Describe the relevance of the nursing research problem addressed in a SRR to practice.

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Describe the relevance of the nursing research problem addressed in a SRR to practice.

1. Describe the relevance of the nursing research problem addressed in a SRR to practice.
2. Critique the levels of evidence of the studies used in the SRR, specifically the designs of the studies included.
3. Critique the clarity with which the studies are presented and critiqued.
4. Describe the overall findings of the studies, as summarized in the SRR.
5. Critique the conclusions of the SRR, with implications for your current practice and future research.
6. Utilize the Cochrane Database of Systematic Reviews to locate a true SRR for this assignment – I will e-mail the article.
7. Paper length should be between 4-6 pages

Comm120 week 7 project | COMM120 | American Military University

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*** I Will attach my week for assignment below so you can see an outline of what my project is about****

Instructions

Goal: Demonstrate the ability to create a field of study project that uses both research-based and personal content while using presentation software to communicate with an intended audience.

Description:

During the first six-weeks you formulated a project plan, researched the content of the plan, and collected quality academic and non-academic sources. For the week 7 Field of Study Project you will create a presentation (CO8) that builds upon the week 2 Project Plan and the week 4 Location and Access (Source Organization worksheet) that effectively communicates the knowledge you have gained during COMM120.

Please consider the following:

Presentation will include an introduction, body, conclusion, and properly formatted reference/work cited slide in the citation style of your degree program (APA, MLA, or Chicago).

Clear evidence that the topic was researched and expanded upon the week 2 Project Plan (CO2 & 5).

Presentation provides audience with information to increase their knowledge of the topic presented (CO1).

Presentation engages the audience by using elements such as images, graphs, and charts. Appropriate citations must be included.

Three (3) vetted credible sources. One (1) of the sources must be scholarly and from the library.

Appropriate length 7-9 slides.

Include ONE of the following: audio of you giving the presentation OR DETAILED speaker’s notes OR a transcript of what you would say if you gave the assignment.

Be professional

Why did CMS become more involved in the reimbursement component of health care?

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Why did CMS become more involved in the reimbursement component of health care?

For this assignment, write a 2-3 page report that you will deliver to Mr. Magone on how the new Centers for Medicare and Medicaid Services (CMS) initiatives and regulations will impact the organization’s revenue structure. In your presentation, address the following questions:
• Why did CMS become more involved in the reimbursement component of health care? How does CMS’s involvement impact the reimbursement model for Healing Hands Hospital and other health care organizations? If CMS reimbursement regulations for Medicare and Medicaid change, does it follow that other insurance providers change their policies on reimbursement?
• What tools can be implemented to ensure organizations such as Healing Hands Hospital and physician practices are meeting the policies and procedures set forth by CMS?
• Identify 3 tools from the CMS Web site that are helpful in meeting the requirements for Medicare reimbursement set forth by CMS.

The case will focus on issues related to market segmentation targeting and/or positioning. You will be asked to answer questions following the case. Your analysis and recommendations must be strongl

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The case will focus on issues related to market segmentation targeting and/or positioning.  You will be asked to answer questions following the case.  Your analysis and recommendations must be strongly communicated to demonstrate your knowledge and understanding of the concepts learned in the course. Be creative in your work and ensure that all your recommendations are fully substantiated.

Instructions

1. Students will purchase the case directly from the publisher.

2. Students will be required to address the questions that follow the case using course materials to inform and support their answers.  Additional research is likely to be needed to satisfactorily address the questions.

3. Remember, this is a Marketing class. The Product (the content, the presentation, etc.), Place (the manner in which it is presented to the instructor), Price (the amount of effort required to read and consider the points – this is a place where clarity, conciseness and attention to grammar, and spelling and punctuation counts), and Promotion (how well are your ideas supported and whether you “sell” your position) work together as the professor evaluates your work.

4. The written submission should be substantive, both in length 1500 words and content, directly and thoughtfully addressing the question or issue.

5. Responses should draw on materials from the assigned readings and discussion materials to develop a thoughtful and reasoned answer.  Students should not hesitate to draw on past experience, knowledge and external sources to support their position.6. The report should address each case question individually and the answers should be formatted in a manner where there is an introductory and a concluding paragraph.  The report should also be free of spelling errors, be grammatically correct, written in full-sentences and contain full words (no shorthand, emoticons, etc.).

7. Responses must be well written, properly cited and referenced (APA), and be free of spelling and grammatical errors.

Students will be expected to read the case, identifying the main issues and, following the case method, provide a thorough analysis of case facts, identify and assess alternatives and provide recommendations to address the problems identified.

Objectives

  • Students will use a solutions-based problem solving approach.Students will analyze and synthesize information provided in the case
  • Students will provide recommendations in response to case questions that are based on a comprehensive analysis of the case materials and other supporting documents

Short Description

The case assignment is an opportunity for students to assess a business challenge and apply their learning to assessing the issues and developing recommendations for their solution.

Requirements and Submission Instructions

  • Maximum 1500 words
  • APA Format

Herbal Supplements Assignment

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ORDER NOW FOR AN ORIGINAL PLAGIARISM-FREE PAPER:  Herbal Supplements Assignment

Herbal Supplements Assignment

Herbal Supplements Assignment

The practice of using herbal supplements dates back thousands of years. Today, there is a renewal in the use of herbal supplements among American consumers. However, herbal supplements are not for everyone. In fact, some herbal products may cause problems for people treatments for chronic ailments. Because they are not subject to scrutiny by the FDA or other governing agencies, the use of herbal supplements is controversial.

Herbal supplements are products made from plants for use in the treatment and management of certain diseases and medical conditions. Many prescription drugs and over-the-counter medicines are also made from plant derivatives. These products contain only purified ingredients and, unlike herbal supplements, are closely regulated by the FDA. Herbal supplements may contain entire plants or plant parts. Herbal supplements come in all forms: dried, chopped, powdered, capsule, or liquid, and can be used in various ways. Please address the followings:

Discuss advantages and disadvantages of dietary supplements, including adverse reactions, drug-drug interactions, drug-food interactions, and specific laboratory issues that may arise from using these products.

Discuss the position of the FDA and other governmental agencies on over the counter herbal supplements. Support your post with at least 2 evidenced-based guidelines published within the last 5 years.

The posts must be referenced as mentioned above and written in APA 6th edition format.

Books:

Teri Moser Woo & Marylou V. Robinson (4th ed.). Pharmacotherapeutics for

Advanced Practice Nurse Prescribers. Davis

Chapters 7, 10, 12, 13: Cultural &

Ethnic Influences in

Pharmacotherapeutics; Herbal &

Nutritional Therapies;

Pharmacoeconomics; Over-the

Counter Medications

Recommended reading: Adams et al.

chapters 7,8,10,11

attachment

PharmacotherapeuticsForAdvancedPractice-TeriMoserWoo.pdf

Herbal Supplements Assignment

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.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.

Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.

One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.

I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.

In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.

Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).

Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).

Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.

I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.

As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.

It is best to paraphrase content and cite your source.

LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.

Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.

Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?

Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

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NursingPapers

Diagnosing and Managing Common Cardiovascular and Neurologic Conditions Custom Essay

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Diagnosing and Managing Common Cardiovascular and Neurologic Conditions Custom Essay

Cardiovascular and neurologic conditions are among the leading causes of death and hospitalization of women in the United States (Centers for Disease Control and Prevention, 2008a).

As an advanced practice nurse, you must routinely monitor patients at risk of these conditions and recommend the appropriate health screenings and preventive services.

When assessing patients for these conditions, it is important to keep in mind that while some female patients might present with typical signs and symptoms, others might present with atypical signs and symptoms that are unique to women.

For this Discussion, consider signs and symptoms presented by the women in the following case studies and develop differential diagnoses:

Case Study 1:

A 48-year-old overweight African American female is in the clinic for a wellness visit. A routine fasting lipid panel returned with the following results:

Total cholesterol: 305 mmol/L
Low-density lipoprotein (LDL): 180 mg/dl
High-density lipoprotein (HDL): 30 mg/dl
Triglycerides: 165 mg/dl

Case Study 2:

You are seeing a 63-year-old African American female for a two-week history of intermittent chest pain. The pain varies in intensity and resolves with rest. She does not believe it has increased over time. She is a nonsmoker with a history of hypertension treated with Lisinopril 10 mg once daily. She had an exercise stress test one year ago that was within normal limits. Her physical exam findings are as follows: HR–90, BP–150/92, R–22, O2Sat 98% RA; lungs: clear to auscultation bilaterally; cardiovascular: apical pulse of 90 RRR, no rubs, murmurs, or gallops. Chest wall mildly tender to palpation that reproduces her complaint of pain. Extremities include no clubbing, cyanosis, or edema. The remainder of the exam is within normal limits.

Case Study 3:

A 32-year-old Asian American female is in the clinic for a history of recurrent headaches for the past year, occurring monthly, lasting up to 12–18 hours. The headaches are sometimes associated with photophobia, nausea, and vomiting. She takes either acetaminophen or ibuprofen for relief that is not always successful. She uses Ortho Tricyclin for birth control. Her physical exam is within normal limits.

To prepare:

Review Chapter 8 of the Tharpe et al. text and the McSweeney et al. article in this week’s Learning Resources.

Discuss all three case studies provided seperately.

Analyze the patients information.

Consider a differential diagnosis for each patient in the case studies.

Think about the most likely diagnosis for each patient.
Reflect on the appropriate clinical guidelines.

Think about a treatment and management plan for each patient.

Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.

Consider strategies for educating each patient on the treatment and management of the disorder you identified as your primary diagnosis.

Discuss the differential diagnosis for each patient in the in all three cases.

Explain which is the most likely diagnosis for each patient and why.

Then, based on the appropriate clinical guidelines, explain a treatment and management plan for the patient, including proper dosages for any recommended treatments.

Finally, explain strategies for educating each patient on the disorder.

Readings:

Tharpe, N. L., Farley, C., & Jordan, R. G. (2013). Clinical practice guidelines for midwifery & Women’s health (4th ed.). Burlington, MA: Jones & Bartlett Publishers.
Chapter 8, “Primary Care in Women’s Health” (pp. 431–560)

This chapter explores health promotion and disease prevention in women’s health. It also describes the presentation, assessment, diagnosis, and management of various systemic conditions, including cardiovascular and neurologic conditions.
McSweeney, J. C., Pettey, C. M., Souder, E., & Rhoads, S. (2011). Disparities in Women’s cardiovascular health. Journal of Obstetric, Gynecologic & Neonatal Nursing, 40(3), 362–371.
Retrieved from the Walden Library databases.

This article explores health disparities in cardiovascular disease, including gender and racial disparities related to the diagnosis, treatment, and outcomes of patients with this disease.
Department of Health and Human Services, National Institutes of Health, & National Heart, Lung, and Blood Institute. (n.d.). Women’s Health Initiative: WHI background and overview. Retrieved March 20, 2013, from https://www.nhlbi.nih.gov/whi/background.htm

This website outlines details of the Women’s Health Initiative (WHI) and introduces the various health issues addressed by the WHI.

adolescent alienation

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Potential causes of and solutions for adolescent alienation

  1. Effects of alcohol, narcotics, prescription drugs, tobacco, and other addictive substances.
  2.  Sexual behaviors and characteristics in adolescents.
  3. Causes, effects, and potential solutions for stress in adolescents.
  4.  Preventative measures staff can take to help adolescents avoid unhealthy behaviors.

Alarm Management and Fatigue in Nursing

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Abstract

The proposed project aims at finding a lasting resolution to alarm fatigue and alarm management specifically in the nursing field. The project thus would be of use, as it will recommend the possible measures to be implemented to solve the problem. The proposal also will reduce the number of patient related injury’s/deaths in hospitals. The proposal will start with an introduction and a statement of the problem that would highlight the gap that exists between false alarms and the effects concerning noise and death. The study will also highlight the set objectives of the project and the possible limitation that may hinder the achievement of project’s goals. The project will also highlight the resolution strategy. The resolution strategy is based on the Iowa’s evidence-based nursing practice model. The model is based on the following steps: statement of the problem, analysis of the problem, evidence of the identified problem and recommendation of the best alternative measure to solve the problem. The project also will highlight an implementation plan that is based on the essentials of baccalaureate education for professional nursing practice. The proposal will end with a thorough review of scholar’s works that are relevant to our study of alarm management and fatigue in nursing. It will be of use to the project since it will result in the understanding of the asserted problem as well as suggesting another measure to solve the problem. With the achievement of the set objective, the project will be submitted to the executive review committee in hopes of making it common practice.

Alarm Management and Fatigue in Nursing


Introduction and Background

The proposal aims at highlighting the measures that should be implemented in the management of clinical alarms so as to avoid the weariness and delayed response to alarms in hospitals especially in the intensive care unit (ICU). It would in turn, lead to the minimization of the number of patient’s injuries and/or deaths caused by alarm fatigue that results in delayed responses to hospital alarms (McCormack

et al.,

2010).


Statement of the Problem

The advancement of modern technology has resulted in the application of scientific machines and equipment in the health community. The application of these machines and equipment is aimed at improving the quality of health care delivered. These machines and equipment have brought new ways to monitor patients’ vital signs and enhance delivery of interventional procedures such as: x-rays, nuclear medicine, and ultrasounds. However, some scientific equipment such as physiological monitors have proved to been ineffective to a certain degree. The point is made that by enhancing health care to patients using these monitors it also contributes to the deterioration or death of a patient as a result of the noise made by the alarms in the hospital by create a fatigue to the nurses to respond to them. The noise made by the alarms also creates an undesirable hospital environment for the patients, families, and nursing. The actual alarms fail to enhance an improvement of patient’s health condition because of the multitude of alarm rings. Among the alarms sounding in a hospital, less than 20% are an indication of the need to check the condition of the patients. More than 80% of the hospital alarms going off are as a result of obsolete alarms, improper setting of the alarms, and poor nursing detection of the alarm monitors (Hockley et al., 2010).

Fatigue and non-response to hospital alarms by the nurses can be attributed to the increased number of irrelevant alarms sounding. It has become an annoyance to nurses and many silence the alarms before attending to the patient. Other nurses also opt in disabling the alarm system so as to avoid the occurrence of irrelevant alarms in their hospitals. It has resulted in deterioration of patient’s conditions and death. Thus, there exists a gap between patient’s health condition and response to alarms. The proposal hence aims to bridge the gap so as to improve the health condition of patients in hospitals. Following the statement of the problem, the following PICO question is developed with considerations of Population, Intervention, Comparison, and Outcome. This will be of use since it will help in bridging the gap between alarm fatigue and effect to the patients.

P: what is the target population? Intensive care unit or critical care nurses

I: what is the intervention of interest? A reevaluation of the current policy and procedure regarding alarm limits as well as increased education about alarm management

C: what is the comparison of interest? Comparison of current evidence-base practice for monitoring alarms in place for intensive care unit and critical care areas

O: what is the outcome of interest? A decreased alarm burden and desensitization


Literature Review

Shuchisnigdha et al. (2015) highlight that with the increased rate of 80-99% of false alarms in hospitals, desensitization and overload begin to take shape in the nurses’ attitudes. As a result, nurses do not respond to any alarms. This is attributed to the inappropriate setting of the monitor’s alarms and possibly outdated or defective monitors. The health condition of patients in hospitals begins to deteriorate, as the nurses do not respond to alarms sounding in relation to the increased number of the false alarms. Thus when there is a genuine alarm sound it is normally not attended to as the hospital staff generalize it to be a false alarm. It in turn commonly results in and increased suffering of the patients when they require attention. The alarms also create a noise pollution in the hospitals. It is because with hospitals encountering approximately 1,300 alarm signals per day that this creates an unfavorable condition for the patients and the nurses. Consequently, this results in a decreased quality of health care. This situation accumulates into massive death or worsening of patient’s condition. A study conducted within a neonatal intensive care unit resulted with 228 thousand alarms in a five-month period for about 13 patients per day (Pul et al., 2014).

According to Drew et al. (2014) research carried out in the United States for 12,671 alarms in a hospital, 88.8% of them were false alarms. Only 11.2% of the alarms were genuine. Their research highlighted the source of the false alarms to be inappropriate alarm settings, non-actionable events, and persistent atrial fibrillation. A hospital in Tokyo, Japan conducted a study with 18 patients for 2,697 worked hours and concluded 11,591 alarms sounded with only 6.4% of them necessitating an appropriate response (Inokuchi et al., 2013). These factors lead to increased alarms in the hospital making it hard for the nurses to identify a real alarm from the false alarms.


A Resolution Strategy

The proposal aims at using the Iowa evidence-based nursing practice model. The models strategies will enhance a standing resolution for alarm fatigue (Burns et al., 2010). To enhance the effectiveness of the Iowa model, it is recommended that the model is communicated to the relevant nurses especially those attending to patients in the intensive care unit. The model’s strategies are in sync in relation to solving our problem. The model’s first step is to acquire a statement of the problem. It will enhance the identification of the problem that exists with the effectiveness of hospital’s alarms. With this, the problem brought about by false alarms such as absolute monitors and improper setting of the alarms will be identified. During this first stage of the model, the topic is selected. Also, there will be the formulation of a team that will involve the nurses and patients in the intensive care unit. Combining patients and staff will enhance the collection of data relevant to the topic under consideration.

The next stage of the model is to analyze or conduct a systematic review of the performance of the alarms. Studying other literature from other writers and scholars enhances this step bringing to light the problems facing the field of nursing specifically. The next step involves the collection of evidence, meaning carrying out scientific and statistical analysis. It enhances the identification of where the source of the problem is. It will also draw attention to the source of the problem and the structuring of alternative measures to curb the problem. The fourth stage of the model is the recommendation/dissemination stage. It involves the selection of the best-measured solution based on a cost-benefits analysis, ensuring that the appropriate actions are taken into account, recommending, and implementing (Melnyk et al., 2011). The Iowa model is adequate in ensuring proper measures are implemented in eradicating fatigue brought about by false alarms in the hospital. The final stage of the model will be to evaluate, interpret, and disseminate the results. Dissemination will occur through the appropriate channels and include: presentations, posters, and peer discussions.


An Implementation Plan

The essentials of baccalaureate education for professional nursing practice have resulted in drastic changes in healthcare delivery since sanctioned by the America Association of Colleges of Nursing (AACN, 1998). According to Wasson, Nelson and Godfrey (2007), the increasing awareness of the importance of changing the healthcare systems has become a turning point for cultivating healthcare outcomes. The only body of healthcare noted to hold the capability of transforming healthcare to a secure, a better cost effective system, and better quality services are the nurses. However, despite the efforts of enrollment of nurses globally in baccalaureate nursing programs since 2001 (Fang, Htut, & Bednash, 2008), there is a future risk of a shortage of nurses. The demand in the nursing profession is projected to rise more than the available number of nurses. This risk calls for initiatives to curb and hinder this future disaster. The implementation plan entails the discussion of the essentials of baccalaureate education for professional nursing practices. Implementation plans also will involve ways to improve the entry level of nurses in the practice (Mailloux, 2011).

Improvement of liberal education is one of the major implementation plans of baccalaureate nursing practices. This liberal education should be facilitated in such a way it takes into consideration the diversity of the global healthcare improvement purposes. The professional nurses practicing in the diverse environment should be sensitive and understand the wide culture diversities within healthcare (Hickey, 2010). The study of a second language and appreciation of the diversity are some of the vital aspects of liberal education that need to be implemented so as to improve the growth in appreciation of the different culture and ethics (Hockley

et al.,

2010). Besides, liberal education should incorporate different aspects such as biological sciences, behavioral and natural sciences in the curriculum of nursing to facilitate the understanding of others and oneself. Studying these aspects also facilitates the understanding of health issues in details, forms, and processes of diseases.

Designing and implementation of patient-centered care is another vital implementation plan to improve the baccalaureate nursing practices. Forces such as accessibility of information by the patient, dynamism inpatient demography, changing the technology of care purposes, and scientific innovation especially in genetics and genomic negatively affect the nurses in meeting their goals. For the nurses to be able to adapt immediately to the changing needs, patient-centered care needs to be implemented in a way that the nurses develop a partnership with the patients. Patient-centered care should also implement in a way to harness customer services provision by nurses (Burns et al. 2010).


Conclusion

From the literature, it is evident that the implementation of the Iowa model and Baccalaureate education for professional nursing practice in nursing are most significant in solving the problem under consideration. Hence, they should be an integral part of the nursing field. There should be an installation of modern alarm monitors and appropriate setting of the alarms enhanced so as eradicate false alarms in hospitals.

References

  • Burns, N., & Grove, S. K. (2010).

    Understanding nursing research: Building an evidence-based practice

    . Amsterdam: Elsevier Health Sciences.
  • Drew, B. J., Harris, P., Zegre-Hemsey, J. K., Mammone, T., Schindler, D., et al. (2014). Insights into the problem of alarm fatigue with physiologic monitor devices: A comprehensive observational study of consecutive intensive care unit patients.

    PLoS ONE PLoS ONE

    ,

    9

    (10), e110274. doi:doi:10.1371/journal.pone.0110274
  • Fang, D., Htut, A., & Bednash, G. D. (2008). 2007-2008 enrollment in baccalaureate and graduate programs in nursing.

    Washington, DC: American Association of Colleges of Nursing

    .
  • Graham, K. C., & Cvach, M. (2010). Monitor alarm fatigue: standardizing the use of physiological monitors and decreasing nuisance alarms.

    American Journal of Critical Care

    ,

    19

    (1), 28-34.
  • Hickey, M. T. (2010). Baccalaureate nursing graduates perceptions of their clinical instructional experiences and preparation for practice.

    Journal of Professional Nursing

    ,

    26

    (1), 35-41.
  • Hockley, J., Watson, J., Oxenham, D., & Murray, S. A. (2010). The integrated implementation of two end-of-life care tools in nursing care homes in the UK: An in-depth evaluation.

    Palliative Medicine

    ,

    24

    (8), 828-838.
  • Inokuchi, R., Sato, H., Nanjo, Y., Echigo, M., Tanaka, A., Ishii, T., et al. (2013). The proportion of clinically relevant alarms decreases as patient clinical severity decreases in intensive care units: a pilot study.

    BMJ Open

    ,

    3

    (9), e003354. http://doi.org/10.1136/bmjopen-2013-003354
  • Mailloux, C. G. (2011). Using the essentials of baccalaureate education for professional nursing practice (2008) as a framework for curriculum revision.

    Journal of Professional Nursing

    ,

    27

    (6), 385-389.
  • McCormack, B., Dewing, J., Breslin, L., Coyne‐Nevin, A., Kennedy, K., Manning, M., … & Slater, P. (2010). Developing person‐centred practice: nursing outcomes arising from changes to the care environment in residential settings for older people.

    International Journal of Older People Nursing

    ,

    5

    (2), 93-107.
  • Melnyk, B. M., & Fineout-Overholt, E. (Eds.). (2011).

    Evidence-based practice in nursing & healthcare: A guide to best practice

    . ‎Philadelphia: Lippincott Williams & Wilkins.
  • Pul, C., Dijkman, W., Mortel, H. Bogaart, J., Mohns, T., Andriessen, P. (2014). Alarm management in an ICU environment. Retrieved from http://www.smarthealth-ami.id.tue.nl/SHHE2014/submissions/shhe2014_submission_6.pdf
  • Shuchisnigdha, Deb. David Claudio (2015). Alarm fatigue and its influence on staff Performance. 5 Howick Place, London.
  • Wasson, J. H., Anders, S. G., Moore, G. L., Ho, L., Nelson, E. C., Godfrey, M. M., & Batalden, P. B. (2008). Clinical microsystems, part 2. Learning from micro practices about providing patients the care they want and need.

    Joint Commission Journal on Quality and Patient Safety

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    34

    (8), 445-452.

Reflection On Ncmh Mandaluyong City

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A visit to country’s prime mental health institution, the National Center for Mental Health (NCMH) in Mandaluyong City. Essentially, the visit was intended to make us, students become familiar with NCMH set up, the delivery of health services provided and the condition of the patients who are confined in groups.

Background of NCMH

NCMH was established through Public Works Act 3258. It was formally opened on December 17, 1928 and was originally called the INSULAR PSYCHOPATIC HOSPITAL. It was later called the National Mental Hospital. On November 12, 1986, it was renamed NATIONAL CENTER FOR MENTAL HEALTH (NCMH) through Memorandum Circular No. 48 issued by the Office of the President. ¹

Today, NCMH has an authorized bed capacity of 4,200 and a daily average of around 3,000 in-patients. It has a total of 35 Pavilions and 52 Wards sprawling on a 46.7 hectare compound in Mauway, Mandaluyong City. The NCMH is a special training and research hospital mandated to render a comprehensive (preventive, promotive, curative and rehabilitative) range of quality mental health services nationwide. It also gives and creates venues for quality mental health education, training and research geared towards hospital and community mental health services nationwide.¹

In 2001, the World Health Organization provided a new understanding of mental disorders that offers new hope to the mentally ill and their families in all countries and all societies. It entails a comprehensive review of the contributing factors of the current and future disorders. It concludes with recommendations that can be adapted by every country according to its needs and its resources.

Due to lack of studies here in the Philippines with regards to Mental Health, it is difficult to update the current situation in the delivery of services in the mental institutions especially in the government mental health facilitates. During our visit in the National Center for Mental Health, we are able to gather some information in terms of delivery of services, the process of admitting the mentally-ill patients and on how they generate funds to suffice the needs and provide services inside the institution.

Our country at present is in the early stage of developing a mental health system.² Due to limited legislative authority and no mental health law has been established, the allotted budget for mental health is only 0.02% of its total health budget, the latter being 3% of its GDP – this is below the World Health Organization’s (WHO) recommendations for developing countries. Mental health policy, programs and legislation are necessary steps for significant and sustained action. These should be based on current knowledge and human rights considerations. Most countries need to increase their budgets for mental health programs from existing low levels.⁵

During the early part of our visit, Dr. Jose Loveria (Head of Pavilion 10-Chronic Improved Patients) accommodated us to gather some facts about the National Center for Mental Health. In NCMH, given the limited budget that they have, there are services inside the institution helping the institution to gain profit to allot for services and to sustain the existing these income generating strategies. Some of them are soap making, different accessories such as wallets made from zippers etc. These materials are located at Pavilion 14 and being sold by the nursing students and interns. A small hospital within the hospital, the Infirmary is equipped with X-ray and an ultrasound facility which is Philhealth accredited with 100 beds and classified it as medical center.¹ It caters not only the patients inside but also patients coming from other referrals outside NCMH.

The World Health Organization (WHO) in 2007 published a report on its assessment on the mental health system in the Philippines. In partnership with the Department of Health (DoH), WHO gathered baseline information using the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS), for the purpose of enabling the country to develop mental health plans.

WHO-AIMS findings reported that the NCMH has all 400 beds for forensic inpatients committed by court order.⁴ During our visit, in Pavilion 14 which is intended for patient with court cases, the patients there were overcrowding due to lack of beds. There is a huge number of patients with court cases inside. According to Dr. Edison Galindez (only forensic psychiatrist in the country), they have several tasks to do due to lack of resident doctors trained in forensic psychiatry. They have this high number of patient per doctor ratio. Based on the WHO-AIMS report, there are 0.41 psychiatrists in the public sector per 100,000 population, and a ratio of 3.21 psychiatrists per 100,000 population working in mental health facilities based in urban areas. The distribution of human resources for mental health is likewise lopsided, favoring the urban centers or Metro Manila in particular.

Still, in our country has an inadequate number of mental health staff providing care; this has slowed its progress in carrying out its de-institutionalization policy. We only have minimal data on refresher training for mental health staff, as well as data on the number of organizations, associations or nongovernmental organizations (NGOs) involved in mental health policies, legislation or advocacy. Having data in these areas would help service planning and resource allocation. ³

Dr. Bernardo Conde noted in his article in the International Review of Psychiatry that the government’s attempts to integrate mental health in general health services have failed. Large hospitals must cope with thousands of patients while community-based programs remained undeveloped. ⁴

Acute psychiatric wards in regional medical centers and provincial hospitals have never been set up. Government general hospitals have no acute psychiatric units because of lack of budget. The access to mental health facilities nationwide is therefore very much uneven across the country, especially as many of the facilities remain located in the National Capital Region.⁴

Since the National Center for Mental Health and some private institutions with psychiatric wards are mostly located in NCR, in terms of mental health promotion, it is done primarily in these tertiary institutions and not reaching the grass-roots level according to Dr. Beverly Azucena (OIC, Chief Medical Staff-Hospital Service). There are also initiatives being done by the other sectors of the government in promoting mental health according to her. On the other hand, there are coordinating bodies that oversee public education and awareness campaigns on mental health and mental disorders. Sectors should be involved in improving the mental health of communities.⁵ Government agencies, NGOs, professional associations, and private foundations have promoted public education and awareness campaigns, in their own capacity, in the last five years according to WHO-AIMS.

In terms of research, according to World Health Report of WHO in 2001, more research into biological and psychosocial aspects of mental health is needed in order to increase the understanding of mental disorders and to develop more effective interventions. In NCMH, according to Dr. Azucena, there are on-going research studies in the institution, but it is focused more on the clinical aspect of mental health. Research in our country is focused on non-epidemiological clinical/questionnaires assessments of mental disorders and services research. The research consists of monographs, theses, and publications in non-indexed journals. There are mental health research publications in indexed journals (e.g., Philippine Journal of Psychiatry is indexed in the Western Pacific Regional Index Medicus).⁴

Challenges encountered by the Mental Health Care Providers

At present, we are in the stage of developing the status of mental health based on the recommendations of World Health Organization. The major resource in the Philippines is its highly literate population who also values education and professional development. Academic institutions and training centers have in the last 4 decades developed good programs to educate and develop the mental health human resources, specifically psychiatrists, psychologists, social workers, nurses and allied mental health professionals.⁵ It contributed a lot in terms of the understanding on the management of mental health disorders and in the development of mental health programs in our country. I am agree with what WHO-AIMS mentioned in their report that the challenge is on how to motivate these professionals to stay here in the country and sustain their involvement, especially in the community setting, because our country is continuing to lose this valuable and crucial resource to overseas employment. Giving priority to this by the government nationally and locally would be a start of a new beginning in the development of mental health in our country.

Mediastinitis And The Germ Theory Nursing Essay

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Prevention and treatment of infection is a large part of practice after surgery. This paper will examine current practice in preventing and treating sternal wound infections, or mediastinitis, after surgery and examine the germ theory and look at how, when applied to practice, it can help decrease sternal wound infections. Sternal wound infections are defined by involving sternal muscle, bone, or mediastinum (Killiam, Russel, & Keister, 2009). Mediastinitis occurs in 5% of patients who have undergone a sternotomy, a procedure done primarily for cardiac procedures (Bosen & Mackavich, 2006). Complications of mediastinitis could be “osteomyelitis, sternal dehiscence, sepsis, or right ventricular rupture (Bosen & Mackavich, 2006, p. 64cc1).” Out of the 5% of patients who end up with mediastinitis, up to 47% die (Bosen & Mackavich, 2006). Treatment of mediastinitis could be as simple as debridement of the wound and antibiotic therapy or as involved as debridement with the wound left open, continued wet to dry dressing changes and sternum removal with following muscle flap coverage of the wound. A new method of treatment involves negative pressure with placement of a wound vac (Bosen & Mackavich, 2006).

Risk Factors

In a study performed in Australia by Robinson, Billah, Leder, and Reid (2007) found that preoperative risk factors for deep sternal wound infections (DSWI) included “diabetes preoperative dialysis, respiratory disease, body mass index, and angina CCS Class 3 or 4. The intra-operative factors were use of a ventricular assist device (VAD), cardiac transplantation, and a procedure involving the use of both internal thoracic arteries (ITAs) (Robinson, Billah, Leder, & Reid, 2007, p. 168).” Valve procedures carried a higher risk of DSWI with the most frequent risk factors were diabetes (49.67% of DSWI patients), being overweight (83.01% of patients) and both ITAs used (17.65% of patients) (Robinson et al., 2007). Diabetic patients are two to five times more likely to develop DSWI, however diagnosis alone was not the only factor, a hyperglycemic state is needed before, during, and after surgery (Killiam et al., 2009).

Current Research

While there is a lot of current research available, it is limited in its scope. There is a lot of research on risk factor reduction, especially focusing on hyperglycemia. There is a lot of research offered on how tight glucose control will help decrease the chance of infection status post cardiac surgery. Another area in which a lot of current research is available is the treatment of mediastinitis with wound vac, or negative pressure therapy. A flaw with the existing research is the inability to study this problem in a randomized manner. As with many medical diagnoses a researcher must first wait for the patient to develop the problem, in this case a person must first need surgery and then go onto develop a sternal wound infection. Also,

Germ Theory

The theory selected to apply to this problem is the germ theory. This was chosen due to its attempts to explain how infection occurs. The germ theory of disease is often viewed as the “single most important contribution to medical science and practice (Abedon, 1998). Louis Pastuer proposed the germ theory based “on the effects that microorganisms had on fermentation and putrefaction of organic matter (Toledo-Pereyra, 2009, p. 82).” Pasteur first made discoveries with bacteria in the germ theory of fermentation and later transferred the same process to disease with the germ theory of disease (Toledo-Pereyra, 2009). First proposed in 1858, this theory is still relevant to practice today. Germ theory is the theory that a specific ‘germ’ is capable of causing an infective process. Facets of this theory are used to prevent infection in current practice by practicing hand washing, cleansing a wound and using antibiotic ointment, or treating a surgery patient with prophylactic antibiotics (McEwen & Wills, 2007). It also is used to identify, understand, and manage infections disease by helping to identify the contributory agent and then preventing and treating the disease (McEwen & Wills, 2007).

The germ theory is often used in nursing research, often without thought because it is now thought to be very basic science, but was originally borrowed from the biomedical sciences. This theory has its basis in middle range theory. Middle range theories can be “(1) a description of a particular phenomenon, (2) an explanation of the relationship between phenomena, or (3) a prediction of the effects of one phenomenon or another (McEwen & Wills, 2007, p. 38).” The germ theory attempts to describe the phenomena of infection by stating it is caused by germs. Strengths of this theory include many viewings of various microorganisms or ‘germs’ and multiple research studies that have shown this theory to be true. The major limitation of this theory is its simplicity. While infection is a basic concept with an agent being introduced and causing infection there are many aspects that are not accounted for in the theory such as strength of a patient’s immune system, nutrition status, and patient’s overall health status (obesity, smoking, other chronic diseases).

Application of the Germ Theory

To use the germ theory to decrease sternal wound infections would be a simple process of keeping germs away from the surgical incision. If no germs or various microorganisms were introduced into the incision from the point of surgery to healing, infection would not occur. The most basic application of the germ theory in attempts to stop sternal wound infections is the act of hand washing (Dunaway & Goldrick, 2007). If all surgeons, nurses, techs, and anyone else present in the operating room and those around during the recovery period would simply take the time to wash their hands thoroughly introduction of bacteria and microorganisms not a part of normal flora for that patient would decrease dramatically and lessen the chances of an infection.

Also important is managing aseptic technique throughout the patient’s stay. To do this have patients bathe with antiseptic skin prep, check for sterility in instruments and packing in the operating room, maintain sterility in the operating room, maintaining sterile procedure when dressing the incision, not changing the dressing for 24-48 hours, and using sterile procedures if the dressing must be changed (Dunaway & Goldrick, 2007). These are all examples of ways to decrease chances of the introduction of a ‘germ’ into the incision site and help decrease chances of infection.

Conclusion

It is always important, as any person in the medical field to be aware of the ideas behind the germ theory, any infection for any patient can be potentially dangerous. It is especially important in the cardiac surgery field with a 47% chance of mortality with a case of sternal wound infection. While there are many risk factors, modifiable and non-modifiable, involved in preventing postoperative sternal wound infections, but sometimes the simplest concepts can be the most important. While the germ theory was first proposed a century and a half ago, it is still relevant and practical to modern medicine and nursing practice.