A Pediatric Assessment of Kawasaki Disease

/in /by


A Pediatric Assessment of Kawasaki Disease


Introduction

Kawasaki Disease is a rare condition that affects children typically from an infant to 5 years of age.  The disease is named after a Japanese pediatrician Dr. Tomisaku Kawasaki who defined this specific pattern of signs and indicators in 1967. Kawasaki disease is most frequently among Japanese children. The disease has occurred in all racial and ethnic groups in the United States but occurs most often among children of Asian-American background.

This disease causes the inflammation of the blood vessels, which is a type of vasculitis.  The origin of the disease is currently unknown, but it can affect every blood vessel in the body.  The inflammation of blood vessels in the coronary arteries can lead to aneurysms. Without the proper treatment, children can develop heart problems, but if the disease is discovered promptly, most children recover with no long-term effects.

Many researchers believe an infectious agent is responsible for Kawasaki Disease due to the seasonal increases during the winter and spring which coincide with the increase of viruses.   The clinical manifestations of Kawasaki disease include fever, dry conjunctivitis, erythema of oral mucosa and lips, rash, and cervical lymphadenopathy (Schaar, 2013).  The way that Kawasaki disease is diagnosis is based on clinical conditions, including fever for at least five days and four or more of the five major clinical features i.e., dry conjunctivitis, erythema of oral mucosa and lips, rash, and cervical lymphadenopathy.  Incomplete Kawasaki disease is the same as Kawasaki disease, except they don’t meet the full diagnostic criteria of Kawasaki disease.

This study will consist of a comprehensive physical assessment, pathophysiology, examination and, interpretation of diagnostic and lab testing, nursing and medical interventions, safe dosed medication cards, and a thorough explanation describing the means of monitoring, measuring, and supporting the hospitalized child.


Determining the Severity of the Patient’s Condition


Pathophysiology

In this particular case study, a 3-year-old boy of Latino, Hispanic descent, with an admitting diagnosis of Incomplete Kawasaki disease. He was admitted to the hospital for the reason of nausea, vomiting, diarrhea, redness in the eyes, cracked lips, pain in mid-lower abdomen and fever.  The patient has a medical history of Chronic Otitis Media.

Kawasaki Disease is considered an autoimmune disease because it activates several proinflammatory responses in the body.  This patient was exhibiting a fever and rash in response to the body, sending cells and chemicals to defend against an attack against the body.  Inflammation is the main way the body defends itself against harmful stimuli.  The primary physical appearances of inflammation are redness, swelling, heat, and pain.

The patient was admitted to the hospital and was suffering from abdominal pain, nausea and vomiting.  The pain associated with these symptoms, caused the patient to complain of pain and it often disrupted the normal activities of a 3-year-old child.  The patients eating patterns were also disrupted due to severe abdominal pain.   There were no clinical indications of damage to the coronary arteries.  Kawasaki disease can develop inflammation of the coronary arteries that transport blood to the heart muscle, and also cause damage to the heart muscle.

The patient’s level of activity was limited due to vomiting, nausea, and, abdominal pain.  The patient is between babyhood and early childhood stage a period of rapid physical growth.


Diagnostic Test Interpretations

The diagnostic test results will be presented below.  Table 1 shows all of the abnormal lab values of the patient.  Each lab result with regards to the overall diagnosis will be discussed.

The diagnostic test results showed an increase in Neutrophils and a decease in Lymphocytes.  The key role of neutrophils is ingesting and destroying infectious agents.  The abnormal values of the white blood cells suggest an inflammatory condition in the body.

The CBC test is done under many diverse conditions to help assess many different diseases.  CBC with differential evaluates the different cells circulating in our blood.  There are three main types of cells in the blood, red blood cells, white blood cells and platelets.  The differential is a count of all of the different types of white blood cells.  The doctor would have ordered this test for a couple of reasons, one would be to rule out other diseases and conditions and the other would be to confirm the current diagnosis of incomplete Kawasaki disease.   The high level of white blood cells indicated an infection and inflammation.

Erythrocyte sedimentation rate and C-reactive protein CRP were ordered for the patient and the abnormal elevated test results suggest inflammation in the patient. Erythrocyte sedimentation rate and C-reactive protein CRP are tests that indirectly measures how much inflammation is in the body and would be used as a general test to validate an inflammatory condition.  This test is usually elevated to a degree not typically found in common viral infections, so the tests would be beneficial in confirming the diagnosis.  In some cases, the CRP test is more accurate than the ESR.

Typical initial laboratory evaluation may include a urinalysis and microscopic urinalysis, and a comprehensive blood panel, for a pre-diagnosis to ruling out other diseases that cause similar signs and symptoms, and also to strengthen the pre-diagnosis.  A comprehensive blood panel was ordered and the abnormal results showed increased liver enzymes, and it was noted in the patient profile that the gall bladder may be dysfunctional due to Kawasaki disease.

Test

Norms

Results

CRP

0.0-1.0 mg/L

16.8 mg/L

Neutrophils

12.0-40.0%

88.6%

Lymphocytes

45.0-77.0%

4.9%

ESR

0-15 mm/h

78 mm/h

Microscopic Urinalysis (WBC)

0-5/HPF

16-20/HPF

Urinalysis (Ketones)

Negative

Trace

Urinalysis (Bilirubin)

Negative

Positive

Urinalysis (Urobilinogen)

Negative

2.0

Total Bilirubin

0.2-1.2 mg/dl

2.1 mg/dl

Albumin

3.5-4.7 g/dl

3.0 g/dl

BUN

6-23 mg/dl

5 mg/dl

Glucose

65-99 mg/dl

104 mg/dl

AST

0-70 U/L

151 U/L

ALT

3-45  U/L

254 U/L

Table 1

The laboratory tests revealed elevated white blood cell count with neutrophil predominance and elevated C-reactive protein and erythrocyte sedimentation rate.  These findings are typical for the acute phase of Kawasaki disease.  Even though there is no specific test for Kawasaki disease, there are several markers that will be similar, that the physician can look for that will make the diagnosis.

The family should be told that based on the results of the pre-diagnosis tests that we suspect Incomplete Kawasaki disease, but further testing and will need to be done over the next few weeks as more symptoms can occur during the different phases of Kawasaki disease.


Medications

Nurses play an important role in the administration of timely medication. A timely administration of medication to children diagnosed with KD assists in altering or slowing down the progress of Kawasaki disease.


Aspirin

chewable ordered 162mg., P.O., the patient’s weight was 17.7 kg. and a safe dosage for the patient is 30 to 50 mg/kg/day. The patient was on a higher dose due to Tylenol not ordered because of his increase in liver enzymes and the benefit outweighed the risk to help control patient’s fevers. The medication was ordered for pain, inflammation and fevers specific to this patient with some common side effects including bleeding, tachycardia, and more severe duodenal ulcers. Signs of toxicity include (tinnitus, headache, dizziness, confusion). ASA may cause easy bruising and physician should be notified if the child exposed to chickenpox or influenza (risk of Reye’s syndrome). Nursing Implications include administering medication with water, food or milk to decrease GI upset. Monitor pertinent labs while on this medication, for example, platelets, CBC and monitor the patient for any signs or symptoms of bleeding.


Pepcid

(famotidine) ordered 1.11ml., P.O., the patient’s weight was 17.7kg. and a safe dosage for the patient is 1 mg/kg/day. Treats GERD, prevent GI ulcers, heartburn, acid reflux or sour stomach. Common side effects can include dizziness, tachycardia, headache or abnormal heartbeat. May be taken without regards to meals, do not chew or shake vigorously for 10 to 15 seconds before each use. Relevant labs and assessment data contain abdominal pain and tenderness, CBC, gastric PH, occult blood with GI bleeding and renal function.


Zofran

(ondansetron HCL) ordered 1.33ml. I.V. infusion with safe dosing at 0.15mg/kg/dose. The patient’s weight was 17.7kg. Used for this patient to treat or prevent upset stomach, nausea/vomiting by way of blocking serotonin. Common side effects include injection site reaction, anxiety, agitation, dizziness, drowsiness, fatigue, headache, malaise, constipation, diarrhea, increased AST or ALT, fever and abdominal pain. The nurse may administer without meals and monitor labs renal and liver function tests.


Nursing Interventions

  • Monitor vital signs (paying special attention to the temperature and pain)
  • Monitor Intake and Output each shift
  • Encourage oral hydration, adequate fluid intake as indicated
  • Administer antipyretics, analgesics, antiemetics, I.V. fluids, medications as ordered and monitor effectiveness
  • Repositioning as tolerated to decrease discomfort
  • Encourage coping mechanisms and distractions to reduce pain (e.g. car ride in the hallway, playing with stuffed animals in crib)
  • Assess I.V. site (redness, swelling, itching)
  • Implement standard precautions (Handwashing)
  • Educate mom on hygiene that’s appropriate
  • Monitor temperature every 4 hours; every 2 hours if elevated
  • Provide adequate rest periods
  • Administer IV immunoglobulin single dose if ordered (Monitor child’s vital signs closely during IV immunoglobulin administration. Terminate the infusion and report immediately for untoward reactions such as fever, chills, urticaria, chest tightness, dyspnea, nausea/vomiting
  • Assess pain level through observation (verbal expressions of pain, facial grimace), utilizing pain scale assessment, and by obtaining relevant pain information from parents about child’s expression of pain
  • Maintain the child’s room distraction-free and keep it dim
  • Handle the child gently and avoid unnecessary movements
  • Apply lubricating lip ointments and glycerin swabs to the oral mucosa; offer cool liquids and soft foods
  • Remove wet and wrinkled bed linens
  • Family teaching on Kawasaki Disease and it’s treatments (e.g. information on the disease condition, signs and symptoms, diagnostics, and management)
  • Encourage intake of protein-rich foods such as eggs, beans, chicken
  • Assess skin for texture, turgor, color, moisture, and integrity
  • Encourage intake of foods such as salmon, tuna, whole grains, carrots (strengthen mobility and maximize energy production)
  • Assess the child’s energy level and ability to perform ADL
  • Provide client with sufficient time to accomplish mobility-related activities and encourage to rest in between
  • Assist parent(s) with follow up appointments for the child
  • Explain to the parents that irritability is a symptom of Kawasaki disease and that they should avoid feelings of guilt; Encourage them to take some rest while the nurse cares for the child
  • Explain to parents that the child may experience a recurrent fever at home and teach them how to take the child’s temperature and when to notify the physician (temp. greater than 38.4° C/101° F)
  • Encourage parents to express their feelings freely. Reassure parents that some anxiety is appropriate when their child is ill
  • Inform the parents of gentle handling of the child as needed
  • Assess the anxiety level of parents by asking them to rate their anxiety on a scale from 1 to 5


Monitoring and Measuring

Nursing monitoring of Kawasaki disease patients involved checking the pulse rate, respiratory rate, blood pressure, body temperature, and completion of the pediatric early warning score every 4 hours. (Ford, 2000) Monitor for fever as high as 104°F that lasts for more than 5 days, hot, flushed skin, chills or shivering, loss of appetite. Measure with a thermometer used to assess temperature frequently and support with medication administration, for example, aspirin or an IV immunoglobulin, give sponge baths for temperature over 101°F, use a cooling blanket for higher temperatures that do not respond to antipyretics, encourage adequate fluid intake as indicated and provide adequate rest periods.

The patient should follow-up with cardiology after discharge. The patient should be seen at two weeks and then at 6 weeks.  An echocardiogram and electrocardiogram will be done during these visits to check the child’s coronary arteries. If there is no evidence of cardiac involvement, your child’s cardiac risks are extremely low.

Nurses play a vital role in helping to manage Kawasaki disease as they can help make early referral to pediatric department when they suspect Kawasaki disease nurses are responsible for administering medication on a timely basis for easier management, nurses monitor and evaluate the progress of recovering patients while at the same time giving assurances to patients’ family members that Kawasaki disease is manageable. This helps to reduce the probability of parents and relatives of children diagnosed with Kawasaki disease from suffering depression and anxiety due to fear of losing their loved ones.

When a child treated of Kawasaki disease is being discharged from the hospital, the nurse clearly explains a follow-up plan to the parents or relatives of the child being discharged, emphasizing on the need to monitor the child’s temperature at home.


Patient Routines Disrupted

For a young child or infant, being sick and hospitalized can be traumatic.  Being ill and hospitalized can cause a significant amount of stress.  For a young infant that is tired and sick and worn out they need the safety, support and comfort of their home to cope.  When an infant or a child is in the hospital, they may be afraid, lonely in need of their family.

Depending on the child’s age, there will be different activities that get disrupted by a hospital stay.  A child’s playtime and exercise can be disrupted.  As much as possible a child should be encouraged to play to help the child keep their mind off from pain, the illness and the surroundings.  The child’s eating patterns will be changed and the types of foods that they are used to.  This child’s appetite can be affected by the stay at the hospital and the child at times may need to be encouraged to eat and stay healthy.  A child’s sleep patterns can be affected due to medication schedules, foot traffic, and other non-planned interruptions.

The whole family can suffer from stress when a child is in the hospital.  Parents can feel overwhelmed, by the unknown health of their child.  Families oftentimes become anxious when they begin to worry about the illness that their child is facing.  This is a common reaction, but can oftentime tilt a family out of balance.  The parent might begin to feel guilty about the child’s sickness, such as did they cause the illness, or what could they have done differently to prevent the illness.  If the family has to spend a large amount of time in the hospital, it can disrupt the family’s routines, such as work schedules, school schedules and every other routine schedule that the family has been observed.  It can oftentimes become overwhelming trying to balance the demands of work, medical appointments and other necessary medical appointments and meetings.

Attending to the needs of all of your children when your child who is ill requires much of your time and can cause less time to be spent with a partner.   Caring for your child can also leave less time for recreational and social activities.  With all of the anxiety, meetings, time spent in the hospital can bring challenges in looking after your health and well-being.  Depending on the family’s financial condition, insurance, the illness, and financial concerns, can also be a big stressor upon the family.

Parents oftentimes struggle with feelings about the illness that their child is facing, while maintaining a positive attitude to the child.   It is normal for parents to feel some guilt and disappointment for the way your child’s illness if affecting them.  Divorce can be common among families that face serious illness with their children, due to all of the stresses that come upon the family.


Conclusion

This case study presents a 3-year boy of Hispanic descent that was admitted to the hospital with nausea, vomiting, diarrhea, redness in the eyes, cracked lips, pain in mid-lower abdomen and fever.  The admitting diagnose was incomplete Kawasaki disease.  There were several diagnostic tests that were ordered including, CBC with differential, complete blood panel, ESR, CRP, urinalysis, microscopic urinalysis.  The results of the tests help to confirm the diagnosis of incomplete Kawasaki disease based on high white blood cells, high ESR and CRP, high fever for 5 days, and redness in the eyes, cracked lips and abdomen pain.

Nurses play a vital role in helping to manage Kawasaki disease as they are responsible for administering medication on a timely basis for easier management, nurses monitor and evaluate the progress of recovering patients while at the same time giving assurances to patients’ family members that Kawasaki disease is manageable.


References

  • Ford, D. M., & Zerwic, J. J. (2000). Kawasaki Disease.

    AJN, American Journal of Nursing

    ,

    &NA

    (Supplement), 6–10. doi: 10.1097/01.naj.0000370963.58388.42
  • Mclellan, M. C., & Baker, A. L. (2011). At the Heart of the Fever: Kawasaki Disease.

    AJN, American Journal of Nursing

    ,

    111

    (6), 57–63. doi: 10.1097/01.naj.0000398543.44660.be
  • Schaar, G. (2013). Kawasaki Disease: Maintain Your Suspicion.

    The Journal for Nurse Practitioners

    ,

    9

    (7), 473–474. doi: 10.1016/j.nurpra.2013.03.023

Describe your Practicum Project, including the anticipated outcomes and implications for nursing practice in your specialty area.

/in /by

Describe your Practicum Project, including the anticipated outcomes and implications for nursing practice in your specialty area.

 

a brief description of your Practicum Project, including the anticipated outcomes and implications for nursing practice in your specialty area. Explain why your results warrant dissemination. Describe your target audience, and explain which method of dissemination you would use as well as the organization or journal you would choose for sharing findings related to your Practicum Project. Support your response with at least two citations from the literature.MUST BE IN APA FORMAT NO TITLE PAGE NEEDED

OSHAs Hierarchy of Controls Discussion

/in /by



ORDER NOW FOR AN ORIGINAL PLAGIARISM-FREE PAPER:  OSHA’s Hierarchy of Controls Discussion

OSHA’s Hierarchy of Controls Discussion

OSHA’s Hierarchy of Controls Discussion

1.) You have been tasked with establishing and implementing an  effective hearing conservation program for a metal stamping facility.  Noise monitoring shows that employees working in the press areas of the  facility are exposed to 8-hour TWA noise exposures between 85.0 dBA and  89.0 dBA. Based on the requirements of 29 CFR 1910.95, summarize the  requirements for an effective hearing conservation program and discuss  steps to make the program as effective as possible. Please refer to 29  CFR 1910.95(b)(2) for the formula.

2.) Three workers (8-hour work shift) were monitored for work in  different areas of a facility using calibrated noise dosimeters. The  results are summarized in the attached table labeled question 3  attachment.

a. Calculate the 8-hour time-weighted average (TWA) noise exposure for each of the three workers.

b. Summarize which (one) of the exposures exceeds OSHA’s permissible exposure limit (PEL) and/or action level for noise.

c. Discuss what factors about the noise monitoring may have affected the accuracy of the noise measurements.

Show your work for all mathematical calculations. Please refer to  Appendix A to 29 CFR 1910.95 for assistance on how-to solve this  problem.

3.) A plant that manufactures automobile chassis includes a  production area containing 100 robotic welding stations. An adjacent  area contains 10 welding booths where employees perform hand welding  using MIG welders to rework welds that have been identified as  unacceptable. Personal air sampling shows that personal exposures at 5  of the welding booths located in the middle of the rework exceed the  OSHA PEL for lead, nickel, and iron oxide fumes. On average, the  personal exposures exceed the applicable OSHA PEL by 2-3 times.

Using OSHA’s Hierarchy of Controls, write one paragraph for the  hazard scenario above that summarizes your approach to reducing the  risks associated with the hazard. Indicate which type of hazard control  you will use, and describe exactly how it will be used to control the  hazard.

4.) A plant has an operation that produces automotive headliners in a  press. The process uses a compound that contains methylene bisphenyl  isocyanate (MDI). The compound containing MDI must be used in the  production process to meet the client’s specifications for the  headliner. The OSHA PEL for MDI is 0.02 ppm as a ceiling concentration.  Personal air samples collected for 15 minutes at the time when the press  opens show that short-term exposures range from 0.02 ppm to 0.06 ppm.

Using OSHA’s Hierarchy of Controls, write one paragraph for the  hazard scenario above that summarizes your approach to reducing the  risks associated with the hazard. Indicate which type of hazard control  you will use, and describe exactly how it will be used to control the  hazard.

5.) A press area of a plant has six 400-ton presses in operation 24  hours a day, 7 days a week. Personal monitoring using noise dosimeters  has shown that 8-hour time-weighted average (TWA) exposures range from  92.0 dBA to 94.5 dBA.

Using OSHA’s Hierarchy of Controls, write a hazard scenario using the  information above that summarizes your approach to reducing the risks  associated with the hazard. Indicate which type of hazard control you  will use, and describe exactly how it will be used to control the  hazard.

6.) Employees in the paint department of an automotive parts  production facility use styrene to clean residue off the parts as they  come off the paint line. The OSHA PEL for styrene is 100 ppm as an  8-hour TWA exposure. Personal air samples show that during peak  production times, exposures range from 150 ppm to 200 ppm for an 8-hour  shift. The parts cleaning is performed in a small room with one door.

Using OSHA’s Hierarchy of Controls, write one paragraph for the  hazard scenario above that summarizes your approach to reducing the  risks associated with the hazard. Indicate which type of hazard control  you will use, and describe exactly how it will be used to control the  hazard.

Get a



10 %


discount on an order above



$ 50

Use the following coupon code :


NursingPapers

Causes and Treatment of Chronic Kidney Disease

/in /by


1.1

Kidneys consists of outer cortex and of inner medulla, located on either side of spinal cord at T12-L3 vertebrae. Twenty-five percent of cardiac output is received by two kidneys. In retroperitoneal space, kidneys are protected by muscle, overlying ribs and renal fat. Nephron is called functional unit of kidneys, consisting of renal corpuscle, renal tubule, glomerular capsule and glomerulus (Chalouhy,2017). Blood is filtered resulting in urine being formed by kidneys. Filtrate passes through glomerulus, entering renal tubules consisting of proximal and distal convoluted tubule along with the loop of Henle. Capillaries surrounding tubules absorbs water and solutes that are send back into blood via reabsorption. About 90% of water is reabsorbed, secreting wastes that did not pass into the filtrate at the glomerulus into the tubule lumen. When fluid leaves the renal tubule via the collecting system it drains to the minor calyx to form urine. Urine is defecated from the body via urethra (AMBOSS,2019).


1.2


PATHOPHYSIOLOGY

:  As Melanie feeling nausea which may be due to the accumulation of uremic toxins as declining kidney function to excrete metabolic waste. (National Kidney Foundation,2013). Melanie reported of being feeling very tired and the reason behind tiredness are decreased RBC and anaemia. Melanie also complaint of severe headaches and palpations which are the symptoms of kidney failure. (Better health,2018).  Melanie ignored the symptoms for a very long period and delayed treatment has progressed to End-stage chronic kidney failure which is diagnosed after her blood test reports.


COMPLICATION

:


RESPIRATORY PROBLEMS

: Melanie is at risk of developing tuberculosis and other respiratory infections because of her depressed immune system. Factors which effects immunity in patient suffering from chronic kidney disease are uremic toxin, malnutrition, chronic inflammation, alternation of vitamin D and Parathyroid hormone, and therapeutic dialysis. Primary pulmonary oedema can be another health issue in Melanie. Fibrosis can occur following visceral calcification, as excess calcium can deposit into alveolar septae in the lungs. Kussmaul respirations may occur because of metabolic acidosis (Rajmaria,2026).


HEMATOLOGIC SYSTEM:

Melanie is at risk of anaemia, as patient suffering from ESKD is highly suspected to get anaemic because of the reduced production of Erythropoietin (EPO). Healthy kidneys produce EPO, a hormone responsible to produce red blood cells by the bone marrow. Renal failure decreases erythropoietin secretion, as a result body do not produce enough red blood cells and haemoglobin level start dropping in the suspect and result in anaemia. Melanie because of CKD is at risk of haematological changes such as decrease of HCT, MCV and RBC and platelet counts (Rajmaria,2016).


PRURITUS:

Melanie is experiencing Pruritus. Pruritus or itchy skin is a common symptom that often occurs in patient with chronic kidney disease and continues after dialysis. Pruritus is believed to happen   because of the formation of a calcium phosphate precipitate in subcutaneous tissues and result in inflammatory response in the skin. (Mettang, 2014).


Gastrointestinal System:

Decline Kidney function result in kidney’s inability to excrete toxins, because of which Melanie can experience disturbance in gastrointestinal (GI) tract. Anorexia, nausea and vomiting are common risk factors for patient suffering from ESKD. Poor appetite and weight loss because of metabolic acidosis are common in CKD patient (Kidney health,2016).


NERVOUS SYSTEM

: Melanie may have trouble in concentration along with some symptoms of apathy, lethargy, lability, and insomnia. Delusions, depression, mania, and euphoria are the risk factors of ESKD. At the beginning of dialysis treatment, sixty-five percent of patient have peripheral neuropathy. Suspect may experience sensory loss in the lower extremities and muscle atrophy (Rao&Juneja,2018).


RENAL OSTEODYSTROPHY

: Pathological changes in the bones may occur in patient suffering from ESKD and result in renal osteodystrophy. Minimal stress may result in spontaneous ruptures of tendons, especially. Metastatic calcification and vascular calcification deposits also may found in the conjunctiva of the eye, around the joints and in the synovial fluid of joints in Melanie (Kidney health,2016).


CARDIOVASCULAR RISKS

: High blood pressure is another risk factor of chronic kidney failure. Narrowing of Blood vessels and damaging of small blood vessels are associated with high blood pressure.  Kidneys play important role in maintaining electrolytes balance in the body. In CKD, level of electrolytes such as calcium, potassium and phosphorous rises and over time  increases the risk of cardiovascular disease such abnormal heart rhythms and atherosclerosis (Kidney health,2016)


TREATMENT:

  • Anti-hypertensive medication such as Valsartan. (Mayo clinic, 2019)
  • Cholesterol lowering medication (Mayo clinic, 2019).
  • Medication to maintain ideal Haemoglobin level and prevent anaemia such as Eprex (Mayo clinic, 2019).
  • Medications, special diet and regular exercise to prevent fluid overload and oedema (Mayo clinic, 2019).
  • Haemodialysis or kidney transplantation. (MedlinePlus,2019).
  • Special diet: choose diet with limited salt, potassium, calcium and less protein. (MedlinePlus,2019)
  • Limit your fluid intakes. (Mayo clinic, 2019).


1.3

  • Acute kidney disease occurs suddenly, and longer time period is required for someone to be diagnosed with CKD. (Alberta,2019).
  • Usual reason of Acute Kidney disease is disease, dehydration, surgery or injury with severe blood loss, drugs or infection, on the other hand   diabetes or hypertension are considered the most common causes of chronic renal disease. (Alberta,2019).
  • Acute Kidney disease is curable if treated in time while Chronic Kidney disease cannot be reversed. (Mullins et al,2016).
  • Duration of Acute Kidney injury is short while for chronic is indefinite. (Mullins et al,2016).
  • Diagnosis for AKI are often accurate while for CKD is often uncertain. (Mullins et al,2016).
  • Diagnostic test for AKI is usually decisive while for CKD is of limited value. (Mullins et al,2016).


1.4

Melanie is diagnosed with Chronic kidney disease, and treatment option for her is permanent dialysis and kidney transplant. Doctor suggested her haemodialysis creating AV fistula. AV fistula is a surgical procedure, in which an artery is connected to vein most commonly in the arm. AV fistula makes the vein wider and thicker and helps the blood to flow out and into the body faster. During haemodialysis, blood goes into the filter caller “dialyzer” also known as artificial kidney. Blood returns to the body when pumped through filter. Blood pressure is checked continuously by the machine and keep the speed of the blood flow through the filter as well as the fluid removed from the body, during the process. Most commonly people have three session a week and each session lasting for 4-5 hours. Melanie can choose have dialysis done at home, because it will give her flexibility to fit the treatment into her lifestyle rather than trying to fit around fixed dialysis schedules at a satellite or hospital. Moreover, it can save her travelling time and expenses. Melanie need to take care of her AV carefully: by keeping the vascular access clean at all the times, looking for signs of infections such as pain, redness, fewer and swallowing (Sofocleous,2015).


2.1


VALSARTAN:

Administration of valsartan is used to control circadian rhythm and protect the kidneys and heart in CKD patients. The negative effects of renin-angiotensin-aldosterone system can damage target organs, so the medication that suppress this system are useful in patients with hypertension. Valsartan is an Angiotensin II antagonist that produces anti-hypertensive effects. Valsartan inhibits the binding of angiotensin II with AT1 receptor that results in vasodilation, reduction of blood pressure and increase in sodium and water reception (Derg, 2014). Main side effects of Valsartan include constipation, dry mouth, dyspepsia, muscle cramps, drowsiness, insomnia, anxiety and upper respiratory infection (Healthline,2018).


NURSING CONSIDERATION:

Nurses need to monitor the vital signs regularly with patient is initially commenced on Valsartan and after that periodic checks-ups required during treatment. In case of hypotension, dose of diuretics and associated antihypertensive agents can be reduced or ceased temporarily.

Nurses need to monitor for fluid overload through various set of daily assessments and observations such as peripheral oedema, dyspnoea, drastic weight gain in short period and jugular venous distention (Hombar,2014).

Nurses need to give their patient information and education on medication and its side effects and how side effects can be managed to ensure medication adherence.

If signs of angioedema or orofacial swelling occurs. Immediately cease medication, ensure supportive treatment and monitor for airway compromise. (unbound medicine, 2019).


EPREX INJECTION:

People with chronic kidney disease(CKD), commonly suffer from anaemia because of the kidney inability to producer enough natural erythropoietin, a hormone which promotes the red blood cell production by stimulating the bone marrow. Eprex, is a synthetic erythropoietin hormone which increases the production of red blood cells and decreases the need for blood transfusions to treat anaemia. Melanie blood result shows that her haemoglobin level is very low and require Eprex. (Healthdirect,2019).

Side effects include diarrhea, Oedema, Flu-like symptoms, hypertension and infection. (WebMD,2019)


CONSIDERATIONS:


●

Haemodialysis patient having EPREX frequently require an increase in heparin dose because of an increase in packed cell volume to prevent coagulation. Risk of occlusion of dialysis system is involved, if heparinisation is not ideal for a patient (C. Health,2019).

●       Female receiving EPREX therapy have chances of resuming menses, so nurses should discuss the possibility of potential pregnancy and need for contraception with Melanie the patient (C. Health,2019).

●       In chronic kidney failure, electrolytes imbalance may occur, so electrolyte level should be monitored. If high serum potassium level is detected, then along with treatment of the hyperkalaemia, ceasing of EPREX administration should be considered until normal serum potassium level is achieved (C. Health,2019).

●       Nurses need to measure the haemoglobin level in patient receiving EPREX therapy on a regular basis, 10g/L per month is an optimal increase in haemoglobin level in patients with chronic renal failure. Nurses need to ensure that haemoglobin level must not surpass 20 g/L per month, as it involves the risk of an increase in hypertension. When haemoglobin approaches 120 g/L, cessation of eprex should be considered. (C. Health,2019).

●       Education and information on medication and its side effects to patient and family members. (C. Health,2019).


2.


2



Glomerular filtration rate



(GFR)

– a value use to evaluate  level of kidney function. Normal Kidney function are indicated if GFR value is 100-140 mls/min, while < 90 mls/min indicates mild Kidney failure and < 60mls/min moderate. When this value remains < 30 mls/min, it means kidney function has declined severely and < 15mls/min value refers to End-stage Kidney Failure and this situation is incompatible with life, without dialysis or transplantation. Melanie GFR value (15mls/min) indicates that she is suffering from ESKD and require haemodialysis (National Kidney Foundation,2019).


HAEMOGLOBIN:

Melanie blood result show that she is anaemic, which is a common risk factor of CKD. Erythropoietin (EPO), is a hormone produced by kidneys which induces the production of red blood cells from bone marrow. In ESKD, kidneys are unable to produce enough natural EPO to stimulate red blood cell production from bone marrow resulting in anaemia. In case of low haemoglobin level, body do not receive the oxygen it needs, and as a result patient feel easy tired, lethargic, short of breath and irregular heartbeat (Roger,2012).

3)


TEACH BACK METHOD:

Teach-back is a very effective communication technique for ensuring health literacy and information to patient and their families to eliminate any risks out of misunderstanding. It is also, an effective method to assist patient to practice autonomy and make their own independent health decisions. It is a technique to empower patients to better engage in their care. It also enhances health safety and yield positive outcomes by ensuring that the patients have correctly understood their conditions, treatment options and any other important information regarding their health. (Cindy,2015).

According to the teach-back method, provide Melanie all important information on available treatment options explaining all the advantages and risk-factors associated with each option. Ensure Melanie has easy access to the supportive health care -services. Ensure Melanie has access to education program and encourage her to participate in it to empower self -care and autonomy (Wong, et al., 2018).

According to teach back method explanation on haemodialysis therapy and why it is important to limit the fluid intake as well as the strategies Melanie can adopt to limit her fluid intake like: Choose diet with limited sodium and spicy food. Educate patient about the hidden fluid content of some foods such as watermelon, ice-creams, soup and gravy. Cold drinks are recommended over hot. Educate patient to keep themselves cool, as it helps to reduce thirst and need for drinks. Sipping is recommenced, as patient can enjoy the small liquid over longer period. Suggestion on using small glasses or cups for your drink and wisely distributing fluid limits over the day (DaVita,2019). Educate patient to record all fluid intake including treats such as ice. During summer, suggest patients to prefer ice over water. Juice can also be freeze and consumed to satisfy thirst. Tell Melanie importance of Using   mouthwash or brushing teeth  to battle dry mouth. Keep lips moist by using lip balm (RACGP,2019).


Tips to manage with your CKD:


Aim for a healthy weight

and control your blood pressure. Always ask for information to monitor your kidney health and participate actively in treatment.  Remain complained with medications and discuss any concerns with your health team. Seek dietitian advice to develop a diet plan. Choose health lifestyle and do physical exercise routinely. Keep healthy sleep pattern.

Manage your stress and depression

in healthy ways. (RACGP,2019).


REFERENCES:

NURS 4211 Assignment Disaster Planning for Public Health

/in /by

NURS 4211 Assignment Disaster Planning for Public Health

NURS 4211 Assignment Disaster Planning for Public Health

 

By Day 7 of Week 5

Select a potential natural or man-made disaster that could
happen in your community. Then, write a 3- to 4-page paper about the disaster
from the community nurse’s perspective.

Section 1: The Disaster, Man-Made or Natural

What disasters may strike your community and why? For example,
do you live in “Tornado Alley,” or has climate change resulted in unusual cold
weather snaps or blizzards in your community? Are you located in a flood plain?
Include possible diseases that may result from a natural disaster, such as
tetanus or cholera.

Section 2: The Nursing Response

Formulate responses to the disaster, considering systems and
community levels of intervention.

Review websites where a disaster plan may be available for
the public, or if one is not currently available, call public health department
to see if a disaster plan exists for your community and what the plan contains.

In addition to reviewing websites for information about your
local disaster plan, you will need to locate best practice/evidence-based
practice guidelines in professional literature to determine whether your
community’s disaster plan is as sound as it might be or if there is room for
improvement.

Section 3: Is My Community Prepared for a Disaster?

What conclusions can you draw about your community’s
preparedness plan from having completed this evaluation?

For this Assignment, review the following:

AWE Checklist (Level 4000)

BSN Program Top Ten Citations and References

Walden paper template (no abstract or running head required)

The Week 5 Assignment Rubric

Framing the Issue

Disasters happen. Coping with them and recovering and rebuilding afterward are nothing new. Systematic, evidence-based advance planning and preparedness are more novel, however, and seeing disasters as fundamental matters of public health, in addition to matters of public safety, is a recent development with important ethical challenges and implications.

In the United States, emergency or disaster preparedness took on a special urgency in the wake of the attacks on September 11, 2001, and the attacks using weaponized anthrax a short time later. From an initial focus on bioterrorism, emergency preparedness soon shifted to an “all-hazards” approach in recognition that contemporary populations were vulnerable to many different types of insults that cause severe social disruption and threaten human life and health on a large scale. Since then, there have been many occasions around the world to call upon public health emergency preparedness and response and to face the ethical dilemmas that accompany it—such as the hard lessons learned in the devastating earthquake in Haiti in 2010, the flooding and damage to Fukushima Daiichi nuclear reactor in Japan in 2011 that resulted in severe radiation, Hurricane Sandy in the New York city metropolitan area in 2013, and the serious Ebola 2014 outbreak in West Africa in 2014.

Additional public health challenges loom on the horizon, including new strains of pandemic influenza and other infectious diseases and the prospect of long-term climate change with its multiple threats to public health and well-being—including fatal heat waves; intensifying violent storms and flooding, sea level rise and the contamination of fresh water supplies, drought, malnutrition, the spread of zoonotic disease, aggravation of chronic conditions such as allergies and pulmonary disease, and large-scale human migration with attendant sanitation and epidemic side-effects.

The Learning Curve of Emergency Preparedness and Response

A public health emergency exists when the ordinary health service capabilities of a community are overwhelmed by an extreme situation or event. Emergency preparedness is that aspect of public health designed to ensure sustained public health and medical readiness in the event of an emergency, minimize the impact of emergencies on affected communities, and foster safe and healthful environments before, during, and after an emergency.

In 2006 Congress enacted the Pandemic and All-Hazards Preparedness Act (PAHPA) and it was reauthorized in 2013. In general it attempted to coordinate and streamline emergency response at the federal level and to work effectively to support emergency planning and preparedness at state and local levels. It also sought to enhance the capacity of the health care system to respond quickly and effectively. Reflected in that legislation was the expanding and evolving understanding of the challenge of public health generally and both the virtual inevitability of disaster and emergency events and the necessity of building resilient health care and social systems to endure and recover from them.

Emergency preparedness encompasses more than adequate equipment, deployment of health professionals, training, and supplies. It also involves community engagement and participation from the outset of the pre-emergency planning process. Emergency plans drawn up behind closed doors are not sufficient. A much more elaborate and ongoing process of community asset and needs assessment, stakeholder participation, and public awareness and engagement is required. Public trust and confidence are essential in emergency preparedness, and public health decision-making will be most effective generally when it is transparent and has direct links to the communities it serves.

An additional point of consensus in the field today is that emergency preparedness should not be separated unduly from the nonemergency concerns of public health policy and capacity. A well-prepared community is a community in which the population is medically well-served, a strong public health infrastructure is in place, and community-based public health services are robust and well- integrated into everyday life.

Ethical Questions Posed by Public Health Emergencies

Emergency preparedness requires ethical analysis at several different levels. It clearly involves a clinical component and thus professional health care ethics with its emphasis on patients’ rights and well-being and professional fiduciary obligations. In addition, this area involves public health and the intersection between the health and safety of populations and of individuals.

There are several core ethical problems in the domain of emergency preparedness. For example, since it involves state action to control individual behavior, one key issue is the problem of justifying limitations on the liberty of individuals and groups. The complex ethical and social values invoked when coercive measures are included in an emergency plan should be examined before such measures are implemented.

In addition, since emergencies often involve scarce personnel and resources, another issue concerns distributive justice, the allocation of scarce resources, rationing, and triage. Examples are the allocation of vaccines and medications during an influenza pandemic and of mechanical ventilators during an outbreak of acute respiratory disease. Several studies have proposed ethical frameworks and principles to address the triage and allocation of scarce resources issues.

A third major issue concerns accommodating people with special needs and vulnerabilities. Public officials and emergency planners should attempt to identify in advance the potential burdens of emergency preparedness and response measures and take steps to mitigate undue burdens on particular segments of the population through, for example, the provision of special resources and compensation.

Finally, there are a number of ethical issues that pertain to the planning, communication, and coordination process of emergency preparedness. These process and policy issues contain many ethical assumptions that are often implicit, and many consequences that are of ethical concern, both to the types of issue listed above and to the question of legitimacy and trust in  democratic societies under stress due to extraordinary circumstances. They include: 1) the relationship between experts, leadership, and elected representatives on one hand, and the diverse body of citizens and ordinary members of society, on the other; 2) the role of the press and other forms of mass communication in mediating this relationship during emergencies; 3) the obligations and duties of individuals who play important roles in the emergency preparedness process, particularly health professionals, whose professional obligations  may conflict with their personal and family obligations; and 4) the sense of responsibility and cooperation on the part of private citizens that will facilitate effective and ethically sound preparation, response, and recovery in a community.

While the use of coercion, such as mandatory evacuation, or deliberately withholding information from the public should be avoided if possible and as a general rule, such measures cannot be ruled out categorically. The ethical justification of coercion in particular instances will be a matter of context and circumstance. Mandatory evacuation or quarantine may be unavoidable and ethically justified under extreme circumstances. Withholding information from the public may be necessary in order to prevent large-scale panic. It is precisely because measures may be taken in emergencies that would be unacceptable in normal times that public health planners should not wait for disaster to strike before trying to work out a viable scheme of carefully orchestrated decision-making. The role of ethics in the planning phase before a crisis and in the recovery phase afterward is to define reasonably just, humane, and responsible parameters for action and decision-making.

The bioethics of emergency preparedness studies norms and values that are pertinent to how emergency preparedness should be conducted in a generic sense and in regard to specific types of hazard or emergencies. It is common to find the articulation of various frameworks of principles or rules, and in this regard discussions of emergency preparedness emulate and derive from more general works in bioethics and public health ethics. The purpose of such analyses is to provide general principles that can guide particular decisions- made concerning emergency preparedness policies and practical activities. In this approach, the object of analysis tends to be specific actions, choices, and decisions by particular individuals or groups. The actions and agents are critically assessed in light of general ethical norms, and recommendations are made concerning training and procedural or institutional reforms that may lead to improved compliance with these general norms or principles in the future.

Public health ethicist Nancy Kass has identified six questions that should be asked in an ethical evaluation of public health policy and practice: What are the public health goals of the proposed program? How effective is the program in achieving its stated goals?  What are the known or potential burdens of the program?  Can the burdens be minimized, for example, with alternative approaches? Is the program being implemented fairly? How can the benefits and burdens of a program be fairly balanced?

Ethical goal setting has also been an important aspect of work on emergency preparedness. (See “Ethical Goals of Emergency Preparedness and Response.”) The ethical goals proposed are generally based on the notion that the emergency preparedness process ought to be guided by values that are accessible and reasonable to the community as a whole, even as they are subject to an ongoing reinterpretation, clarification, and discussion. These values are the compass points of a general orientation and a mode of thinking designed to increase the likelihood that public health emergency preparedness will be both effective and trustworthy.

In addition to goals, Kass focuses on effectiveness and fairness as ethical benchmarks. Emergency preparedness planning requires accountability in terms of effectiveness and fairness because it is an activity, resting on the legal authority of the state, that involves the use of power. In other words, emergency preparedness and response has an impact, not only on the health and safety of individuals, but also on their liberty, autonomy, civil and human rights, property, and other fundamental interests. In addition to using power, emergency preparedness planning is inherently prone to paternalism, since one of its basic missions is to tell people how to behave during an emergency so as to promote their own best interests.

For example, public health measures during emergencies—such as so-called “social distancing” plans that call for people to remain in their own homes, close schools, and prohibit mass gatherings—require individuals to forgo or temporarily suspend some ordinary civil liberties and freedoms for the sake of the public good and the health of others. Therefore, in the planning phase prior to the onset of an emergency, proposed paternalistic restrictions must be fully explained and justified. Indeed, if the planning and its directives are deliberative, transparent, and publicly justified, emergency preparedness can actually turn into a kind of social contract to which the citizens have given free informed consent. That notion suggests an important theme—namely, that the ethical acceptability of an emergency plan is a function both of its substantive content (what it tells people to do and what the consequences of that are) and of the process through which that content is discussed, formulated, argued about, and ultimately agreed to.

In the aftermath of an emergency or a disaster, experience shows that solidarity and self-sacrifice often give way to disillusionment, recrimination, and even litigation. To mitigate these reactions, it is important to take a “who watches the guardians” approach: there should be ongoing monitoring of the use of authority and power during the implementation of emergency plans. This is to ensure that power and authority are not abused and that paternalistic or coercive measures are justified under the circumstances. This oversight can be accomplished in several ways: by having multiple authorities involved in the emergency response (including federal, state, and local public health officials; law enforcement officials; and elected officials), through press coverage, and through recourse to the courts for relief if government officials exceed or abuse their authority. It is also important to have ongoing and ex post facto evaluation and assessment to gauge the effectiveness of emergency plans, to learn from mistakes, and to make improvements for the future.

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS:NURS 4211 Assignment Disaster Planning for Public Health

Ongoing Ethical Engagement in a Dangerous World

Ethical analysis in public health preparedness planning—by its very nature an ongoing activity—will help engage the public when hard decisions must be made. Emergency plans and mitigation activities should have clearly defined, widely understood, and realistic goals that are reached by consensus. These goals should be pursued and implemented as effectively as possible, given existing resources and information. Ineffective, unduly burdensome, and wasteful policies and practices are not ethically justified.

Officials and planners should attempt to identify in advance the known or potential burdens of the mitigation activity, and identify the segments of the population upon whom those burdens are likely to fall. Moreover, planners and policymakers should attempt to minimize the burdens of the mitigation activity. They should consider alternative approaches to achieve the same goals. They should avoid imposing undue burden on groups unfairly or inequitably.

Fairness should be a feature not only of the outcome of any mitigation activity but also of the way in which it is conducted and carried out. Planners should attempt to make the public health benefits and the accompanying social, economic, and personal burdens balanced and proportionate.

Finally, public trust is key to the success of any emergency planning, and public engagement is one important key to securing and sustaining public trust. Planning processes should be transparent and multiple venues for deliberative citizen participation should be provided for. Meaningful two-way communication, bottom up communication as well as top down communication, is essential. Deliberative planning that is broadly inclusive and participatory is not only the most effective means for creating well-informed and successful emergency plans, it will also strengthen the ethical fabric of the very open, pluralistic society we seek to protect.

Ethical Goals of Public Health Emergency Preparedness and Response

In their book, Emergency Ethics: Public Health Preparedness and Response, Hastings Center Fellows Bruce Jennings and the late John Arras formulated seven ethical goals designed to inform both the content of preparedness plans and the process by which they are devised, updated, and implemented in an emergency situation and its aftermath.

  • Harm reduction and benefit promotion. Emergency preparedness activities should protect public safety, health, and well-being. They should minimize the extent of death, injury, disease, disability, and suffering during and after an emergency.
  • Equal liberty and human rights. Emergency preparedness activities should be designed so as to respect the equal liberty, autonomy and dignity of all persons.
  • Distributive justice. Emergency preparedness activities should be conducted so as to ensure that the benefits and burdens imposed on the population by the emergency and by the need to cope with its effects are shared equitably and fairly.
  • Public accountability and transparency. Emergency preparedness activities should be based on and incorporate decision-making processes that are inclusive, transparent, and sustain public trust.
  • Community resilience and empowerment. A principal goal of emergency preparedness should be to develop resilient, as well as safe communities. Emergency preparedness activities should strive towards the long-term goal of developing community resources that will make them more hazard-resistant and allow them to recover appropriately and effectively after emergencies.
  • Public health professionalism. Emergency preparedness activities should recognize the special obligations of certain public health professionals, and promote competency of and coordination among these professionals.
  • Responsible civic response. Emergency preparedness activities should promote a sense of personal responsibility and citizenship.
Get a
10 % discount on an order above
$ 80

Use the following coupon code :


SAVE20
Did you find apk for android? You can find new
Free Android Games and apps.

Effectiveness of Dementia Care Mapping on Patient Centred Care

/in /by


A report into what is the effectiveness of Dementia Care Mapping (DCM) on patient-centred care for patients living with dementia in care home?

This assignment will explore Evidence Based Practice (EBP), explain what it is and how significant it is in current day nursing which is evidence-based. A clinically researchable question will be formulated and rationale behind the choice of topic will be explained. Details of how the search was conducted will be discussed followed by critically appraising quantitative, qualitative, guidelines and review evidence and finally a conclusion.

Zimmerman (2017) reports that, EBP is a well-recognised standard of care that is essential for health professionals and is an effective decision -making process which includes the best available evidence. Melnyk and Fineout-Overholt (2015) defines EBP as a practical, accurate and clear use of best available evidence that is current in making nursing decisions about care given to individual patients. Zimmerman (2017), Melnyk and Fineout-Overholt (2015) further explain that when EBP is practised within healthcare and with involvement of nurses of different hierarchical levels, best possible clinical decisions are accomplished leading to positive patient outcomes.


NMC (2015) suggests it is a regulatory requirement for nurses to appreciate the value of evidence-based practice, be able to understand and appraise research, apply nursing theory and research findings to their work, and identify areas for further development. However, Hoe and Hoare (2012) suggest that in providing patient care that is effective, safe and evidence- based, nurses are supposed to decide how relevant the evidence is in making clinical decisions without replacing clinical judgement (Godshall, 2010).

Effectiveness of Dementia Care Mapping on patient-centred care in older people living with dementia in nursing homes is my topic. The reason for this topic is to find the best evidence available used to support the use of DCM in dementia care in comparison from not using it. As healthcare professionals it is important that effective care is provided for people living with dementia which is evidence-based. REF

The topic is important to health professionals because the amount of people living with dementia is rapidly increasing and there are available strategies that are evidence-based that can be implemented in healthcare settings. REF

Alzheimer’s disease International (2013) reports that provision of care that is suitable to the growing number of older individuals who are living and dying from dementia is a public health concern and it is a global concern.

Mansah

et al.

(2008) defines Dementia Care Mapping (DCM) as an observational method that is widely used in dementia care to improve person-centred care. This view is supported by Quasdorf

et al.

(2017) who states that, for the intervention to work effectively, DCM must be implemented successfully in care practice.



SEARCH STRATEGY:





The Cumulative Index of Nursing and Allied Health Literature (CINAHL) is the most commonly used health database recommended when searching health related literature which consist of Systematic reviews, Random control Trials (De Bruin and Pearce-Smith, 2014). Dementia is a mental health condition, so literature was searched from Psych Info, Medline and Science Direct.

EBP proposes that clinical problems that emerge from care practice, teaching or research be composed and organised using PICO strategy to find literature. Holland and Rees (2010) define PICO as an acronym for Patient, Intervention, Comparison and Outcome. These four components are the essential elements of the research question in EBP and of the construction of the question for the bibliographic search of evidence. The adequate (well -constructed) research question allows for the correct definition of which information (evidence) is needed to solve the clinical research question, maximises the recovery of evidence in the databases, focuses on the research scope and avoids unnecessary searching state Davies (2011). A literature search was conducted on what is the effectiveness of Dementia Care Mapping on patient-centred care for patients living with dementia? Relevant articles published between 2008 and 2018 were obtained by searching Psych Info and ScienceDirect electronic databases in order to source relevant evidence that is most up to date and still applicable to practice.

The main outcome measure which is “the effectiveness” was used as a search term and combined with the Boolean operator ‘AND’ with other search terms with respect to the disease (dementia or Alzheimer’s) and cognitive impairment or memory loss. This was followed by place of residence which is care home OR nursing home then finally the focus of the research question (determinant or factor) dementia care mapping and patient-centred care.

When search was conducted, more than 500 hits were returned. This made me realise that dementia is a broad subject with a vast of articles that were in English and non-English. At first, I read abstracts and titles to choose articles relevant to my chosen topic.  Studies were eligible if they evaluated interventions or focused mainly on primarily on focused on DCM and PCC for people living with dementia. Both UK and non-UK materials were used.  According to the World Health Organization (2018), the number of people living with dementia worldwide is currently estimated at 47 million and is projected to increase to 75 million by 2030, it is vital for healthcare professionals to learn about non-pharmacological strategies that have been implemented in other countries and have been effective and improved quality of life for people living with dementia. There are many still going researches that are being conducted in a view to find a cure for dementia.



QUANTITATIVE RESEARCH


:

Ingham-Broomfield (2014) defines quantitative research as a study that uses measurable data to answer or explain a phenomenon of interest by collecting and analysing objective numerical data. This is supported by Aveyard and Sharp (2013) who define quantitative research as a study that uses quantifiable variables, presents data in a numerical manner and collecting data using closed questions such as how often, how many and how much. Furthermore, Ingham-Broomfield (2014), Aveyard and Sharp (2013) state that due to strong focus on evidence-based practice in healthcare, it is important for nurses to culture themselves with evidence evaluation.

Watson (2015) reports that randomized controlled trials (RCT) are considered to provide stronger evidence than other quantitative design studies such as cohort studies, case-control studies, or case reports that are quasi or non-experimental for reasons that they are not biased.  Aveyard and Sharp (2013) describes RCTs as studies that experiment the successfulness of a treatment or an intervention between 2 or more groups with a treatment or intervention and a control group.

Hoe and Hoare (2012) emphasised the importance for nurses to learn to critically analysing research technically, Hoe and Hoare (2012 describes critical analysis as a process whereby strengths and weaknesses of a study are evaluated. Nurses must ask questions, such as are the methods appropriate, does the study explain the phenomenon of interest and are the findings useful in checking for credibility (Gordon and Watts, 2011).

Ingham-Broomfield (2014) also agree with Grove

et al.

(2013) that there is no perfect study, hence  an analysis  and clinical judgement  will help nurses decide on the value of findings and how to apply them into practice, despite identified weaknesses which can also be referred to as limitations of the study and these may include areas such as sampling technique and sample size.


Caring for Aged Dementia Care Resident Study (CADRES) of person-centred care, dementia-care mapping, and usual care in dementia: a cluster-randomized trial

by Chenoweth

et al

. (2009) is the quantitative research paper found. It is an Australian study that focuses on dementia care mapping which is used in U.K so the information is relevant even though the healthcare systems are different. Researchers aimed to do a large, randomised comparison of person-centred care, dementia-care mapping and usual care.

The aim of the paper was to measure agitation as a primary outcome using the Cohen-Mansfield agitation inventory (CMAI) and secondary outcomes included hallucinations, quality of life and falls (Chenoweth

et al

., 2009).

Caldwell et al. (2011) suggest that there are numerous frameworks to use when evaluating research studies, the literature suggests areas to consider when critically reviewing reports of quantitative research. This notion is supported by Gray and Grove (2017) who state that title, abstract, introduction; framework, purpose and method are the key areas to critique. This trial addressed clearly focused issue and assignment of patients to interventions was randomised.

Critical Appraisal Skills Program tool (CASP 2018) is the tool used to critique this trial. This tool has been trialled by healthcare professionals and it is in a form of a checklist (Aveyard and Sharp, 2013). The title clearly and accurately illustrates the content of the trial including information of the population and the design giving the opportunity to determine if the paper was relevant to the topic as it answers the research question and is a RCT. The trial has shown that both person-centred care and dementia-care mapping seem to reduce agitation in people living with dementia, however there were more falls with person-centred care.



QUALITATIVE RESEARCH


:


Grove, Burns & Gray, (2013)

described qualitative research as a collection of descriptive data gathered in people’s own words, written or spoken and recording people’s behaviour. Qualitative researchers are mostly concerned with the meaning people attach to things in their lives (Grove , Burns & Gray, 2013) .Harvey and Land (2017) state that qualitative researchers understand people from their own frames of reference and experiencing reality as they experience it, furthermore, Harvey and Land (2017) adds that qualitative researchers sympathise with people they study in order to comprehend how these people see things and still able to separate or suspend their own perspectives and taken for granted interpretations of the world.

Qualitative methodology is more than a set of data- gathering technique; it is a way of approaching the empirical world.  Glaser and Strauss (1967) state that qualitative research is strengthened by numerous theoretical perspectives such as post-positivist, constructivist-interpretive, critical, feminism and post-structural. According to Borbasi and Jackson (2012), qualitative research consists of five approaches namely phenomenology, ethnography, grounded theory, exploratory and descriptive.

Maz (2013) describes “grounded theory” as an inductive theorizing process involved in qualitative research that has a goal of building theory especially if there is no previous investigation has been conducted on the research topic Maz (2013) further explains that qualitative research is inductive, meaning  researchers develop concepts, insights and understanding from pattern in the data rather than collecting data to assess preconceived models, hypothesis or theories.

Munhall (2012) state that qualitative evidence is placed lower than the quantitative evidence because it is not replicable and qualitative research does not have statistics on which evidence can be based in the hierarchy of evidence rank. Healthcare professionals can gain understanding into certain problematic questions using an investigative method such as a qualitative research according to Cutcliffe and Ward (2014).


The role of leadership in the implementation of person-centred care using Dementia Care Mapping: a study in three nursing homes

by Rokstad et al. (2015) is a qualitative literature found. The study is a non-UK based paper conducted in Norway but still contain relevant information for the chosen topic.

The study shows insight into how important leadership is for the implementation of nursing practice. However, the empirical knowledge of positive leadership processes enhancing person-centred culture of care in nursing homes is limited (Rokstad et al. 2015).

The study has a clear statement of the aims of the research and research design is appropriate, however trustworthiness is paramount when critiquing this research because it considers credibility, dependability and conformity (Polit & Beck ,2010). The researcher explained how participants were selected and ethical issues were taken into consideration.




GUIDELINES:

Aveyard and Sharp (2013) defines guideline as a set of specifications, standards or criteria which are systematically developed to be followed when delivering evidence-based care. In medical science, guidelines are referred to as a series of suggestions that are published by official associations or institutions where independent experts exist for the management of illnesses (Lee et al.2015).

Woof et al. (2012) refer evidence-based clinical guidelines as clinical pathways or care protocols. Furthermore, Woof et al. (2012) suggest that clinical guidelines have become a paramount feature of patient care which is evidence based. However, health professionals need to refer to published guidelines when delivering evidence-based care in daily practice.

Woof et al. (2012) further explain that the overall aim of clinical guidelines is to improve the efficiency and effectiveness of delivery of care by equipping health professionals and patients with information that aid to make best clinical decisions.

This notion is supported by Graham et al. (2011) who define clinical guidelines as statements of recommendations with the drive of improving patient care. Moreover, guidelines are expected to evaluate the available options in the present circumstances and recommend proper solutions for certain problems.

Furthermore, these guidelines are kept up to date constantly by a methodical evaluation of the current evidence and review of other care alternatives and the possible harm they pose to patients as well as the benefits (Woof et al. 2012).

According to Grove et al. (2013), separate guidelines may be created by different institutions even though they are on the same subjects. The expert panel will provide a guideline with the best available evidence to health professionals for making clinical decisions in practice, however Aveyard and Sharp (2013) state that the challenging part is to overcome obstacles to implementation of EBP to get positive outcomes for patients, healthcare agencies and families.

Health professionals and patients may not adhere to guideline recommendations immediately or automatically due barriers such as financial or organizational constraints, lack of knowledge about the guidance and resistance to behaviour change, nonetheless active implementation through regulation, financial incentives and education and communication might improve adherence to guidance and minimise suboptimal care for patients reports (Grol ,2010 & Rapu, 2005).

In medical practice, guidelines are mostly established on category level of the evidences, and they present the strong point of recommendations. (Gordon &Watts,2011). Systematic review and good-quality randomized controlled trials (RCTs) deliver the best reliable and valuable sources and create Level 1evidences and Grade A recommendations. (Gordon &Watts,2011).

National Institute for Health Care Excellence (NICE), (2016) state clinical guidelines can be limited in their applicability and purposefulness due to research evidence that is unique and of high-quality to patients when providing care that is patient-centred.

When searching for a clinical guideline, NICE guidelines have been used and

Dementia: Supporting people with dementia and their carers in Health and Social Care

, is the guideline located (NICE, 2016).

NICE guidelines are developed with an evidence-based approach namely Grading of Recommendations Assessment Development and Evaluation (GRADE) (NICE, 2011). Guidelines lacking the methodological components, especially on topics with enough evidence, whilst conveying the (unstructured) opinions of clinical experts in the field, have a significant risk of providing recommendations that are biased that may be then used to guide patient care (NICE,2009a)

The above guideline is written clearly with statement recommending interventions to support people living with dementia and their carers. There is evidence to show that delivering care that is person-centred help reduce agitation in patients living with dementia in different health care settings.



REVIEWS:

There are two main types of reviews and these are systematic and non-systematic review. Grove, Burns & Gray, (2013) describes systematic review as a comprehensive structured synthesis of literature research to inform the best research evidence available to address a healthcare question.

This view is echoed by Nelson (2014) who explains that a systematic review is a special type of literature that confers added advantages that uses systematic and explicit methods to identify, select and critically appraise relevant research, and to collect and analyse data from the studies that are included in the review.

Craig and Smith (2012) state that, systematic reviews are characterized by being methodical, comprehensive, transparent and replicable and they are used to regulate the existing information for use in practice and for the improvement of national and international standardized guidelines for management of health issues. Furthermore, they include a systematic search process to locate all relevant published and unpublished work that addresses one or more research questions, as well as a systematic presentation and synthesis of the characteristics and findings of the results of that search (Craig & Smith ,2012).

As reported by Higgins and Green (2011), systematic reviews are becoming increasingly popular as they enable consistency to the research. Their nature means that they tend to be of higher quality, more comprehensive, and less biased than any other types of literature review, which makes them more likely to be published and to have an impact and if done well it is an important substantive contribution to knowledge (Higgins and Green ,2011).

Aveyard and Sharp (2013) describes non-systematic review as a critical assessment and appraisal of some but not all research conducted on a specific subject where the researcher does not use any method that is organised when gathering evidence. Non-systematic reviews can also be referred to as descriptive or narrative for they lack detail, research question, search strategy and synthesis of literature or method of appraisal (Aveyard and Sharp ,2013). This view is echoed by Higgins and Green (2011) who state that non-systematic reviews lack trustworthiness, credibility and they are biased.


Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials (Livingston

et al. 2014) is the review found from the search conducted. The aim of this review is to review evidence of a randomized controlled trial regarding non-pharmacological interventions systematically. The criteria for inclusion and exclusion in the systematic review are clearly stated and consistently implemented such that the decision to include or exclude particular studies is clear to readers and other researchers. In this study all participants had dementia and they were all analysed separately. The study evaluated non-pharmacological interventions for agitation and agitation was measured quantitatively. Studies were excluded if every individual was given psychotropic drugs or some participants received medication as the sole intervention (Livingston et.al 2014). The results showed that person-centred care and adapted dementia mapping decreased symptomatic and severe agitation immediately, but the review concluded that there are evidence-based strategies for care homes and further research is needed for people living in their own homes (Livingston et.al 2014).



CONCLUSION:

In the healthcare system, nurses lead EBP to facilitate the evidence-based nursing process, nurses must have the knowledge and skills to formulate clinical questions in a searchable manner. EBP is application of research evidence and dissemination into clinical practice directly and health professionals must promote and support use of EBP so that positive patient outcomes can be achieved and also improve clinical practice. Through conducting this research topic about dementia care mapping and patient centred care for people living with dementia, I am now aware that these non-pharmacological interventions are effective, the improve patient quality of life. It is essential for healthcare workers to familiarise themselves on where to find evidence based information and recommendations and to have better knowledge.



REFERENCES:

  • Alzheimer’s Association. (2016). 2016

    Alzheimer’s disease facts and figures. Alzheimer’s and Dementia

    , 12, 459-509.10.1016/j.jalz.2016
  • Aveyard, H. and Sharp, P. (2013).

    A beginner’s guide to evidence-based practice in health and social care.

    Maidenhead: Open University Press.
  • Aveyard, H. (2014).

    Doing a literature review in health and social care

    . Maidenhead: McGraw-Hill Education.
  • Bench, S., Day, T., Metcalfe, A. (2013).

    Randomised controlled trials: an introduction for nurse researchers.

    Nurse Researcher, 20(5), pp. 38-44.
  • Burns, N. and Grove, S. (2009)

    The Practice of Nursing Research: appraisal, synthesis and generation of evidence

    , 6

    th

    edn. Saunders, St Louis.
  • Caldwell, K., Henshaw, L., & Taylor, G. (2011).

    Developing a framework for critiquing health research: An early evaluation.

    Nurse Education Today, 31(8), e1-e7. Doi: 10. 1016/j.nedt.2010.11.025
  • CASP-

    Critical Appraisal Skills Programme. (2018). CASP Checklists- CASP – Critical Appraisal Skills Programme

    . Available at: https://casp-uk.net/casp-tools-checklists/ Accessed 15 Dec.2018.
  • Coulter, A., Entwistle, V., Eccles, A., Ryan, S., Shepperd, S. and Perera, R. (2015)

    Personalised care planning for adults with chronic or long-term health conditions.

    Cochrane Database for Systematic Reviews. No. 3.

    https://doi.org/10.1002/14651858.CD010523.pub2

    . Accessed 12 Dec. 2018.
  • Craig, J. and Smyth, R. (2012).

    The evidence-based practice manual for nurses

    . Edinburgh: Churchill Livingstne Elsevier.
  • Cutcliffe, J. and Ward, M. (2014).

    Critiquing nursing research

    . Luton: Andrews UK.
  • Ellis, P. (2010).

    Understanding research for nursing students

    . Exeter: Learning Matters
  • Davies, K. (2011).

    Formulating the evidence-based practice question: A review of frameworks.

    Evidence Based Library and Information Practice 6 (2):75-80.
  • Gough, D., Oliver, S., Thomas, J. (2017).

    An introduction to systematic reviews.

    2nd ed. London: Sage.
  • Grol, R. (2010).

    Has guideline development gone astray? Yes

    . British Medical Journal.340, c306
  • Graham, D., Oliver, S., Thomas, J. (2017).

    An Introduction to systematic reviews

    . 2

    nd

    ed. London: Sage.
  • Hoare, Z., & Hoe, J. (2013).

    Understanding quantitative research:

    Part 2. Nursing Standard, 27(18), 48-55.
  • Ingham-Broomfield, R. (2014).

    A nurses’ guide to quantitative research.

    Australian Journal of Advanced Nursing, 32(2), 32-38.
  • Lachance, C. (2014

    ). Nursing journal clubs: A literature review on the effective teaching strategy for continuing education and evidence-based practice.

    The Journal of Continuing Education in Nursing, 45(12), 559-565. doi:10.3928/ 00220124-20141120-01
  • Maz, J. (2013).

    Employing a grounded theory approach: core characteristics

    . British Journal of Cardiac Nursing, 8(9), pp.453-458.
  • Nelson, H. (2014).

    Systematic reviews to answer health care questions.

    Philadelphia: Wolters Kluwer Health.
  • NICE. (2018).

    Benefits of implementing NICE guidance.

    Available at: https://www.nice.org.uk/about/what-we-do/into-practice/benefits-of-implementing-nice-guidance Accessed 12 Dec. 2018.
  • Nursing and Midwifery Council (2015)

    The Code: Professional standards of practice for Nurses and Midwives.

    London. NMC
  • Polit, F and Beck, T (2010)

    Essential of Nursing Research: Appraising Evidence for Nursing Practice,

    7

    th

    edn, Wolters Kluwer: Lippincott Williams &Wilkins.
  • Watson, R. (2015

    ). Quantitative research. Nursing Standard

    , 29(31), 44-48. doi:10.7748/ns.29.31.44.e8681
  • Woolf, S., Schünemann, H., Eccles, M., Grimshaw, J. and Shekelle, P. (2012).

    Developing clinical practice guidelines: types of evidence and outcomes; values and economics, synthesis, grading, and presentation and deriving recommendations

    . Implementation Science, 7(1).


What philosophies or strategies did Spaeth utilize and what are your opinions on his approaches?

/in /by

What philosophies or strategies did Spaeth utilize and what are your opinions on his approaches?

 

Interview with Ronald G. Spaethe, FACHE.

In Unit 3 you will a report based on the article, interview with Ronald G. Spaeth FACHE, president , Evanston Northwesten Healthcare Foundation, Northbrook, Illinois, which can be found online at:
http://search.ebsccohost.com.lib.kaplan.edu.edu/login.aspx?
direct=true&db=rzh&AN=2009408202&site=eds-live

Your project should include thorough responses to the questions below , but you are not limited to these questions only.

A, Summarize Spaeth’s work and educational background and the award highlighted in this article.

B, What philosophies or strategies did Spaeth utilize and what are your opinions on his approaches?

C, What school of management from Chapter 2 do you think Spaethe most uses and why?.

D, What are the biggest obstacles facing today’s health care administrator, according to Spaethe?

E, For you, the graduate student in health care administration, what lessons can be learned from interview?

Study into pain management of Phlebitis

/in /by

Intravenous therapy is an infusion of medicine and fluids into a vein. IV therapy is essential part of clinical use. There are also complications which included in IV infusion are local and systemic, local include thrombophlebitis, infiltration, extravasations, nerve injury and systemic include bacteremia, septicemia, emboli, thrombus, circulatory overload etc .

Thrombophlebitis,”Thrombo” means “clot” “Phlebo” means “vein” and “itis” means inflammation. Thrombophlebitis refers to the presence of a clot plus inflammation in the vein. Phlebitis is defined as the acute inflammation of internal lining of the vein Infusion Nursing Standards of Practice (2000).

According to international association of pain (IASP) (1994), “pain is an unpleasant sensory experience associated with actual and potential tissue damage”.

The pain is classified as nociceptive, neuropathic, acute and chronic pain. The nociceptive pain is caused due to damage to somatic or visceral tissue damage which pain from surgical incision ,a broken bone, or arthritis ,the neuropathic pain is caused by damage to peripheral nerves or CNS which include trauma, inflammation ,metabolic diseases like diabetes mellitus, tumors, toxins, and neurologic diseases such as multiple sclerosis and acute pain is dure to post operative pain ,labour pain, and pain from trauma and the chronic pain is for longer periods due to cancer.

Pain is a highly unpleasant and professional sensation that cannot be shared with others. It can occupy all a personal thinking, direct all activities and change a person. Yet pain is a difficult concept for a client to communicate. Pain is universal experience its exact nature becomes mystery. Unrelieved pain presents both physiological and psychological hazards to health and recovery. Care givers should include assessment of pain as a fifth vital sign to emphasize its significance and to increase the awareness among the health care professional of the importance of effective pain management. There are many non pharmacological measures which is provided including massage, exercise, transcutaneous electrical nerve stimulation, percutaneous electrical nerve stimulation, accupunture heat therapy, cold therapies, and cognitive therapies including distraction ,hypnosis and relaxation strategies.

Edema which is the accumulation of fluid in subcutaneous tissue due to extracellular volume expansion. There is swelling of tissues which can be demonstrated by pressing lightly with the thumb over a bony prominence especially on dorsum of feet and around the ankles. The types of edema include hydrostatic edema, oncotic edema, inflammatory and traumatic edema and lymphatic edema.

Phlebitis can be classified into 3 three categories which include mechanical, chemical and bacterial where mechanical is due to the size of cannula is too big for the selected vein causing unnecessary friction on the internal lining leading to inflammation, chemical phlebitis is due to peripheral IV devices when the medication or solution irritate the endothelial lining of the small peripheral vessel wall and bacterial phlebitis is usually precursor to an infection at the infection site. Thrombophlebitis is evident by localized pain,redness, warmth, and swelling around the insertion site or along the path of the vein,immobility of the extremity because of discomfort and swelling.

Non pharmacological treatment includes discontinuing the IV, applying a warm compress, elevating of the extremity, and restraining the line in the opposite extremity .In the presence of signs and symptoms of thrombophlebitis, one should not attempt to irrigate the line.

Pharmacological and non pharmacological agents are available for relief of pain, edema and inflammation. The cost and side effects are comparatively high in modern medicine. The number of client seeking unconventional treatment has risen considerably. Nonpharmocological therapies, natural therapies, cryotherapies, and aromatherapies are available with less expensive and fewer side effects. Likewise in combact aloveragel is also very much used in reducing pain, edema and severity of inflammation.

For local treatment in order to relieve pain, edema and severity of inflammation alovera gel can be used. Since in the era of Ancient Egypt humans having using aloe. They used one of the ingredients of embalming fluid. In the tenth century, the Europeans were introduced, where it became an important ingredient in many herbal medicines. By the sixteenth century, aloe arrived in the West Indies, where still today it is harvested.

Alovera is one of the therapeutic herbs as a healing plant. The uses of aloe of popularized in 1950’s itself.There are over 300 different types of aloe, but only a few were used traditionally as an herbal medicine. In the middle ages the yellowish liquid found inside the leaves was a favored as purgative. Aloevera gel is the mucilaginious gel produced from the centre (the parenchyma) of the plant leaf. It contains 400 species.The gel portion of the plant is prepared by peeling the outer portion of the skin and the pericap away. It is preparation which is called pure aloevera gel in commerce. Aloevera is thick, tapered with spiny leaves grow from a short stalk near ground level. It is not a cactus, but a member of the tree Lilly family known as Aloe Barbandesis. Some species , in particular Aloevera are used in alternative medicine and in home first aid .Both the translucent inner pulp and the resinous yellow exudates from wounding the Aloe plant are used externally to relive skin discomforts. The gel found in the leaves is used for soothing minor burns, wounds and various skin conditions like eczema and ringworm.

Aloevera gel has both antimicrobial and anti-inflammatory effects. The constituents include gibberlin,lectins,lignins,glucose ,mannose, glucuronic acid other polysaccharides including galctogalacturans and galactoglucoarabinomannas.The most abundant constituents is water(99%).The aloevera gel contain anti-inflammatory agent gibberlin and polysaccharides which effectively decrease inflammation and promote healing.Aloevera effectively relieves pain because it contain salicylic acid .Aloevera contain ligin which helps to penetrate deeply into skin to deliver its therapeutic effects.

Most of the nursing interventions fit comfortably within the real of the natural therapy’s the illness healing paradigm shift and converge, and role of nurses shifts can gives to the healer. Therefore aloevera gel could be a suitable intervention which helps the nurse to reduce pain, edema and phlebitis.

NEED FOR THE STUDY

IV therapy has become a pervasive world wide as a routine therapy. Nurses yearly still insert, use and monitor millions of peripheral venous catheters (PVC).To diagnose and assess phlebitis severity is essential as a way to prevent a host of severe complications such as septic phlebitis, bacteremia, septicemia, arthritis, osteomyleitis eventually leading to death. However it is still prone to associated complications, of which phlebitis is most common, with prevalence varying between 20% to 80% Workman (2000).

Villicampa (2008)Spanish review a national multicentric epidemiological study having the institutional participation of 10 centres. In this study 381 complications appears in the 2701 peripheral catheters studied which represents an incidence level of 14.11%.They reviewed 8700 treatment records this study proved that implementation of strategies to improve the quality of care reduces non instrumental complication persistent pain at the entrance point ,extravasations of edema, second or third degree phlebitis and infection associated with catheters.

Nassaji Zaveareh (2007) conducted a prospective study on peripheral interventions catheter related factor .In this study 300 patients admitted to medical and surgical wards from April 2003 to Feb2004 were participated. Variables evaluated were age ,gender, site and size of catheter ,type of insertion and underlying condition were observed for 3 days continuously. Out of that 26 % occurred phlebitis . There were no significant relationship between age catheter bore size trauma and phlebitis. Related risk factors were gender,ie.,female site and type of insertion of catheter, diabetes mellitus and burns. Important role of nurse is to control pain that of thrombophlebitis.

The quality of care received in the hospital was often reflected in client care. Among paramedical profession, nursing personals were inserting intravenous line, monitoring, administering intravenous fluids and administering medicines. Maintenance of peripheral intravenous cannulae and removal of peripheral cannulae was an integral component of nursing care.

Nordell, et al.,(2002)in a study of 52 patients, found 5 diagnosed cases of thrombophlebitis (10% ) .Out of fifty two patients twenty six hand or wrist venipunctures, he found 3 with thrombophlebitis.Also he had done Fifteen forearm punctures produced the other 2 cases of phlebitis while of the eleven patients undergoing antecubital fossa venipuncture, none were found to have developed thrombophlebitis.

The reported incidences of thrombophlebitis vary from a low of 2% 21 up to 15%.33.One well-controlled Swedish study of over 1000 cases reported venous complications of many types at 31% is having thrombophlebitis.

Singh , Bhandary ( 2007) , Dhulikhel Hospital Kathmandu University Teaching Hospital, Nepal carried out a prospective observational study to determine the occurrence of peripheral intravenous catheter related phlebitis and to the possible factors associated to its development.A total 230 patients under intravenous catheter were selected peripheral infusion site was examined for signs of phlebitis once a day using jackson Standard visual phlebitis scale and the result obtained was 136(59.1%)patients developed thrombophlebitis. Related risk factors as found in the present study were insertion site (forearm), size of catheter (20G) and dwell time (>=36 hours). There were higher incident of phlebitis among the client with Intra venous drug administration and especially between ages 21 – 40 years. Therefore more attention and care are needed in these areas by the care provider.

In another study the overall phlebitis rate was 39%. Phlebitis developed in 53% of patients with short lines, in 41% of patients with midsized lines, and in 10% of patients with long lines, and these catheters remained in place an average (± SD) of 3.0 ± 2.4 days, 4.6 ± 3.4 days, and 7.8 ± 6.6 days, respectively. The variables that influenced the development of phlebitis, as determined by multivariate analysis, type of catheter, blood hemoglobin levels, and IV therapy with either corticosteroids or erythromycin

Lutter et al.,conducted a retrospective survey to identify the complication of venous catheterization in the left lower limb and right lower limb for 1,143 patients. Patients occurred phlebitis in 56% in left lower limb 51% in right lower limb.

Aloevera has salicylic acid which include in analgesic effects, it contains ligin which helps to penetrate deeply into skin to deliver the therapeutic effects, it contain anti-inflammatory agent gibberlin and polysaccharides which decrease inflammation and promote healing.

Netherlands, conducted a prospective study on treatment of superficial thrombophlebitis with aloevera gel in relieving the local pain, swelling and redness. In this 116 patients were selected with thrombophlebitis and applied for a period of 3 days. The efficacy of aloevera was recorded. There is a drastic improvement in patient received aloevera gel as treatment than the control group Winchers IM (2005).

The investigator selected this study because during her clinical experience has observed the many patients who had admitted in the hospital with cannula, developed the catheter related complications such as blockage, pain, redness and thrombophlebitis. This incidence insists the investigator to do some intervention to overcome this problem. Nurses need to be equipped with current interventional skills in relieving the pain, edema severity of inflammation and to prevent and treat complications.Hence the investigator interested in assessing the effectiveness of aloveragel in thrombophlebitis patients in reducing pain, edema, and severity of inflammation.

STATEMENT OF THE PROBLEM:

A study to assess the effectiveness of aloveragel in reducing pain, edema and severity of inflammation among thrombophlebitis patients in selected hospitals at Kanyakumari District May 2010.

OBJECTIVES

To assess the pretest level of pain, edema and severity of inflammation for the experimental and control group.

To assess the post test level of pain, edema and severity of inflammation in experimental and control group.

To compare the pre test level of thrombophlebitis between experimental and control group.

To compare the posttest level of thrombophlebitis between the experimental and control group.

To compare the pre and post test level of thrombophlebitis for both the experimental group.

To compare the pre and post test level of thrombophlebitis for both the control group.

To associate the post test level of thrombophlebitis of the experimental and ontrol group with their selected demographic variables.

OPERATIONAL DEFINITION

Assess

Systematically and collecting, validating and communicating the patient data.

Effectiveness:

In this study effectiveness means reduction of pain and edema and severity

of inflammation of thrombophlebitis patients after the administration of aloveragel.

Pain

Refers the discomfort and irritability felt by the patient intravenous infusion

site due to inflammation of vein and it is assessed by numerical pain scale.

Edema

Refers to the swelling in the infusion site and assessed by edema scale.

Phlebitis:

Refers to the redness which is occurred due to the intravenous infusion and is assessed by phlebitis scale.

Aloeveagel:

Refers to green leaves when it is teared which contain semi solid liquid and is applied in affected site.

ASSUMPTION

Pain,edema and severity of inflammation among thrombophlebitis can be reduced in adults by applying Aloveragel.

Patient with thrombophlebitis at intravenous infusion site have pain , edema and inflammation .

HYPOTHESIS

RH1 – There is a significant difference in pre test level of pain, edema and severity of

inflammation between experimental and control group.

RH2 – There is a significant difference in post test level of pain, edema and severity of

inflammation between experimental and control group.

RH3 – There is a significant difference in pre and post test level of pain, edema and

severity inflammation among thrombophlebitis patients in experimental group.

RH4 – There is a significant difference in pre and post test level of pain, edema and severity of inflammation among thrombophlebitis patients for control group.

RH5 – There is a significant association of post test level of pain, edema and severity of

inflammation among thrombophlebitis patients with their selected demographic

variables (age, sex, site,duration etc).

DELIMITATION

The study is delimited for 4 weeks of data collection.

The study is limited to a sample of 60 adults.

CONCEPTUAL FRAME WORK

Conceptual model presents certain views of phenomena in the world that have profound influences on our perception of that world. A model is a simplification of reality or representation of reality. Concepts in the model builds consider relevant and as aids to understanding.

The study is mainly focused to find out the effectiveness of aloeveragel in reducing pain,edema and severity of inflammation among thrombophlebitis patients. In order to reduce pain,edema and severity of inflammation aloveragel was applied.

The investigator adopted the King’s Goal Attainment theory (1980) as a base for developing the conceptual framework. Imogene King’s Goal attainment theory is based on the personnel and interpersonal systems, including interaction, perception, communication, transaction, role, stress, growth and development, time and action.

PERCEPTION:

Refers to person representation of reality. It is universal yet highly subjective and unique to each person. Hence the investigator perception was peoples may have pain,edema and severity of inflammation

JUDGEMENT:

The investigator judged that application of aloeveragel reduces pain,edemaand severity of inflammation thrombophlebitis patients. The investigator to judge the need to reduce the level of pain,edema and severity of inflammation.

ACTION:

The investigator applied aloeveragel. The thrombophlebitis patient willingness to accept aloeveaagel and participate in the study.

REACTION:

The investigator and to asset mutual goal setting.

INTERACTION:

Refers to verbal and non verbal behavior of individual and the environment or two or more individual with a purpose to achieve goal. It includes the goal directed perception and communication. Here the investigator interacts with the thrombophlebitis patient by giving aloeveragel applied 3 times per day.

TRANSACTION:

Refers to an observable, purposeful behavior of individual interaction with their environment to achieve the desired goal. At this stage the investigator analysis the pain,edema and severity of inflammation among thrombophlebitis patients in order to administer aloeveragel application.The positive outcome in post test is the reduction of pain,edema and severity of inflammation which indicate the aloeveragel application.

OUT LINE OF THE REPORT

The report is divided into 6 Chapters:

Chapter I – dealt with background of the study, need for the study,

statement of the problem, objectives, operational definitions, research hypotheses, assumptions, delimitations of the study, conceptual framework and outline of the report.

Chapter II – relates with review of related literature pertaining to

various areas of study.

Chapter III – contains with the research design, variables, setting of the

study, population, sample, sample size, sampling technique, criteria for sample selection, development and description of the tool, content validity, reliability of the tool, pilot study, procedure for data collection and analysis of the study.

Chapter IV – presents the data analysis and interpretation of data

Chapter V – relates with discussion based on the findings of the study.

Chapter VI – includes summary, conclusions, nursing implications,

limitations and recommendations of the study.

The report ends with bibliography and appendices.

Dementia Care Training for Nurses

/in /by



Improving Dementia Care Training for Registered General Nurses and Adult Student Nurses: examining the need, efficacy, content and barriers.

This Independent Project aims to explore the efficacy of current provision for Dementia care training for Adult branch Student Nurses and Registered General Nurses (RGN’s). A range of audits and research literature on this area of special interest will be examined to obtain a better picture of the situation with an aim to discover a recommendation for whether more training in this area is needed. The content and provision needs of training will also be explored with barriers to effective care and training critically analysed.


Introduction

Dementia is an umbrella term used to describe a wide range of symptoms caused by certain diseases or conditions associated with decline in a person’s cognitive abilities such as memory, personality changes, impaired reasoning and use of verbal language, which are severe enough to reduce a person’s ability to perform every-day activities (Chater and Hughes 2012). The most common of these diseases is Alzheimer’s reference. Dementia is progressive and incurable, therefore it is vital these people are supported and cared for by nurses who have been trained with the skills and knowledge needed to deliver high quality evidence based care. ADD IN STRONG REFERENCE THAT TRAINING IMPROVES QUALITY EVIDENCE-BASED CARE.

There are currently 800,000 people with dementia living in the UK, with these figures expected to rise by 40% over the next 12 years and by 156% over the next 38 years due to an ageing population. Evidence from the Department of Health (2012) shows that 95% of these people are over the age of 65 and are therefore more likely to have complex medical needs. As a result; they spend increased time in acute hospital wards under the care of RGN’s, making training in this area for this group of health professionals a contemporary issue which needs exploration (Department of Health 2012) .

  • The rising number of patients with dementia presents a challenge for all acute hospital trusts and many different health professionals. Such patients experience higher mortality rates and are more likely to have longer lengths of stay than others, they are also more at risk of falls and other incidents whilst in hospital (Cornwell et al 2012). Aside from the cost implications to the NHS when trusts do not get to grips with this challenge, the patients are not getting appropriate care – they are not ‘living well with dementia’ (Department of Health 2009). The National Dementia Strategy set a clear vision that people with dementia and their carers should be helped to live well with dementia, no matter what the stage of their condition or where they are in the health and care system. Through examination of Dementia training efficacy, it is hoped a recommendation will be made to improve the lives of those living with Dementia through changes in Dementia Care training for RGN’s.

Following initial exploration of evidence available surrounding Dementia care training, the following issues will be addressed and critically analysed:



  1. Why is Dementia Training for RGN’s needed?


  2. How can the efficacy of training on Dementia care for RGN’s be




    improved?


  3. What content should be used in Dementia care training?


  4. What are the barriers to implementation of Dementia care training?


  1. Why is Dementia Training for RGN’s needed?

Patients admitted to acute hospital wards with dementia have comparatively poorer outcomes regarding length of stay, mortality and further institutionalism (DH 2009, Alzheimer’s Society 2012). In addition, this group of patients place higher demands for nursing care, are more likely to functionally decline during admission and suffer increased rates of delayed discharge. This can result in permanent decline in health and added costs to NHS trusts (Mukadam and Sampson 2011). Though thought by many to be due to their complex health needs (REFERENCE), The Health Foundation (2011) has suggested a significant reason for these poorer outcomes is lack of professional understanding by RGN’s in providing appropriate care.

Improvement in Dementia care is currently a nationwide health initiative reference. National audits over the last 5 years have recommended implementation of dementia services such as dementia lead nurses, standardised assessment and care protocols and compulsory staff training (DH 2009, Harwood et al. 2010, Thompson and Heath 2013, RCP 2013). Yet there are many recent reports of poor and sometimes negligent care suggesting these recommendations have not yet been followed or implemented (Leung and Todd 2010, Francis 2013, RCP 2013). Results from the National Audit of Dementia Care in general hospitals indicated that nurses working on acute wards rated significantly lower adequacy of training than nurses working on care of elderly wards. Other audits such as Counting the Cost report (Alzheimer’s Society 2009) indicated that more than half of nurses had not received any pre or post registered dementia training.

Elliot and Adams (2011) further identify the lack of understanding around Dementia, meaning the needs of older people with Dementia are not addressed in many acute hospital settings. As can be seen, the need for specific training in Dementia care for RGN’s is strong.

There is evidence to support positive influence on effective care with training. The National Audit of Dementia Care in General Hospitals (NAD 2012) was commissioned by Healthcare Quality Improvement Partnership to address the concerns of care for people with dementia (Tadd et al. 2011). These audits aimed to identify hospital’s provision of assessment, care models and staff training. Following the 1

st

round of audits in 2011 a report by Thompson and Heath concluded that the main barriers to providing good care were lack of understanding of the condition, not enough time to care and failing to communicate with patients. Improvements are not as forthcoming in dementia assessment on admission to acute wards. Results from the 2

nd

round audit of NAD acknowledge that there had been improvement in implementation of staff training frameworks in hospitals since the 1

st

round audit and represented an improvement in care as a result (Royal College of Psychiatrists 2013).

The 2

nd

round report highlighted that approximately 75% of hospitals now provide dementia awareness training to nurses, although almost 50% are still failing to provide dementia awareness training as part of induction programmes. The report suggests that further improvement is required in providing better and more consistent staff training, as despite some progress, there appears to be a gap between actual training and written reports (RCP 2013). As a result, the recommendations outlined and analysed in this Independent project may be of some use in raising positive statistics.



  1. How can the efficacy of training on Dementia care for RGN’s be improved?

It is the evaluation of this evidence which aims to generate key recommendations for provision of Dementia care training.

Elliot and Adams (2011) were able to show improvements in needs met where specific education for RGN’s is provided by a Dementia Nurse Specialist (recommendation number 1). This shows the role of the Dementia Nurse Specialist to be vital in improving the efficacy of Dementia training and infiltrating best possible evidence-based care into clinical practice. However, despite this, the minimal numbers of Dementia Nurse Specialists currently practicing has to be identified as a limiting factor. In many trusts and academic institutions, there is no availability for a Dementia Nurse Specialist to provide training, therefore limiting efficacy even when extensive training is to be provided (Knifton et al. 2014).

In terms of training content, it is well documented that evidence used should be reliable and credibly underpin clinical practice as this promotes evidence –based practice and better health outcomes (Jeffs et al. 2013). Evidence based practice is vital in all nurses’ roles (REFERENCE NMC CODE). REFERENCE suggests up to date qualitative and quantitative research is the only knowledge and information base which should be used to allow best care to be provided, hence placing important value of increased use of evidence based research in training sessions. Currently, Moyle et al. (2008) suggests the lack of research used to underpin Dementia training for RGN’s is limiting ability to not only provide best care but also identify those living with Dementia (Chang et al. 2009) RECOMMENDATION 2. However, barriers to evidence based care remain even when high quality evidence is used to support training. Smith-Strom and Nortvedt (2008) have identified that RGN’s often find evidence difficult to interpret and evaluate while Oermann (2009) suggests very little of the content is retained to be implemented into practice. This suggests RGN’s may also need training on evidence based practice and processing research (REFERENCE). Gerrish (2008) suggested the knowledge and skill of the individual nurse prior to receiving specific training heavily influenced their ability to improve their practice following. This suggests multiple training sessions on Dementia may be needed before practice can be changed and improved (REFERENCE). RECOMMENDATION 3.



  1. What content should be used in Dementia care training?

Tadd et al. (2011) explain that one reason for increased functional decline is that care of patients on acute wards is prioritised from the perspective of the medical condition for which they have been admitted, often overlooking their mental health condition. Most acute wards follow rigid, task driven routines such as drug rounds, meal times and washing, while staff lack the necessary skills required to provide proficient dignified care. This form of nursing can cause increased anxiety and delirium resulting in poorer outcomes for individuals (Tadd et al. 2011, Calnan et al. 2013). Alzheimer’s Society (2009) report that patients admitted to acute hospital wards for longer periods are more likely to suffer from permanent worsened effects of dementia and physical health. They are more likely to receive prescribed antipsychotic drugs and to be discharged to residential care rather than their home (Thompson and Heath 2013).

Leung and Todd (2010) acknowledge that specialist services do exist in some trusts and that training in managing behaviour, using life stories and implementing dementia care mapping are all good techniques that can help nurses to improve quality care. Dementia care mapping is an observational method of recording interactions that take place between individuals and nurses over a period of time (Ervin and Koschel 2012). This enables evaluation of what works and doesn’t work for patients, it is a useful way of tailoring person-centred care to help staff understand the experience of dementia from the patient’s perspective while rating quality of care given (National Institute for Health and Clinical Excellence and Social Institute for Care Excellence 2007) (NICE-SCIE).

Alzheimer’s Society (2013) suggest that nurses must challenge their task driven ward environment and provide a more flexible approach providing care from the patient’s perspective as this is achievable and beneficial to patients. Leung and Todd (2010) reported that most nurses have received little or no training and are ill equipped to deal with the many challenges that face both patients and nurses. Additionally NICE (2013) state that nurses suggest dementia education programmes should include identifying signs and symptoms, communication and person-centred care methods, treatment to include medicine administration and how to monitor side effects, particular emphasis was placed on requirement to assess pan. Nurses also suggested that learning about the impact of dementia on the individual and managing challenging behaviour would be useful. Dementia training is not a compulsory element of the pre-registered nursing curriculum although this has been recommended to the Nursing and Midwifery Council (NMC) by several national organisations. (NICE-SCIE 2007, Alzheimer’s Association 2009, All-party Parliamentary Group on Dementia 2012, Higher Education for Dementia

Network 2014 (HEDN)). The NHS Confederation (2010) recognise that providing dementia training to staff could benefit hospital trusts in several ways. These include nurses being equipped to identify those with dementia, therefore being able to implement care pathways appropriate to patients. Effective management of patients with dementia helps avoid disorientation and anxiousness which could reduce the amount of time spent attending to challenging behaviour and allow staff more time to care for all patients on an acute ward.



  1. What are the barriers to implementation of Dementia care training?

Even when effective dementia training has been provided, barriers to good quality evidence-based care remain and it is important these do not go unnoticed. Identification and knowledge of these barriers alone can minimise their limiting factor (reference). Acute hospital settings pose many challenges to both patients with dementia and the nurses caring for them. Yet Harwood et al. (2011) report that there is little evidence of research aimed at investigating these challenges and the provision of detailed policies on how to deal with them. Patients with dementia are more likely to find an unfamiliar environment unsettling, frightening and confusing due to the nature of impaired cognitive ability (Moyle et al. 2008). This accounts for literature suggesting that an acute ward environment comprised of identical doorways and bed spaces causes added confusion to patients (Reference). This often creates increased disorientation, aggression or withdrawal (Leung and Todd, Thompson and Heath 2013). This further challenges the nurse’s role in maintaining nutritional, personal hygiene and drug administration tasks as individuals can no longer respond to familiar faces, environment and daily routines (Tadd et al. 2011).


Barriers


Overcoming the barriers

The government accepts improvements are needed and is pinning hopes on the £3.8 billion Better Care Fund, which will was launched in April 2015. The pot has been earmarked for joint projects between the NHS and local government to encourage more integrated care.



STUDENT NURSES


2015 report: Dementia education to bestandardised at degree level

  • some nursing degrees offer only three hours of dementia education throughout the whole three-year course.
  • How this should change following the dementia core skills framework, but it doesn’t state how many hours students will be required to undertake.
  • Student nurse attitudes towards working with the elderly



Future plans for RGN’s

HEE 2013 Mandate targets. – ensure that tools and training opportunities in dementia are available to all staff by the end of 2018.



Current training requierments of RGN’s in relation to Dementia training



References

Department of Health (2009) Living well with dementia: a national dementia strategy. The Stationery Office, London.

National Institute for Health and Clinical Excellence/Social Care Institute for Excellence guideline (2006) Dementia: supporting people with dementia and their carers in health and social care. NICE/SCIE, London.

What are the physicians trying to accomplish through buying the same EHR product as their hospital? What are the pros and cons?

/in /by

What are the physicians trying to accomplish through buying the same EHR product as their hospital? What are the pros and cons?

Paper, Order, or Assignment Requirements

Chapter 16

Electronic Health Records

Margret Amatayakul, MBA, RHIA, CHPS, CPHIT, CPEHR, FHIMSS

Real-World Case

Community Hospital has a single-vendor hospital information system (HIS) that provides typical financial and administrative information systems services, including laboratory, radiology, and pharmacy information systems, and order-entry/results review. Other ancillary departments such as dietary, physical therapy, nursing, and others are not online. The hospital participates in a cardiac care registry but abstracts data from their paper charts to contribute to the registry. The health plans servicing the community are starting to offer incentives for use of health information technology if positive patient outcomes can be identified. Community hospital is considering acquiring a CPOE system to reduce medication errors.

Physicians who are affiliated with Community Hospital have expressed interest in acquiring EHR systems for their practices but are waiting for the hospital to make a vendor decision concerning CPOE. They believe that if they acquire an EHR from the same vendor as the hospital, they will be able to write orders from their offices for patients who are in the hospital, have better access to the information they need to monitor their patients, and be able to tap into other providers’ EHR systems when they are covering in the emergency department.

The hospital and representative physicians are reviewing vendor products but are confused by what various vendors are telling them. One vendor has suggested that the hospital does not have the type of pharmacy information system that would support CPOE and thus would have to also buy a new pharmacy system. A vendor selling EDMS has suggested scanning and COLD feeding all the current chart forms from all provider settings into one repository so that they would be readily available when needed in an emergency. In the meantime, a couple of physicians purchased a stand-alone electronic prescribing device. They can send prescriptions to the major chain pharmacies in the community, but not to the community pharmacy, nor are they told they can get an interface written between the device and the clinical pharmacy in the hospital that would be needed for CPOE.

Real-World Case Discussion Questions

What are the physicians trying to accomplish through buying the same EHR product as their hospital? What are the pros and cons?

Why can’t the physicians send a medication order to the hospital from their e- prescribing device?

What is the difference between scanning, COLD feeding, and point-of-care (POC) data entry?

How could the hospital improve upon its data quality?

Application Exercise: #3

Search the web for information on the issue of usability and making the EHR more user friendly. What are some of the key issues clinicians have using today’s EHRs and what are some of the proposed means to overcome these issues?

<script src=”https://mylivechat.com/chatinline.aspx?hccid=91177560″ type=”text/javascript”></script>
<p style=”text-align: center;”><span style=”color: #418c00;”><img class=”alignleft wp-image-8359″ src=”https://www.nursingtermpapers.com/wp-content/uploads/2015/09/smile.jpg” alt=”smile” width=”50″ height=”57″ /></span><span style=”color: #418c00;”><img class=” wp-image-8359 alignright” src=”https://www.nursingtermpapers.com/wp-content/uploads/2015/09/smile.jpg” alt=”smile” width=”50″ height=”57″ /></span><span style=”color: #418c00;”>PLACE THIS ORDER OR A SIMILAR ORDER WITH NURSING TERM PAPERS TODAY AND GET AN AMAZING DISCOUNT </span></p>
<a href=”https://www.nursingtermpapers.com/place-order”><img class=”aligncenter size-full wp-image-8236″ src=”https://www.nursingtermpapers.com/wp-content/uploads/2015/10/get-your-custom-paper.png” alt=”get-your-custom-paper” width=”380″ height=”101″ /></a>