and Rapid Response Team

Evidence-based Medicine and Rapid Response Team

Evidence-based Medicine and Rapid Response Team

Evidence based practice is the use of current evidence in making decisions in health care for the patients in the safest and most efficient ways. Pressure ulcer prevention is one of the nursing practices that have been improved by the evidence based practice studies. Using the braden scale was once an important tool for knowing the chances of skin breakdown. Based on studies they developed the interventions that could be used to prevent a patient from skin breakdown based on what stage they are in.

Rapid response teams (RRT) are important in the hospital they have been known to improve patient outcomes in acute emergency settings. Having a RRT is a good way to help get a patient into a stable situation when they are not doing well before they get to the point of cardiac arrest or respiratory distress situations. Through evidence based medicine they were able to see how important a RRT is and get them started in all hospital settings.

Refrences

Bruckel, J. (n.d.). Evidence-based Medicine and Rapid Response Team Implementation. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2687898/

Quality improvement, research, and evidence-based practice: 5 years experience with pressure ulcers. (n.d.). Retrieve from http://ebn.bmj.com/content/1/4/108.full.html




ORDER NOW FOR CUSTOM-WRITTEN, PLAGIARISM-FREE PAPERS




You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.


Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.


Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.


The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.


Evaluate how you have achieved course competencies and your plans to develop further in these areas.

Evaluate how you have achieved course competencies and your plans to develop further in these areas.

Evaluate how you have achieved course competencies and your plans to develop further in these areas. The course competencies for this course are as follows:
Explore the historical evolution of the advance practice nurse.
Differentiate the roles and scope of practice for nurses working in advanced clinical, education, administration, informatics, research, and health policy arenas.
Analyze attributes of the practice arena such as access and availability, degree of consumer choice, competition, and financing that impact advanced practice nurses and their ability to effectively collaborate with other health professionals.
Integrate evidence from research and theory into discussions of practice competencies, health promotion and disease prevention strategies, quality improvement, and safety standards.
Identify collaborative, organizational, communication, and leadership skills in working with other professionals in healthcare facilities and/or academic institutions.
Synthesize knowledge from values theory, ethics, and legal/regulatory statutes in the development of a personal philosophy for a career as an advanced practice nurse.competencies for this course are as follows:
Explore the historical evolution of the advance practice nurse.
Differentiate the roles and scope of practice for nurses working in advanced clinical, education, administration, informatics, research, and health policy arenas.
Analyze attributes of the practice arena such as access and availability, degree of consumer choice, competition, and financing that impact advanced practice nurses and their ability to effectively collaborate with other health professionals.
Integrate evidence from research and theory into discussions of practice competencies, health promotion and disease prevention strategies, quality improvement, and safety standards.

RUA Case Study: Chronic Obstructive Pulmonary Disease


Health History

Pamela Carothers is a 71-year-old Caucasian female who was diagnosed with COPD last year is being admitted for shortness of breath and chest pain that she has had for the last 2 days. She is sitting up in the bed gripping tightly the bed rails, breathing through her mouth with rapid, shallow breaths and the use of accessory muscles. Pamela’s daughter Karen is present and answering questions for her mother. Karen tells the nurse that Pamela has a past medical history of emphysema and hypertension and that Pamela smokes 2 packs of cigarettes a day as she has for the past 35 years. Since her last follow up with her cardiologists, she has lost 15 pounds. Today in the ER Pamela’s vitals are, blood pressure of 152/90, heart rate at 82, temperature of 98.9F, O2 saturation at 92% at 2L on nasal cannula, respirations of 12, and wheezing noted for breathes sound. The nurse is aware that amongst COPD patients diagnosed within the past year, they have a higher prevalence of acquiring a case of severe pneumonia compared to patients without COPD (Restrepo, Sibila, & Anzueto, 2018).

When asked about exercise Pamela states she cannot exercise because she gets “winded” immediately and even getting in and out of her favorite chair at home leaves her out of breath. She exclaims that she is always extremely tired as it is difficult for her to sleep in her bed at night so she sleeps in her favorite chair which is now causing swelling in her legs and feet. Pamela has also expressed that she is extremely tired and frustrated with feeling like she is dying. She states that she is a burden to her daughter and that her daughter would be better off if she didn’t have to take care of her. Pamela states “a mother is supposed to take care of her child not the other way around”. Pamela states that she has not been taking her prescribed medications as she is on a fixed income and cannot afford them. Pamela stated, “I have to choose between food on my table or medications that I don’t need”. She stated she has opted to buy and take herbal supplements because one of her good friends recommended, she take a tablespoon of apple cider vinegar a day for her “pressure” and turmeric capsules because she read online that it was good for inflammation.


Laboratory/Diagnostic Testing

Arterial blood gas is the best way to determine the severity of a COPD exacerbation. The pH is closer to normal in those with COPD, anything less than 7.3 is considered to be an acute episode. Pamela’s result was pH 7.39 PCO2 28.6 PO2 55 HCO3 20.6.

Spirometry was used to measure the expiratory forced vital capacity which is how much air she could forcefully exhale after breathing in as deeply as possible. Normal value is eighty percent or greater and abnormal is considered lower than eighty percent. The second measurement is forced expiratory volume which is how much air you can force out of the lungs within one second. The FEV1 is the grade on how severe an abnormality is. Pamela’s results were FCV/FEV1 40%. A chest x-ray was done to help support a diagnosis of COPD by showing images of enlarged lungs, a flat diaphragm, or air pockets. Pamela’s results were hyperinflation of the lung.


Collaborative Management

Pamela has states that she is non-compliant in taking her prescribed medication due to the cost of the medication. She is currently prescribed albuterol and fluticasone to treat her COPD and emphysema. With compliance of medications the patient should see an improvement in her COPD. There are many resources that can assist Pamela with the costs of her medications. Many drug companies offer discounts to people who may not be able to afford those medications. Due to the cost of the albuterol inhaler the patient could try the Albuterol Sulfate tablet, which is a twelve-hour extended release. The Albuterol sulfate tablet is offered at many pharmacies ranging from four to nine dollars (RxVantage, 2019). This may also assist with compliance because it is a once a day dose. A social worker will follow up with Pamela to see if she may qualify for government assistance to aid in the purchase of her medications and to possible have a CNA assist her a few days a week in her home. The social worker can also arrange to have modifications made to Pamela’s bed to make it easier for her to breath while sleeping.

Pamela was scheduled for a chest x-ray to rule out any other lung problems other than her emphysema and COPD and to rule out heart failure. Next a referral for a pulmonary function test will be place so that a new baseline can be established for her COPD. The pulmonary function test will allow us to adjust her treatment and medications appropriately. Since Pamela is still currently smoking the recommendation for smoking cessation will be made as well as education on the importance of quitting smoking. We would also recommend that Pamela participate in a pulmonary rehabilitation program in the future. She would greatly benefit from their services. This program includes education, nutrition advice, counseling, and exercise training. This program includes a specialist from different fields, who can build a plan based on her specific needs. Pulmonary rehabilitation will allow Pamela to gradually increase her ability to participate in daily activities and improve her quality of life (Lee & Kim, 2019).

Pamela’s weight has decreased by fifteen pounds since her last visit. As a result, a consult with nutrition will be placed to help her pick foods that are easier for her to eat so that she will not be fatigued as easily with eating. The recommendation for a soft food, low sodium, high protein diet has been explained at length with the patient. She understands but realizes she needs assistance with food choices (Hodson, 2016). “Stopping smoking may also help with improving the senses of taste and smell making food more pleasurable” (Hodson, 2016).


Nursing


Management


Nursing Diagnosis: Priority physiological

Ineffective breathing pattern related to hyperventilation as evidenced by the use of accessory muscles to breathe.


Short term goal:

Pamela will exhibit no use of accessory muscles by end of shift


Long term goal:

Pamela will take her medications as prescribed with the help of case

management to find assistance with paying for medications by discharge.


Interventions:

  1. Demonstrate to Pamela how to perform pursed lip breathing (PLB).

    Rationale:

    This type of breathing prolongs exhalation and prevents the bronchioles from collapsing and trapping air. PLB is also gives the patient more control over breathing and is very beneficial during exercise and periods of dyspnea (Lewis, Bucher, Heitkemper, Harding, Kwong, & Roberts, 2017).
  2. Assist Pamela with maintaining a diet high in protein and calories consisting of mechanical soft foods.

    Rationale:

    Diet is a main concern as Pamela is losing weight due in part to the fact that she breathes out of her mouth, so it is more difficult for her to eat. Pamela will need to eat mechanical soft foods which will be easier for her to consume.
  3. Educate Pamela on the importance of regular exercise as physical activity.

    Rationale:

    Patients with COPD is consistently associated with mortality and increased exacerbations (Gimeno-Santos, Frei, Steurer-Stey, De Batlle, Rabinovich, Raste, Garcia-Aymerich, 2014).


Evaluations:

  1. Pamela has demonstrated effective pursed lip breathing.
  2. Pamela has identified appropriate foods included in her mechanical soft, high protein and calorie diet.
  3. Pamela has begun exercising as tolerated by walking from her room to the end of the hall and back while using pursed lip breathing and resting when needed.


Education:

  1. Educate Pamela on the Huff coughing technique to expel mucus from her airway.
  2. Educate Pamela on the importance of smoking cessation.
  3. Educate Pamela on the importance of taking her medications as prescribed.


Nursing Diagnosis: Priority Psychosocial

Stress overload related to coping with chronic illness (COPD) as evidence by patient expressed that she is feeling extremely tired and frustrated with feeling like she is dying and burden to her daughter and that her daughter would be better off if she didn’t have to take care of her.


Short term goal

: Pamela will identify at least three stressors that can be controlled and

those that cannot by the end of the shift.


Long term goal

: Pamela will identify three behavioral modifications to reduce or

eliminate that will increase successful stress management.


Intervention:

  1. Assist Pamela to recognize her thoughts, feelings, actions, and physiological responses to feeling of tiredness or frustration.

    Rationale

    : Self-awareness can help Pamela reframe and reinterpret her feelings and experiences of what she can control and what she cannot control (Carpenito-Moyet, L.2016).
  2. Teach Pamela how to break the stress cycle and how to decrease heart rate, respirations, and strong feelings of anger or feeling of powerlessness or hopelessness.

    Rationale:

    Pamela faced with overwhelming multiple stressors (health condition, dependence on her daughter, medication/financial), this will assist Pamela to differentiate which stressors and behavior can be modified to reduce or eliminate the stress overload.
  3. Initiate health teaching and referrals.

    Rationale:

    Pamela expressed that she is feeling extremely tired and frustrated with feeling like she is dying and burden to her daughter and that her daughter would be better off if she didn’t have to take care of her. Consulting professional counseling would be very beneficial for Pamela.


Evaluations:

  1. Pamela able to identify and recognize three of her thoughts, feelings, and actions that she took reduce of her feeling tired or frustrated.
  2. Pamela able to use breathing technique correctly to reduce her heart rate and respiration.
  3. Pamela scheduled or meeting with counseling to talk about her feelings.


Education:

  1. Teach Pamela to purposefully distract herself when she is feeling overwhelmed by thinking of something pleasant and positive.
  2. Teach Pamela to use mini-relaxation (breathing) techniques while also thinking of something pleasant and positive and this will help reduce her heart rate, respiration, and also can help reduce her COPD exacerbation as well. This will help Pamela to recognize which modification she can change.
  3. Encourage Pamela meet with counseling to talk about her feelings.


Conclusion

In conclusion caring for a patient with COPD takes continuous monitoring and care. The patient must be willing to be compliant with care and medications to successfully manage their disease. It is important to treat the patient as a whole. By taking care of the patient’s psychosocial, socioeconomical and physiological needs then the patient is more likely to be successful. It is also important to be knowledgeable about their disease so that proper diagnosis and care can be given to the patient.


References

  • Bodescu, M.-M., Turcanu, A. M., Gavrilescu, M.-C., & Mihăescu, T. (2015). Respiratory rehabilitation in healing depression and anxiety in COPD patients. Pneumologia (Bucharest, Romania), 64(4), 14–18. Retrieved from https://search-ebscohost-com.chamberlainuniversity.idm.oclc.org/login.aspx?direct=true&db=mdc&AN=27451589&site=eds-live&scope=site
  • Carpenito-Moyet, L. (2016).

    Handbook of nursing diagnosis

    (15th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
  • COPD. (2017, August 11). Retrieved from https://www.mayoclinic.org/diseases-conditions/copd/diagnosis-treatment/drc-20353685
  • Eun Nam Lee, & Moon Ja Kim. (2019). Meta-analysis of the Effect of a Pulmonary Rehabilitation Program on Respiratory Muscle Strength in Patients with Chronic Obstructive Pulmonary Disease.

    Asian Nursing Research

    , (1), 1. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1016/j.anr.2018.11.005
  • Gimeno-Santos, E., Frei, A., Steurer-Stey, C., De Batlle, J., Rabinovich, R., Raste, Y.,
  • Garcia-Aymerich, J. (2014). Determinants and outcomes of physical activity in patients with copd: A systematic review.

    Thorax,


    69

    (8), 731-731. doi:10.1136/thoraxjnl-2013-204763
  • Hodson, M. (2016). Integrating nutrition into pathways for patients with COPD.

    British Journal of Community Nursing

    ,

    21

    (11), 548–552. https://doi-org.chamberlainuniversity.idm.oclc.org/10.12968/bjcn.2016.21.11.548
  • Lewis, S. L., Bucher, L., Heitkemper, M., Harding, M., Kwong, J., & Roberts, D. (2017).

    Medical surgical nursing: Assessment and management of clinical problems

    (10

    th

    ed.). St Louis, MO: Elsevier.
  • Restrepo, M., Sibila, O., & Anzueto, A. (2018). Pneumonia in patients with chronic obstructive pulmonary disease.

    Tuberculosis and Respiratory Diseases,


    81

    (3), 187-197. doi:10.4046/trd.2018.0030
  • RxVantage. (2019). Patient Assistance Programs. Retrieved from https://www.rxassist.org/

CLINICAL SETTING: Medical surgical/ orthopedic unit

CLINICAL SETTING: Medical surgical/ orthopedic unit

This course, NURS 484, has 9 course outcomes and your learning will address all of these to some degree. Since all clinical situations and settings are unique, more specific/individualized outcomes are needed. Thus, please do the following:
1. Identify and describe your clinical environment. (1 point)
2. Explain the benefits of a clinical experience in this chosen environment. (1.5 points)
3. Provide at least three additional learning outcomes/goals for your practicum based on your clinical environment and personal learning needs. Please write thoughtful, thorough outcomes. Use bullet points. (4.5 points)
4. Include particular ways you intend to meet the additional learning outcomes.(3 points)
Please write thorough responses, use paragraph breaks, and follow APA formatting. The assignment is worth 10 points.

COURSE/CLINICAL OUTCOMES: NURS 484

The student will:
1. Assume responsibility for professional growth through the design of an individualized learning plan. (P
2. Use theoretical concepts, research findings, and other ways of knowing to guide nursing practice with clients from diverse cultural backgrounds who have complex care needs in various phases of the life span.
3. Practice in a caring, responsible, and accountable manner in accordance with professional ethics and accepted standards of practice.
4. Integrate critical thinking skills into the practice of professional nursing with clients experiencing complex care needs.
5. Apply appropriate leadership and management principles in designing, coordinating, managing and advocating for meeting the complex health care needs of individuals, familiesand groups in various phases of the life span.
6. Demonstrate an ability to reflect on interpersonal and interactional processes with individuals, families, and groups and critically analyze own role in relation to them.
7. Intervene independently and in collaboration with other health professionals, using appropriate nursing strategies and actions.
8. Evaluate the outcomes of therapeutic nursing interventions and plan further interventions accordingly.
9. Participate in informal critique of the health care delivery system and identify areas for change in nursing and health care delivery

Please write a well-crafted statement about your desire to become a nurse-midwife or family nurse practitioner.

Please write a well-crafted statement about your desire to become a nurse-midwife or family nurse practitioner.

 

Goal Statement Essay: Please write a well-crafted statement about your desire to become a nurse-midwife or family nurse practitioner. Include information about yourself and your professional goals as a nurse-midwife or nurse practitioner. Please type separately and limit yourself to 300-500 words.

 

 

Arguments For and Against the Vaccine


Vaccine Debate



Introduction

There has always been a debate over the idea that children our newborns don’t need vaccinated. Some people think they give babies deadly diseases that would kill them. Who knows it may or may not be true. In this paper I’m going to go over both sides of this big debate and explain why getting your children vaccinated is VERY important, especially when it comes to your children’s lives. Another thing is how a vaccine even works to show you that vaccines are safe.


The Doctor Is out: The anti-vaccination movement in America

Since 1998, a growing fear surrounding vaccinations in the United States and England has been spreading. The claim is that vaccinations contain dangerous amounts of Mercury, Formaldehyde, and other toxins and can possibly link to bowel disease and autism. Despite mountains of evidence to the contrary, the anti-vaccination (which has gained the dubious moniker, anti-vax) movement continues to grow in The United States and England. This paper looks to outline the history of the movement, both historical vaccination scares and the modern incarnation of anti-vax, and shed light on the dangers of not having children vaccinated, as well as present evidence to the safety and effectiveness of vaccines. The current vaccination scare is nothing new, and is reminiscent of previous historical scares, the worst of which being in 19th Century Europe. In 1853, the British government passed the Vaccination Act of 1853, making vaccinations mandatory for all children in the first three months. The passage of the act caused a violent anti-vaccination movement to begin, with riots in Ipswich, Henley, and Mitford. Subsequently, the Anti-Vaccination League in London was formed the same year, giving the movement an appearance of credibility. In 1867, Parliament passed another law, The Compulsory Vaccination Act of 1867, extending the vaccination schedule to fourteen years. This caused more backlash within the anti-vaccination community, and more groups began forming, such as the Anti-Compulsory Vaccination League, as well as scientific journals such as The Anti-Vaccinator (1869), The Vaccination Inquirer (1879) and The National Anti-Compulsory Vaccination Reporter (1874) (Wolf, Robert M; Sharp, Lisa K, British Medical Journal).

The movement didn’t stop in England, however. By the 1870’s it had spread to Sweden, and the vaccination rate in Stockholm dropped from 90% in 1872 to 40% in 1873. The Swedish government did little to react to this until Stockholm was hit by a major Smallpox pandemic in 1874. With so few people vaccinated against the virus, it spread quickly and ravaged the city, leaving 4,063 dead in Sweden, and 1,206 of those deaths in the city of Stockholm (Kotar, S.L., Smallpox: A History p. 177).

Other countries weren’t immune to this outbreak, either. Europe was in the middle of the Franco-Prussian war at this time, meaning large forces were moving quickly across Europe, and taking the disease with them. Smallpox spread into Denmark and Norway, which led to 6,620 reported cases and 425 deaths in Denmark, and 2,235 cases with 275 deaths in Norway (Kotar, S.L., Smallpox: A History p. 177). By this point in history, a viable Smallpox vaccine was available and had been for decades. In 1798, Edward Jenner effectively immunized patients against Smallpox by injecting them with a weaker strain of Cowpox. The body’s immune response to fight off the Cowpox virus conferred a permanent immunity to contraction of Smallpox. The uproar over vaccine denial in Europe, however, made the vaccination useless, and while Sweden had laws in place requiring vaccinations, they were not well enforced. 49% of children weren’t immunized in Stockholm, the city that took the brunt of the pandemic.

Understanding this direct cause and effect relationship between lack of vaccinations, mobility of people, and deaths from preventable diseases is important in the fight against the modern day anti-vaccination movement. Europe in the 1870‘s lost a portion of its population to a preventable disease, which was spread so quickly by the movement of armies during the Franco-Prussian war as well as the displacement of civilians resulting from the war. Smallpox, as with most diseases, incubates in people for a few days before symptoms are visible, however it is still possible to spread the virus while it’s in its incubatory stages. So, this means that many people who arrived in Sweden and Denmark that were carriers had no outward symptoms. They were interacting with a culture that was largely unvaccinated against Smallpox, allowing the disease to run rampant amongst the population with deadly consequences.

Fast forward 130 years to the modern world and this scenario could again become a lethal reality. We live in a world that increasingly connected, where people travel daily from one country or continent to another, and with little effort. While there are vaccination laws in the United States and most of the rest of the developed world, places such as West Africa have no such laws, and very high rates of vaccine preventable illnesses. People can travel quickly and with relatively little effort from these places and back again in less than the amount of time it would take a viral infection to start showing symptoms. This is exactly what happened in Newark, Texas in 2013. The Eagle Mountain International Church in Newark is a church that boasts over 1,500 members. They are also vehement anti-vax proponents. In August of 2013 a member had traveled to Indonesia, where he contracted measles. He showed no outward symptoms upon his return to Texas and attended church, where he then spread the measles to other members of the congregation. Sixteen people contracted the illness, nine children and seven adults, none of whom had been vaccinated against it. One of the adults then spread the measles to nearby Denton, Texas, infecting another five people, again, not vaccinated (Aleccia, Jonel; NBC News). While this case was relatively mild and brought no fatalities, it shows a demonstrable pattern between vaccine denial, migration, and infection.

To understand why vaccinations are important, it’s necessary to understand how they work; and to understand the denial movement it’s important to know the stance of the anti-vaccinationists. Without delving too much into the science (entire doctoral and PhD thesis have been written on the subject), vaccines work by injecting weak or paralyzed forms of viruses and other chemicals directly into the bloodstream of a patient. The patient’s (typically an infant) immune system then fights off the infection, and the body builds an immune response to the infection. This response is permanent, and the patient has now developed anti-bodies to various diseases (Centers for Disease Control and Prevention, How Vaccines Prevent Disease).

The anti-vaccination stance is that vaccinations are not tested enough, that pharmaceutical companies cannot be trusted, and that the added chemicals in vaccinations aren’t safe for human consumption. They claim, as well, that parts from aborted fetuses, rabbit brains, dog kidney, and chicken embryos are used in the manufacture of vaccines, and that while you can always get a vaccination, you can’t undo an existing one. The list of chemicals in vaccinations is indeed staggering, according to the anti-vaccination camp. Thimerosol, MSG, anti-freeze, and formaldehyde are just a few of the long list of dangerous chemicals in vaccinations, according to the web site The Healthy Home Economist (

Six Reasons To Say NO to Vaccination

).

While it is true that many of these chemicals exist in vaccines, they are frequently in trace amounts not harmful to humans. Many of them are used only during the manufacturing process and are actually removed from the final product. Thimerosol, which contains ethyl mercury, is common in many vaccines, and is used as a disinfectant (Centers for Disease Control and Prevention; Vaccine Ingredients). Anti-vaxers have claimed for years that the addition of mercury into an infant is incredibly dangerous, however, a study published in The Lancet and conducted at the University Of Rochester proved just the opposite. 40 infants were randomly selected, 19 of them received vaccines with ethyl mercury, and 21 without. Blood, urine, and stool samples were then taken from the infants from three to twenty eight days after the initial vaccination. The infants were exposed to 111.3 micrograms of Thimerosol containing ethyl mercury (higher than is contained in vaccines) or to 82.5 micrograms if the infant was under 3 months old (for scale, 1 microgram is equal to 1.0e-9 kilograms). The findings showed that, between 4-10 days, the half-life decay of ethyl mercury was 95%, meaning that 95% of the chemical had dissipated from the infants in just over a week. Further, the trace amounts that were actually injected into the infants were incredibly minute, so much so that, by comparison, you would consume more mercury by eating an apple, almost ten times as much. Only one of the infants was shown to have an increased level of ethyl mercury after 28 days, but the amount still fell within the acceptable tolerance range (Pichichero, The Lancet). Mono Sodium Glutamate, or MSG, is present as well in vaccinations; however this chemical in small amounts is in no way harmful to humans. It’s commonly found in table salt and other food seasonings. While formaldehyde is indeed used in the manufacture of vaccines, it is not in the final product. The formaldehyde is used to paralyze the virus that is going in the vaccination, and is subsequently removed before the vaccine is complete. The American Journal Of Public Health performed a study in 1954 of the use of formaldehyde in the poliomyelitis vaccine, and found it to be completely safe (American Journal Of Public Health, Salk, Jonas E. M.D., Volume 44 Issue 5).

Anti-freeze is another harmful chemical that the anti-vaccinators will frequently tell you are contained within all vaccines. While this isn’t completely untrue, it’s not totally true either. It is more the subject of a poor understanding of chemistry. Anti-freeze is primarily methanol, which is in the chemical family of alcohols. However, methanol is completely harmless to humans in small amounts. Anti-freeze, though, is very poisonous in nearly any dosage. That’s due to the active ingredient, the freezing-point depressor ethylene-glycol. While methanol is certainly found in vaccines due to its sterile properties, ethylene-glycol certainly isn’t (Brown, M.D., Baby 411: Clear Answers & Smart Advice about Your Baby’s Shots).

The modern evolution of the anti-vaccination movement started in earnest with Dr. Andrew Wakefield in 1998. He published a study in The Lancet Medical Journal in which he claimed to have found a link between the Measles, Mumps, and Rubella (MMR) vaccine and Autism Spectrum Disorders, or ASD. The initial report sent shock waves through the medical community. However, four years later the results of his research were unable to be reproduced by any other medical team and speculation arose. Finally, in 2004, Brian Deer, an investigative journalist for The Sunday Times in London published his findings. In the course of his research into Dr. Wakefield’s study he found multiple conflicts of interest (Deer, Brian, The Sunday Times). His article prompted a lengthy investigation by the General Medical Council (GMC), England’s medical ethics and licensing board.

During the course of their investigation, they found Andrew Wakefield to be guilty of serious professional misconduct and stripped him of his medical license, and had his home stricken from the Medical Register. The GMC found that he had accepted money from a private contingent of lawyers, the Legal Aid Board (LAB), who were engaging in a class action lawsuit against a vaccine production company. Wakefield was paid $84,160.00 (converted from Pounds Sterling) for his research, and it was concluded that over half of the money went directly to Mr. Wakefield instead of into the study. He was also found to be guilty of tampering with 5 of the patients, even though he had a strict no contact rule with all patient test subjects (General Medical Council, Fitness to Practice Council, 1-7). As far as a link between autism and the MMR vaccine, doctors have dismissed it as a classic case of correlation not being equal to causation. Most children are diagnosed with ASD shortly after they are vaccinated, but that’s only because nearly all children are vaccinated, and the age at which vaccinations take place are the same age at which ASD starts to show its symptoms, but there is no direct correlation between the two.

Even though the evidence all points to the contrary, and the research and testing have proven vaccinations to be both safe and effective, vaccination denial is still a prevalent health issue. The Centers for Disease Control and Prevention (CDC) releases a weekly report, the Morbidity and Mortality Weekly. Report that shows all cases of infectious and communicable diseases reported in the United States. The data shows a clear spike of vaccine preventable illnesses, such as Measles, Diphtheria, Rubella, and Smallpox in geographical areas that have higher concentration of anti-vaccination advocates (Centers for Disease Control, Morbidity and Mortality Weekly Report, report data for April 2014).

The danger isn’t just for those who choose not to get vaccinated or choose not to get their children vaccinated. Vaccinations are so effective because of “herd immunity”. There are people who are incapable of getting vaccinated, either due to allergies or to rare medical conditions. They rely on the people around them to be properly vaccinated, thus eliminating a host for the virus. As rates of vaccination decline, the herd becomes smaller, and viruses and diseases will be able to find hosts easier, not only contaminating those foolish enough not to get vaccinated, but also those who are just unable to get vaccinated.


Conclusion

This is a dangerous and very real health concern. The CDC has (unofficially) referred to celebrities such as Jenny McCarthy and Bill Maher, who are staunch opponents of vaccinations, as public health threats. The data is clear, vaccinations are safe, and there is absolutely no link between vaccinations and autism. The media has leaned heavily on scare tactics to boost ratings, reporting that vaccinations are potentially dangerous and encouraging people to seek homeopathic or natural remedies instead of synthesized ones. It is our duty as a people to educate and be educated on such matters that concern our public health with such tremendous force.

Medical Negligence And Malpractice Law

Protection of patients / clients’ rights under the care situation is an area of great importance in the work of care. All health professionals are obliged to patients / clients duty of care. Health care professionals are legally bound to ensure that they abide by and comply with legislation that protects the rights and interests of their patients / clients under their care, related to matters of confidentiality.

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Care profession based on the principle that its members can be relied upon to conduct its business in a manner that will reflect credit on them and bring honour to their profession; this principle is universally understood in the care profession. Therefore, the health profession should be strict adherence to rules and guidelines to its members. To this end, the Code of Professional Conduct, approved by the Nursing and Midwifery Council (2002a) issued to all members of qualified nursing and midwifery.

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It is important to note that the protection of clients’ rights in situations of care is an area of great importance in the work of nursing, all health professionals are obliged to patients / clients duty of care and are under a legal obligation to ensure compliance with laws protecting the rights and interests of their patients / client issues related to confidential information. In addition, users of care have become more aware of their rights for many years, and their expectations of services are now much higher than previously. Patients / clients rights and interests are now protected by medical services associated rights such as the Data Protection Act 1984, government statutes such as the Patients’ Charter, and the NMC code of practice 2002. Thus, the code was developed as a basis for professional work, she used to deal with failure, shape and influence the role of nurses, and learn from the mistakes of the past, which is vital to the success of any code of conduct.

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Nurses are accountable to themselves, although the Code of Conduct may conflict with their own positions, often in the nursing professions in order to comply with the standards of care (Dimond, 2002). The Code of Conduct should be implemented by health professionals to recognize and realize that they are responsible for their practice, both for themselves and the public. This is necessary due to the fact that leaving the profession is more demanding than ever. Today, users of care have become more aware of their rights for many years and their expectations from the standard of care to which they are entitled are now much higher.

Given the statement “You must treat information about patients and clients as confidential and use it only for the purposes for which it was given, the meaning of privacy in the care, the importance of confidentiality, which must remain confidential and the disclosure of confidential information to be examined, with order to better understand this complex and sometimes confusing subject.

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The meaning of confidentiality

Confidentiality is one of the values of good medical practice, which relate to the protection of private information about the patient / client, which is obtained in the period of professional activities.

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With respect to care, confidentiality, plays a vital role in establishing and maintaining the confidence that an effective nurse – patient / client relationships depend. Health professionals who are able to build good relationships with their patients / clients may have a positive therapeutic effect in terms of speed of recovery after the operation. Confidentiality refers to the protection of personal and private information about a patient or client situations and / or conditions. In kindergarten, the term privacy is used to designate the rights of patients / clients that can access their personal information, as well as limiting access to confidential information to people who are accepted need to know who is part of the care team.

A typical team care on medical or surgical ward will be composed of doctors, nurses, social workers, therapists, dietitians, pharmacists, and related care team are the secretaries, receptionists and porters (Downie & Calman, 1994) Customers generally consenting to the information available on this limited group of medical professionals.

As a nurse, midwife or health visitor, you must protect confidential information, Section 5 NMC guidelines, 2002 (see Annex .1). Nurse / patient / client relationship special. Nurses are in a relatively strong position in relation to service users, as their special skills, knowledge and clinical privileged access that they have to information about the client’s social situation and health status.

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Patients / clients can also expect that health professionals will comply with restrictions on their place on the disclosure of confidential information outside the command, and for any reason not related to their care. The nurses did not violate confidentiality in situations where clients have a right to privacy, and their comments and behavior will not cause injury to others and break the law.

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As a student nurse, who is likely to be a temporary visitor care settings, while on placement and collection of information for the purpose. Observed or heard about things patients / clients and even employees, must remain confidential. Confidentiality is a key value of care and is an important part of nurses base value (Kenworthy et al, 2003).

The importance of confidentiality

Confidentiality is given high value, health care, it is one of the cornerstones on which they build their relationships with patients / customers. For health care workers to do their jobs well, they must range of information about their patients and clients, it may be in the range of facts about someone, physical well-being and financial situation in a more personal details about their feelings and attitudes.

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People who use care services are often vulnerable and concerned about situations in which they are located. Providing such information may be embarrassing and disturbing. Despite this, patients / clients should be able to establish appropriate relationships and be able to communicate effectively with medical and social workers, patients / clients need to feel they can talk openly about their health and social care practices. This means trusting them to keep confidential any information received. If patients / clients do not believe in the ability to care practitioner “to save your personal information confidential, they will never trust them enough to create an effective therapeutic relationship.

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While the need for establishing trust concerns is one of the important reasons of confidentiality, there are other practical reasons for ensuring that confidential information about patients / clients are not disclosed inappropriately. Safety of patients / clients’ property, information about their finances and homes, and their personal safety are also issues of confidentiality. Disclosure of even simple details to the man, for example, the fact that the patient / client is in the hospital, lives alone or has a special status, may open the possibility of human exploitation, theft, robbery and discrimination.

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Restraint On Dementia Elderly Patient

Nursing is a profession that involves a fusion of autonomy and collaboration in taking care of individuals of all ages who are not in a state of good health for promotion of a safe and healthy environment. However nursing is different from other health care professions in terms of training, scope of practise and advent of patient care. However every profession in the world is accompanied by challenges and obstacles. One of the biggest challenges in nursing is to decide between applying restraints or using alternate intervention on agitated dementia elderly patients. Understaffed nursing bodies and nursing homes usually do not allow nurses the time to intervene with these patients using therapeutic communication and this at times can cause the use of restraint measure on these patients to conflict with legal, ethical and professional nursing system. Especially among nursing experts, the appropriateness of using restraints on distressed dementia elderly patients has become a sensitive topic of discussion. Similarly, this paper aims to discuss the use of restraints related to the professional aspect of nursing exemplifies with a real life scenario where a dementia elderly patient is being physically and chemically restrained in the surgical unit 4 North-West (4NW) of Jewish General Hospital during the clinical internship of 180.AO 60N.

Summary of incident

On February 8th, 2013, Ms A.C., a 96 year old female patient hospitalized in 4NW, was brought to the attention of nurses when Ms. A.C. refused to take her medication and moved herself on the edge of bed while all four bedrails were still raised. Ms. A.C. was restricted to stay in her bed because she has recently undergone a left hip replacement surgery due to a recent fall injury. Moreover, she has a relevant medical history of right hip hemiarthroplasty, dementia and Alzheimer’s disease. The nursing clinical instructor prevented Ms. A.C. from falling by standing opposite to the patient with the left arm holding around patient’s back and left shoulder and with the leg blocking patient’s knee. Meanwhile, the nursing instructor calmly explained to Ms. A.C that it was unsafe for her to ambulate which could further deteriorate her left hip injury if she keeps it flexed at 90 degrees. After a lengthy session of therapeutic communication by the nursing instructor, Ms. A.C. still exhibited agitated behavior. Subsequently after initial assessment by the nursing instructor, the patient was determined that she had impaired cognition to understand the reason of her hospitalization, to recognize where she was and to be cooperative. After failing in calming the patient, the nurse in-charge then attempted to administer Haloperidol, as prescribed, orally to the Ms. A.C. which she resisted to take either. Ms. A.C. was brought back to supine position on bed with collaboration of the nursing staff. As the patient had an intravenous access, Dimenhydrinate, which could be found in patient’s PRN medication list, was administered intravenously by the nurse in-charge to Ms. A.C. After five minutes, the patient slept quietly on bed. The student nurse then closely monitored Ms. A.C.’s vital signs every hour after the administration of Dimenhydrinate.

In this real life situation, both physical and chemical restraints are being applied on patient. The four side rails of the bed and the physical presence of the nursing instructor around the patient both serve as the physical restraint. The chemical restraint used in this case is the administration of Dimenhydrinate. The professional nursing issue to be discussed in this paper is to determine whether the use of chemical restraint is necessary and appropriate in this particular situation.

Criteria indicating credibility of nursing resources

Before getting into discussion on the professional aspect of nursing in using restraints on dementia elderly patients, the credible nursing resources, such as nursing journals and articles, are necessary to be included as reference during this discussion. The purpose of the nursing articles is aimed to continuously improve nursing care and to provide credible evidence-based knowledge for the general public and for nurses. The credibility of a nursing article can be determined by the following criteria: written by recognized expert, peer reviewed, current and connected to recognized organization.

In the nursing academic article, “Use of physical restraint in institutional elderly care in Finland”, used as one of the references of this paper, can be found in the “Cumulative Index to Nursing and Allied Health Literature” (CINAHL) database. The overview snapshot of this article as shown in the CINAHL database indicates that the article was selected to publish in the “Research in Gerontological Nursing” journal, in 2009. Therefore, the content of this journal is considered to be current as it was published within these recent five years. Moreover, this article was reviewed by expert peer and especially by the editorial board. Thus, this academic article is a credible nursing resource.

Acknowledgement of using restraints on dementia elderly patient

The nurse in-charge administered Dimenhydrinate intravenously to Ms. A.C. to prevent the patient from further deteriorating the left hip and from falling. Physical restraints are seen to be used to increase the patient’s safety who are in a poor health state by preventing falls (Saarnio et al., 2007; Suen et al., 2006) but that seemed to fail in this case so the nurse had to use chemical restraint on Ms. A.C. With regard solely to the professional aspect of nursing, I am in favor with this nursing intervention in this particular circumstance, because we are all in consensus that the patient’s safety is the first priority. Moreover, since the patient demonstrates agitated behavior and impaired cognition, nurses are at risk of physical injury during the de-escalation of patient agitation. Furthermore, Ms. A.C. is at risk of further injured her left hip while sitting at the edge of the bed, who is also at risk of developing other complication, such as fracture and hip dislocation. Therefore, I believe that applying both physical and chemical restraints for the sake of the patient’s safety is the appropriate nursing intervention for this exceptional circumstance.

In A.C.’s case, I believe that dementia has affected the patient’s cognition and prevents her from being cooperative with the nursing staff. Zampieron, Galeazzo, Turra, and Buja (2010) points out that “aggressors often have impaired cognitive processing and data suggested that many patients may not have been fully aware of their situation and might have experienced some difficulty in comprehending the staff member’s actions, which triggered the episode of violence” (p. 2338). In my knowledge, A.C’s case was of a serious fall and the restraint was intended to protect her from falling again. Restraint should only be used to prevent harm to the person who is being retsrained according to the Mental Capacity Act 5005 (Rhidian Hughes, 2008). Falls frequently result in serious injuries and pain regardless of the older adult’s cognitive status or living situationand falling is a leading contributor to hospitalization, lowered quality of life, negative psychosocial consequences, loss of confidence, attenuated activities of daily living and death (J.Williams, 2010). Concerning resident characteristics, one prime contributor was the presence of dementia. Physical therapists and special aid cares described that residents who have cognitive impairment with limited sense of judgment, foresight, incapability to know their capabilities and to navigate their environment, tent to ambulate more and can result in a fall (Kaasalainen & Williams, 2010). “. . . and they seem to get to a point um in their abilities where they just have this urge to get up and don’t recognize they don’t have the skills to do that” an occupational therapist describes the problem that is majorly linked with falls (J. Williams et al, 2010). Older people are most likely to be restrained if they have physical and mental disability, are perceived to be difficult or threatening or cannot be persuaded by other means to do what staff wants them to do (Commission for social Care Inspection, 2007). All three of these conditions may apply to older people with learning disabilities who are, therefore, particularly likely to experience restraint to prevent from fall.

With the advent of Bill 90, nurses have greater decisional power and more latitude to use their own judgment. It also allows them the autonomy to make decisions as to the use of restraint measures. However there are a few limitations:

Restraint measures must be used only as a last resort

Nurse must use their clinical judgment and decision making power to make the best choice for the patient (restraint use must be justified)

Nurses are empowered to resort to restraints after examining the options, including alternative measures

Nurses will determine what kinds of measures are needed, how long they must be used, and the necessary monitoring

In A.C’s case, all these limitations were taken in consideration as evident from the scenario. The sole purpose was to protect her from further aggravating her condition. Moreover she is suffering from dementia and is unable to judge or understand her position and environment which she is not responding to. In this situation the nurse in charge first tried other options like calmly making her understand what she is going through but after failing in doing so she had to opt for the last resort. Nurse in charge however did consult her prescription first to confirm whether sedatives have been prescribed or not and after an assurance, she took the step of chemically restraining her and if I would have in her place, I would also have followed the same procedure in this particular case.

However, there are always two sides of the coin. We cannot neglect what other side of the issue has to say and the reasons behind that. A.C’s case was of a fall and fracture and the restraints used were not meant to be long term, however in the usual nursing practice, other cases have of dementia patients have been recorded where restraints were used without a valid justification and not as last resort. Thereafter, these cases are framed as A.C’s case when questioned by the authorities. Reported reasons for its use are preventing interference with treatment, controlling behavior such as aggression and wandering, and lack of nursing staff (Pellfolk & Karlsson, 2010). After dementia has been diagnosed in people with learning disabilities, there is a greater likelihood of nursing home care being sought (J. Ridley & S. Jones, 2011). However, care staff may have little training or experience in dealing with people with dementia (Department of Health (DH) 2009), learning disabilities or both.

Dementia is associated with a range of challenging behaviours, most of them difficult to manage, including agitation, anxiety, irritability and motor restlessness. It can lead to eating problems and mood disorders, and behaviours such as wandering, pacing, aggression, psychosis and sexual disinhibition. It is also associated with abnormal vocalizations, including shouting, screaming and demands for attention. People who have dementia and who exhibit such challenging behaviour are more likely to be restrained. It involves the intentional restriction of a person’s voluntary movements or behaviour, associated with a range of nursing interventions, from the use of sedatives to the application and use of plaster casts (Counsel and Care, 2002). Different types of restrictive practices are used as identified by Watson (2001): Physical restraint by staff by holding, moving or blocking people’s movements, mechanical, involving the use of equipment such as cot sides, heavy tables and baffle locks are some commonly used physical restraints. Reetta Saarnio (2009) advises that the need for such physical restraint can be reduced through the use of technical aids aimed at increasing the safety of elderly patients, such as pillows and bedside mats (p. 277). Chemical restraint involves the prescribing of medications or use of over-the-counter drugs. In some cases, this can involve the use of illegal drugs. Psychological, whereby staff makes verbal commands or conveys, verbally or visually, false information and technological, involves the use of equipment such as electronic tags and door alarms.

Ontario law sanctioned the use of restraints by the nurses with certain restrictions but at the same time makes it challengeable under the Charter of Rights and Freedom Canada, by providing insufficient procedural protection to residents in the nursing home. The charter gives the right of life, freedom, security and liberty to the person and the use of restraints violate this libertyand freedom (Canadian Charter of Rights and Freedom, section 7). Arbitrary detention and imprisonment is against the right of a person (Canadian Charter of Rights and Freedom, section 9) and restraining is a kind of detention. In my view, these legalities when come in contact with the everyday nursing practices create confusion for the nurses. The major reason of this is the lack of legal knowledge in nursing practice and the incomplete outline of the procedural rights in regard to the use of restraints in the law. Lack of proper legal knowledge and legal training of nurses has lead to some fatalities due to the use of restraints in the health care world.

An Ontario patient admitted at the Centre for Addiction and Mental Health in 2005 was physically restrained for five days which resulted in his death from acute pulmonary thromboembolism. After this incident, a new best practice guideline was developed by the Registered Nurses’ Association of Ontario that aimed limiting use of restraints in health-care facilities. Evidence-based knowledge on prevention, assessment, and alternative approaches, de-escalation interventions for limiting the use of chemical and physical restraints and stresses that restraints should only be opted after all other approaches have failed. There has been legislation that outlines that consent for use of a restraint must be in place and that the doctor must be notified to review the patient’s condition and follow up on orders for restraints (Patient Restraints Minimization Act, 2001). The focus should be on getting patients and their families engaged in an assessment to plan and identifying the alternative approaches (Brenda Dusec, 2001).

In case of dementia patients the use of restraints becomes even more sensitive issue whether it’s an application of a physical restraint or a chemical restraint. Non restrictive practices have been promoted when dealing with the dementia patients and when essential limited and appropriate restraint should be used but as the last resort (National Dementia Strategy, 2009). Use of chemical restraints such as sedatives and neuroleptics to manage behavior is discouraged and if under uncontrollable circumstances such as extreme violent and aggressive behavior which threatens the safety of the patient, otherpatients or the nursing staff, is used should be a part of the patient’s prescription and should be reviewed routinely. According to a study lead by Poole and Mott in 2003, nurses reported the use of chemical restraints on the patients during busy periods and to manage workloads. Some adverse effects of neuroleptic medicines on dementia patients have been found. These drugs can advance the cognitive decline. Since dementia patients are unable to show their consent regarding the administration of any drug, special procedures should be followed (Department for Constitutional Affairs, 2007) to protect the elderly patients from further deteriorating their cognitive skills.

Under the review of the literature that I have gone through, my stance on the use of restraints has shifted a little. Though it has not gone completely against its use but in my opinion should be used according to the Least Restraint Policy (J. Williams et al, 2010). These policies allow you to understand your position as nurse and your decision power more effectively. Understanding your patient that you are taking care of must be utmost priority. Only then you will be able to figure out the reasons for his/her behaviour and can act accordingly by taking into account the alternatives such as therapeutic communication or understanding that whether their needs and care requirements are fulfilled or not. Furthermore, I favour the least amount of restraint use under the legal procedures and policies, for the right reason and not on faulty grounds. The use of chemical restraints should be avoided as much as possible especially in the case of dementia patients and other alternatives should be used which include incorporating the help of patient’s relatives and family, and discussing the patient’s issue with other experienced fellow nurses in case use of restraint seems inevitable. I think this approach can help you take a better decision which satisfies the patient as well as your own self.

In the professional nursing practice, the use of restraints is common and that too without justified and valid reasons and can be used to as a result of lack of knowledge and proper training on the hands of the nursing staff. Therefore, staff education in small dwelling groups is very important to increase their knowledge with both the medical aspect as well as the legal aspect, changing their attitudes and can reduce the use of physical and chemical restraints. Nurses should be trained in making meticulous assessment including physical health, mental health and related psychosocial needs. It will help them to understand the service users’ needs and evaluates them to judge the use of minimum and controlled restrained.

This paper outlines the needs of patients as well as the nursing staff referred to the use and implications of physical and chemical restraints on the elderly patients with dementia. In my opinion, only a proper training and education of the nursing staff regarding the medical, ethical and legal procedures on the use of restraints and incorporating these in their everyday practice can help in reducing the unjustified use of restraints on elderly patients especially those suffering from dementia. Nurses need to put themselves in the position of these patients to understand what they need and why they behave in a way that forces the nurses to use restraints on them. Change in policy and awareness amongst the nurses to follow these policies can help make the environment of the nursing homes more healthy and benign for our elderly peers.