Project to Decrease Alarm Fatigue

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Project Description

Resetting alarms from default settings to each individual patient will decrease the number of unactionable alarms. In decreasing the number of unactionable alarms, the noise heard in the telemetry unit will decrease and therefore the noise on the unit floor will also decrease. The decrease in unnecessary noise on the floor will increase patient outcomes by decreasing patient anxiety and increasing nurse response time. The identification of the need for telemetry monitoring also needs to be addressed. This needs to be a nurse driven protocol in which telemetry should be discontinued for patients who do not meet criteria for being monitored this way. The decrease in noise and alarm fatigue will also decrease nurse burnout.

Decreasing unactionable alarms from warning and crisis mode settings to something that is specific to each patient (Knox, 2014). This will in turn, will result in a noise reduction not only in the telemetry unit but also on the unit floor where the calls from telemetry would decrease. The reduction in noise on the floor will increase patient’s overall outcome by decreasing anxiety (The Effects of Alarm Fatigue, 2017).  Having a decrease in noise and a reduction of false alarms that are almost 72-99% of the time, will increase the nurse response time. In having numerous “boy who cried wolf” scenarios, nurses may feel that it is just another false alarm and not respond as quickly which could have a devastating effect on that one time when it was an actual emergency. Having more accurate alarms or calls will reduce nurse burnout (How Nursing is using EBP to Reduce Alarm Fatigue, 2016).

Project Rationale

NEED: Decreasing alarm fatigue, which is a sensory overload and desensitization of nurses from numerous alarms during shift which 72-99% are false. The number of false alarms called could cause a true emergency to be overlooked, missed or delayed (McKinney, 2014).

JUSTIFICATION: While our patients with telemetry are monitored in a central location and the alarms are not being sounded on the unit floor, the calls from our Telemetry unit are non-stop. This alarm fatigue is listed in the top 10 technology hazards in acute care settings (McKinney, 2014).

BENEFITS: Noise level is one of the determining questions in HCAHPS surveys which determine reimbursement. Another one of the survey questions relates to how well the patient is/was treated with respect, nurse listened, and nurse came when call light was answered in a timely manner. Noise level affects patient anxiety because it affects rest and makes healing difficult (McKinney, 2014).

STAKEHOLDERS: The numerous number of calls from the telemetry unit interfere with floor staff who already have an extensive number of tasks to perform in a set amount of time, and so going to rooms to frequently check a patient who may have one lead off or their pulse ox monitor may not be positioned correctly decreases the amount of quality time that nurses could be spent doing patient care (The Effects of Alarm Fatigue, 2017). Beyond the frontline healthcare team with direct patient care, due to the effects of excessive noise and in turn, alarm fatigue by nursing staff, there is a direct correlation between noise and HCAPS scores (The Effects of Alarm Fatigue, 2017).




Project Goals

Most of my patients have telemetry and are in normal sinus rhythm and/or their pulse ox remains >90%, in reassessing these patients the number of times I have to stop what I am doing in order to reapply a telemetry patch or pulse ox monitor, will greatly increase the amount of time that I am able to spend with my patients and provide them with more attention and education during their hospital admission. Working on the urology/nephrology floor, we have many patients who have End Stage Renal Disease (ESRD) and many other patients who would fall in the Class III category, as identified by the ACC/AHA practice stands in which telemetry monitoring is not indicated (Navetta, 2014). These patients also have a high-risk of non-compliance to include keeping telemetry monitors on which brings into the questions of why monitor a patient that it is not clinically indicated and also does not wish to have on as well? In reassessing the patient’s criteria for telemetry, the reductions of monitors used on our floor should decrease which would also have an increase of patient outcomes and thereby increasing HAP scores for reimbursement

Will having better policy and procedures for placing patients on telemetry help reduce alarm fatigue therefore, decrease patient anxiety, increase nurse response time, and overall improve patient outcomes?

Research

Increased technology over the years have developed its own set of hazards. New equipment developed to assist medical professionals in the monitoring of patients started what is commonly referred to as “alarm fatigue”. When the Joint Commission saw that alarm safety/alarm fatigue as a national patient safety goal in 2014, they urged hospitals to develop systems that address this issue and implement new protocols which includes the following:

  1. Ensure that there is a process for safe alarm management and response in areas identified by the organization as high risk.
  2. Prepare an inventory of alarm-equipped medical devices used in high-risk areas for high-risk clinical conditions and identify the default alarm settings and the limits appropriate for each care area.
  3. Establish guidelines for alarm settings on alarm-equipped medical devices used in high-risk areas and for high-risk clinical conditions; include identification of situations when alarm signals are not clinically necessary.
  4. Establish guidelines for tailoring alarm settings and limits for individual patients. The guidelines should address situations when limits can be modified to minimize alarm signals and the extent to which alarms can be modified to minimize alarm signals.
  5. Inspect, check and maintain alarm-equipped medical devices to provide for accurate and appropriate alarm settings, proper operation, and detectability.
  6. Base the frequency of these activities on criteria such as manufacturers’ recommendations, risk levels and current experience.

    8

Each of these areas described above are the basis of telemetry monitoring policies. The criteria for beginning telemetry monitoring is based on each individual patient’s current status. Though many patients begin to be lumped into categories based on their initial ECG to find a baseline, the overall need for telemetry is to identify new lethal arrhythmias and monitor oxygen saturations. The parameters for both are usually set at a default but by adjusting to each individual patient’s trends and patterns, the number of unactionable alarms and/or false alarms would decrease dramatically as well as decrease the unavoidable alarm fatigue seen by healthcare professionals. Patients may also be wearing cardiac monitors and have no clinical need for this. The identification of patients who are in NSR and adequate oxygenation should have their monitors removed in order to decrease in patient’s anxiety and improved their overall healing process for whatever had brought them to the hospital in the first place.

Procedure

  • Patients should be assessed to see if they require monitoring.

    • Patients who had maintained Normal Sinus Rhythm/90% or greater O2 should be on a running list which would be presented to the physician for discontinuation of their telemetry monitoring.
    • Patients that frequently remove their telemetry on their own should be assessed if they require continuous monitoring due to their non-compliance
  • Patients who require monitoring should have their settings adjusted individually

    • Current parameters are HR 20 above and 10-20 below if not bradycardic but an increase in some patients would still result in being called about a heart rate of 90bpm.
  • Revise policy to have staff from telemetry adjust leads or O2 probes if they are not being ready appropriately.

    • Through training with the telemetry monitors, these individuals should be able to identify any problems with current equipment

Recommendations

First, a team would need to reassess current telemetry protocols, which were dated 1979 yet updated last in 2011 and 2017. The changes put forth would present a new process to alarm management which would overall increase patient outcomes. The current method of calling the nurse ever five minutes is not an effective time management policy and the resources needed to call a selected nurse takes away those resources from other critical areas. Next, reviewing and adjustment of default parameters to be more patient specific would not only all a two RN team to critically analyze current telemetry trends to adjust the highs, low, critical and warning settings to each patient. This in turn will also assist physicians in determining when telemetry is no longer warranted on patients. Lastly, a thorough examination of all current telemetry monitors and all lead wires will determine if there are any shorts in wires or any dysfunction of the monitors themselves. This can dramatically decrease the number of false alarms that nurseses are called about.

Evaluations

The evaluation of a new telemetry monitoring system would need to be evaluated over time by a non-involved member of the healthcare team. To judge any successes, the evaluation should include the number of actionable versus non-actionable alarms. Another method to evaluate a new process is by nurse response or survey as well as any increase in HCPAP scores.

References

Nursing Assessments for Geriatric Client with Mental Illness

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In this assignment, nursing assessments and interventions for a geriatric client suffering from long term mental illness, depression and suicidal tendencies is studied with reference to relevant theories, nursing assessments and interventions. Systematic approach of studying nursing process will be explained along with a role of mental health nurse in care assessment of the patient. There are four stages which are identified in the nursing process that are assessment of patient, planning of care, implementing care which is designed and evaluating the care against the interventions designed. A well-developed problem solving structure will be designed in order to layout, structure, present and organise a nursing intervention based on the assessment of the case study. In the first section, a detailed price of a client will be given. The following section will describe a well-planned nursing health assessment followed by interventions and approaches. In the entire nursing plan, it is made sure that client is totally involved so that he can be educated and empowered. In addition, nursing plan would be based on person centred approach and interventions will mainly be based on evidences observed trough the client. In a accordance with the confidentiality criteria developed by nursing and midwifery council, a pseudonym will be given to the patient analysed in the case study by the name (Jane).

Jane, a 79 year old female was admitted in a mental nursing ward after a week of regular medical check-up. On admission, she was diagnosed of abdominal pain and temperature. She was described as confused, disoriented and adamant to leave her house. She was single without any close acquaintances living nearby. One of her relative who stays far away believes that she is depressed and required regular, dedicated care in a facility. When her neighbours were contacted, they expressed that she began to feel isolated after three of her friends who used to accompany her to day centre passed away. They also said that Jane was terrified with a thought of leaving her home and joining a residential unit. Further evaluation of Jane revealed that she has not been eating properly, not been taking care of herself hygiene and the hygiene of surroundings. In addition, it was also reported that she had arthritis which lowered her mobility due to which she did not take liquids in the evening with fear of moving in the night. Although treated for her UTI with antibiotics, her other symptoms continued to progress and detailed evaluation of her medical condition revealed that she was suffering from depressive illness.

Nursing assessment revealed that the mon conditions from which Jane was suffering are poor hygiene, reduced appetite, loneliness, lack of interest in life and unwillingness to move out of home with a feeling of insecurity. In order to improve Janes situation, the primary assessment done wad a good psychosocial assessment which is believed to aid the patient as therapeutic tool where patients could express their concerns to an external person seeking possible help (Rose and Barnes, 2008). This assessment is regarded to be patient centred and important in developing a well evaluated care plan which would favour and stabilise condition of James. This assessment utilised recovery model intervention in which clients explored their feelings, thoughts and ability to discover their illness and motivate themselves to improve their life (Repper and Perkings, 2007).

Presenting the conditions and symptoms of Jane, it was observed that her depression score was 19/21 based on the Beck Depression Inventory (Beck et al., 1971). These high scores revealed that any kind of self-report interventions designed in these cases are often unhelpful as the clients in these conditions either under present their symptoms or mislead evaluators in order to reduce their depression score whereby they could avoid facing further interventions.(Castillo, 2003). Therefore, Department of Health suggested the assessors to use proper assessments that would target the patients care strategy. It was also suggested that evaluation of proper interventions would reduce demand for any extra services.

According to Beck et al (1998), the dimensions of health involves being spiritual, biological, cultural and social. In this particular intervention of nursing, the health of Jane and his social wellbeing can be improved with the help of a nurse. In implementing the strategies of intervention, it is highly necessary for the nurses to follow the approach of problem solving Mathews (1996). So in order to perform an intervention of nursing on providing good care on Jane, the process of nursing is utilized by the mental health nurses. According to Allen (1991), in providing good care for the patients, the nursing process involves problem solving approach. It involves four stages of step by step process. In planning proper care to the patients, hierarchy of needs by Maslowâ€

™s

(1954) acts as a guide to the nurse. All human necessities are addressed in this. Pillings (1991) explained that it is very important to make sure that all the patients’ needs are fulfilled irrespective of their health. Regardless of the wellbeing, considerable data regarding human necessities were explained by Abraham Maslow. The rationale involved in Maslowâ€

™s

hierarchy of needs as a tool of assessment is that, it is highly important to first address the physiological needs of the patient. If the nurse fails to do so it may lead to the death of the patient. So in the present case study, the nurse assessed that Jane did not have the ability to suffice his physiological requirements rather than his other necessities. Jane would not be able to possess self-esteem if Jane’s physiological requirements like unhealthy eating and poor hygiene were not addressed. In the process of assessment, the nurse identified few physiological needs that are important. They are unhealthy eating habits, high alcohol intake, suicidal thoughts, poor hygiene etc. A framework model is considered as an artifact that adds up points to new thoughts and ideas Roper et al (1983). According to Newton (1991), a model is defined as gathering of mental images that depicts the nursing responsibilities of a nurse. This model helps in providing direction and structure to fulfill its goal. Roper, Logan and Tierneyâ€

™s

(1983) Activities of Daily Living is the model of nursing that is chosen for the present intervention. This particular model was chosen as it utilizes the systematic approach and implements Maslow model by first emphasizing on physiological necessities. So in the present case study, the activities of health promotion were planned by the nurse to improve the health of James and prevent further deterioration. According to Kemn and Close (1995), definitions and approaches of health promotion, the health promotion is defined as involving the activities that are necessary to prevent illness and disease and in improving the community’s wellbeing. Jane was explained about the process of intervention before initiating it. This is based on the Newton model (1991) which explains the importance of autonomy and choice that should be given to the patient and should be given the freedom to take decisions where ever necessary and important. In the process of assessment four stages were worked out by the nurse based on the Roper, Logan and Tierney (1983) model. This was implemented by first gathering necessary data from Jane, reviewing the information that is collected and recognizing the problems which are in priority. Another important model that can be used in assessing the James health is the Oremas self-care model (1985). According to this model, in maintaining the health, life and wellbeing, activities were initiated and performed by the individuals. In the present case study of Jane, more prompting is required regarding his self-care. So this model could be utilized to support Jane to suffice his needs of personal cleansing without excess prompting. According to Brown (1995), Planning refers to the activity of the nurses which involves taking necessary actions that are required based on the recognized needs. During the process of planning it is important for the care nurses and clients to give a thought on goals aims and their objectives. According to Ewles and Simnett (1999), an aim refers to the outcomes that are achieved on long term in a particular time period. In the case of Jane, the primary objective is to make him understand the necessity of taking healthy food with regards to his weight. Another objective is to make him aware of good hygiene with respect to his wellbeing and health. In the present case the goals that were established include:

Make Jane to adopt health eating and develop healthy lifestyle by encouraging him, make Jane to practice good hygiene to prevent him from diseases. The objectives are required to be time framed, realistic, achievable, measurable and specific (Fawcett et al 1997). Objective refers to the process that is intended by the teacher to achieve Kiger et al (1995). In this case Jane is allowed to eat only limited food during his meal. He is take proper care to avoid diabetes. He is made to perform his daily routines like bathing himself, changing the socks and putting in the laundry etc. The nurse that is concerned with taking care of Jane would conduct one to one sessions so as to develop healthy eating habits. The nurse would refer Jane to dietician to solve the issues of overweight through diet. It is necessary for the staffs who are concerned with providing health care to Jane to attend training classes on healthy eating. Educative leaflets could be provided to Jane. The nurse would also take the opinion of James regarding the personal hygiene through open ended questions. It was observed that a felt need is expressed by Jane when he expressed feelings of faithlessness and confidence.

From the detailed assessment of Jane and interventions applied by the staff, great knowledge and information on various aspects of care planning was learnt, analysed and understood. The care planning included detailed assessment which served to be one of the vital component in care planning. Next, in the planning stage, the evaluating nurse acquired a detailed understanding on the methods of addressing needs of the clients during which they took into consideration all the predetermining and necessary factors. The main factors which were taken in to account were the cognitive abilities of the people suffering with mental illness. The evaluating nurse regarded that communication with the patient is necessary at all times of delivery of care. In addition, it was also evaluated that good interpersonal skills are required for development of good holistic care. As a part of psychosocial individualized intervention, Jane was empowered and encouraged to engage in wide range of social activities where she can mingle with general population.

Further, this essay has describes the various aspects that are involved in care planning. The essay has also laid emphasis on the imperative role of a mental health nurse in the management of health of people suffering with various kinds of mental illness. As suggested by the NMC in the year 2002, nurses should act proactively to pick, identify and reduce the risks to the clients. The whole assessment, evaluation and intervention prove that there are various things which are kept in kind before implementing a care process. In addition to the nursing process and care planning, there are other factors that include the nurse’s role, consent from the patient, multi-agency working and self-empowerment which aid in efficient care implementation

Middle Adulthood Cognitive Competencies

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In this short video, the narrator discusses cognitive abilities in middle adulthood. Specifically, the narrator discusses those abilities that remain stable, those that improve, and those that decline. Please pick two of these cognitive abilities and discuss in some detail using examples and research for support.

Patient Safety in Healthcare

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Introduction and background

Patient safety has always been the heart of healthcare practice and nursing through the history of medicine. However, all through the world occasional non-deliberate accidental harm occurs to patients looking for care. Such unfavourable incidents can occur at all levels of healthcare whether clinical or managerial, curative or preventive, and in general healthcare, or private. It may occur at any stage of management (radiology, laboratory, operating room, ward, or ICU).

The WHO, at the meeting held on July 2006, in New Delhi, India, identified an adverse event as a separate unconnected incident associated with health care, which results in in-deliberate injury, illness, or death. Such incidents can be preventable as with contaminated injections.

Published surveys on patient safety show that in industrialized advanced countries, more than half of these adverse events are preventable and occur because of a shortage in system or organization design or operation rather than because of poor performance of healthcare providing staff (WHO report, 2006).

Harvard Medical Centre study in 1991 (after WHO report, 2006) was the first to draw the attention to the volume of patient safety problem. Based on medical records review, the rate of adverse event in three US medical centres ranged between 3.2 to 5.4 percent. In UK, the rate was 11.7 percent and in Denmark, the rate was 9 percent (WHO report, 2002). Results of recent studies suggest the rate is between 3.2 and 16.6 percent (per 100 hospital admissions). The situation in the less well-documented health care centres in the developing countries is more serious (WHO report, 2006).

The cost of adverse events that endanger patient safety can be very high, considering all the aspects. It includes, loss of confidence and credibility and reputation of health care institutions, loss of enthusiasm and job gratification among the working staff. In addition, the cost includes damage to the patients and their relatives especially when taking defensive attitudes and keeping information hidden from patient’s families. Other added costs are those of prolonged hospital stay and increased medical expenses and those of lawsuit demands (WHO report, 2006).

Objective

The objective of this paper is to review, in brief, the problem of patient safety with particular attention to patient safety in the ICU being one of the essential patient care systems in a health care organization. Besides, the vulnerability of ICU patients augments the importance of patient safety concept.

Methodology

This thesis is a literature review study. The researcher performed an article search using the following internet databases:

  1. National Centre for Biotechnology – National Library of Medicine – National Institutes for Health (NCBI), at

    http://www.ncbi.nlm.nih.gov
  2. Medscape database, at

    http://www.medscape.com
  3. Amedeo: The Medical Literature Guide, at

    http://www.amedeo.com
  4. British Medical Journals, at

    http://group.bml.com/products/journals
  5. World health organization – Publications, at

    http://www.who.int/en/publications
  6. Yahoo and Google scholar general databases, site of .org, .gov and.edu only considered.

Terms of search were patient safety, basics, and principles of patient safety, review of patient safety, patient safety in the ICU and the critically ill patient safety.

Findings

Patient safety event is a wide term; it does not only mean a medical error during the course of medical management and nursing. The Department of Health and Human Services, 2008, defined a patient safety event as an incident, which takes place during providing a health care service.

It causes or may have caused a harmful outcome to the patient. It includes errors of not doing (omission) or errors of doing (commission), it also includes faults and mistakes of the patient care processes (involving drugs and equipment’s) or the environment where these processes are carried out.

The phrase, one cannot manage what cannot be measured hold true for patient safety. One of the reasons of the lack of effective patient safety strategies is the need for a measurement tool to provide measures, consequently, reduce medical errors and improve patient safety.

The Agency for Healthcare Research and Quality (AHRQ) developed an array of Patient Safety Indicators planned to screen administrative data for events related to patient safety. This list of indicators includes 16 situations where a threat to patient safety may occur during the course of healthcare delivery. Using this measurement tool shows that patient safety incident of highest rates are failure to rescue, decubitus ulcers and postoperative wound infection (which is specifically increased by 35% during the period 2002-2006) (Health Grades Inc, 2006).

Infection control: An important part of patient safety

Bruke, 2006, has provided a comprehensive review of infection control as an important aspect in patient safety strategy. Based on many studies, hospital acquired infection; in this context, alternatively called health care associated infection, is one the most frequent risks for patient safety in patients admitted to hospitals. The answer to the question of why it is an important aspect for patient safety lies in the fact that 5-10 percent of patients admitted to acute care hospitals acquire one or more nosocomial infection. In the US, 2 million patients acquire hospital infection every year with 90.000 deaths.

This adds a cost of 4.5 to 5.7 billion US $ to the health care cost (Bruke, 2006). There are four types of hospital-acquired infections, which account for 80% of the total rate. These are infection associated with urinary catheterization, blood borne infection (usually with vascular invasive procedures), surgical wounds infections, and pneumonia (usually associated with the use of ventilators). Therefore, it is understandable that 25 per cent of these infections occur in the ICU (Bruke, 2006).

The increased awareness of patient safety resulted in reorganizing the concepts of infection control and placing it in the domain of public health with consequent increased surveillance and epidemiological studies. It is true that recognizing risk factors allows clarification of what is adjustable and what is not, however modification of some terms is advisable. Instead of saying avoiding the use of catheters, we should recommend reducing the duration of use of catheters. Many other terms as use antibiotics intelligently, and training and staff education are hazy and indistinct, accordingly, tricky to employ (Bruke, 2006).

Nursing practice and patient safety

The report of the Institute of Medicine, 2004 (after Armstrong and Laschinger, 2006) recognized nursing role as pivotal to patient safety. The report suggests the degree of activity of hospital nurses and the extent of giving them authority to take part in decisions, directly affects the quality and perception of patient safety. The results of Armstrong and Laschinger, 2006 supported this assumption; they recommended that nurses should enjoy better communication and participation in decision-making. The responsibility of nurse managers, at the unit level, is even greater.

They take part to establish nursing practices, which support patient safety culture, they also sustain professional nursing practices, and they should listen carefully to nurses relevant affairs. If nursing managers achieve their direct responsibilities, then they work with others in the healthcare establishment to make the organizational process better as regards limiting the nurse’s competence towards better patient care. The result of Armstrong and Laschinger, 2006 suggested that nurse managers (nurse leaders) have the capability of developing patient safety in healthcare organizations.

Medication management and patient safety

Duthie and colleagues, 2004, analyzed the 108 reports submitted to the New York State Department of Health investigating the medical errors in New York State healthcare organizations. From quantitative viewpoint, their results suggested that nursing the first discipline to be involved in such errors and they provided the explanation that nurses are the end dispenser since they give the medications to patients directly.

In addition, they showed that patients over 65 years are the most vulnerable to these errors, perhaps because of the increased number of medications prescribed at this age. From a qualitative viewpoint, they suggested that what may endanger patient safety is dispensing system malfunction, failure to rescue situations and working space limitations. They suggested the need to educational initiatives and pointing out possible dispensing system malfunctions.

Adamski, 2005, suggested the following precautions to minimize medication errors:

  1. Monitoring how patients respond to medications as long as it is dispensed in the healthcare organization.
  2. Diagnosis and indication for a particular medication should be available in the patient’s progress notes, history or examination sheets.
  3. Clear order forms to dispense medications in order to ensure clear and mutual understanding among the prescribing physician, pharmacist, and thenurse who administers the medication.

Davis and colleagues, 2006, examined the patient role in medication errors. They suggested that low literacy patients (up to 6

th

grade level) are more liable to misunderstand medications label instructions. However, they suggested that lower reading and writing skills and high number of medications prescriptions link separately to misunderstanding of instructions on medications labels.

Hospital design and device purchase in patient safety strategies

Reiling, 2005, suggested that building a hospital (whether new or relocated) around the principles of patient safety would have two important impacts on return of investment. First, it combines safety and efficiency, second, it reduces the costs of adverse effect and hospital stay therefore; reduces the patient’s cost on discharge.

To achieve a safety cantered hospital design, Reiling, 2005, suggested that architects, engineers, contractors, heads of departments and executive managers should participate in discussions around what they need. There is no specific design but contributions of the whole team from the perspectives of patient safety culture are mandatory.

Johnson and colleagues, 2004, examined the patient safety in purchasing equipment. They analysed purchasing decisions taken at three different healthcare centres. Johnson and other, 2004, assumed there were points of strengths and others of weaknesses. The points of weaknesses draw the attention to the necessity of having guidelines to help healthcare providers to assess issues of patient safety when purchasing medical devices.

Patient safety in the ICU

There are many reasons that make the ICU a special unit to look at specifically as regards patient safety. Of these reason, the patients are critically ill, which renders them vulnerable to the adverse effect of medical errors. Second, the great effort performed by nurses and internists with sometimes exhaustive shift work, which may result in sleep deprivation and possibly lack of concentration.

Third, the diverse use of equipment (ventilators, catheters, monitors etc) and the invasive procedures sometimes adopted (emergency tracheotomy, central venous pressure or arterial-venous cannulation) which add to the risk of hospital-acquired infection or increase the incidence of adverse effects (Rothschild and others, 2005).

Rothschild and colleagues, 2005 conducted a one-year prospective observation study as a part of Harvard Hours and Health Study (2002-2003). They designed their study as a multidisciplinary epidemiological study to portray both frequency and types of adverse effects in the ICU. The result were informative, there were 120 adverse events reported (80.5 per 1000 patient-day). Of the patients who suffered adverse effects, 13.8% suffered one adverse effect, and there were 16 life-threatening adverse effects.

The commonest were respiratory, infection, and cardiovascular system (19%, 15%, and 12% respectively). The incidence of serious medical errors was 149.7 per 1000 patient-day of which, 11% were life threatening. Incident discovery was by direct observation in 62% of the cases and the patient’s nurses discovered 36 % of the cases. In 74.8% of cases, errors occurred during the course of treatment or a procedure.

An intern failure to wash hands after attending a patient formed 51% of sterility hazards related to procedures. Although their results cannot be applied to all ICU units, yet it draws the attention to how frequent and how serious patient safety can be compromised in ICU units. At the same time, their result show how results of treatment in the ICU would improve, despite the hard work, if teams stick to unit protocols and principle of patient safety (Rothschild and others, 2005).

Kho and others, 2005, used the Safety Climate Survey (a tool approved by the Institute of Health Care Improvement) to measure patient safety in four ICU units, 56.9% of those responded to the survey were nurses. Based on their results, they assumed that Safety climate survey and Safety culture scales are reliable tools to measure patient safety in ICU.

Chang and other, 2005, suggest that reform of patient safety in the ICU should start by establishing physician and nurse leadership, once this is achieved, carrying out patient safety protocols becomes a matter of team effort and commitment to the concept. Identifying a specific group of patients to start with (as an example, patients on ventilators), planning carefully the procedures, and opening a communication channel among the staff should reach the best results.

Following evaluation of what progress made, the next move is for another group of patients. At the end, this should provide synchronization among the staff that makes decision making in shortage of time easier and provides better training and education to the newly coming staff.

Obstacles facing the implementation of patient safety

Cook and colleagues, 2000, considered the complexity of healthcare as an overwhelming obstacle to achieve desired patient safety levels. Technical work in healthcare needs appropriate and quick decision making, critical to the patient’s safety at times, moreover, it is risky by nature. It is true that health practitioners whether physicians, nurse, technicians or other staff are trying to cope with this complexity, however this complexity creates a disparity in healthcare practice and nursing (they called it gap).

Cook and colleagues assumed the means of improving patient safety is by supporting practitioner’s ability to perceive and cross these disparities, rather than making changes in authority or different roles with possible division of professional work force. The search and detection of these disparities or gaps as a research goal should make the breakthrough in patient safety achievements. During this research pursuit, disparities indicate areas of weaknesses and susceptibility and may elicit the means complexity flows through health care systems to patients (Cook and colleagues, 2000).

Amalberti and colleagues, 2005, identified five system barriers to even safer healthcare; the first is regulations, which significantly limit the risk allowed, thus, limiting maximum performance of healthcare givers. There is a real need for proper balance between the industrial notions to get a high productivity whatever it takes, and the concepts of patient safety culture. Doing that, researchers should take into consideration the economic troubles of the healthcare system and the spontaneous drive of productivity among healthcare workers.

Second, other important issues need dealing with before or in conjunction with the issue of patient safety, an important example to these issues is the need for standardization of healthcare practice and nursing. Third, the core of healthcare work is synchronization among practitioners, therefore recommendations should stress on teamwork and opening communication channels among the healthcare staff, instead of trying to reach optimal performance of each organizational level separately. The fourth obstacle is the need for system-level mediation to improve patient safety planning.

References

  • WHO Regional Office for South-East Asia (2006). Working Paper: Promoting Patient Safety At Healthcare Institutions. Retrieved 28/04/2008, from
  • WHO Secretariat report (2002). Quality of care: patient safety. Retrieved 30/04/2008, from
  • Department of Health and Human Services. (2008). Patient Safety and Quality Improvement. Washington DC: Federal Register. Vol.73 (29): 8112-8183.
  • Health Grades Inc. (2006). Third Annual Patient Safety in American Hospital Study. Golden, Colorado.
  • Bruke, J. P. (2006). Infection Control – A Problem for Patient Safety. The New England Journal of Medicine, 348 (7), 651-656.
  • Armstrong. K J. and Laschinger H (2006). Structural Empowerment, Magnet Hospital Characteristics, and Patient Safety Culture: Making the Link. J Nurs Care Qual, 21 (2), 124-132.
  • Duthie E, Favreau B, Ruperto A et al. (2004). Quantitative and Qualitative Analysis of Medication Errors: The New York Experience. Advances in Patient Safety, Vol. 1, 131-144.
  • Adamski P (2005). Medication Management: A patient safety priority. Nurs Manag, 36 (10), 14.
  • Davis T C. Wolf M S. Bass P F. et al (2006). Literacy and Misunderstanding Prescription Drug Labels. Annals of Internal Medicine, 145 (12), 887-894.
  • Reiling J G. (2005). Creating a Culture of Patient Safety through Innovative Hospital Design. Advances in Patient Safety, Vol. 2, 425-439
  • Johnson T R., Zhang J., Patel V L. et al (2004). The Role of Patient Safety in the Device Purchasing Process. Advances in Patient Safety, Vol. 1, 341-352.
  • Rothschild J M., Landrigan, C P., Cornin J W. et al (2005). The Critical Care Safety Study: The Incidence and Nature of Adverse Events and Serious Medical Errors in Intensive Care. Crit Care Med, 33 (8), 1694-1700.
  • Kho M E, Carbone J M, Lucas J and Cook D J (2005). Safety Climate Survey: reliability of results from a multicenter ICU survey. Quality and Safety in Health Care, 14, 273-278.
  • Chang, S.Y., Multz, A. S. and Hall, J. B (2005). Critical Care Organization. Critical Care Clinics. Vol. 21 (5), 43-53
  • Cook R I. Render M. and Woods D. D (2000). Gaps in the continuity of care and progress on patient safety. BMJ, 320 (7237), 791-794.
  • Amalberti, A, Auroy, Y, Berwick, D and Barach, P (2005). Five System Barriers to Achieving Ultrasfe Health care. Annals of Internal Medicine. Vol. 142 (9), 756-764
  • Wilson, A R., Dowd, B E. and Kralweski, J E. (2005). Patient Safety Research in Medical Group Practices: Measurement and Data Challenges. Advances in Patient Safety, Vol. 2, 51-62
  • Woolf, S H. (2004). Patient Safety Is Not Enough: Targeting Quality Improvements To Optimize the Health of the Population. Ann Inter Med, Vol. 140, 33-36
  • Baxter, S K and Brumfitt, SM (2008). Benefits and Losses: a qualitative study exploring healthcare staff perception of teamworking. Quality and Safety in Health Care, Vol.17, 127-130
  • Pstay, B M. and Bruke, S P. (2006). Protecting the Health of the Public: Institute of Medicine Recommendations on Drug Safety. The New England Journal of Medicine, Vol. 355, 1753-1755

Philosophy Of Nursing Education In Terms Of The Role Of Educator

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The purpose of this paper is to describe my philosophy of nursing education in terms of the role of educator and learner, evidence-based practice in nursing education and useful teaching strategies. Three key issues in nursing education are examined: raising the educational level of nurses, increasing interdisciplinary learning opportunities, and preparing nurses to lead initiatives to improve care and enhance patient outcomes. These challenges are related to my goal as an educator.

Role of the educator

The role of the educator is to facilitate student development of critical thinking by helping the student build on existing knowledge and integrate curriculum content with clinical experiences. Peters (2000) described a teaching as a process of medication where the educator “works as the interface between curriculum and student.” Core competencies for nursing education have been developed by the National League for Nursing (2005). The competencies include facilitating a learning environment by providing structure to content and learning activities, goals and objectives, assessment, evaluation and feedback to students. In addition, the core competencies outline the role of educator in curriculum development and program evaluation. Educators should function as role models and change agents, working to continuously improve the learning experience. Educators should function within the academic environment and serve as leaders in scholarship through the development and refinement of evidence-based teaching practices. Finke (2009) outlines the scholarship dimensions of nursing education: discovery, integration, application and teaching. The effective educator is a facilitator, coach, mentor, and role model in continuous practice improvement.

Role of the student

Students build existing knowledge by interpreting new information through personal constructs and prior experiences. Students employ a variety of learning styles and have diverse educational needs and come to the learning experience with a variety of perspectives, expectations, and motivations. Students who take an active role in learning acquire important skills of scholarly inquiry and discovery. Svinicki (2011) described strategic learners as “diligent and resourceful” who are open to continuous learning to improve their practice. Benner (2010) identifies the ability to prioritize and a acquiring a sense of salience as central goals of nursing education. Through feedback, reflection, and discussion, the student creates meaning and gains awareness of personal constructs influencing his or her perceptions. Students develop skills for lifelong learning, a key to successfully adapting to ever-changing technology, information, and clinical situations.

Useful strategies in nursing education

The most useful strategies in nursing education are those that help the learner integrate clinical knowledge with patient experience. Emergency situations happen rarely in clinical practice and simulator training helps students gain confidence as they test their performance under a variety of conditions without risking harm to a patient. Benner (2010) describes several strategies educators use to enhance learning such as contextualizing patients’ experiences, and guiding students in learning how to respond to changing situations. Constructive planned feedback helps students improve their practice. Learning is also enhanced when the educator creates opportunities for students to integrate clinical experience with classroom content. Through clinical coaching and classroom interactions, the educator and student engage in an empowering social process aimed at the development of the student nurse. Narrative pedagogies are a useful strategy to help students learn to think critically through analysis and interpretation. Reflective journaling allows students to find meaning in clinical experience and explore feelings when clinical interactions are complex or challenging. Interdisciplinary collaboration on service projects builds a foundation of mutual respect and understanding of roles and boundaries and students learn from patients, families, communities and each other.

The role of evidence-based practice in nursing education.

Chisari (2006) Evidence-based elements of nursing education. Should be adopted by all programs. Mission to educate a nursing workforce maximizing their ability to provide safe, effective, patient-centered care.

Oermann, 2007 Using evidence in your teaching.

Strategies that work, so much content knowledge, simulators – training best practices,

Three most important issues in nursing education and why

My goal as an educator

I hope to impart the spirit of continuous improvement so that learners seek new knowledge and learning opportunities throughout their careers. I hope to contribute to the preparation of nurses who can practice effectively in complex, technological healthcare environments with the skills necessary to work with others in the efficient management of health information and resources. I hope to reveal the learning opportunities that exist in everyday experience as nurses interact with other disciplines and patients and families who are the experts in their care. Most of all, I want to teach nursing by example through respect, thoughtful reflection, and continuous refinement of my teaching practice.

RIGHTS AND RESPONSIBILITIES OF THE REGISTERED NURSE

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RIGHTS AND RESPONSIBILITIES OF THE REGISTERED NURSE

This assignment consists of three tasks. Each task is to have certain number of words and requires neither an introduction nor conclusion. References used for this assignment must not be older than 2009 and must be Australian ones.

Task One looks at the specific rights and responsibilities of the registered nurse in a specialty clinical area (perioperative setting), including from the perspective of keeping the nurse and her/his patients/clients physically and emotionally safe. It also raises the issue of legal responsibilities and identifies issues specific to the specialty area.
Write a 500 word paragraph on an issue of safety that you explored in some depth, ensuring it is specifically related to the specialty area (perioperative setting).
The website bellow will help you establish a basis for your reflection and enable you to complete the activity. However, this 500 word paragraph is to have another 3 references.
http://www.ncbi.nlm.nih.gov/books/NBK2661/

Task Two-write a paragraph of 600 words on your understanding of the dilemma of providing information to carers while considering the confidentiality concerns relating to the patient/client. This 600 word paragraph is to have 3 references. Don’t forget to consider the ethical implications in your consideration of the issues.
Task Two looks specifically at the rights of clients and in more depth the rights of their carers in the process of treatment and recovery. It raises some questions about how the nursing profession views and deals with the rights of the carers and their need for information, particularly in the context of patients/clients who may lack insight in their care needs.
Where are the carers in the healthcare law and ethics’. It is important to understand that while the holistic approach to health care is preferred it is hard to balance the rights of all parties. What is the nurse’s role in ensuring carers and patients/clients have a say and that all opinions are respected. Sharing of information is fundamental to this consideration. The carers play an important role in providing information to health care professionals but do they have any rights to be consider in the decision making of care if there is no legal directive. The patient/client has rights but do the carers have rights as well. Further to this ethical theorie are often at the foundation of nurse’s approach to care. Ethics of Care theory claims that moral agents (carers, clients, health care professionals and institutions) are not separate entities and that the application of universal ethics is not in appropriate. This theory is based on consensus ethics which incorporates the views of all involved in care (Freegard & Isted, 2012).
Most health care organisations have a patient charter or similar document that is given to patients or clients in the care of the organisation, to explain their rights.
• Find this document for your specialty area (perioperative setting) and read it.
• Consider, who is it aimed at and does it include the rights of the carers as well?
• Is the organisational charter proscriptive in nature allowing no room for flexibility based on ethical considerations
It would also be worth finding out if the health care organisation has specific policies to cover the rights of patients/clients and their carers.
• Go to the organisation’s policies and procedures manual or web page, and find out what the relevant policies are.
• Are there policy for each party or just a general policy that is inclusive, again is there flexibility in the policy
Jot down some answers to these points as they will assist you in completing this assessment task.

Task Three- write a 550 word paragraph on your reflection from the activity bellow. This paragraph is to have 3 references including the reference bellow.
The activity: Read Brian’s story (the link bellow) and write a reflection on how that has changed your perspective or given you some insight into the meaning illness has for Brian’s wife as his care.
http://www.palliativecarensw.org.au/pdfs/PCNSW-A-Journey-Lived.pdf
This task gives you the opportunity to explore how the various people we interact with in the health care environment make meaning of their illness and of their situation. It also gives you the opportunity to reflect on how you relate to that and to make meaning of your own experiences.
When writing your reflection make sure you consider your own perceptions, morals and ethics.

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The Social Model Of Disability Health And Social Care Essay

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In this essay I will be looking at models of disability, focusing mainly on the social model of disability and drawing upon the academic writing of disabled people and others as well as looking at a case study of David; a fifty five year old male who was admitted to hospital six months ago from having being diagnosed with a mild stroke. I will then go on to discuss the social model’s relevance to the practice of therapists.

Disability is a major issue faced by our society. An attempt to describe the term disability can be very challenging. At present, there is no legal definition of disability as described in the social model of disability. Under the Equality Act, (2010) a disabled person is described as someone with “a physical or mental impairment that has a substantial and long-term adverse effect on his/her ability to carry out normal day-to-day activities”. This also covers people with progressive conditions such as HIV, cancer or Multiple Sclerosis, and those with hidden disabilities like dyslexia. There are two main models of disability, the medical model and the social model. The medical model of disability, sees disabled people’s inability to join in society as a direct result of having an impairment and not as the result of features of our society which can be changed (Swain, French, and Cameron, 2003).The World Health Organisation (1980) categorises disability into three main groups; Impairment, Disability and Handicap. They state impairment is different to disability, from this it is easy to see how people with disabilities might become stigmatised as lacking or abnormal. The medical model of disability, assumes that the first step solution is to find a cure or, using the World Health Organisation Classification (1980) to make disabled people more “normal” (cited in Reynolds,2005). When policy makers think about disability in this individual way they tend to focus on compensating people with impairments, for example, targeting specific benefits such as the Disability Living Allowance (1992) for those individuals and providing segregated ‘special’ services for them.

This model of disability has been criticised as it does not offer a realistic perspective from the viewpoint of disabled people themselves, disabled people can be led to believe that their impairments automatically prevent them from participating in social activities. This view was rejected by disabled people who then advocated a different way of looking at disability (Oliver, 1983).

In 1983 lecturer Mike Oliver, proposed the social model of disability. He adapted the model from the Fundamental Principles of Disability published by the Union of Physically Impaired Against Segregation (1975), where an impairment is defined as “lacking all or part of a limb, or having a defective limb, organ or mechanism of the body” and disability as “the disadvantage or restriction of activity caused by contemporary social organisation which takes no or little account of people who have physical impairments and thus excludes them from participation in the mainstream of social activities.”(Swain and Cameron,1999, p.69).

Central to this model is the belief that individuals with disabilities have a right to access, belong to, contribute to, and to be valued in society. The social model focuses on the strengths, abilities, and experiences of people with disabilities. Supporting individuals with disabilities in this model does not mean helping them to become “normal,” but instead focuses on tackling the social or physical barriers the individual faces in daily living (Oliver, 1983).

In contrast to other models of disability, the social model is based on knowledge of the experiences, views, and practices of people with disabilities. The model understands individuals with disabilities as experts on their own lives and as experts on disability; it does not necessarily see difference as problematic or necessarily negative. Oliver (2004) goes on to argue that people with disabilities have faced prejudice and discrimination, therefore those who support this model believe that attention should be focused on restructuring society, not treating the individual.

The social model views disability as a consequence of structural, environmental and attitudinal barriers that prevent people with a disability or impairment from maximum participation in society (Oliver, 2004, cited In Swain, French, Barnes and Thomas, 2004). For example, short-sighted people living in the United Kingdom are not classified as disabled. Eye-tests and visual aids, which are available means that this impairment does not prevent them participating fully in life. If, however, they live in a third world country where such eye care is not available they are severely disabled. The inability to read, subsequently learn, and gather information would be considered as a severe impairment in any society.

If we apply the social model to the case study of David: “Adapting to life after stroke”, we are able to identify hidden attitudinal barriers that may exist in support of the social model, in the way society may view individuals with disabilities as being dependant and an inability to function fully due to their impairment. An example of this is when David states “sometimes in shops, if I struggle to find the right money or to put away change, I feel really patronised”, he may also experience these as hidden barriers from family members, this is indicated when David states “At times I think they get annoyed with me being slower than before”.

In addition to these barriers, David may also encounter structural barriers; this may prevent him from being able to continue drive after his stroke due to legislations in place whereby you are not allowed to drive for one month following the event. This is a legal requirement even if your symptoms have fully resolved. The Driving Vehicles Licensing Authority would need to be contacted if “one month after the stroke you are still suffering from weakness of the arm or legs, visual disturbance, or problems with co-ordination, memory or understanding.” (Driver and Vehicle Licensing Authority, 2011). Other structural barriers in insurance policies mean David may also have to pay more for his car insurance due to suffering a stroke, this can be viewed as society penalising him for having a disability. Environmental barriers may also exist which prevent David using public transport to get to work.

Oliver (1990) argues that the removal of these structural, environmental and attitudinal barriers will improve the lives of disabled people, giving them the same opportunities as others. For example in the case study, David was able to return to his job as a Health and Safety Advisor on a part time basis under the Employers and the Equality Act (2010) employers are required to make reasonable adjustments to their policies or practices. By making adjustments, employers are removing the barriers that disable according to the social model, they are effectively removing the disability.

The strength of this model lies in its placing the responsibility upon society and not the individual. At the same time, it focuses on the needs of the individual whereas the medical model uses diagnoses to produce categories of disability, and assumes that people with the same impairment have identical needs and abilities. It also offers positive solutions that have been proven in the United Kingdom (Reynolds, 2005).

The social model however has limitations. Firstly, Crow (1992) criticises the model for its failure to emphasize certain aspects of disability such as the pain of impairment, both physical and psychological. In other words, the struggle may be over for disabled people in terms of obtaining human rights but the personal struggle of just getting out of bed in the morning remains. This struggle means that no matter how accommodating society is for disabled people, disabled people will always be disabled people.

Morris (1991, p.10) then goes on to argue “While environmental barriers and social attitudes are a crucial part of our experience of disability – and do indeed disable us – to suggest that this is all there is, is to deny the personal experience of physical and intellectual restrictions, of illness of the fear of dying”. Further criticisms made of the social model, is its failure to take into account that as the population gets older the numbers of people with impairments will rise and making it harder for society to adjust. Lastly, the model’s concepts can be difficult to understand, particularly by professionals in rehabilitation. These professionals have to be persuaded that their role must change from that of “cure or care” to a less obtrusive one of helping disabled people take control of their own lives (Morris,2004).

If we look at the relevance of the social model in the practice of therapists;

Occupational therapists and Physiotherapists working with people with disabilities would be able to align themselves to the model, by identifying barriers that may exist for the client and implement interventions to overcome these disabling barriers and promote social integration. “Assessments based on the social model of disability do not ask ‘What is wrong with this person?’ but instead ask ‘What is wrong for this person?’ At the core of an assessment based on the social model of disability.” (Morris, 2004, p.24).

In the case study of David, he identifies fatigue and mobility as key areas he wishes to address with the help of therapists. A therapist may assess the client in their own environment whether that is in their home or work and then suggest adaptations such walking aids or assistive aids to help enable the client to carry out occupations while removing barriers in order to live a more independent life.

In the case of Speech and Language Therapists they may work towards bringing about changes in the individual’s environment in order to maximise the opportunities for communication. This might, for example, involve teaching carers how to adjust their language to suit the client’s level of understanding, or use gesture in addition to verbal communication when conveying their message (Coles, 2001).

The social model of disability is a key mechanism for ensuring that Social Care services and resources work in partnership with people who need support. Assessments should identify the barriers, external to the individual, which are getting in the way of human rights. The planning and delivery of services should be focused on tackling these disabling barriers. All of this opens up exciting possibilities of using public resources in ways, which really make a difference to people’s lives (Morris, 2005).

To conclude, models of disability are tools for defining impairment and disability, and ultimately for providing a basis upon which government and society can devise strategies for meeting the needs of disabled people. They are a useful framework in which to gain an understanding of disability issues, and of the perspective held by those creating and applying the models.

Previous models of disability were essentially devised by people about other people, however the social model of disability provides an alternative perspective from those who experience disability.

The social model proposed by Oliver (1990) has played a key part in promoting ways of overcoming disabling barriers for disabled people and a move forward to empower those individuals to be apart society.One of the major criticisms that have made of the social model is its detachment with having to deal with of impairment and its experiences. It is important to acknowledge that therapists play an important role in overcoming disabling barriers and adopting a holistic approach to enable individuals to carry out everyday meaningful activities as well promoting social inclusion, through adaptations to their environment.

Models of disability provide us with a continuum on changing social attitudes to disability and where they are at a given time. Models change as society changes; therefore, we should develop and implement various models, which will empower people with disabilities, giving them full and equal rights as others within their society.

References

Coles, J. (2001) The Social Model of Disability: what does it mean for practice in services for people with learning difficulties? Disability and Society, 16(4), pp. 501-510.

Crow, L. (1992). Renewing the Social Model of Disability. Coalition pp.5-9.

HM Government (2011) Directgov: Driver and Vehicle Licensing Authority (2011) Available at: http://www.direct.gov.uk/en/Motoring/DriverLicensing/MedicalRulesForDrivers/MedicalA-Z/DG_185787 [Accessed on 10 November 2011].

HM Government (2011) Directgov: Employers and the Equality Act (2010) Available at: (http://www.direct.gov.uk/en/DisabledPeople/Employmentsupport/YourEmploymentRights/DG_4001071) [Accessed: 5 November 2011].

HM Government (2011) Directgov: Disability Living Allowance (1992) Available at: http://www.direct.gov.uk/en/MoneyTaxAndBenefits/BenefitsTaxCreditsAndOtherSupport/Disabledpeople/DG_10018702 [Accessed on 10 November 2011].

HM Government (2011) Directgov: Equality Act (2010) Available at: http://www.direct.gov.uk/en/DisabledPeople/RightsAndObligations/DisabilityRights/DG_4001068 [Accessed: 5 November 2011].

Morris, J.1991: Pride Against Prejudice-Personal Politics of Disability, London: The Women’s Press.

Morris, J. (2004) Social Model Assessment Team Pilot Project Essex Social Services: Report of Evaluation. p24 [PDF online].

Available at: www.leeds.ac.uk [Accessed: 5 November 2011].

Oliver M (1983) Social Work with Disabled People. Basingstoke, Macmillan.

Oliver, M. (1990) The individual and social models of disability. Available at: http://www.leeds.ac.uk/disabilitystudies/archiveuk/Oliver/in%20soc%20dis.pdf 4 [Accessed: 5 November 2011].

Oliver, M. (2004) If I had a hammer: The Social Model in action. In Swain, J., French, S., Barnes, C. and Thomas, C. (eds) (2004) Disabling barriers – enabling environments. 2nd ed. Los Angeles, SAGE Publications.

Reynolds, F. (2005) Communication and clinical effectiveness in rehabilitation. Oxford: Butterworth-Heinemann.

Swain, J. and Cameron, C. (1999) Unless otherwise stated: Discourses of labelling and identity in coming out. In Corker, M. and French, S. (eds) Disability Discourse. Buckingham: Open University Press.

Swain, J., French, S. and Cameron, C. (eds) (2003) Controversial issues in a disabling society, London: Sage in Association with the Open University.

Section B : word count 879

Juvenile Chronic Arthritis (JCA) is a condition, which causes pain and inflammation of the joints and bones. The main symptoms include pain, stiffness, restricted movements of the joints, swelling, and warmth and redness of the skin over the joint. “About 12,000 children in the UK under the age of 16 have a form of Arthritis.”(Arthritis care, 2011).

The purpose of this leaflet is to provide information on support services available and coping strategies for Helen, a fourteen-year-old female who suffers from JCA. The leaflet focuses on three main support services which address the identified needs of Helen.The case study of Helen highlights swimming as a meaningful leisure activity, so one of the programmes offered in the leaflet is an Arthritis foundation aquatic programme, there is evidence based research to suggest swimming can help to ease stiffness, improve movement in joints, and strengthen muscles. The program incorporates the buoyancy of water and the soothing warmth of a heated pool to make a safe and ideal environment for relieving pain and stiffness (Arthritis, 2011).

Other Programmes aimed at Helen and her family focus on teaching knowledge and skills to better manage JCA and providing the opportunity to meet others who share similar experiences. This acknowledges the need for support for the whole family, which is strength of the leaflet however a limitation is the lack of in depth information provided.

The use of a case study of a teenager with JCA, is an effective way of providing reassurance and encouraging Helen to remain positive. Coping strategies are also included as a way of offering practical advice on how to manage JCA on a daily basis, and takes into account if reader is not ready join they can still take away some useful tips.

An important factor in whether health information will appeal to this target audience is design (Houts et al 2006). According to Hoffman and Worrall (2004), a health education leaflet should be patient centred and designed with the principles of good health education material design in mind, including layout of both illustration and text. Often leaflets in clinical areas are ignored; however leaflets with pictures draw the attention of patients and encourage attention to the information contained within and as the leaflet selected is vibrant and colourful it catches the eye. There is a blue background for the leaflet, on which the text is placed on; this makes the black of the main body of the text stand out as well as the use of suitable images Helen can relate too.

In terms of content of information, written material should contain accurate content and be written in a simple manner which can be understood easily.

The front cover of a leaflet is particularly important as it is the main device used to initially attract the target audience (NHS,2003).To attract Helen to the leaflet an image of a group of teenagers is used for the cover as she would be able to identify more with as most leaflets on Arthritis have images of older people and can be off putting for a teenager.

A logo is also used so it is clear to the reader who is responsible for producing the leaflets and if she wants to seek additional information then the logo will help her to remember the organisation. The heading “If you are a teenager with Juvenile Chronic Arthritis, you are not alone” is clear and written in a large front so it immediately addresses the target audience and provides reassurance. Bearing in mind that an average person will only look at a leaflet for a few minutes, this is very important as the information and the purpose of the leaflet comes across clearly and immediately on the front cover which is one of the main strengths of the leaflet. However, the contact details on the back of the leaflet with extra support services is not clear enough to the reader in regards to whom to contact if interested in joining the programme.

The language used throughout the leaflet is simple in order to appeal to young teens, but a Flesch test has not been carried out to indicate this, as “Standard” texts should have an FK Grade level of about 7-8 which is similar to a reading age of 13-14 years, therefore suitable for the target audience. (Frances, 2005)

NHS Toolkit for producing patient information (2003) recommends using a 14 point or larger for those with sight difficulties, therefore an Ariel 14 point sized font has been used in the main body of the text so that the leaflet is both clear and easy to read and a more bolder style of font is used for subheadings inside so it is more eye-catching. This takes into account the reader who has JCA may have deterioration in sight as one of the symptoms of their condition.

To conclude, the overall content and presentation of the leaflet successfully addresses the needs of Helen, focusing on providing information on support services. The leaflet has been designed so it is not overly cluttered but provides basic information by including a case study, coping strategies and facts that may encourage her to join. However, Improvements can be made in the design layout and incorporating more depth of information.

Skills and Technology in Phlebotomy

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Phlebotomy is more than the skill of drawing blood or acquiring different specimens. It is an important procedure to determine specific aspects of patient health the physicians need to know in order to treat their patient. “Phlebotomy, which dates back to the age of ancient Greece, has gained experience through the evolution of medicine becoming a fundamental diagnostic tool.” (Ialongo, C., 2016). In order to obtain a variety of specimens, it is crucial to preform phlebotomy procedures safely and effectively. A phlebotomist needs to be well trained in their scope of practice and be well educated in all aspects of phlebotomy. Knowing the tubes being used and in what order to use them in is part of the knowledge needed to be a phlebotomist.

When obtaining a patient’s blood, it is significant to draw in the correct order of draw. Each tube has specific additives and these additives can affect certain tests. If blood is drawn in the wrong order of tubes, the blood collected can be contaminated. This will exhibit improper values for the tests being done on that tube. This comes back to patient safety, because the patient may get an improper diagnosis or treatment that can harm them. The correct order of draw and tube colors are blood cultures (anaerobic and aerobic), light blue, red-clear, red, red-black tiger or gold, light green, green, gray-green tiger, lavender, pink, tan, royal blue, and gray. It is important to know this order because patients will need a specific amount of tubes drawn, per the doctors orders, and the phlebotomist needs to order them correctly.

The lavender tube comes ninth in the order of draw and is a very common tube for phlebotomists to use. It is crucial to draw a lavender tube after all the previous colors have been drawn. This will ensure the additives have not contaminated future specimens. The additive in the lavender (purple) topped tube is ethylenediamenetetraacetic acid or abbreviated to EDTA. Inside the tube wall is coated with K2EDTA or K3EDTA. The K2 and K3 represent the form of potassium in the tube. “The EDTA can be ordered as K2 (spray-dried potassium) attached to EDTA or K3 (liquid potassium) attached to EDTA.” (Garza, D., 2015). This additive is also a coagulant, which is important for certain tests the lavender topped tube is used for.

The common tests for each tube depend on the additives that are in each tube. For the lavender tube, the common tests are complete blood count (CBC), hemoglobin and hematocrit (H&H), red blood count (RBC), white blood count (WBC), platelet count, WBC differential count, erythrocyte sedimentation rate (ESR), sickle cell screening, HGB A1-C, mean corpuscular  hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and mean cell volume (MCV). Some other tests used with this tube are molecular diagnostic testing, immunology, and hemoglobin A1-C. The additives in this tube, K2 and K3, are important for certain types of tests. For hematology tests like CBC and RBC, the additive K2 is better to use. For viral markers it is better to use the K3 additive. (Garza, D., 2015).

Most tubes have special considerations which are actions that need to be taken for that specimen and additive. The lavender tube does not have many special considerations, but like all tubes, need to be filled with the correct amount of blood, need to be inverted the proper amount of times, and used in the correct order of draw. However, if the lavender tube is not mixed properly with 8 inversions, micro clots may form. Mixing the sample to much or violently may cause hemolysis. An interesting fact about the lavender tube is that it can also be used for blood donor screening like the pink topped tube.

Each tube has a specified amount of blood the vacuumed pressure of the tube will allow. The lavender topped tubes can hold 2.0 mL, 3.0 mL, 5.0 mL or 0.75 mL depending on the size of the tube. “To assure proper ratio of EDTA to blood, it is recommended that the tubes contain no less than one-half of the stated volume.” (Department of Pathology, 2019). Over or under filling a tube can cause errors in the test results because of the improper ratio between blood and additive. Under filling the lavender topped tube can cause false low blood counts, low hematocrits, blood smears, and morphologic changes to red blood counts. “Insufficient sample volumes produce relatively elevated EDTA levels, which can increase the chelation of magnesium and zinc, and can then affect reagent enzymes used for signal generation, such as alkaline phosphatase.” (Bowen, R. A., 2014).

To properly mix the blood sample for the lavender topped tube, the tube is inverted 8 times. Gently inverting the sample will mix the correctly mix the additive with the blood. It is also important to not break the blood cells and mix the sample quickly to avoid micro clots. Each tube will vary slightly on the amount of inversion needed to mix the sample. As part of staying educated on all the tubes and tools for a blood draw, the phlebotomist should be aware of each tubes inversions.

A phlebotomist has numerous responsibilities that include the patient’s safety, staying educated, and preforming their skills effectively. Knowing each tube will ensure the phlebotomist will carry out all of their responsibilities. The phlebotomist must know the additives, the tests that tube is used for, any special considerations that tube may have, the volume of blood that needs to be in the tube, how many inversions the tube needs to properly mix the blood and additives, and where in the order of draw the tube needs to be. “Tubes are drawn in a specific order to avoid the possibility of erroneous test results caused by carryover of an

additive

.” (Mohammed, S., 2013). If one or any of these aspects about the tubes are not done properly, the test results will be flawed. When the test results are off, the patient is in danger of a false diagnosis or treatment options.

References

Impact of Occupational Therapy on the Global Burden Of Mental and Substance Use Disorders

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The burden of mental and substance use disorders exists globally whether reported or not. According to many global surveys and longitudinal studies, populations with mental and substance use disorders contribute to a larger burden of diseases than any other communicable or non-communicable disease worldwide due to the limited accessibility and availability of services (Mannelli & Wu, 2019; Degenhardt et al., 2018; Erskine et al., 2015; Whiteford et al., 2013). Globally, one in six people who suffer from a substance use disorder receive treatment each year without distinguishing economic or social factors related to services (Whiteford, Ferrari, & Degenardt, 2016; Erskine et al., 2015; Mannelli & Wu, 2019). Based on various Global Burden of Disease (GBD) studies, the burden of mental and substance use disorders have increased by 37.6% between 1990 and 2010 due to the increase of population growth and aging (Whiteford, Ferrari, & Degendardt, 2016). Nonetheless, the individuals diagnosed with mental and substance use disorders are not the only ones affected by this global burden but also the families, friends, corporations, and healthcare workers who require greater support (Merikangas & McClair, 2012). The profession of occupational therapy identifies drug use as an occupation, acknowledges the injustices formed around dysfunction, and addresses the various contexts that constrain people from participating in a meaningful, healthy lifestyle (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019).

The prevalence of mental and substance use disorders vary significantly across countries with clear differences geographically, culturally, socially, politically, and economically hindering the accessibility and availability of services (Degenhardt et al., 2018; Merikangas & McClair, 2012). Although mental and substance use disorders critically vary among environmental and contextual factors, the research for effective treatments and programming has been scarce when accounting for the causal-temporal relationship (Merikangas & McClair, 2012). Many epidemiological studies have identified a global need to improve disease education, advance prevention and treatment protocols, and promote awareness while reducing stigma, but outstanding barriers restrict healthcare services from reaching optimal, cost-effective practices to populations in need (Mannelli & Wu, 2019; Degenhardt et al., 2018). The priority must focus on reducing costs and increasing long-term availability and accessibility of treatment to larger populations with mental and substance use disorders (Mannelli & Wu, 2019). Despite the personal and economic costs, the treatment rates for people with mental and substance use disorders are low, with treatment gaps of more than 90% in developing countries (Whiteford et al., 2013). The combination of stigma about mental and substance use disorders and the vast treatment gaps constrain the use of available resources, even in high income countries where a higher proportion of health budgets are spent to address these issues (Whiteford et al., 2013; Degenhardt et al., 2018). The density of international data on drug use patterns has highlighted the universal nature of substance abuse and the impact of untreated mental illness in the community (Merikangas & McClair, 2012; Whiteford, Ferrari, & Degendardt, 2016). The emergent awareness of a client-centered approach aims to direct quality individualized care to diminish practices that create barriers to treatment access and continued care (Mannelli & Wu, 2019). Many factors, both directly and indirectly, hinder the healthcare needs unmet for populations experiencing mental and substance use disorders globally where occupational therapy practitioners may ameliorate healthcare services (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019).

People engaged in and recovering from drug addiction encounter concerns with occupational participation and require services emphasizing environmental supports, integrative care, and the promotion of meaningful alternatives to replace drug-based affiliations (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019). The needs of clients with mental and substance use disorders are vast and vulnerable to setback to aversive routines if not addressed with a structural and meaningful approach (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019). Occupational therapists cannot overlook drug use as a risky occupation that exposes individuals to injustices such as alienation, imbalance, deprivation, and discrimination (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019). Instead, occupational therapy’s unique practice acknowledges the holistic perspective of populations with chronic health conditions and addresses these dimensions during evaluation, intervention, and outcome measurement based on a client-centered approach (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019). Occupational therapists manage their clients’ needs by conforming to roles that achieve client-centered outcomes and functionality (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019). An occupational therapist may explore the political and financial opportunities for clients with mental and substance use disorders by advocating for quality, cost-effective care based on their clients’ values (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019). Occupational therapists may play the role of a facilitator by identifying and reducing obstacles within physical and social environments as well as educating or coaching the client about the impact of cultural, personal, temporal, and virtual contexts (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019). Occupational therapy practitioners are strategically positioned to work in various settings and establish interprofessional collaboration and partnership with organizations (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019). The goal of interprofessional collaboration and partnership focuses on facilitating effective intervention and programming for individuals, groups, and communities (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019). Occupational therapy may direct interventions for mental and substance use disorder populations to alter educational trajectory, social participation, vocational attribution, familial responsibilities, and adaptive functioning (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019). The distinctive and wholesome practice of occupational therapy promotes specialized, cost-effective care accustomed to clients’ value-based needs across contexts and supports the opportunity to reduce the burden of mental and substance use disorders worldwide (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019; Mannelli & Wu, 2019).

The unmet healthcare needs of people with mental and substance use disorders contributes to a global burden across all countries (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019; Mannelli & Wu, 2019). Many contextual factors restrict the availability and accessibility of healthcare services required by vast populations to thrive (Merikangas & McClair, 2012). The current healthcare services do not address the basic needs of people with mental and substance use disorders to relieve global burden and other attributable diseases (Mannelli & Wu, 2019; Degenhardt et al., 2018; Merikangas & McClair, 2012). The profession of occupational therapy offers unique services by addressing the needs and values of people with mental and substance use disorders (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019). Occupational therapy focuses on a client-centered approach and navigates clients around contextual barriers through a holistic perspective (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019). Occupational therapists promote health and wellness for people with mental and substance use disorders by conforming to role in support of their clients’ needs (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019). Although occupational therapists do not frequently work with this population, their specialized skillsets encourage structured routines and alternative activities from aversive behaviors elicited from substance use (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019). The implementation of occupational therapy services worldwide can minimize the global burden of mental and substance use disorders and other attributable conditions (Sy, Delos-Reyes, Roroaldo, & Ohshima, 2019).


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What advantages or disadvantages do you see in using qualitative and quantitative methods in a nursing study? Support your answer with current evidence-based literature.

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What advantages or disadvantages do you see in using qualitative and quantitative methods in a nursing study? Support your answer with current evidence-based literature.

The theoretical foundations of qualitative and quantitative methods are very different, but many researchers believe both methods should be used in the research study to increase validity and reliability. What advantages or disadvantages do you see in using both types of methods in a nursing study? Support your answer with current evidence-based literature.

Analyze the ethical considerations associated with the conduct of nursing research.
Identify the research problem, questions/purpose, and literature review.
Critically appraise components of a published qualitative study and a published quantitative study.
Contrast theoretical foundations of qualitative and quantitative research methods.
Identify critical components of qualitative and quantitative methods………………

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