IOM Future of Nursing Report and Nursing Review the IOM report- The Future of Nursing: Leading Change- Advancing Health- and explore the Campaign for Action: State Action Coalition website. In a 1

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IOM Future of Nursing Report and Nursing

Review the IOM report, “The Future of Nursing: Leading Change, Advancing Health,” and explore the “Campaign for Action: State Action Coalition” website. In a 1,000-1,250 word paper, discuss the influence the IOM report and state-based action coalitions have had on nursing practice, nursing education, and nursing workforce development, and how they continue to advance the goals for the nursing profession.

Include the following:

1.     Describe the work of the Robert Wood Johnson Foundation Committee Initiative that led to the IOM report, “Future of Nursing: Leading Change, Advancing Health.”

2.     Outline the four “Key Messages” that structure the IOM Report recommendations. Explain how these have transformed or influenced nursing practice, nursing education and training, nursing leadership, and nursing workforce development. Provide examples.

3.     Discuss the role of state-based action coalitions. Explain how these coalitions help advance the goals specified in the IOM report, “Future of Nursing: Leading Change, Advancing Health.”

4.     Research the initiatives on which your state’s action coalition is working. Summarize two initiatives spearheaded by your state’s action coalition. Discuss the ways these initiatives advance the nursing profession.

5.     Describe barriers to advancement that currently exist in your state and explain how nursing advocates in your state overcome these barriers.

You are required to cite to a minimum of three sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

Substance Abuse in the Nursing Profession

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Danielle Labitad

A career in nursing can be the most rewarding occupation most people can think of. It truly takes a unique person with a strong sense of discipline, diligence, responsibility, and a love for mankind to take on such a role. While nursing for most is very rewarding, it is also an occupation that can very easily overwhelm employees and requires most of the time more so then none, a great tolerance to stress. For some when the stress becomes overwhelming, it may lead to addiction, especially in the medical profession where prescription drugs are readily on hand. The addicted/under the influence nurse affects many people including their colleagues. Most importantly, under the influence nurses pose a serious risk to their patients. There is a major controversy in the medical field because not all states in the U.S. handle these matters in the same way. Some policies use a disciplinary method in regards to substance abuse others remove the nurse from practice and give them a chance at rehabilitation, a chance to save their licenses, and for their problem to remain confidential. Adopting a nationwide policy to address substance abuse among nurses will ease the role of the professional nurse dealing with this controversy. The sooner this situation can be addressed and reconciled in the most productive and effective way, the sooner nurses can achieve delivery of the best quality of care possible to their patients.

Approximately 10 to 15% of all nurses may be under the influence or recovering from alcohol or drug addiction. Nurses are not at a higher risk then other people but their pattern of dependency is like no other because they have greater access to narcotics in their work environment.(ISNAP 2012)

The decisions that nurses make are at times a matter of life and death, and it is imperative that nurse and healthcare providers are attentive and alert to what they are doing at all times with no exceptions. All the combined stressors that may often come with this profession, along with the other stresses of personal life may lead a person to feel as though they will do what they have to so they can make it. Sadly for some this can lead to disappear and addiction. In the healthcare setting where medication is widely accepted as a cure to ailments and is readily accessible, nurses are at high risk to develop substance issues. Although the incidence of addiction among nurses is about the same as the general population, there is a higher rate of prescription-type medication abuse as opposed to street drugs. Nurses may administer medications on a daily basis, thus may feel more comfortable self-medicating.

One of the most important roles of a registered nurse is to assure the patient is getting the safest and most appropriate care possible. If a nurse is providing care while under the influence they are failing to fulfill this role. There is also a legal and moral responsibility of all nurses to report suspicions of abuse because the number one role of the nurse when dealing with an impaired colleague is to protect the patient. There may not be many signs or symptoms in the beginning, however as it progresses, it becomes more clear that something may not be right.(Bettinardi-Angres K,& Bologeorges 2011)

Impaired nurses become unable to provide safe and appropriate patient care. Today addiction is considered a disease, but the addicted nurse still remains responsible for actions when working. The most common substances abused by healthcare professionals are alcohol, cocaine/crack, Ritalin, marijuana, inhalants, ultram, methamphetamines, ecstasy, hallucinogens and stadol, sleeping pills, antidepressants, morphine, Demerol, Percodan, vicodin and codeine. However, coworkers should never underestimate the need or desire for drugs from a substance-abusing nurse. The nurse might use whatever drug is available to satisfy the addiction while at work.(Monroe & Kenaga, 2011)

Nurses must be aware and proactive on the signs and symptoms that represent substance abuse. It may be difficult to suspect a co-worker of substance abuse, and the fear of retaliation may keep some nurses from taking action, it’s important to take the necessary steps to confront or notify the chain of command of your suspicions.

Educate yourself on the facility policy and procedures for employee substance abuse. Through documentation of any changes in the suspected impaired nurses’ behaviors is important. You may choose to urge the nurse to seek help and avoid any desire to enable the impairment.

The legal aspects to report an impaired nurse vary from state to state, but nurses have a moral and ethical duty to their patients, colleagues, the profession, and the community to take action. Documents such as the American Nurses Association Code of Ethics for Nurses provide a framework for patient safety.(Vernarec 2012)

Nurses who will have the courage to seek treatment have a good opportunity for a successful recovery. Treatment can be effective to improve health, social, and occupational well-being. Many organizations offer alternative treatment programs instead of termination. As of 2012 37 states offer some form of a substance abuse treatment program to direct nurses to treatment, they monitor the nurses’ re-entry to work, and continue their license according to the National Council of State Boards of Nursing.

Alternative programs monitor and support the recovering nurse for safe practice. Strong recovery programs offer a comprehensive individualized treatment plan. However, boards of nursing have a responsibility to safe guard the public, so they may suspend the nursing license of an identified impaired nurse if they suspect he or she may pose a danger to patients.(ISNAP 2012)

The American Nurses Association (ANA) is a strong supporter of alternative or peer assistance programs that monitor and support safe rehabilitation and the eventual return to the professional workforce. While relapse is high, the goals for the substance-abusing nurse is to seek treatment, reach recovery, and re-enter the workforce.(ISNAP 2012)

Poor or ineffective policies that mandate punitive action endanger the public by making it difficult for impaired professionals to ask for help. Providing early intervention and assistance is essential in helping colleagues and students recover from an addictive disorder and providing a non-punitive atmosphere of support may well be a life-saving first step for nurses and those in their care. Many territories and countries throughout the world now offer confidential, non-punitive, assistance for nurses suffering from addictions.(Monroe & Kenaga, 2011).

The nursing profession is all about caring and educating not only for the patient, but also anyone who needs assistance and it is important for everyone to understand that those who are suffering with addiction have an illness, which requires treatment and evaluation.


References

Bettinardi-Angres K, Bologeorges S. Addressing chemically dependent colleagues.

J Nurs Regulation

. 2011;3(2):10-17.

ISNAP Indiana State Nurses Assistance Program. Retrieved July 7, 2012 from

http://indiananurses.org/isnapsite/warning_signs.php

.

Monroe, T., & Kenaga, H. (2011). Don’t ask don’t tell: substance abuse and addiction among nurses.

Journal Of Clinical Nursing

,

20

(3/4), 504-509. doi:10.1111/j.1365-2702.2010.03518.x

Vernarec, E. Impaired nurses: Reclaiming careers. The Carter Center. Retrieved July 7, 2012 online from

http://www.cartercenter.org/news/documents/doc591.html?printerFriendly=true

2001.

What are the benefits of being a member of the WTO?

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What are the benefits of being a member of the WTO?

Dispute settlement is the focus of the World Trade Organization (WTO) and the way that the organization keeps the global economy stable.

What is the WTO, and what is its history?
What are the benefits of being a member of the WTO?
What are the disadvantages?
How does it settle disputes?
Choose a recent dispute between 2 countries, and discuss it with your peers. Include the following:

Summary of what happened
How it was resolved
Role played by the WTO

ENCOURAGE THE HEART

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ENCOURAGE THE HEART

Writer here are a series of questions I needed to answer and reflect on. Im attaching references to this order as well. Please use my answers to the questions as well as enhance them. Also please reference: Kouzes & Posner. (2012). J-B Leadership Challenge. 5th edition. Chapters 10, 11, & 12. Here are the questions and my responses. Im attaching them as well so that you can see them better.

1. Think back over the times when someone has personally recognized and rewarded you for outstanding performance- the times when someone showed genuine appreciation for what you accomplished.

2. Select one time that you would consider your most memorable recognition- a time when you felt the most appreciated by someone. Recall the story in as much vivid detail as you can. When I was recognized for Nursing Education Award in 2014. What made this time so memorable? It was during Nursing week and held in the auditorium. It was the very first time this award was given. Why did you recall this particular experience? I recalled this experience because I was nominated from the whole hospital and I was up against some very stiff competition. The award was also very nice.

3. What did this person do to recognize you? I was nominated by several people in the organization. What actions did he or she take? Nominating and writing a very nice essay on my behalf. Describe the setting and your feelings. The setting was very formal and a auditorium for Nurses week. The entire auditorium was full and very prestigious people were in attendance. I was shocked when I found out among all the nominees that I had won.

4. How can you personally recognize someone? I have written several emails and given verbal recognition in front of the person supervisor. What will you do to make the recognition special for this person? I personally believe in a small token of appreciation such as a gift card is always nice. Who else should know about this persons achievement and the actions this person took to accomplish what they did? I believe not only the manager of the person but maybe the next in line the Director. How can you publicize it? We have a Nursing Newsletter that gets published monthly that could be a good place to recognize someone. 5. What have you learned about yourself as a leader and your leadership capabilities from the activities in this course? What Ive learned is that every leader needs to look at the whole picture of every situation before making a judgement. I believe the best leaders empower their staff as well as recognize them. Good leaders are accessible and good resources.

Case Study: Multiple Sclerosis

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Kaitlyn Elliot



Values and Principles



Case Study

Bob is 65 and has had multiple sclerosis for 15 years. He has a wheelchair and drives a specially adapted car. He lives with his wife, Jean, in a cottage in the country and they have always been involved in several community and church activates. Jean is Bob’s main carer and although Bob is quite independent, Jean tends to do everything for him. Last month Jean had a slight stroke which left her with a right sided weakness and some speech difficulties that she finds frustrating. She cannot walk without a walking frame and still needs help with most personal care tasks. While Jean’s been in hospital Bob has been supported by daily visits from home carers, however he is missing his outings as Jean’s not been there to help him. Jean will be discharged from hospital next week and is worried about how they will manage.

Suri is the hospital social worker and is going to meet jean later today to plan her discharge from hospital next week and her future care.

  • Describe at least one individual using car services and explain at least two needs of this individual.

Jean used to be an independent woman but after she had her stroke she has become more vulnerable and can’t do all the daily tasks that she used to do like looking after Bob. Jeans basic essential physical needs are not being met completely. The stroke has caused her right-hand side of the body to become weaker and she also struggles to walk unsupported. Jean may have to be referred to a physiotherapist who would assess her abilities and draw up a treatment plan that will help Jean improve her muscle strength and help her to walk without the frame. An occupational therapist might also have to be introduced to assess her ability to carry out everyday tasks and may have to adapt her home to suit Jean’s ability. Jean might struggle to keep a balanced diet up as she might find it hard to swallow some foods and may not be able to get access to pureed or easy to swallow food. The stroke could also be causing Jean to be extremely tired. She also might struggle to clean and dress herself and let her good hygiene go down.

Cognitive needs refer to the things that helps us to develop and maintain an active mind. Jean’s stroke has cause her to have speech problems and will find it hard to communicate. She could be referred to a speech and language therapist who could do some exercises to improve the control over Jeans speech muscles. They could introduce her to some letter charts and using gestures and writing to communicate with others. Jeans memory will deteriorate as the stroke will have affected her brain. A care worker could introduce a diary or even just routines and involve her in the planning of this to help her out with daily tasks when she is discharged from hospital. Jean may also end up with dementia and if she does you could show her some family pictures or even find out what activities she used to do and encourage her to try some of them again or take her to some of her favourite places her and Bob used to go to. Without cognitive spurring, mental abilities will not develop or will deteriorate. Most of these functions will return after time and rehabilitation, but she will notice they do not return to what they used to be.

  • Explain how two methods of assessment are used to identify needs of individuals.

Needs are essential things in our life’s that we cannot live without. Needs can often be confused with wants. One way of assessing an individual’s needs is using the SPECCS model. This is your social, physical, emotional, cognitive and cultural. All individuals have these types of needs. Social needs ae the need to have conversations and experience a variety of social relationships and how we interact with others. However, people who use care services may not be able to make these needs by their self’s. if they don’t get any help they might not achieve a sense of acceptance and belonging and this may cause isolation and low self – esteem. Physical needs refer to fresh air, food, water, warmth, shelter, hygiene, sleep and exercise. These are the basic physical needs that we need in our lives to promote wellbeing. Emotional needs are our feelings. We all experience different emotions including happiness, excitement, sadness and anxiety. Emotional needs include the need for love, security and confidence. If we have these needs, we can express our feelings and people can also recognise them. Cognitive needs refer to our thought processes and how we make sense of the world. Cognitive abilities include the use of memory, thinking, understanding, communicating and making choices and decisions. Without these our mental abilities, will deteriorate. Care workers can play an important part in meeting an individual’s cognitive needs by just even talking to them and giving opinions. The last one is cultural needs. This refers to values, beliefs language, gender, sexuality, clothing worn, and food eaten. It is important for the care worker to find out about the care users cultural needs and not make any assumptions about their culture.

Another way of assessing an individual’s needs is using Maslow’s Hierarchy of Needs. This theory is split into 5 sections. The stages in this theory are Biological and physiological needs, safety needs, belongings and love needs, esteem needs and self-actualisation.  Maslow believes that all humans are motivated towards achieving their full potential. He stated, “People are motivated to achieve certain needs and that some needs take precedence over others. Our most basic need is for physical survival, and this will be the first thing that motivates our behaviour. Frustrated and unmet needs can lead to dysfunctional behaviour.

  • Describe three features of positive care practice. At least one of these ways must include reference to values and principles.

There are six principles to the National Care Standards, dignity, privacy, choice, safety, realising, potential and equality and diversity. Carers should value the service users and respect their space and own way of life. The service user also has the right to stop other people from seeing or knowing about their personal information. Choices help staff understand what range of options can be put in place for the user. Carers should be encouraging and help care service users to make the most of their life and achieving as much as they can with the resources available to them. In a positive care practice empowerment, should be used. All carers should help the service users to make their own choices and have some sort of control over their own lives. The carers could provide them with opportunities, information and support to help them do this. The SSSC have a code of practice to help gain a positive care practice. The code is set out in two parts. The first part if for the employers of social service workers. Employer must make sure the social service workers are suitable for the job and help them understand their responsibilities and roles they will have. They also must have written policies in place to protect those who use the services and the carers. The employer must also promote the use of the code of practice to the social service workers. The second part is for the social service worker. They must protect and promote the rights and interests of the service users and treat them all as an individual. The worker must create trust and build confidence with the service users to allow them and you to be open and honest with each other. Promote the service users independence and help them understand their rights. The Nursing and Midwifery Council (NMC) have created a code of conduct to create a positive care practice. The nurse or midwife should be kind and respectful and putting the care and the safety of the patients first. They should also listen and take any notes that may concern them and also respect their right to their dignity, privacy and choice and will share any information about the patient’s treatment or health in a way that they should be able to understand. They should always be paying attention to the patient’s wellbeing as well as their treatment and care.

  • Describe how one care service creates a positive care environment.
  • Give at least one example to explain how they meet the needs of individuals.

Speirs Care Home, Beith creates a positive care environment by allowing the care service users to socialise in their lounge areas and provide spacious gardens for the users to relax in beautiful surroundings. They provide regular music entertainment for the users to allow them to have some sort of social life. They have a positive atmosphere in the care home and allow the community to be involved in their fair. They allow different types of care such as palliative care, respite care and convalescent care. The home also provide any transport the users need for going out and doctor appointments or even going out on day trips. They encourage the relatives to visit regularly to allow the users with alzheimer’s to familiarise their memory and hopefully try and help them not forget.

  • Describe one way in which legislation helps promote a positive care environment.

Care workers must comply with the legislation when they are carrying out work in a care environment to create a positive care environment. The legislation becomes a policy in the work place so, if the care workers fail to do this it could jeopardise their carer as legal action will be taken. The legislation is in place for the health and safety and their right to confidentiality as a care service user. Is also promotes health and wellbeing and equality of opportunity to promote a positive care practice.


References


http://www.carehome.co.uk/carehome.cfm/searchazref/20006048SPIA


http://hub.careinspectorate.com/knowledge/national-care-standards/


https://www.nmc.org.uk/standards/code/


http://www.sssc.uk.com/about-the-sssc/codes-of-practice/what-are-the-codes-of-practice


www.simplypyschology.org

Review the case study The Toro Company SNo Risk Program by David E. Bell (1994) from this modules assigned readings. Click here to download the Toro Excel worksheet which contains data exhibits from the article; the exhibit titles match the tabs long

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Review the case study “The Toro Company S’No Risk Program” by David E. Bell (1994) from this module’s assigned readings. Click here to download the Toro Excel worksheet which contains data exhibits from the article; the exhibit titles match the tabs long

Causes and effects of childhood obesity

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Childhood obesity has become a worldwide epidemic, and the condition is now obvious much earlier in life. Thirty years ago, less than five percent of children were considered obese. Today’s figures put the number of obese American children somewhere between 12 percent and 15 percent! That translates into millions of children, preteens, and teens suffering from very adult conditions like diabetes and depression related to weight gain (Tessmer, Beecher, & Hagen, 2006). Overweight and obesity in childhood are recognized to have significant impact on physical and psychological health. There are several causes that lead children to become obese. Childhood obesity is now considered a disease and is diagnosed by doctors. Not all children that watch television several hours a day or are inactive or just eat mal-nutritious foods develop obesity, many children get obese because of genes inherited from their parents. Some children become obese because of their lifestyle. For example, late-day or night eating, snacking and other behavioral behaviors have influence on the progress of obesity. Moreover, social and economic conditions are shown to have a significant relationship to nutrition and dietary intake. In addition, there are certain effects resulted from childhood obesity such as physical, mental, emotional, and social effects. Obesity in childhood is responsible of early development in girls and delayed development in boys. It’s also found to be associated with numerous medical problems related to physiological, metabolic, and structural changes. What is more is that obese children are more likely to develop psychological problems. Physical, social, and mental well-being is considered health related quality of life. Low self-esteem and social discrimination can be noted in obese children due to physical limitations, feelings of isolation or loneliness, and teasing from class mates.

Causes and Effects of Childhood Obesity

Childhood obesity has become a worldwide epidemic, and the condition is now obvious much earlier in life. Thirty years ago, less than five percent of children were considered obese. Today’s figures put the number of obese American children somewhere between 12 percent and 15 percent! That translates into millions of children, preteens, and teens suffering from very adult conditions like diabetes and depression related to weight gain (Tessmer, Beecher, & Hagen, 2006). Obesity is defined as a disproportionate buildup of stored fat tissue when compared to other tissues. Childhood obesity is now considered a disease and is diagnosed by doctors. Children become overweight for a variety of reasons. The most common causes are genetic factors, lack of physical activity, unhealthy eating patterns, or a combination of these factors. Moreover, socio-economic factors have influence on children, which may cause a child to become obese. In addition, there are certain effects resulted from childhood obesity such as physical, mental, emotional, and social effects.

Diagnosis of Childhood Obesity

Only a doctor can diagnose children for obesity by evaluating adiposity, or “how much fat a person has.” Adiposity can be assessed using different ways, for example, by using an underwater scale, or by an MRI, but these methods are considered excessive and expensive. Another way of evaluating children for obesity is by measuring the distribution of body fat. Also, a chart called the body mass index (BMI) is used to optimally measure the amount of fat person carries most frequently to differentiate between just an overweight child and the one who is really obese. In addition to BMI and charting weight on the growth charts, the doctor also evaluates the family’s history of obesity and weight-related health problems, such as diabetes, the child’s eating habits and calorie intake, the child’s activity level, and any other health conditions the child may have.

Causes of Childhood Obesity

After the child gets diagnosed as obese, the doctor will start investigating the causes that lead this child to become overweight. To begin with, there are several causes that lead children to become obese. First of all, many children get obese because of heredity. Because of some genes inherited from parents, those children have higher risk of becoming overweight. For example, not all children that watch television several hours a day or are inactive or just eat mal-nutritious foods develop obesity. Therefore, heredity has been found to have effect on fatness, distribution of fat on body, and response to overfeeding. It has also been suggested that heredity does not only concern the genes but also resulting dietary habits, food intake, and lifestyle, including physical activity level and spontaneous interest in exercise (Paˇrízková & Hills, 2004). Moreover, mothers whom are overweight are found to born neonates that are less active and gain more weight compared to neonates born of normal weight mothers, which suggest a preserving energy inborn drive. The information taken from genes can suggest that genetic factors can take role to determine the susceptibility of adding or losing fat in response to physical activity and diet. The life style of some children also plays a role in being obese. Some behaviors, present in certain children (late-day or night eating, snacking, etc.) ease the progress or persistence of obesity. Children spend several hours each day watching television, and eating lot of snacks that is high in calorie. Food is nothing more than easy to cook energy. The potential energy is measured by the calories that are contained in specific amount and type of food. A body needs a minimum amount of calories in order to perform its basic functions, and the recommended caloric intake for this purpose varies according to age, body frame, and activity level (Tessmer, Beecher, & Hagen, 2006). Obese children do not show excessive appetite for sweet foods. Children and adults simply enjoy foods high in fat. Ice cream, cakes, and biscuits are all examples of high fat foods which are very popular among obese and non-obese people alike. Physical activity is important for achieving proper energy balance, which is needed to prevent or reverse obesity (Flamenbaum, 2006). Moreover, distribution of body fat is affected independently by physical activity which affects body weight. Last but not least, social and economic conditions have a significant relationship to nutrition and dietary intake. For example, as income increases, the type of the diet is going more likely to change in a persistent manner. In particular, the sugar, protein and animal fat intake increases, while the intake of vegetable fat, complex carbohydrates and protein decreases. Also, if the family has a higher income, there might be an increase in take away readymade foods intake which is high in fat content or an increase in intake of meat. The lower social support in low social class is associated with a high food intake and higher weight of children. Another study showed that children from low-income families who were exposed to less cognitive stimulation and who had an obese mother showed an increased risk of obesity independent of other demographic factors (Paˇrízková & Hills, 2004). However, the general effect of these changes in consumption behavior with the high intake of total fat is the increase in the occurrence of obesity.

Effects of Childhood Obesity

As a result of the above, there are certain effects that might result in children from being obese. To start with, the physical effects in childhood obesity include, for example, the increase adult morbidity in men for gout, and in women for arthritis. Obese children are usually above average height for age (Dietz, 1993). Obesity in childhood is responsible of early development in girls and delayed development in boys. For women, menstrual problems in middle age are found to be associated with childhood. Men whom are overweight during adolescence have three times more possibility to develop gout when compared with men whom where normal weight. Furthermore, Obesity in childhood is associated with numerous medical problems related to physiological, metabolic, and structural changes. It’s suggested that adult obesity developed from childhood may be more problematic than adult-onset obesity due to an increased risk of the metabolic syndrome (Vanhala, 1998). Obese children have a higher risk for developing hypertension, high cholesterol levels, diabetes, and metabolic syndrome. Research shows that obesity in children, particularly during adolescence, persists into adulthood and is associated with an increased risk of many diseases including atherosclerosis, cardiovascular disease, cancers, respiratory disorders, gall bladder disease, infertility and several non-fatal but debilitating conditions (Flamenbaum, 2006). Obese children have approximately a threefold increased risk for hypertension compared to their normal-weight peers. The prevalence of obesity in children affected by diabetes was on average twofold from the age of 2 years onward compared to control children (Paˇrízková & Hills, 2004). What is more is that obese children are more likely to develop psychological problems. Severely obese children recorded their quality of life with scores as low as children undergoing chemotherapy for cancer (Walker, 2005). Physical, social, and mental well-being is considered health related quality of life. Low self-esteem and social discrimination can be noted in obese children due to physical limitations, feelings of isolation or loneliness, and teasing from class mates, in example, which is frequent in young people who are obese. The age of onset of obesity, presence of emotional instability, and negative evaluation of obesity by others may predispose an obese person to a disturbed body image. These include during the formative years. Disturbances in adulthood are often commonplace in those who became obese during childhood or adolescence Depressed obese children are more likely to stay depressed all over adulthood.

Prevention of Childhood Obesity

The technique used to prevent childhood obesity is by keeping the weight from coming back. Such technique requires great effort as overweight is not just a hit-and-run problem, where the child can simply drop the weight and be free from obesity the rest of his life. It’s always easy to get overweight than to lose weight. A child who lived a sedentary lifestyle with bad eating habits is at higher risk of getting back to such habits because such habits are just easy to follow. It’s so a lot easier for children to sit at home and watch TV rather than going outside with others or alone to play. This is why parents, physicians, and nutritionists should sit together and set a plan for the child. The plan should include the restriction of fast food and soft drinks, limitation of time allocated for watching television or computer, and promotion of physical activity. However, this plan must be monitored and supervised by parents and a physician to ensure the elimination of any side effects that might occur from the prevention plan.

Conclusion

To summarize, childhood obesity is now considered a global epidemic. There are multiple causes that lead certain children to become obese. Genetic factors and environmental conditions play a great role in the early development of childhood obesity, but the condition varies in different countries. In addition, it appears that there are dangerous effects that result from being obese which can continue till adulthood. Therefore, parents should be aware of their children life style and the food they consume to avoid such health problems in their later adulthood. Moreover, the picture of the obese child as unhealthy, unfriendly and fat is best to prevent as early as possible. As for prevention of childhood obesity, it is also recommended that parents, physicians and nutritionists set together to set the proper plan. Nevertheless, there must be raising in alertness, consideration, and public understanding for the matter of childhood obesity

Nursing is a medical profession overseen by many rules and regulations, Discuss

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Nursing is a medical profession overseen by many rules and regulations, Discuss

Nursing is a medical profession overseen by many rules and regulations. Expectations of

the Registered Nurse are high, predominately due to these abovementioned safeguards. There

are two main bodies involved with the development of the profession of Registered nurse;

regulatory agencies and professional organizations.

A main regulatory agency is the Board of Registered Nurses (BRN), a state governmental

agency developed to protect the public through regulating the registered nursing practice.

Provide a detailed description of implementation logistics (When and how will the change be integrated into the current organizational structure, culture, and workflow? Who will be responsible for initiating the change, educating staff, and overseeing the implementation process?)

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Provide a detailed description of implementation logistics (When and how will the change be integrated into the current organizational structure, culture, and workflow? Who will be responsible for initiating the change, educating staff, and overseeing the implementation process?)

 

Developing an Implementation Plan

Order Description

Read the instructions and requirements thoroughly and make sure to answer each part.
Developing an Implementation Plan
This is a capstone project and this is the 4th part of my research paper. The topic or, as it is called in research, PICOT question is:Are the patients in acute care settings (P) who have limited mobility (I) compared with those in long term care facility (C) at higher or lower risk of developing pressure ulcer (O) during their stay (T)?
I will provide you with the previous parts because all the parts must correlate. In addition, I will provide you with the 15 articles that must be used as references. These are the only 15 references to use for the assignment. Remember, the research paper must be written from the nursing point of view. I have been encountering too many problems with the previous orders on this paper, hence, if you have questions or do not understand the requirements completely, please let me know ahead of time, so we both can avoid extra work.
Also, you can upload some part of the paper as you write for me see if you are going in the right direction.
Instructions:
Consider the population in which the solution is intended, the staff that will participate, and the key contributors that must provide approval and/or support for your project to be implemented. These stakeholders are considered your audience.
Develop an implementation plan (1,500-2,000 words) using this checklist. The elements that should be included in your plan are listed below:
1. Explainsmethod of obtaining necessary approval(s) and securing support from your organization’s leadership and fellow staff.
2. Provide description of current problem, issue, or deficit requiring a change. Hint: If you are proposing a change in current policy, process, or procedure(s) when delivering patient care, describe first the current policy, process, or procedure as a baseline for comparison.
3. Provide detailed explanation of proposed solution (new policy, process, procedure, or education to address the problem/deficit).
4. Discuss rationale for selecting proposed solution.
5. Incorporate evidence from your Review of Literature in Topic 2 to support your proposed solution and reason for change. (I will upload it for you separately)
6. Provide a detailed description of implementation logistics (When and how will the change be integrated into the current organizational structure, culture, and workflow? Who will be responsible for initiating the change, educating staff, and overseeing the implementation process?)
7. Identify resources required for implementation: staff; educational materials (pamphlets, handouts, posters, and PowerPoint presentations); assessment tools (questionnaires, surveys, pre- and post-tests to assess knowledge of participants at baseline and after intervention); technology (technology or software needs); funds (cost of educating staff, printing or producing educational materials, gathering and analyzing data before, during, and following implementation), and staff to initiate, oversee, and evaluate change.
Prepare this assignment according to the APA guidelines.

Laminar Air Flow In Controlling Operating Room Infection Nursing Essay

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Surgical site infections (SSIs) are defined as infections occurring within 30 days after surgical operation or within one year if an implant is left in place and affecting either the incision or deep tissue at the operation site (Owens and Stoessel 2008). SSIs are reported as the major cause of high morbidity and mortality among post -operative patients (Weigelt et.al. 2010). According to UK National Joint Registry Report, during 2003 -2006 period infection was responsible for about 19 % failure of joint surgery resulting in revision procedures (Sandiford and skinner 2009).

Micro-organisms in the air particles settle on the wound, dressings and surgical instruments and cause infections (Chow and Yang 2005). Whyte et.al (1982) identified that contamination from patient s skin as the cause of infection in 2% cases and from theatre personnel in 98% cases. They also found that in 30% cases, contaminants reach the wound from theatre personnel via air and in 70% cases it is via hands.

Generally air quality in the operating room is maintained ventilation system. Additional improvements can be achieved by laminar air-flow system or UV lights. Laminar air-flow system is expensive and require continues maintenance. Its installation increases building cost and the operational cost (Cacciariet.al., 2004: Hansen, 2005). Studies conducted to evaluate the effectiveness of laminar flow produced mixed results and there is no consensus on its role in infection control (Sandiford 2007). In this setting, this paper reviews the recent studies to examine the effectiveness of laminar air-flow in reducing SSIs.

Studies for this review were found by searching on databases such as CINAHL, PubMed, Science Direct, Ovidsp, Science Citation Index (ISI) and Google scholar. Keywords used for this search are laminar air flow , surgical site infection , operating room air quality , airborne infections + operating theatre , LMA + infection control . As laminar air-flow is used mainly in orthopaedic theatres, majority of the studies are on joint surgery.

OPERATING THEATRE AIR QUALITY AND INFECTION CONTROL

Indoor air in an operating theatre contains dust which consists of substances released from disinfectant and sterilizers, respiratory droplets, insect parts smoke released from cautry. Dust particles act as a carrier for transporting microorganisms laden particles and can settle on surgical wound and there by cause infection (Neil 2005). Air particles are found to be responsible for about 80% – 90% of microbial contamination (CDC 2005).

Modern operating theatres are generally equipped with conventional ventilation system in which filters can remove airborne particles of size >5mm about 80-95% (Dharan 2002). The efficacy of operating room ventilation is measured by the colony forming units (CFU) of organisms present per cubic meter. The conventional ventilation (Plenum) with 20 air exchanges is considered efficient if it achieves the colony count of 35cfu/m3 or less (Bannister 2002).

Ventilation system with laminar air-flow directs the air-flow in one direction and sweeps the air particle over the wound site to the exits (CDC 2003). Laminar air-flow with HEPA (High Efficiency Particulate Arrestment) filters system has the capacity to remove air particles of size 0.3 m up to 99.9 % and can produce 300 air exchanges per hour in ultraclean orthopaedic theatres. (Sandiford and skinner 2009).

Laminar air-flow units are generally two types; ceiling-mounted (vertical flow) or wall-mounted (horizontal flow). There are inconveniences associated with both types. Generally the major problem associated with laminar air-flow is flow disruption. With vertical laminar flow, it is the heat generated by surgical lamps creates air turbulence while with horizontal laminar flow it is the surgical team that disrupt the air-flow (Dharan 2002).

LAMINAR AIR FLOW IN INFECTION CONTROLL

Laminar air-flow system is mainly used in implant surgeries where even a small number of microorganisms can cause infection. In joint replacement surgeries, one of the main causes of early (within 3 months) and delayed (within 18 months to 2 years) deep prosthetic infections was found colonisation during surgery (Knobben 2006). Laminar air flow is supposed to minimize contamination by mobilizing uniform and large volume of clean air to the surgical area and Contaminants are flushed out instantly (Chow and Yang, 2004). Some studies found that this method is effective in reducing infection but some others produced contradicting results (give some reference)

A recent study conducted by Kakwani et.al. (2007) found that laminar air-flow system is effective in reducing the reoperation rate in Austin-Moore hemiarthroplasty. Their study compared the reoperation rate between theatres with laminar air-flow and theatres without laminar air-flow system. A cohort of 435 patients who had Austin-Moore hemiarthroplasties at Good Hope Hospital in Birmingham between August 2000 and July 2004 were selected for this study. Of those 435 patients, 212 had operation in laminar air-flow theatres and 223 had operation in non-laminar air-flow theatres. Data were collected by reviewing case notes and radiographs. For all cases antibiotics were administrated and water impervious surgical gowns and drapes were used. In the non-laminar air-flow group it was found that the re-operation rate for all indication in the first year after hemiarthroplasties was 5.8 % (13/223), while in the laminar air-flow group it was 1.4% (3/212). Analysis found that there were no statistically significant relation between re-operation rate and water impervious gown and drapes (p=0.15), while use of laminar air-flow found a statistically significant drop (p=0.0285) in re-operation rate within the first year after hemiarthroplasties. They found that re-operation rate in no-laminar air-flow theatres were four times greater than that in laminar airflow theatres.

Even though the aim of the study was clearly described there was no review of existing studies to identify the gap in the research. Study methods and details of statistical analysis were given elaborately. The sample size seems sufficient. Results were summarized and presented using graphs and charts. Discussion of results was short and seems not adequate to address the objectives of the study. There was no attempt to explain the casual relationship. For example researches were making statements such as the introduction of water-impervious drapes and gowns did not seem to make a statistically significant improvement in the result . (p.823). Researchers failed to acknowledge any limitations of the study. Data for this study was collected by reviewing patients records. Patients records are considers as confidential and researchers didn t mention whether they received consent from the patients or ethical approval form institution to conduct the study. This can be considered as an ethical flaw of this study.

There are studies which found that laminar air-flow system is not effective in reducing infection rate. In their study Brandt C et.al (2008) found that infection rate was substantially high in theatres with laminar air-flow system. This was a retrospective cohort-study based on routine surveillance data from German national nosocomial infections surveillance system (KISS). Hospitals which had performed at least 100 operations between the years 2000 and 2004 were selected for this study. Type of ventilation technology installed in operation rooms of selected hospitals were collected separately through questionnaire from infection control teams in the participating hospitals. Surgical departments were grouped into categories according to the type of ventilation system installed. Departments using artificial operating room (OR) ventilation with either turbulent or laminar airflow was included in this study.

Total 63 surgical departments from 55 hospitals were included in this study. Analysis was performed to the data set created by merging the questionnaire data on OR ventilation and surveillance data from the KISS data base. The data set analysed contained 99230 operations with 1901 SSIs. Age and gender of the patient was found a significant risk factor of SSI in most procedures. Univariate analysis conducted found that rate of SSIs was high in departments with laminar air flow ventilation. Multivariate analysis also confirmed this finding. Authors argue that it may be due to the improper positioning theatre personnel in horizontal laminar flow room.

Researches provided a well-researched literature review which clearly identified gap in current research. Objectives and design of the study was properly explained. Study was based on a large sample size. Results were discussed in detail and casual relations were well explained. Enough tables were used to present results. Limitations were properly discussed.

Knobben et.al (2006) conducted an experimental study to evaluate how systemic changes together with behavioural changes can decreases intra-operative contamination. This study was conducted in the university Medical Centre Groningen, The Netherlands. A random sample of 207 surgical procedures which involved total knee or hip prosthesis from July 2001 to January 2004 was selected for this study. Two sequential series of behavioural and systemic changes were introduced to ascertain their role in reducing intra-operative contamination. The control group consisted 70 cases. Behavioural changes (correct use of plenum) were introduced to the first intervention group of 67 operations. Intense behavioural and systemic changes were introduced to second intervention group of 70 operations. The systemic changes introduced was the installation of new laminar flow with improved airflow from 2700m3/h to 8100m3/h. Two samples each were taken from used instruments, unused instruments and removed bones. Control swabs were also collected to make sure that contamination was not occurred during transport and culturing. Early and late intra-operative contamination was also checked. All patients were monitored for any wound discharge while in hospital and followed-up for 18 months to check whether intra-operative contamination affects post-operative infection.

Among the control group contamination was found 32.9% while in intervention group 1 it was 34.3% and in intervention group 2 it was 8.6%. Except in Group 1 (p=0.022) late phase contamination was not significantly higher than early phase contamination. During the control period wound discharge was found in 22.9% patients and 11.4% of them had wound infection later. Deep periprosthetic infection had been found in 7.1% of them in the follow-up period. Deep periprosthetic infection was found in 4.5% cases of first intervention group and in 1.4% of cases in second intervention group in the follow-up period. But none of these decreases were found statistically significant. Contamination, prolonged wound discharge and superficial surgical site infection were found decreased after both first and second intervention. But a statistically significant reduction was found only in second intervention (contamination p=0.001, wound discharge p=0.002 and superficial SSI p=0.004). This study concluded that behaviour modifications together with improved air flow system can reduce intra-operative contamination substantially.

Purpose of the study was clearly defined and a good review of the current literature has given. Gap in current research was clearly presented and justification for the study had given. Sample size seems sufficient. It is reported that .bacterial cultures were taken during 207 random operations (p. 176), but no details of the sampling method used were provided. Details of interventions were given elaborately and results were discussed in detail. But only one table and two charts used to present it. The readers would have been more benefited if more tables were used to present the results. Discussions of the results were concise and findings were specific and satisfying the objective. No information on whether they received informed consent from the patients and approval form the ethical committee of the institution was missing. This arise a serious question about the ethics of this study.

It is found that laminar airflow is more effective when use in conjunction with occlusive clothing (Charnley, 1969 cited in Sandiford and Skinner 2009). While in their recent study Miner et.al (2007) compared the effectiveness of laminar airflow system and body exhaust suits found that body exhaust suits are more effective than laminar flow system in reducing infection.

For their study Miner et.al (2007) selected 411 hospitals which have submitted the claim for total knee surgery (TKR) for the year 2000 from four US States were surveyed to collect the details of use of laminar air flow system and body exhaust suits. Those hospitals which were fulfilled three criteria were included in this study. The inclusion criteria were 1) returned the survey instrument, 2) using laminar air flow system or body exhaust suits for infection control and 3) was evidence of at least one Medicare claim for TKR for the study period. Total 8288 TKRs performed in 256 hospitals between 1st January and 30th August 2000 were selected. Data on patient outcomes after total knee replacement (TKR) were collected from Medicare claims. The patients who underwent bilateral TKR were not included in this study and for those who underwent a second TKR during a separate hospitalisation during the study period, only the first procedure was included. International Classification of Diseases, Ninth Revision (ICDS-9) codes was used to identify post-operative deep infection that needed additional operation. Hospitals were grouped as users or non-users for both laminar airflow and body exhaust suits. Users were defined as those who use any of these methods in more than 75% procedures and non-users were those use any methods less than 75%. The over-all 90-day incidence of deep infection, subsequent operation was found required only in 28 cases (that is 0.34%). Analysis found that the risk ratio for laminar airflow system was higher (1.57, 95% confidence interval 0.75-3.31) than body exhaust suits (0.75, 95% confidence interval 0.34-1.62). Study found that there were no significant differences in infection between hospitals that use specific either protective measure.

Other than mentioning few studies researchers failed to provide any background of the research problem. Methods used for this study were explained concisely. Even though the sample size was large, limited number of events (28) were there to be observed. Analysis was based on this small number of events; this may have affected the result. Not many variables were included in this study, and researchers didn t mention how they controlled some possible confounders. Researchers were successful in identifying the advantages and limitations of the study. Results were properly presented in tables.

Instead of expensive laminar air-flow system, installation of well-designed ventilation system is found beneficial. Scaltriti et.al (2007) conducted a study in Italy to examine effectiveness of well-designed ventilation system on air quality in operation theatre. They selected operation theatres of a newly built 300 beds community hospital which have ventilation system designed to achieve 15 complete outdoor air changes per hour and are equipped with 0.3 m, 99.97% HEPA filters. All these satisfy the condition for a clean room as per ISO 7 standard. Passive samples of microbiological air counts were collected using Tripticase Soy Agar 90 mm plates left open thorough out the duration of the procedure. Active samples were also collected using a single state slit-type impactor. Total 82 microbiological samples were collected of which 69 were passive plates and 13 were active. Air dust was counted with a light-scattering particle analyser. Details of the surgery, number of people in the room, door opening rate and estimated total use of the electrocautery unit were also collected.

It was found that there were positive correlations between particle contamination, surgical technique (higher risk from general conventional surgery), electrocauterization and operation length. Door opening rate was found negatively associated. Researchers suggest that this may because when theatre door open a turbulent air flow blows out of the operating room which may result decrease in the dust particles. No association was found between particle contamination and number of people present at the time of incision. Researchers suggest that human movement rather than human presence is the factor that determines airborne microbial contamination. It was found that average particle concentration in the theatres did not exceed the European ISO 14 644 standard limits for ISO 7 clean room, and so concluded that well-designed ventilation system is effective in limiting particulate contamination.

Uncultivable or unidentifiable organisms can also be a reason for surgical site infections. It may be difficult to identify such organisms through standard culture techniques (Tunney 1998). Clarke et.al (2004) conducted a quantitative study to examine the effectiveness of ultra-clean (vertical laminar flow) theatres in preventing infections by unidentifiable organisms. They used the molecular technique, Polymerase Chain Reaction (PCR), to detect bacteria presence. Their study compared the wound contamination during primary total hip replacement (THR) performed in standard and ultra clean operation theatres. 20 patients underwent primary THR from 1999 to 2001 were recruited for this study. Patients with previous incidents of joint surgery or infection were excluded. The standard operation theatres had 20 air changes per hour and CFU count was 50 CFU/m3, while ultra-modern theatres had 530 air changes per hour and CFU count was 3 CFU/m3.

For all surgeries same infection control precautions were used. Two specimens each of pericapsular tissues were collected from posterior joint capsule both at the beginning and at the end of the surgery (total 80 samples). Patients were given antibiotic prophylaxis after taking the first specimen. All these samples were underwent Gram stain and culture to detect bacterial colonies and Polymerase Chain Reaction (PCR) to detect bacterial DNA.

Among the 20 specimens taken form the standard operation theatres at the beginning of the surgery only 3 were found positive with PCR, while from the ultra-clean theatres only 2 were found positive. None from both theatres found positive with culture. Samples from the standard theatres taken at the end of the surgery, 2 found positive by culture and 9 found positive by PCR. The contamination rate in the standard theatre at the end of the surgery found significantly greater than the beginning (p=0.04). Samples taken from the ultra-clean theatres, none was positive by culture while only 6 were positive by PCR. Statistical analysis found that contamination rate at the end of the surgery is not statistically different than the start (p=0.1). It was found that there were no statistically significant difference in overall contamination rate (p=0.3) between standard and ultra clean theatres. (I will add critique of this study here)

NURSES ROLE IN INFECTION CONTROL

Understanding the source of contamination in operating theatre and knowing the relationship between bacterial virulence, patient immune status and wound environment will help in improving the infection rates (Byrne et al 2007).

Nurses are responsible to take a proactive role in ensuring safety of their patients. To improve patient outcome, it is necessary for the nurses to take lead role in environmental control and identifying hazards through environmental surveillance (Neil 2005). Non-adherence to the principle of asepsis by surgical team is identified as a significant risk factor of infections. Hectic movement of surgical team members in the operating room and presence of one or more visitors were also found as major causes of SSI (Beldi G 2009). Nurses and managers should emphasise on controlling factors like the traffic in theatre, limiting the number of staff and reinforcement of strict aseptic technique (Allen 2010). Creedon (2005) argues that infections can reduce up to one third if staffs follow best practice principles. For better outcome staffs needs additional education and positive reinforcement.

Nurses have a vital role in the development, reviewing and approving of patient care policies regarding infection control. Nurses are not only responsible for practicing the aseptic techniques but also responsible for monitoring other staff for their adherence to policies. They are responsible for developing training programmes for members of staff. Educating the environmental services personnel like technicians, cleaners will not only improve their knowledge in patient care but also provide a sense of commitment in patient outcomes (Neil 2005).

Perioperative nurses can contribute in research regarding theatre ventilation system through organised data collection and documenting evidences. Nurses can contribute in giving optimum and safe delivery of care in areas where environmental issues can put the patient at risk. Knowledge is changing fast, so it is important that staff must keep themselves up to date. Continues quality improvement is needed and it should be based on evidence based research and on-going assessment of information (Hughes 2009).

CONCLUSION

Reviews of current research shows that still there is a lack consensus on the effectiveness of laminar airflow in infection control. Studies include in this review has used either clinical outcomes (infection or reoperation rate) or intermediate outcomes (particle count or bacterial count) to evaluate the effectiveness of laminar flow. Kakwani et.al (2007) found that re-operation rate was lower in laminar airflow theatres but Brandt et.al (2008) found SSI rate was high in hospitals with laminar flow. Clarke et.al (2004) found that contamination was not significantly different in ultra clean theatres compared to standard theatres equipped enhanced ventilation system. Supporting this finding Scaltriti et.al (2007) found well designed ventilation system is effective in reducing contamination.

Study by Knobben et.al (2006) found that combination of systemic and behavioural changes are required to prevent intra-operative contamination. Miner et.al (2007) found that there were no significant differences in infection between hospitals that use laminar airflow and body exhaust suits.

From these studies it can be concluded that use of laminar airflow alone can guarantee infection prevention. Behavioural and other systemic changes are necessary to enhance the benefits of laminar airflow. Evidence shows that conventional theatres equipped with enhanced ventilation system can prevent infection effectively, this can be consider as an alternative for expensive as laminar flow system.