Use of X-Radiation for Diagnostic and Therpeutic Purposes

/in /by


Compare and contrast the use of X-radiation for diagnostic and therapeutic purposes.

Introduction

Radiation is energy that comes as a form of either a wave or as energised particles. In a radiation spectrum, at the lower end is considered harmless, these include radio waves and microwaves. [1] Whereas at the higher end of the spectrum beyond the ultraviolet range is where ionising radiation can be found, these consist of x-rays and gamma rays. In medicine, ionising radiation can be useful for both diagnostic and therapeutic radiation. [1] However, ionising can have adverse effects on the human body as it can damage tissues, gene and DNA, therefore it is important to control the exposure and compare the risk and benefit of the imaging/treatment in clinical settings. [1]

History

X-ray was first invented in 1895 by Wilhem Roentgen who was experimenting with electric currents through cathode ray tubes which were covered in thick black cardboard. [1] While Roentgen was experimenting, he realised that a screen nearby covered in barium platinocyanide had become bright due to the radiation emitted from his experiments. [1] Roentgen then projected an image of his wife’s hand on the screen which created a contrast between his bones and flesh, this became the first x-ray image captured. [1]

X-ray production in tube

X-rays are made using x-ray tubes, which is uses a heated filament made of tungsten and consist of an anode and cathode. [2] The cathode produces electrons through a process called thermionic emission. [2] Once there are electrons emitted it will be attracted towards the positive anode and the tube will use voltage (kVp) to accelerate the electrons so that the electrons can gain kinetic energy to hit the target (anode). [2] This allows for x-rays to be produced. [2] In an x-ray tube the electrons are accelerated at a voltage usually between 30-150kV from the cathode towards the target anode. [10] The number of electrons being produced is measured in milliampere (mA), whereas the kinetic energy of an electron is measured in keV. [2] Also, the tube voltage, current and time exposure can be controlled by the individual. [2]

X-ray production with target materials

In an x-ray tube, there are two ways x-rays can be produced, they are called bremsstrahlung and characteristic x-rays. [2] Bremsstrahlung produces a continuous spectrum, the electron when injected from the cathode will be attracted to the positively charged nucleus of the atom. [2,6] The electron will break around the nucleus due to electromagnetic interaction, causing the electron to decelerate and lose energy. This will cause a photon (x-rays) to be emitted. [2] The energy of the emitted photon will depend on the energy of the incident electron which was emitted from the cathode. [6] Whereas characteristic radiation produces discrete x-ray energies. [6] A projectile electron will hit an electron within the inner shell of the atom, knocking the inner electron out of the shell. [6] Another electron from a higher shell will be attracted to the vacancy in the inner shell as the original electron has been kicked out. [6] The higher shell electron will move to the inner shell, hence the difference in energy between the shells when the electron moves will be produced as a monoenergetic photon. [6]

Units for dose and exposure

In radiation science, there are several units for radiation dose and exposure used. [9] The units can come in two forms, conventional and S.I units. [9]

Exposure is the amount of radiation that is in the surrounding area where a person can come into contact with. [9] Whereas dose is the amount of radiation that is absorbed by a person. [9] Exposure is measured by the physical quantities of x-ray or gamma radiation ability to ionise the air and the strength of the radiation field. [9]

In the following table below shows each of the conventional and SI units for the absorbed dose, radiation exposure and dose rate.


Conventional units


SI units


Absorbed dose

rad

Gray or Sievert


Radiation exposure

Roentgen

Gray in air


Dose rate

Rem/h

Sievert/h

[9]

X-ray interaction

There are four ways x-rays interact with matter such as tissue, these include the photoelectric absorption, Compton scattering, pair production and Rayleigh scattering. [3] The two main modes of attenuation in diagnostic radiation are the photoelectric absorption and Compton scattering. [3] Whereas pair production and Rayleigh scattering although present does not have a significant attenuation on patients. [3] Therefore, to enhance diagnostic utility during an examination, radiographers will have dedicated mammography equipment and contrast materials to utilize the different types of x-ray interactions. [3] The type of x-ray interaction will depend on the exposure parameters, the type of tissue being imaged and the x-ray target and filter combinations. [3] Once all these factors are taken into consideration, a predominate x-ray interaction will be chosen and in turn will affect the amount of dose a patient is exposed to, the quality of the x-ray image and the utility of diagnostic testing. [3] In diagnostic radiology it is important for a radiologist to produce the highest quality diagnostic image while trying to have minimal scattering radiation and proper contrast between tissues by controlling the x-ray attenuation. [3] Controlling the attenuation and having minimal scattering is critical in diagnostic radiography, as radiographers must obtain a high-quality x-ray image while achieving the lowest dose possible to minimise the amount of radiation a patient absorbs. [3]

The total mass attenuation coefficient is a measure of how photon energy penetrates the material, therefore it can be a way to evaluate the usage in dosimetry of human tissues and organs. [4] It is important in the medical field to understand how much radiation dose and contrast occurs as each of the 4 different x-ray interactions can interact with the human tissue in different ways. [3,4] Hence, in the following paragraphs below will explain how 3 different x-ray interactions in diagnostic radiation, interact with human soft tissues.

Compton Scattering

Compton scattering is an inelastic interaction and occurs when x-rays interact with the outside valence shell electron as seen in figure 1. [3] The x-ray or incident photon will knock the outer shell electron off the atom, this will result in scattered photons being released. [3] For example, in diagnostic radiation Compton scattering can occur when a 100 keV photon interacts with a water molecule such as hydrogen and oxygen in soft tissue. [3] The water molecule due to having lower binding energy than the incident photon, the water molecule will be ejected from the atom when the incident photon collides with it. [3] Compton scattering predominates in both diagnostic energy range in tissue above 30 keV and beyond diagnostic energy to about approximately 30MeV. [3] At lower x-ray energy (25 -150 kVp), Compton scattering will cause most of the incident photon energy is transferred to the scattered photon, which can be detected by an image receptor will produce an image of the contrast of the tissue but will leave some noise. [3,11]


Figure 1 [3]

The photoelectric Absorption

The photoelectric absorption is another important interaction that occurs in diagnostic imaging. In the photoelectric effect, the incident photon will collide with an inner valence electron (k or L shell) of a patient. [3] As depicted in figure 2, once the incident photon collides with the inner electron, it will transfer some energy to the inner electron causing the inner electron to become free (ejected). [3] The ejected electron becomes a photoelectron and atom will become ionised and excited. [3] The vacant spot of the inner shell will attract an electron from the outer shell, therefore the outer shell electron will move to the vacant spot. [3] The difference in the energy between the shells will be released as a low energy photon or characteristic x-ray. [3] In diagnostic imaging, the photoelectric effect will predominate in materials such as lead and sodium iodide which have low energy photon but a high atomic number. [3] However, in patients the photons are absorbed by their atoms and this will create a contrast in the image, which will come out as white on the film detector. [11]


Figure 2 [3]


Rayleigh Scattering

Rayleigh scattering which compared to the other 3 types of x-ray interactions is when the incident photon interacts with the whole atom rather than the individual electrons. This interaction can be seen in figure 3. [3] Therefore, Rayleigh scattering can often appear with diagnostic x-rays that use low energy such as mammography (15-30 keV). [3] When Rayleigh scattering occurs in mammography it has no ionisation energy and the scattered photon energy is barely lost. [3] As Rayleigh scattering occurs only in low energy diagnostic x-rays, the scattering is unlikely to occur in other higher energy x-rays hence making up less than 5% of x-ray interactions in diagnostic x-rays. [3] When Rayleigh scattering occurs, the x-ray photon interacting with a patient’s atom will also change direction. [11]


Figure 3 [3]

Diagnostic uses

Images produced in diagnostic radiology is produced due to the incident x-ray beam containing a quantity of x-rays and by the amounts of non-interacting photons that are present on the x-ray film. [5] In diagnostic radiation there are two types of uses, radiology which is an external use and nuclear medicine which is an internal use. [5] Since the discovery of x-rays, diagnostic radiology has developed from being a scientific experiment to becoming a part of modern medicine. [5] When radiology was first introduced into medicine, it was originally used to diagnose diseases, but over the years due to development of nonionizing technologies, new ways of imaging was introduced. [5] These include ultrasounds and magnetic resonance imaging. [5] Due to this new change, this brought a new term called medical imaging. [5]

In radiography there are two types of examinations, they are conventional examinations and conventional examinations. [5] Conventional examinations are primarily used to diagnose diseases such as infections and cancer found in the lungs, to provide information about the cardiovascular system and anatomical structures and to monitor the progression of diseases of severely ill patients. [5] On the other hand, conventional examinations are radiographic imaging used to examine the spine, skull, breast, pelvis and abdomen. [5] It is used to diagnose broken bones and injured joints. [5] Now due to new and advanced technology such as the CT and MRI machines, radiographic imaging is used less for imaging of the spine and skull for central nervous system assessment. [5] The CT and ultrasound have also decreased the abdomen and pelvis conventional radiographic examinations. [5]

Therapeutic uses

In the health sector, ionizing radiation can be used for therapeutic purposes. [5] Therapeutic radiation can be applied for external uses; radiation oncology and teletherapy, and internal uses; brachytherapy and therapeutic nuclear medicine. [5]

In the medical field, therapeutic uses of radiation such as radiation oncology (radiation therapy) are used for treating cancer with ionising radiation. [5] The process is to kill the tumor cells that are developing and depending on the type of tumor, stage of the disease and where the tumor is located (organ or tissue), the dose may range from 30 to 70 gray (Gy). [5] The treatment can be delivered using an external beam of ionizing radiation such as gamma rays, photons or electrons. [5]

Linear accelerator

In 1924, Gustav Ising had proposed the idea of creating a linear accelerator and 4 years later in 1928, the first linear accelerator (linacs) was invented by Rolf Wideroe. [7] The first generation of linacs used for medical purposes had many limitations due to its design, it produced relatively low beam energy and radiation output. [7] However, over time the linac design changed to become safer and correspond to each of the different particles used for treatment; electrons, protons and ions. [7] Now the linac has become an important way to treat cancer in radiation therapy by generating x-rays and high energy electrons using electric power. [8] The linac uses collimators and filters which help to control the shape and intensity of the beam during treatment. [8] Hence, this can accurately target the cancer tissue while minimising the exposure to the surrounding normal tissues. [8]

Future of radiation therapy

Radiation therapy is always evolving to find new and better treatments for cancer. [7] Therefore, researchers have been thinking of new machines such as combining the linac and MRI or using laser-particle accelerators. [7] Although there are many ideas, these machines must be tested to understand if it has any benefits and the cost it brings to integrate them into clinical settings. [7] However, there will likely be further advancements made, such as beam shaping which can improve resolution and flexibility, more use of computer control and use of robotics in radiography. [7]


References

  1. Donya M, Radford M, ElGuindy A, Firmin D, Yacoub MH. Radiation in medicine: Origins, risks and aspirations.

    Glob Cardiol Sci Pract

    . 2014;2014(4):437–448. Published 2014 Dec 31. doi:10.5339/gcsp.2014.57
  2. Tafti D, Maani CV. Radiation X-ray Production. [Updated 2019 Sep 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from:

    https://www.ncbi.nlm.nih.gov/books/NBK537046/
  3. Bushberg, J T (1998) ‘The AAPM/RSNA physics tutorial for residents. X-ray interactions’,

    Radiographics : a review publication of the Radiological Society of North America

    , 18(2), pp. 457–68. Available at:

    https://pubs.rsna.org/doi/10.1148/radiographics.18.2.9536489

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  4. Ferreira C, Ximenes R, Garcia A, Vieira J, Maia A. Total mass attenuation coefficient evaluation of ten materials commonly used to simulate human tissue. Journal of Physics: Conference Series 249 (2010). Available from:


https://iopscience.iop.org/article/10.1088/1742-6596/249/1/012029/pdf

  1. Institute of Medicine (US) Committee for Review and Evaluation of the Medical Use Program of the Nuclear Regulatory Commission; Gottfried KLD, Penn G, editors. Radiation In Medicine: A Need For Regulatory Reform. Washington (DC): National Academies Press (US); 1996. 2, Clinical Applications of Ionizing Radiation. Available from:

    https://www.ncbi.nlm.nih.gov/books/NBK232715/
  2. Mccollough, C H (1997) ‘The AAPM/RSNA physics tutorial for residents. X-ray production’,

    Radiographics : a review publication of the Radiological Society of North America

    , 17(4), pp. 967–84. Available at:

    https://pubs.rsna.org/doi/10.1148/radiographics.17.4.9225393

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  3. Thwaites, D. I. and Tuohy, J. B. (2006) ‘Back to the future: the history and development of the clinical linear accelerator’, Physics in Medicine and Biology, 51(13), pp. R343–R362. doi: 10.1088/0031-9155/51/13/R20.
  4. Jaffray DA, Gospodarowicz MK. Radiation Therapy for Cancer. In: Gelband H, Jha P, Sankaranarayanan R, et al., editors. Cancer: Disease Control Priorities, Third Edition (Volume 3). Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2015 Nov 1. Chapter 14. Available from: https://www.ncbi.nlm.nih.gov/books/NBK343621/ doi: 10.1596/978-1-4648-0349-9_ch14
  5. National Research Council (US) Committee on Evaluation of EPA Guidelines for Exposure to Naturally Occurring Radioactive Materials. Evaluation of Guidelines for Exposures to Technologically Enhanced Naturally Occurring Radioactive Materials. Washington (DC): National Academies Press (US); 1999. Appendix, Radiation Quantities and Units, Definitions, Acronyms.Available from:

    https://www.ncbi.nlm.nih.gov/books/NBK230653/
  6. Monash University. (2019) [Moodle book].

    3.3 Energy interaction with matter.

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  7. Monash University. (2019) [Lecture slides].

    X-ray production and interactions

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Community/Public Health Nursing: Promoting the Health of Populations

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Community/Public Health Nursing: Promoting the Health of Populations

Students must submit all journals through the Assignment Tool
The journal due dates are listed on the document titled, “Course Schedule.” and in the Weekly Modules. These due dates are not open to debate or negotiation. As a senior nursing student, your status as a professional nurse is imminent. As such you are expected to manage time effectively and make submissions of critical course requirements on or before due dates. Students not faculty are responsible for deadlines and submitting assignments on or before due dates. Failure to submit the journals will result in zero points for the assignment.
Total of 15 points
GUIDELINES FOR SUBMITTING CLINICAL JOURNAL #3
Have lunch with someone who is of a different cultural background. Include the following data categories pertaining to the person’s culture: 1. History of ethnic/racial origin of the person, 2. Values orientation, 3. Cultural sanctions/restrictions, 4. Communication, 5. Health-related Beliefs and Practices, 6. Nutrition and 7.Socioeconomic considerations. Compare and contrast to your own culture. ( This must be an actual interview for total points to be earned). The write-up of this interview must be included in Journal #3. Journal #3 needs to include:

1. Write-up of the Culture Assessment. (Use the questions on pages 239-240 in your textbook). (8 points)
2. Summary of student clinical activities since the submission of journal 2 (2 points)
3. Student clinical outcomes met to date. ( refer to student clinical objectives for the course) The objectives and the clinical activity that supports achievement of the outcomes must be written out. (2 point)
4. Documentation of course content as it relates to clinical activities. (Must document at least three areas of course content with explanation) (3 points)

Total of 15 points

Something to Think About:
On a 1-10 scale (1=not so important & 10=critically important) what number would quantify the import of using Transcultural Care Models as a framework in planning, implementing and evaluating nursing care delivery for the community? Do you think there is a positive relationship between delivering “culturally competent” care and “effective” nursing care delivery–That is, the more culturally competent the care, the more effective the nursing intervention, as measured by the clients (community) outcome?

Comparison of Musculoskeletal Disorders in Gender

/in /by


Nichelle Morgan


Research Question: Does the physical and psychosocial effects of musculoskeletal disorders differ between both male and female computer workers employed at the UWI St. Augustine Republic Bank Branch, Trinidad?



Introduction

A musculoskeletal disorder is defined as “injuries or disorders that affect the human body’s movement or musculoskeletal system, i.e. muscles, tendons, ligaments, nerves, discs, blood vessels, etc.” (Middlesworth, 2015). They are one of the most common occupational disorders that occur to employees both in and out of the office. When a worker experiences a musculoskeletal disorder, it has an impact on the quantity and quality of the work that they perform. Not only do these disorders affect the health of the worker, but it also affects the productivity of the organization and furthermore the economy (Nunes, 2012).

For this topic, there were very limited sources that discusses gender and its association with the development of musculoskeletal disorders. As there is very little focus on musculoskeletal disorders amongst computer workers in Trinidad, this study will seek to gain more information and a better understanding of the known and unknown causal factors of musculoskeletal disorders, how or why it may differ between genders and what methods can be implemented to reduce the risk of an employee developing these disorders in the future.



Problem Statement

As places of business become more dependent on technology, there has been the increase in the usage of desktop computers and laptops in the workforce. Therefore, this brings about one of the most common occupational health problems, i.e. musculoskeletal disorders. One of the many groups of workers who has experienced this occupational ailment are the employees that work with computers. This group mostly express concerns about pains in their necks, arms, and backs (Punnet, 1997). The age, gender and lifestyle choices of the individual are a few factors that contribute to musculoskeletal disorders. For Trinidad and Tobago, there is very limited research conducted on the effects of musculoskeletal disorders among computer workers. Considering the lack of information for this topic, it gives rise for further research to be done on this occupational disorder in Trinidad and Tobago.



Aim

The aim of this research question is to further examine the long term physical and psychosocial effects of musculoskeletal disorders amongst computer workers. Factors such as gender, age, exposure time to computers and lifestyle of the worker would be used as additional control measures in this study.



Theoretical Perspective

With regards to the possible causes and long term effects of musculoskeletal disorders at the workplace, there are four theories which aids in analysing these causal injuries. Kumar (2004, 2007) explains the four theories as follows:


  1. The Multivariate Interaction Theory

    – encompasses all the factors [genetic, morphological, psychosocial, and biomechanical] that a biological entity uses while conducting work activities.

  2. The Differential Fatigue Theory

    – speaks to the various and repetitive muscle movement in the body that occurs while the worker is performing various tasks. Each muscle would experience different levels of fatigue and this depends on the type of work being conducted and how much stress that the muscle is undergoing.

  3. Cumulative Load Theory

    – where all the muscle pain or stresses are accumulated. These repetitive motions over time causes the muscles to become weak and in some cases even deformed.

  4. Overexertion Theory

    – This is when the muscles become extremely overworked due to the amount of stress or pressure being placed on those muscles. The muscles would either experience pain all at once or the pain will accumulate over time.

The Differential Fatigue Theory is best suited to the discussion of causes of musculoskeletal disorders and its short and long term effects amongst computer workers. The neck, shoulder, back and arm muscles of the worker all undergo different levels of stress every day. The different levels stress in these muscles leads to the worker experiencing different types of pain while doing their job and even out of the office.



Research Question/Hypothesis

To further examine the long term physical and psychosocial effects of musculoskeletal disorders between male and female computer workers.


Hypothesis:

H

O

: There is no association with the length of computer usage and the development of musculoskeletal disorders between genders.

H

A

: There is an association with the length of computer usage and the development of musculoskeletal disorders between genders.



Definition of key terms


Visual Display Unit


[VDU]
– another term used to describe a computer monitor. A large projector can also be considered a VDU (TechTerms).


Video Display Terminal [VDT]
– a computer terminal consisting of a screen on which data or graphics can be displayed (The Free Dictionary).


Carpal Tunnel Syndrome [CTS]
– this is when there is pressure on the median nerve of the wrist. When this pressure is continuous, the arm or hand of the individual experiences tingling, numbness and pain (Faust, 2016).


Repetitive Strain Injury [RSI]
– this is where an individual experiences pain in the muscles, nerves, and tendons after doing an activity that involves repetitive action (NHS UK).



Delimitations

The focus group for this research are the bank employees at the Republic Bank Limited branch located in the University of the West Indies, St. Augustine Campus.



Limitations

The group selected for the questionnaire may be too small and not a large enough representation of all staff members at Republic Bank Limited, Trinidad.



Literature Review

Within the last century, the corporate workforce has increased exponentially and with this there is also the increase in the number of computers and the length of time that workers spend these devices in the workplace. Even though this machine is very helpful with everyday work tasks, its use over extended periods of time begins to have negative effects on the physical health of the worker. These physical health effects that a computer worker will most likely experience is referred to as musculoskeletal disorders. The parts of the body such as the arms, neck, shoulders and back are the main problem areas and contribute to the development of musculoskeletal disorders (Eltayeb et.al 2007).

In an article written by Tittiranonda et.al (1999), it was mentioned that in the United States there was an increase in the number of the occurrence of musculoskeletal disorders in a ten-year period. The author also stated that the increase in cases involving musculoskeletal disorders is in conjunction with the increase of computer usage at the workplace.

One of the most common musculoskeletal disorders that several computer users experience is carpal tunnel syndrome. This disorder affects the wrists and fingers of the worker, thus limiting the movement of the hands and the pain ranges from light to severe (Faust, 2016). The Mayo Clinic (2014) indicated that there was scientific research was done to verify the link between extended computer use and carpal tunnel syndrome but the evidence to support this statement is limited. Similarly, in his study Kryger et.al. (2003) spoke about repetitive stress injury [RSI] with regards to the pain that workers experience in their forearm and mentioned that there were “inconsistent findings” in a few studies which were conducted to find the association between computer use and forearm pain.

Middlesworth (2015) divided the risk factors that contributes to musculoskeletal disorders into two categories, these are the Ergonomic and Individual risk factors. The Ergonomic risk factors consists of force, repetition, and posture, whereas the Individual risk factors are poor work practices, poor fitness, and poor health habits. For example, if the posture of the worker is poor throughout the entire workday, not only would it cause pain in the lower back, shoulders, and neck, but it would also lead to increased fatigue. Poor posture and the utilization of inadequate office equipment such as unsuitable computer chairs for extensive periods can also contribute to the development of musculoskeletal disorders. In terms of poor health habits and its relation to musculoskeletal disorders, it is not considered to be a major factor in the development of musculoskeletal disorders as there is very little research done to prove this as a fact. However, there is some correlation between poor fitness and the development of musculoskeletal disorders. For example, if an individual is not physically fit and is sitting at the desk most of the day, it heightens their chances of experiencing both muscle and joint pain.

With regards to gender and musculoskeletal disorders, one report stated that there is no evidence to confirm that gender is a main factor in the development of this occupational disease (Petreanu, 2015). However, in another study conducted by de Zwart (1997) it was found that as both working males and females age, they are at a higher risk of developing musculoskeletal disorders at the workplace. In another article, Madeleine et.al (2013) carried out an experiment on the long-term pain complaints amongst Danish computer users which resulted in the women having higher reports of pain complaints than the men.

Given the difference in opinions in the previous paragraph, this gives an indication that there is still more research to be done to find the association with gender and musculoskeletal disorder development. Trinidad and Tobago has many persons that are employed in the public sector and by carrying out a study in this area of occupational health, it would give some insight as to how musculoskeletal disorders affects the office worker and how we can reduce the number of cases of this occupational disease.



Research Design/Method

The quantitative design method would be used alongside with the true experimental design in this study. By pairing the quantitative method and the true experimental design, this would reduce the chances of bias during both pre-test and post-test stages.



Sample Populations and Participants

The population that this study will be sampling from are the employees of Republic Bank Limited in Trinidad that work with computers daily. The sample group will comprise of 100 employees that work with computers for more than six hours during the work day at the Republic Bank Limited, St Augustine Branch. The participants in this sample group were randomly chosen as this would allow for a fair distribution of participants to both the control group and the experimental group.



Data Collection Instruments, Variables and Materials

For this study, data would be collected by means of questionnaires and an experiment. The independent variable would be the exposure to computers during the work week [hours/week]. The dependent variables would be the musculoskeletal symptoms [back pains, neck pains, shoulder pains, arm, and wrist pains], gender, lifestyle and age of the employee.

The questionnaire would consist of closed ended questions which would gather data from the employees such as lifestyle choices, health, workspace comfort, etc. To ensure that the participants respond to the questions, there would be two supervisors [a research team representative and a representative from the Human Resources Department] present while the employees take the allotted time to fill out the questionnaire. After all the questionnaires have been completed, they would be collected immediately and handed over to the research team representative.

In terms of the experiment, it will be carried out at the workplace of the participants for a period of two months. In the first week, the experimental group [made up of 50 participants] would receive new ergonomically friendly computer desks and chairs, while the control group [also comprised of 50 participants] would be given a placebo. The employees would be required fill out a digital weekly log for eight working weeks to record whether there has been any decrease in muscle pains and at the end of each week the participants must submit these logs to the research team representative via the email address which was provided one day prior to the commencement of the experiment.



Data Analysis Procedure

As the research would be focusing on the length of computer usage and its association with the development of musculoskeletal disorders between men and women, the SPSS program was chosen to analyse the data. After the data from the questionnaires and the weekly logs have been gathered, the researchers would then go through a series of steps to ensured that the data is properly analysed. The first step is to code the data from the weekly logs [hours/week versus the musculoskeletal symptoms] and the questionnaires. Secondly, the data would be edited and then placed into a computerised system. The data would then be cleaned as this would remove any errors that may offset the results and finally, the data will be modified.



Expected outcome

The results from the statistical analysis should indicate that there is indeed an association with the exposure time of computers and the development of musculoskeletal disorders between male and female computer workers.



Anticipated Ethical Issues

This study is being conducted with human beings as the test subjects. To ensure that the ethical rules in research are not broken, the research team took measures to ensure that all the data that was gathered from the participants were to remain confidential and used only for research purposes. This would be done by having the participants signing two consent forms, one before filling out the questionnaires and the other on the morning of the experimental trial. Secondly, the head of the research team would meet the Human Resources manager of the Republic Bank Limited prior to the experimentation period to discuss the purpose of the study, why their establishment and the St. Augustine branch was chosen and how the data gathered from the employees was to be utilized.



Preliminary Studies and Pilot Tests

Before the research team carries out the experiment, a pilot test will be given to 40 employees at the Republic Bank Limited branch. The purpose of this pilot test is to give an assessment of the estimated cost to run the experiment, gives an idea of how feasible the study is going to be and may also predict any possible adverse events during the test period.



Significance of study

The study of musculoskeletal disorders and its effects on computer workers is of key importance as it allows for a deeper understanding of the causal factors of the disorder. It also brings about ways in which the computer workers themselves may have contributed to the development of musculoskeletal disorders in their bodies. The study may also bring about possible solutions for reducing the physical and psychosocial health effects of this occupational disease amongst the computer workers not only at the Republic Bank, but also all corporate businesses in Trinidad and Tobago.


References

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, 2017.


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.

de Zwart, B., Broersen, J., Frings-Dresen, M. et al. Int Arch Occup Environ Health (1997) 70: 352. Accessed on January 8

th

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Eltayeb Shahla et.al. 2007. Prevalence of complaints of arm, neck and shoulder among computer office workers and psychometric evaluation of a risk factor questionnaire.


http://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-8-68


Accessed on December 30

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Faust Katherine, Charles D. Jennings. “Carpal Tunney Syndrome”. 2016.


http://orthoinfo.aaos.org/topic.cfm?topic=a00005


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Kryger A.I. et.al. “Does computer use pose an occupational hazard for forearm pain; from the NUDATA study”. Occup Environ Med 2003;60:e14. Accessed on January 3rd, 2017. doi:10.1136/oem.60.11.e14.

Kumar, Shrawan:

Muscle Strength

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https://books.google.tt/books?id=IXRJ457fGp8C&pg=PA10&lpg=PA10&dq=differential+fatigue+theory&source=bl&ots=6ZQ3rQg2Kj&sig=1GtsSbEPM6fKvdB7LqBgHGyY8Hw&hl=en&sa=X&ved=0ahUKEwic67C-h6XRAhVBLSYKHStyBwwQ6AEIKTAC#v=onepage&q=differential%20fatigue%20theory&f=false


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Biomechanics in Ergonomics

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, 2017. DOI: 10.1186/1471-2474-14-226.

Mayo Clinic. Carpal Tunnel Syndrome: Risk Factors. 2014.


http://www.mayoclinic.org/diseases-conditions/carpal-tunnel-syndrome/basics/risk-factors/con-20030332


Accessed on January 3rd, 2017.

Middlesworth, Matt. “The Definition and Causes of Musculoskeletal Disorders (MSDs)”. Accessed on December 29

th

, 2016.

The Definition and Causes of Musculoskeletal Disorders

NHS UK. Repetitive Stress Injury. 2016.


http://www.nhs.uk/Conditions/Repetitive-strain-injury/Pages/Introduction.aspx


Accessed on January 3rd, 2017.

Nunes, Isabel L. and Pamela McCauley Bush (2012). “Work-Related Musculoskeletal Disorders Assessment and Prevention, Ergonomics – A Systems Approach”. Accessed on January 8

th

, 2017. DOI: 10.5772/37229.

Petreanu Viorica and Aurelia-Mihaela Seracin. 2015. Risk factors for musculoskeletal disorders development: hand-arm tasks, repetitive work.


https://oshwiki.eu/wiki/Risk_factors_for_musculoskeletal_disorders_development:_hand-arm_tasks,_repetitive_work


Accessed on January 8

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Punnet, Laura. “Visual Display Unit Work and Upper Extremity Musculoskeletal Disorders”. 1997:16.

https://gupea.ub.gu.se/bitstream/2077/4159/1/ah1997_16.pdf

Accessed on January 8

th

, 2017.



Appendices


Appendix 1: Questionnaire

Good day participant,

My name is Nichelle Morgan and I am a postgraduate student in the Chemistry Department of the University of the West Indies, St. Augustine Campus. As a requirement for one of my core courses, I have been asked to create a questionnaire which looks at musculoskeletal disorders and the physical and psychosocial effects that it has on computer workers. Once this questionnaire has been completed in its entirety, the responses will be used to further explore the known and unknown causal factors of this occupational disease.

With regards to confidentiality, you will not be required to fill out your name or contact information on the questionnaire thus reassuring you that your responses will remain private. I appreciate you taking the time to participate in this study. If you have any questions, please feel free to contact me via my email address

nichelle.morgan@my.uwi.edu

. Once again, I thank you for taking part in this study.

Yours respectfully,

Nichelle Morgan

MSc. Occupational and Environmental Safety and Health,

Department of Chemistry,

The University of the West Indies, St. Augustine Campus.

  1. What is your gender?

• Male •Female

  1. Which age group do you belong to?

• 20-24 • 25-29

• 30-34 • 35-39

• 40-44 • >45

  1. What is your ethnic background?

• Afro-Trinidadian • Indo- Trinidadian

• Chinese • Syrian

• Mixed • Other

  1. How often do you exercise?

• Once a month • Twice a month

• 1-2 times a week • Everyday

• Never

  1. How often do you purchase or consume fast food?

• Daily • 1-3 times a week

• Twice a month • Once a month

• Never

  1. How long have you been employed at Republic Bank?

• <1 year • 1-4 years

• 5-9 years • 10-14 years

• 15- 19 years • >20 years

  1. Do you use computers daily at work?

• Yes • No

  1. If you responded Yes to Question 7, how many hours do you use the computer?

• < 2 hours • 2-4 hours

• 4-6 hours • 6-8 hours

  1. While working with the computer, how often do you take a short break (besides lunch hour)?

• Never • Every 2 hours

• Every 4 hours • Depends on the work load

  1. Do you experience any muscular pains while working?

• Yes • No

  1. If you responded Yes to Question 10, which part of the body does this pain occur?

• Neck • Shoulders

• Upper back • Lower back

• Arms and Wrists • Legs

• All the above

  1. How often do you experience these pains?

• Everyday • Every other day

• 1-2 times a week • Twice a month

• Once a month • Never

  1. Select the pain intensity that you experience

• Mild • Some Discomfort

• Very Uncomfortable • Intense

• Unbearable

  1. At times does the pain cause you to stop working?

• Yes • No

  1. Was there an occasion where you missed working day/working days because of the pain?

• Yes • No

  1. If you responded Yes to Question 15, how many days were you absent from work?

• 1-2 days • 3-5 days

• 2 weeks • 1 month

  1. Is your office furniture (computer chair) comfortable?

• Yes • No

  1. If your response to Question 17 is No, select the reason below

• Chair is not adjustable • The seat of the chair is too hard

• The back of chair does not support your spine properly

• Not enough leg room below desk

• All the above



Appendix 2: Budget

The estimated cost of the equipment required to carry out this study is $110,000. The cost of the ergonomically friendly chairs for the experimental group is $63,646.65 and the cost of the placebo chairs for the control group is $36,478.15. The rest of the funds ($9,845.05) would be distributed to the 100 participants as a token of appreciation for taking part in this study. There was a signed agreement between the sponsor of the equipment where they arranged to cover 60% of the cost while the research team will cover the remainder 40%.

Essay on Obesity Prevention

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One in every three adults in the United States is obese, not to mention the other third of the population that is simply overweight. According to the Centers for Disease Control and Prevention, more than 200 million people in the United States exceed the standard weight of a healthy individual. That is nearly seventy percent of the population that is considered overweight. Numerous people don’t understand the difference between the state of being overweight and being obese. Being overweight refers to an extra amount of body weight that can be caused by having excess bones, muscle, fat and water while being obese is strictly locked down for large amounts of fat (Ambinder). Obesity is attained when a person reaches a certain body mass index. Adults with a BMI of 25 – 29.9 fall in the overweight class, while adults with a BMI of thirty or more fall in the obese class (Ambinder). This plague of the 21st century can cause several types of life-altering diseases including heart failure, type II

diabetes

,

hypertension

, cancer, osteoarthritis, gallbladder disease, etc. (Ambinder). Obesity is a health problem that has reached pandemic levels in the United States that can be prevented with an active life style, strong metabolism, and proper sleep.

Initially, having a vibrant lifestyle is vital to losing weight. Wasting so much time of the day in a car, watching television, playing games, or simply living a lazy lifestyle makes it almost impossible to cut off pounds. In 2011, Los Angeles County, California, set aside nearly $16 million in funding for an enterprise aimed at limiting obesity, which involved growing bike networks and endorsing open spaces (Maciag). “When cutting expenses, health costs are an easy target” said Mike Maciag in his article “Analysis: Cities With” as he went on to show that a recent study done by two Lehigh University researchers conveyed $190 billion accounted annually for costs related to obesity in U.S. health expenses, nearly twenty-one percent of the country’s total bill. “Approximately half of Fort Collins-Loveland, Colorado, metro area residents are neither overweight nor obese” (Maciag). Although this sounds like nothing, Collins-Loveland has the highest percentage of healthy citizens of all metro areas surveyed for the CDC’s 2010 Behavioral Risk Factor Surveillance System, a yearly telephone survey evaluating a variety of health issues (Maciag). Thus, the records indicate 5.3 percent of Fort Collins-Loveland area residents walk or bike as their first choice of transportation to either work or personal reasons, one of the uppermost rates in the country (Maciag). Metropolitan areas with the less overweight individuals are “home to high counts of walkers and bike commuters” (Maciag).

A strong metabolism is a necessity for one’s body to be able to use all the food consumed. A metabolism is the process where one’s body converts the food consumed into usable energy. A failure to balance an excess of food, exercise or sleep would upset the body’s metabolism. In the article on WebMD, “Lose Weight Fast” by Kathleen M. Zelman, to obtain a faster metabolism one needs to have light snacks every two or three hours. This way, the body is constantly using energy to burn the extra food consumed plus the fat stored in the body to produce more energy (Zelman). Foods that will boost one’s metabolism usually contain lots of iron (Zelman). Eating enough of monounsaturated and polyunsaturated mostly found in nuts and oil will provide one’s body the fats it need without putting on extra weight because these fats have Omega-3 and Omega-6 fatty acids which lower cholesterol, boost metabolisms, and supplement in over sixty health issues according to “61 Health Benefits” (Robinson). There is evidence that an everyday diet based on entire plant foods can avoid or reverse most of the chronic health issues afflicting America – high cholesterol, type 2 diabetes, hypertension, heart disease, etc. (Robinson). Self-esteem and health concerns are the best motivating factors for weight loss in teens. “Part of the routine to weight loss is cutting back on sugar and portion sizes, while having a constant fruit and vegetable intake” said Nanci Hellmich in the article “Weight Loss Crucial”. She also mentions that Olivia Tilini, a student at Brigham Young University in Provo, Utah, started eating healthy foods by not having greasy foods, chips and sweets in her daily intake. She also dropped portion sizes without counting calories, grams of fat, or carbs. “In five months, she lost fifty-five pounds and weighed 170 pounds. She has kept it off ever since by eating healthy and working out every day.” (Hellmich).

Starvation slows the metabolism and allows the human body to burn the fuel provided by food more efficiently. Obviously, metabolism and weight are connected in some fashion. Studies have shown that the speed at which food is converted into energy varies greatly among individuals and that a variety of factors probably influence the process (Goode). Among them are exercise, age, how much food is consumed and whether calories are eaten in the form of fat, protein or carbohydrates. Scientists believe that one’s metabolism is affiliated as much with genetics as one’s daily diet (Goode). It is still unclear how the specific instructions about weight and weight distribution are inscribed into strips of DNA and passed down through the generations. But research shows that scientists are convinced that genes somehow dictate aspects of the metabolic process, the speed and efficiency with which food is converted into energy, and they are developing theories about the mechanisms at work (Goode). These unfortunate inequalities of weight point to genetic influences that have become a central focus of new research (Goode). The evidence provided by large-scale studies indicates that children of obese parents are 3 to 4 times more likely to be fat than children of lean parents (Goode).

Another key point to losing weight is getting the right amount of sleep. Skipping sleep prepares one’s brain to make poor decisions. It reduces activity in the brain’s frontal lobe, the center of decision-making and impulse control (Does Sleep Affect). When overtired, the brain’s reward centers start up, in search for something that feels pleasing (Does Sleep Affect). So while one might be able to get rid of comfort food cravings when well-rested, a sleep-deprived brain might have trouble saying no to another slice of cake. A second study discovered that too little sleep prompts people to eat larger portions of all types of foods, increasing weight gain (Does Sleep Affect). According to the article “Sleep More, Weigh Less”, in a review of eighteen studies, researchers learned that a lack of sleep steered to increased cravings for high-carbohydrate, energy-dense foods.

Sleep is considered as nutrition for the brain. The majority of people need and desire between seven and nine hours every night (Sleep More, Weigh). If an individual gets less than that, their body will respond in ways that lead even the utmost determined dieter straight to iHop. Why? Because sleep deficiency affects hunger and fullness hormones, including the more significant ones called ghrelin and leptin (Sleep More, Weigh). Ghrelin alerts one’s brain that they’re hungry and it’s time to feast. When sleep-deprived, one’s body creates more ghrelin (Sleep More, Weigh). Leptin works the opposite way; it tells the brain that the person is full and to stop eating. When not getting enough sleep, leptin levels fall, signaling the brain to eat more food (Sleep More, Weigh). Then there’s the cortisol spike which occurs from the lack of sleep. This stress hormone hints the body to save energy for fuel during waking hours (Sleep More, Weigh). University of Chicago researchers say, within just four days of insufficient sleep, a body’s ability to process insulin, the hormone desired to change starches, sugar, and other foods into energy the body can use, doesn’t function properly. The researchers found that, insulin sensitivity decreased by more than thirty percent. When a body doesn’t respond properly to insulin, it has trouble processing fats from the bloodstream; as a result, it stores them as fat that affects nutrition levels.

In order to receive right amount of nutrition, junk and fast foods must be abandoned from one’s diet. As a solution, taxing junk foods will decrease consumption of unhealthy foods and decrease obesity rates. Raising the price of food for home consumption by ten percent can lower the body fat percentage in adolescences by about eight or nine percent, according to new statistics and research from the National Bureau of Economic Research (Whoriskey). This new research, concentrating on adolescences, strengthens the idea that prices of junk and fast foods affect obesity and that raising these costs would help, but at the same time this would increase the prices of healthy and organic foods, such as fruits and vegetables (Whoriskey). The research also showed that individuals from different groups – whites and nonwhites, males and females – have diverse repercussions to increased food prices (Whoriskey). For example, raising the prices of fast-food lessens the body fat of men more than of women (Whoriskey). On the other hand, costs of fruits and vegetables have a greater effect on females, who have a habit of gaining weight when those prices rise, probably because of a consequential change in their diets (Whoriskey). In correlation with raising fast food prices, the soda companies Coca-Cola Co., PepsiCo Inc. and Dr. Pepper Snapple Group Inc. will work to cut beverage calories in the American diet twenty percent by 2025 through promoting bottled water, low-calorie drinks and smaller portions.

Most of the time, parents are the ones at fault for not looking out after their kids and not making home food. This can be either because the parent is working full-time to have extra income or they are just being lazy. “Fast food is not to blame for childhood obesity, poor eating habits learned in children’s home are” affirms a new study led by the University of North Carolina (Whoriskey). Investigators for the study discovered that while fast food does play a role to having unhealthy children, the leading offender for childhood obesity is cultured dietary habits children perceive at home (Templeton). Although, fast food restaurant menu options inspire unhealthy eating, they should not be held accountable for childhood obesity. Parents need to be responsible for the food choices they make for their children (Templeton). Restaurants don’t force families to eat their food, they don’t tell them what to buy or how much to buy. It would be the same as having liquor stores responsible for one’s drinking habits or developing alcoholism. If parents and their children don’t stand responsible for their own decisions, major changes will not occur. “After all, a restaurant is a business, not a parent.” (Do You Think).

Many people know how bad junk food is for them, yet they still devour every last bit of it. First, there’s the feeling of eating the junk. This includes the taste (sweet, salty, umami, etc.), the smell, and the feel in one’s mouth (Esterl). This last feature, known as “orosensation”, is usually the most important (Esterl). Many food companies spend millions of dollars to uncover the ultimate nourishing stage of crunch in a potato chip. These scientists also experiment the perfect amount of fizzle in sugary soft drinks (Esterl). The second factor is the macronutrient formula and ingredients of the food — the blend of fats, carbohydrates and proteins it contains. In the matter of junk food, manufacturers are trying to find a perfect combination of sugar, salt, and fat that thrills his brain and makes him come back for more. All these tests and factors combine to produce “the sensation that a brain associates with a particular food or drink” (Esterl).

In the United States, more than one third of the population is categorized as obese because of the lack of a dynamic life-style, a fast metabolism, and the right amount of sleep. A daily diet is required to stay in shape and lack health problems such as diabetes and heart disease in the future. People want to be healthier but don’t do anything about it. Many allow their own bodies to take control over their mind and nourish their cravings with greasy, sweet and salty foods. The weakness to one’s thought process and being able to withhold the urge to open that bag of chips is the sight of food. But with the right mentality and determination, those craving can be withheld and even nonexistent. Following these health tips, assures definite weight loss along with the liveliness and encouragement to be better.


Works Cited

“61 Health Benefits of Omega-3 Fatty Acids.”

GreenMedInfo

. N.p., n.d. Web. 01 Oct. 2014.


Centers for Disease Control and Prevention

. Centers for Disease Control and Prevention, 14 May 2014. Web. 29 Sept. 2014.

Ambinder, Marc. “Beating Obesity.”

Atlantic Monthly Vol. 305, No. 4

. May 2010: 72+.

SIRS Issues Researcher.

Web. 01 Oct. 2014.

“Does Sleep Affect Weight Loss? How It Works.”

WebMD

. WebMD, n.d. Web. 01 Oct. 2014.

“Do You Think Fast Food Restaurants Are Responsible for Child Obesity?”

“”

N.p., n.d. Web. 14 Oct. 2014.

Esterl, Mike. “Soda Producers Set Goals on Cutting U.S. Beverage Calories.”

Wall Street Journal Online

. 23 Sep. 2014: n.p.

SIRS Issues Researcher.

Web. 09 Oct. 2014.

“Foods That Boost Your Metabolism Naturally.”

– Foods That Boost Your Metabolism Naturally

. N.p., n.d. Web. 01 Oct. 2014.

Goode, Erica E. “Getting Slim.”

U.S. News & World Report

. 14 May 1990: 56+.

SIRS Issues Researcher.

Web. 14 Oct. 2014.

Maciag, Mike. “Analysis: Cities with More Walkers, Bike Commuters are Less Obese.”

Governing

. 14 Jun. 2012: n.p.

SIRS Issues Researcher.

Web. 01 Oct. 2014.

“Obesity in U.S. Fast Facts.”

CNN

. Cable News Network, 01 Jan. 1970. Web. 30 Sept. 2014.

“Sleep More, Weigh Less.”

WebMD

. WebMD, n.d. Web. 01 Oct. 2014.

Templeton, David. “Not Just Vegetarian, but Vegan.”

Pittsburgh Post-Gazette

. 01 Jul. 2014: C.1.

SIRS Issues Researcher.

Web. 01 Oct. 2014.

Whoriskey, Peter. “Taxing Food Calories Could Help Reduce Obesity, Study Finds.”

Washington Post

. 27 Jun. 2013: A.17.

SIRS Issues Researcher.

Web. 09 Oct. 2014.

Zelman, Kathleen. MPH, RD, LDWebMD Expert Column. “How To Lose Weight Fast and Safely – WebMD – Exercise, Counting Calories, and More.”

WebMD

. WebMD, n.d. Web. 09 Oct. 2014.

Complete the “Organizational Culture and Readiness for System-Wide Integration of Evidence-Based Practice Survey,” located in the textbook appendix.

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Complete the “Organizational Culture and Readiness for System-Wide Integration of Evidence-Based Practice Survey,” located in the textbook appendix.

 

Nurses Improving Patient Satisfaction through meaningful hourly patient rounds

Order Description

Part 1 ( 1 page )
Before making a case for an evidence-based project, it is essential to understand the culture of the organization in order to begin assessing its readiness for EBP implementation. Complete the “Organizational Culture and Readiness for System-Wide Integration of Evidence-Based Practice Survey,” located in the textbook appendix. Develop an analysis of 250 words from the results, addressing your organization’s readiness level, possible project barriers and facilitators, as well as how to integrate clinical inquiry. Make sure to include the rationale for the survey categories scores that were significantly high and low, incorporating details and/or examples. Also explain how to integrate clinical inquiry into the organization, providing strategies that strengthen the organizations weaker areas. Submit a rough draft of the survey results with your narrative analysis. However, a final draft of the survey results should be placed in the appendices for the final paper. Prepare this assignment according to the APA guidelines . An abstract is not required. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. Upon receiving feedback from the instructor, revise “Section A: Organizational Culture and Readiness Assessment” for your final paper submission. This will be a continuous process throughout the course for each section. Rubric Describe the results from the Organizational Culture and Readiness for System-Wide Integration of Evidence Practice Survey addressing the readiness level of your organization. Provide an analysis of any possible project barriers and facilitators, and describe how to integrate clinical inquiry into your organization. Detailed information in relation to the survey categories that scored high and low on the survey is provided. The rationale for the scores, including details and/or examples, is provided. The major project barriers and facilitators are thoughtfully analyzed and evaluated. Warranted conclusions are drawn. An informed position on how to integrate clinical inquiry into the organization is developed and explained, providing strategies which align to the weaker areas of the organization. Clarity and specificity of comprehension are demonstrated, and all relevant information is synthesized. Coverage extends beyond what is needed to support subject matter. Writer is clearly in command of standard, written, academic English.
Part 2 ( 2 page)
Write a paper of 500-750 words (not including the title page and reference page) on your proposed problem description for your EBP project. The paper should address the following: Describe the background of the problem. Tell the story of the issue and why it deserves attention. Identify the stakeholders/change agents. Who, or what organizations, are concerned, may benefit from, or are affected by this proposal. List the interested parties, patients, students, agencies, Joint Commission, etc. Use the feedback from the Topic 2 main forum post and refine your PICOT question. Make sure that the question fits with your graduate degree specialization. State the purpose and project objectives in specific, realistic, and measurable terms. The objective should address what is to be gained. This is a restatement of the question, providing focus. Measurements need to be taken before and after the evidence-based practice is introduced to identify the expected changes. 5) Provide supportive rationale that the problem or issue is an important one for nursing to resolve using relevant professional literature sources. Develop an initial reference list to assure that there is adequate literature to support your evidence-based practice project. Follow the “Steps to an Efficient Search to Answer a Clinical Question” box in chapter 3 of the textbook. Use “NUR-699 Search Method Example” to assist you. 7) The majority of references should be research articles. However, national sources such as Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), Department of Health and Human Resources (HHS), or the Agency for Healthcare Research and Quality (AHRQ) and others may be used when you are gathering statistics to provide the rationale for the problem. Once you get into the literature, you may find there is very little research to support your topic and you will have to start all over again. Remember, in order for this to be an evidence-based project, you must have enough evidence to introduce this as a practice change. If you find that you do not have enough supporting evidence to change a practice, then further research would need to be conducted. Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center. Upon receiving feedback from the instructor, refine “Section B: Problem Description” for your final submission. This will be a continuous process Describe the background of the problem. Identify the stakeholders/change agents and list the interested parties. Provide the PICOT question. State the purpose and project objectives in specific, realistic, and measurable terms. Develop an initial reference list throughout the course for each section. —————————————————————————————————–
SOME SUGESTION I WANT TO USE
Nurses improving patient satisfaction through meaningful hourly rounds using AIDET 1.
Hourly rounding is a simple and cost-effective intervention to improve patient perception of
Evidence-based research indicated implementation of hourly rounding would increase pt. satisfaction, decrease fall rates, decrease skin breakdown rates, and increase staff satisfaction. All patient care staff in clinical areas was educated utilizing the Studer Group Hourly Rounding Module. https://www.mc.vanderbilt.edu/root/pdfs/nursing/hourly_rounding_supplement-studer_group.pdf
Information hcaps, Studer customer satisfaction ect.
Hourly rounds—intentionally checking on patients at regular intervals—continues to be debated in nursing circles. Often, registered nurses make rounds on even hours and support staff make rounds on odd hours from 6 AM to 10 PM (and every 2 hours from 10 PM to 6 AM). While making rounds, staff engage patients by checking on the “4 P’s”: pain, positioning, potty (elimination), and proximity of personal items. Patients are told that staff will check on them frequently, so hourly rounds help manage patients’ expectations. Patients become less anxious about getting their needs met as they learn to trust the process of hourly rounds.
Attending to patients’ comfort, safety, and environmental needs may also prevent adverse events like falls, pressure ulcers, or unrelieved pain; and contribute to patients’ satisfaction with nursing care. Proponents also attest that hourly rounds organize work flow, offering efficiencies by giving nurses time back as they proactively (rather than reactively) anticipate and attend to patients’ needs. In this review I discuss available evidence about the effects of hourly rounds on clinical outcomes in inpatient settings.

Advanced practice nursing roles

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Advanced practice nursing roles

Topic: advanced practice nursing roles

Overview/Description: The final assignment will synthesize what you have discovered about the different advanced practice roles and scope of practice found in the master of nursing curriculum: NP, nurse educator, nurse informaticist, and nurse administrator. You will review all roles and then examine the specialty for which you were admitted, focusing on the scope of practice, core competencies, certification requirements, and legal aspects of practice for that specific role. You will also identify the practice environment and population you will be working with, as well as peers and colleagues. In addition, you will discuss your future leadership role and participation in professional organizations.

Your paper is to be based on current literature, standards of practice, core competencies, and certification bodies for your chosen role. The paper should be 10–12 pages excluding the title and reference, and APA format is required.

Criteria:

Advanced Practice Roles in Nursing:
Compare and contrast the roles of the NP, nurse educator, nurse informaticist, and nurse administrator in advanced practice nursing pertaining to clinical practice, primary care, education, administration, and research.
Selected Advanced Practice Role:
Examine regulatory and legal requirements for Indiana in which you plan to practice.
Describe the professional organizations available for membership based on your selected role Adult gerontology nurse practitioner (ADGNP).
Identify required competencies, including certification requirements for your selected (ADGNP) role.
Predict the organization and setting, population, and colleagues with whom you plan to work.
Leadership Attributes of the Advanced Practice Role:
Determine your leadership style( Participation style)
Identify leadership attributes you currently possess, and attributes you may need to develop.
Determine how to attain and evaluate those missing attributes.
Health Policy and the Advanced Practice Role (ADGNP)
Visit the Robert Wood Johnson Foundation (https://www.rwjf.org/en/about-rwjf/newsroom/features-and-articles/health-policy.html) and identify a health policy issue. Conduct a review of literature and address the following:
Describe the current policy and what needs to change; justify your conclusions with citations from the literature.
Provide the process required to make the change with key players and parties of interest.
Explain how you could lead the effort to make or influence the change in policy.
Predict the effect on healthcare quality if the change in policy is implemented.

The cost classification hierarchy listed below is beneficial in determining costs relevant to a particular decision. Briefly describe the cost categories and provide an example of how they can assist

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The cost classification hierarchy listed below is beneficial in determining costs relevant to a particular decision. Briefly describe the cost categories and provide an example of how they can assist with relevant costs.

  • Unit Level
  • Batch Level
  • Product Level
  • Facility Level

Accepting Medicaid Patients-Identify ways that Medicaid discounting can cause hardships on the type of facility that you selected.Select a health care facility or service that would accept Medicaid.

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Accepting Medicaid Patients-Identify ways that Medicaid discounting can cause hardships on the type of facility that you selected.Select a health care facility or service that would accept Medicaid.

Identify ways that Medicaid discounting can cause hardships on the type of facility that you selected.

Create a presentation in Powerpoint. The presentation should be 10 slides in length and include detailed speaker’s notes for each slide. Your presentation should explore how Medicaid participation has affected organizational finances and what can be done to reduce any loss incurred.

Cite 3 reputable references to support your assignment (e.g., trade or industry publications, government or agency websites, scholarly works, or other sources of similar quality).

What type of Organizational structure does your place of employment?

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What type of Organizational structure does your place of employment?

 

Answer the following Questions in paragraph form.

What type of Organizational structure does your place of employment?

How does this type of structure support the agencies mission and goals?

What title is given to highest nurse administrator in the facility and where is her/his position regarding the CEO?

Does the type of structure offer avenues of direct communication between the highest RN position and staff?

Required Text:
Marquis, B.L., & Huston, C.J. (2009). Leadership roles & management functions in nursing: Theory & application (7th ed.). Philadelphia: Lippincott Williams & Wilkins.

Side Note:I work at LIJ a large NY hospital, part of Northwell health system. this is for your reference in case you need any info. Hospital name not to be mentioned. The highest level of nursing is the chief nursing officer.
This is property of essayprince.org. Log in for Research paper help

Pain Management Interventions and Chronic Pain Disorders

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Introduction

This essay will identify the issue of how poorly addressed acute pain in hospitalized patients may lead to chronic pain disorders, critically compare and discuss a range of pain assessment tools referring to contemporary research literature and practice guidelines for patients who are able to self describe their pain and who are unable to self describe their pain due to verbal communication barriers, critical illness or delirium/dementia.

Main Body

According to the International Association for the Study of Pain, pain is an unpleasant sensory and emotional experience arising from actual or potential tissue damage. The emphasis of this definition is both the sensory and emotional experience of an individual in pain. According to Tsui, Chen & Ng (2010, p.20.), ” Pain can be emotional, behavioral, sociocultural and spiritual”. The exhibition of pain is multidimensional. Therefore, in the assessment of pain, not only a general guideline for a quick review is needed, but also a specific tool to help the professionals to have a more accurate assessment of the experience of pain from a multidimensional perspective.

Clinically, “Pain is whatever the experiencing person says it is, existing whenever he/she says it does” (McCaffery, 1968). The temporal profile classification is most commonly used to classify pain.This broad classification of pain duration is often used to better understand the biopsychosocial aspects that may be important when conducting assessment and treatment. For example, many times chronic pain is a result of unresolved acute pain episodes, resulting in accumulative biopsychosocial effects such as prolonged physical reconditioning, anxiety, and stress. It is obvious that this type of time categorisation information can be extremely helpful in directing specific treatment approaches to the type of pain that is being evaluated (Gatchel & Oordt, 2003).

Acute pain is usually indicative of tissue damage and is characterized by momentary intense noxious sensations (i.e., nociception). It serves as an important biological signal of potential tissue/ physical harm. Some anxiety may initially be precipitated, but prolonged physical and emotional distress usually is not. Indeed, anxiety, if mild, can be quite adaptive in that it stimulates behaviors needed for recovery, such as the seeking of medical attention, rest, and removal from the potentially harmful situation. As the nociception decreases, acute pain usually subsides. Unlike acute pain, chronic pain persists. Chronic pain is traditionally defined as pain that lasts 6 months or longer, well past the normal healing period one would expect for its protective biological function. Arthritis, back injuries, and cancer can produce chronic-pain syndromes and, as the pain persists, it is often accompanied by emotional distress, such as depression, anger, and frustration. Such pain can also often significantly interfere with activities of daily living. There is much more health care utilization in an attempt to find some relief from the pain symptoms, and the pain has a tendency to become a preoccupation of an individual’s everyday living.

Assessment of a patient’s experience of pain is a crucial component in providing effective pain management. A systematic process of pain assessment, measurement and re-assessment (re-evaluation), enhances the health care teams’ ability to achieve: increased satisfaction with pain management. According to Buckley (2000) nurses are the primary group of health care professionals responsible for the ongoing assessment and monitoring of patients to ensure that pain is effectively and appropriately managed and that patients and families are informed of the consequences of acute pain. Assessment of pain can be a simple and straightforward task when dealing with acute pain and pain as a symptom of trauma or disease. Assessment of location and intensity of pain often suffices in clinical practice. However, other important aspects of acute pain, in addition to pain intensity at rest, need to be defined and measured when clinical trials of acute pain treatment are planned. If not, meaningless data and false conclusions may result. The 5 key components: Words, Intensity, Location, Duration, Aggravating factors pain assessment are incorporated into the process. Objective data are collected by using one of the pain assessment tools which are specific to special types of pain. The main issues in choosing the tool are its reliability and its validity. Moreover, the tool must be clear and, therefore, easily understood by the client, and require little effort from the client and the nurse.

According to Husband (2001) to measure the pain severity or intensity, several scales can be used such as a numeric rating scale (NRS), the visual analog scale (VAS), observation scales with indicators of pain, and even creative depictions of pain intensity with scale using a pain thermometer. The numeric rating scale allows patients to rate their pain on and 11-point scale of 0 (no pain) to 10 (worst pain imaginable). The majority of patients, even older adults can use this scale. The thermometer scale may be useful in the elderly, according to Rakel and Herr (2004). It shows a picture of a thermometer arranged on a background with a vertical word scale. Finally categoric scales use verbal descriptors to quantify the level of pain and those scales have been validated and are considered to be reliable.

Pain assessment in older adults can be challenging and very difficult in some situations (Rakel & Herr, 2004). When the patient cannot report his/her subjective pain experience, proxy measurements of pain must be used, such as pain behaviours and reactions that may indicate that the person is suffering painful experiences. Besides communication difficulties caused by language problems, patients in the extremes of age, and critically ill patients in the intensive care setting, are common assessment problems. Older patients may prefer to use alternate means to express their pain through the use of word descriptors that best characterize the pain, such as “aching,” “hurting,” and “soreness” (Herr & Garand, 2001).

The most important components of pain assessment in older adults are regular assessable, standardized tools, and consistent documentation (

Horgas, 2003

). Pain assessment may also be complicated by decreases in hearing and visual acuity, so tools that require extensive explanation or visualization to perform will be more difficult and possibly less reliable. The verbal descriptor scale may be the easiest tool for the elderly to use. This measure allows patients to describe what they are feeling with common words rather than having to convert how they feel to a number, facial representation, or a point somewhere on a straight line. An observational assessment of pain behavior may be more appropriate for people with severe cognitive impairment, for example, the Abbey pain scale. Identifying pain in the cognitively impaired older adult depends heavily on knowing the patient and paying attention to slight changes in behavior (

Soscia, 2003

). An interesting veiw was expressed that “nurses may lack knowledge and have attitudes and practices toward pain management that may compromise pain management for older patients” ( Yates et al., 2002, p.403).

Conclusion

In conclusion,

References

American Geriatric Society Panel on Chronic Pain in Older Persons (2002). The management of persistent pain in older persons: AGS panel on persistent pain in older persons.

Journal of the American Geriatrics Society, 6

(50), supplement 205-224.

Horgas, A.L. (2003). Pain management in elderly adults.

Journal of Infusion Nursing, 26,

161-165.

Soscia, J. (2003). Assessing pain in cognitively impaired older adults with cancer.

Clinical Journal of Oncology Nursing

, 7, 174-177

Drayer, R. A., Henderson, J., & Reidenberg, M. (1999). Barriers to Better Pain Control in Hospitalised Patients. Journal of Pain and Symptom Management, 17(6), 434-440.

Yates, P. M., Edwards, H. E., Nash, R. E., Walsh, A. M., Fentiman, B. J., Skerman, H. M., & Najman, J. M. (2002). Barriers to Effective Cancer Pain Management: A Survey of Hospitalised Cancer Patients in Australia. Journal of Pain and Symptom Management, 23(5), 393-405.

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