1- We need to reassure Mrs. J to decrease her anxiety.  Lab work, chest x-ray and ECHO will be needed.  She will need a septic work-up and qualifies for a sepsis alert, however with signs and symptoms of congestive heart failure she may need an inotropic infusion instead of fluid bolus to correct her hypotension.  She may have developed pneumonia from the flu virus and could possibly have a pleural effusion.  The rationale for each of the medications ordered are as follows (U.S. National Library of Medicine, 2015)

1. Lasix      -for pulmonary edema – frothy blood-tinged sputum
2. Enalapril      – an ACE inhibitor is given for heart failure; it works by decreasing      vascular resistance – watch for further hypotension
3. Metoprolol      – a betablocker is for hypertension and heart failure; it slows the heart      rate and relaxes veins – again watch for hypotension
4. IV      morphine is usually for pain, but in this case, it is for the anxiolytic      properties and vasodilation (Naito, Kohno, & Fukuda, 2017).

       Four cardiovascular conditions that cause heart failure are coronary artery disease, myocardial infarction, myocarditis, and congenital heart defects (American Heart Association [AHA], 2017).  One condition is coronary artery disease caused by fatty deposits and cholesterol that clog arteries.  This can lead to the arteries that feed heart muscle becoming closed off resulting in heart muscle damage.  Second, a myocardial infarction happens when an artery that feeds the heart muscle is blocked causing lack of oxygen.  This ultimately results in death of the muscle and pump failure.  The blockage can be from a blood clot that traveled to the heart or from arteriosclerosis.  Another condition is myocarditis.  It is caused by an infection that attacks the heart muscle resulting in pump failure.  Finally, congenital heart defects can result in heart failure because the heart is malformed.  The malformation makes the heart work harder and the blood may not flow in an efficient manner (AHA, 2017). 

    For the most part, being active and eating a healthy diet are important factors to reduce the risks of developing heart failure.  Taking prescribed medications are very important to help improve heart function and reduce the heart’s work load.  For congenital heart defects, the patient may need surgery to correct the malformation; or sometimes, a heart transplant may be required.

    For medication safety,

1. Develop      an accurate medication list for your patient.  This medication list      should be in words the patient can understand and include the name, dose,      time for administration and the reason for each medication.       Encourage the patient to take ownership of her medications and keep the      list up to date.  Take it to every appointment no matter who the      doctor is.  Also, include any over the counter medications and check      for interactions with prescription medications.
2. Have      the patient use only one pharmacy for all of her prescriptions.  The      pharmacist will be able to identify any risks or issues with      contraindications or double medications for the same disease.
3. Have      your patient use a pill dispenser or other reminder system.  The pill      dispenser will not only keep the medications straight but will help the      patient know whether she took her medications for the day. 
4. Ask      your patient to bring her medications (the actual bottles) at least once a      year for evaluations.  This will allow for evaluation of dosages,      expired medications, etc.  This will also allow you to help the      patient dispose of medications that are no longer used or needed.       This will prevent the patient from accidentally taking the wrong pills. 

References

American Heart Association. (2017). Causes of heart failure. Retrieved from https://www.heart.org/en/health-topics/heart-failure/causes-and-risks-for-heart-failure/causes-of-heart-failure

Naito, K., Kohno, T., & Fukuda, K. (2017, July). Harmful impact of morphine use in acute heart failure. Journal of Thoracic Disease, 9(7), 1831-1834. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5542994/

U.S. National Library of Medicine. (2015). Medline plus- trusted health information for you. Retrieved from https://medlineplus.gov/druginformation.html

 

2-Your post is very knowledgeable and in thorough detail. As you have mentioned in your post about  Morphine , is a vasodilator and reduces the workload on the heart and improving blood flow to the heart. Morphine can help to slow the respirations and alleviate dyspnea and anxiety (WebMD, 2019 ). Morphine can be used for pulmonary edema, heart failure and in Myocardial infarction as well. I still remember MONA from nursing school stands for Morphine, Oxygen, Nitroglycerin and Aspirin treatments  for Myocardial Infarction.

 

3-Yes ! that is right, polypharmacy is a very serious  problem in elderly patients. They get easily confused over their medications. Even  with a little stress whether physical or mental, they easily get confused and start missing their meds or can consume too much to relieve their symptoms. Which will  leads them to very critical health issues. So it is health care professionals responsibility to educate them about all the medications they are taking. They should always have all the written information about all their medications and an emergency call number for help.

 
 

4-Ms. J is showing the symptoms of Acute bilateral ventricular heart failure and pulmonary edema (Copstead &  Banasik , 2013). Clinical signs of heart failure are an S3 heart sound and the PMI at the 6th Intercostal space, as normal is at the 5th  and this indicates a shift with the enlarged heart. Crackles in the lungs, + cough, frothy blood tinged sputum, hypoxemia, and dyspnea are signs of pulmonary edema and left sided failure.  The bilateral jugular vein distention and hepatomegaly are two signs of right sided failure. This patient is very critical but manageable and already admitted in Intensive care settings. My priorities would be oxygenate her ASAP and resume all stat medications to make her comfortable. As she is on room air and her SPO2 is 82% only. I will get an order from MD  to put her on “Non Invasive Ventilation” OR BIPAP and call RRT to initiate it right away. Initiating NIV, is a non-pharmacological approach may improve outcomes for patients with heart failure . With this NIV she needs to be sitting in  high fowler position and complete bed rest until stable, cardiac monitor, foley’s catheter insertion to monitor I & O strictly. She also needs to  send all her initial blood work for instance, elytes, CBC, cardiac enzymes and liver enzymes with blood culture.

Medically, she is given morphine and lasix which are perfect treatment for CHF and pulmonary edema. Lasix is a loop diuretic will increase her U/O which will decreases the preload or workload on the heart. She already has foley catheter to monitor her  output. Morphine is a vasodilator and reduces the workload on the heart and improving blood flow to the heart. Morphine can help to slow the respirations and alleviate dyspnea and anxiety (WebMD, 2019 ). She is getting Enalapril, is an ace inhibitor which works by relaxing blood vessels and decreasing blood volume which results in lowering the blood pressure and oxygen demand. Metoprolol is a beta blocker and improves the heart’s ability to relax, decreases heart rate and blocks stress hormones that can cause the heart to enlarge and weaken over time. If metoprolol does not help with her Afib, physician can also prescribe her an  Antiarrhythmic such as amiodarone 150 mgs bolus IV following with infusion as per standard protocol.Which is very effective for Afib. However, her BP is a kind of border line needs to be monitored. While she is on beta blocker or Antiarrhythmic. As she is on strict bed rest and she is already in uncontrolled Afib HR 132/ mnt she is at high risk of developing DVT. She needs Low molecular heparin, dose according to her weight as DVT prophylaxis. For being on BIPAP she needs to be NPO so that she does not aspirat her gastric contents. She also needs gastric prophylaxis to reduce gastric acid production such as ranitidine or pantoprazole.

Four cardiovascular conditions that may lead to congestive heart failure are Coronary Artery Disease, Hypertension, previous myocardial infarction, and valvular disorders. Coronary artery disease results primarily from atherosclerosis which causes a narrowing in the arterial lumen. This causes the heart to work harder and can result in risk for thrombus or myocardial infarction (American Heart Association, n.d.). Hypertension will cause an increase in pressure to the heart over time if uncontrolled and eventually the heart will weaken and not function (American heart Association, n.d.). These conditions can be improved by  educating patients on risk factors and lifestyle changes and by talking their prescribed medications on regular basis. Educating them on smoking cessation programs, healthy diet and maintain daily regular activity and maintain normal weight makes a difference in their treatment . People needs to learn that, being overweight can cause the heart to work harder than normal and cause sleep apnea too. People needs to be Educated on the long term effects of obesity and some ways to help with their weight loss.

Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide rationale for each of the interventions you recommend.

1. Help and teach the patient on keeping an exact record or a list of all  over the counter and herbal medications as well as all the vitamins and minerals that the patient is taking. So as to lessen the opportunity of MD’s requesting prescription that may have drug interaction.

2. Teach the patient on the significance of picking one primary  doctor so as to lessen polypharmacy.

3. Help and instruct the patient on guaranteeing appropriate dosage and recurrence are trailed by utilizing a medicine organizer.

4. Guarantee the patient is taught on every single new medications, indications, potential reactions and potential collaborations.

Reference :

American Heart Association (n.d.).  Causes and risk for heart failure. Retrieved from https://www.heart.org  

Copstead , L., &  Banasik , J.L. (2013).  Pathophysiology (5 th ed.). St. Louis, MO: Saunders  

WebMD (2019).  Heart failure questions and answers.  Retrieved from https://www.webmd.com

 Reply  |  Quote & Reply 

Feb 18, 2019 06:45 PM0 Like

5-Strong work mentioning, strict i & o’s. This is an a really important aspect in heart failure patients to prevent further fluild overload. Mrs. J will  also need to be taught what her dry weight is, and the importance of taking her weight everyday upon discharge. 

 

 
 

6-Ms. J i s showing signs of biventricular heart failure (Copstead &  Banasik , 2013). Crackles in the lungs, + cough, frothy blood tinged sputum, hypoxemia, and dyspnea are signs of pulmonary edema and left sided failure. The bilateral jugular vein distention and hepatomegaly are two signs of right sided failure. Additional clinical signs of heart failure are an S3 heart sound and the PMI at the 6 th  Intercostal space, as normal is at the 5 th  and this indicates a shift with the enlarged heart.  

This patient is unstable which requires an Intensive care setting. Initial interventions would require addressing her hypoxia and dyspnea. Initiate oxygen due to her hypoxia per the physician order and adjust as needed to get her oximetry >90%. Place her in upright position in bed to help alleviate dyspnea. Administer ordered meds (IV Lasix and IV morphine) would be a priority. Cardiac monitoring is critical to monitor her hemodynamic status. Assess for cardiac output by assessing skin for temperature and color, mental status, urine output, and peripheral perfusion. Assess for clinical signs of improvement in her heart failure by auscultating lungs and heart and checking for any peripheral edema or jugular distention (Riley, 2015). Assessing this patient’s response to medications given and if her anxiety is reduced by the interventions. If not, then it would be important to discuss with the physician to order an antianxiety medication as well.  

Lasix, enalapril, metoprolol, and morphine are all used on this patient and are common for heart failure. Lasix is a diuretic and works to remove excess fluid from the body by increasing renal blood flow and blocking sodium and chloride reabsorption. This decreases the preload or workload on the heart. Enalapril is an ace inhibitor which works by relaxing blood vessels and decreasing blood volume which results in lowering the blood pressure and oxygen demand. Metoprolol is a beta blocker and improves the hearts ability to relax, decreases heart rate and blocks stress hormones that can cause the heart to enlarge and weaken over time. Morphine is a vasodilator and reduces the workload on the heart and improving blood flow to the heart. Morphine can help to slow the respirations and alleviate dyspnea and anxiety (WebMD,  2019  ) .  

Four cardiovascular conditions that may lead to congestive heart failure are Coronary Artery Disease, Hypertension, previous myocardial infarction, and valvular disorders. Coronary artery disease results primarily from atherosclerosis which causes a narrowing in the arterial lumen. This causes the heart to work harder and can result in risk for thrombus or myocardial infarction (American Heart Association, n.d.). Hypertension will cause an increase in pressure to the heart over time if uncontrolled and eventually the heart will weaken and not function as well (American heart Association, n.d.).   Inteventio s n to  both of these  conditions include educating on risk factors and lifestyle changes. Educate on smoking cessation programs, healthy diet and activity and taking meds such as antihypertensives and cholesterol lowering meds as prescribed. Myocardial infarctions  ( MI) are caused by a sudden blockage to the myocardium which can cause scarring and lead to  poor  functioning and result in ineffective pumping. Valvular disorders result from stenosis which is a decrease in blood flow or regurgitation when the valve fails to close properly. Educating people on the signs/symptoms of an MI and valve disorders are important for early detection and treatment.  

There are many risks to the elderly for taking multiple medications. The following are interventions I would suggest.  

1. Instruct      patient to carry a list of medications including over the counter to all      physicians. Consulting physicians may not be aware of all the meds that      are prescribed by the other physicians.  
2. Instruct      patient on all meds and side effects. Write out generic and brand name and      include dosage, frequency and reason to take.  
3. Teach      patients or a family member to use a pill caddy to prefill weekly meds to      encourage compliance and that are correctly taking meds  
4. Instruct      patients and families on risk to falls. Patient taking multiple meds are      at a higher risk to fall.  

Reference  

American Heart Association (n.d.).  Causes and risk for heart failure.  Retrieved from https://www.heart.org  

Copstead , L., &  Banasik , J.L. (2013).  Pathophysiology  (5 th  ed.). St. Louis, MO: Saunders  

Riley, J. (2015). Cardiac failure review.  The Key Roles for the Nurse in Acute Heart Failure  Management, 1 (2),  Retrieved from  https://www.cfrjournal.com/article  

WebMD (2019).  Heart failure questions and answers.  Retrieved from https://www.webmd.com

 

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1-Ultraviolet (UV) radiation comes from the sun, sunlamps, and tanning booths. It causes early aging of the skin that can lead to skin cancer. People of all ages and skin tones should limit the amount of time they spend in the sun, especially between mid-morning and late afternoon, and avoid other sources of UV radiation, such as tanning beds. It is important to keep in mind that UV radiation is reflected by sand, water, snow, and ice and can go through windshields and windows. Even though skin cancer is more common among people with a light skin tone, people of all skin tones can develop skin cancer, including those with dark skin. Wear a hat with a wide brim all around that shades your face, neck, and ears. Wear sunglasses that block UV radiation to protect the skin around eyes. Wear long sleeves and long pants. Tightly woven, dark fabrics are best. Some fabrics are rated with an ultraviolet protection factor (UPF). The higher the rating, the greater the protection from sunlight. Use sunscreen products with a sun protection factor (SPF) of at least 15. Ionizing radiation can cause cell damage that leads to cancer.

Reference:

Sunlight and ionizing radiation. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3521879/

 

 
 

2-Educating a person with life style modification (smoking, excessive body weight, safe work place) and removing the factors that can predispose to different types of cancer can enhance the layperson exposure and awareness to the disease. But one point is not clear to me, how can physical inactivity be a predisposing factor to cancer?

3-Modifiable risk factors are a risk factors to cancer, that a person can control them (NCI, 2017). Cancer can be caused by environmental factors, diet and life style however our knowledge to the modifiable risk factors can impact for cancer exposure. Some of the modifiable risk factors for lung cancer are smoking, workplace risk factors, radon etc. so I would educate and recommend my patient to avoid those risk factors. For instance, quitting smoking can decrease the exposure to lung cancer. To do so smokers need advice from experts (counselor) on how to quit smoking such as the use of nicotine replacement products and antidepressants therapy. A person who quits smoking for 10 years can lowers his/her risk of developing lung cancer by 30% to 50% (NCI, 2017).

A safe work place is a work place environment without chemicals that can cause to lung cancer such as asbestos, arsenic, nickel and chromium. In addition to that a work place should be smoke free to avoid secondhand smoke. Prevent high level of radon at your home for example on preventing leakage by sealing the basement (NCI, 2017).

Reference

National Cancer Institute (NCI) (2017) Lung Cancer Prevention (PDQ®)–Patient Version retrieved [online] from: https://www.cancer.gov/types/lung/patient/lung-prevention-pdq

 

4-, after reading your post I stopped to think about the link between nutrition/ lack of activity and cancer.  Cancer does not “run” in my family.  So there is definitely no chromosome issue that is being passed along.  For many, many generations back my ancestors have been farmers.  I even have family in North Carolina who were tobacco farmers.  They did not develop cancer.  I did have one second cousin contract brain cancer.  The doctor felt like it was caused by gasoline.  He was a garage attendant for many years as a teenager and young adult.  This was a time when you could get full service at the gas station.  Anyway, my point is ….i wonder if family after me will start to develop cancer as our society becomes more and more sedentary.  Everyone I know is still very active even though no one farms anymore.  We all have jobs that naturally have moderate activity built into it. Will my grand children become sedentary due to so much automation in our lives?  I guess we will see if things like this start to cause cancer in an otherwise healthy family.

 

5-Developing the Human Papillomavirus (HPV) is a risk factor for developing cervical cancer. This is a group of over one hundred and fifty viruses that can cause symptoms such as warts. The virus can cause infections around the genitals, mouth, throat, and anus, spreading through unprotected sex. Sometimes the infections resolve on their own, but other times the infections can become chronic and lead to cell changes and cervical cancer. HPV can be prevented through the vaccine and practicing safe sex. It is also important to have regular pap smears (American Cancer Society, 2019). I would focus on educating my patients on the importance of reproductive health and seeing their gynecologist regularly. I would educate on the importance of safe sex practices and give vaccination education. 

Reference:

American Cancer Society. (2019). HPV and HPV treatment. Retrieved from 

https://www.cancer.org/cancer/cancer-causes/infectious-agents/hpv/hpv-and-hpv-testing.html

 

6-I think it would be important to educate on the importance of eating healthy and moving everyday. The American Cancer Society website is a great resource to provide them with. They recommend staying lean and maintaining a healthy weight. They recommend that adults have one hundred and fifty minutes of moderate activity each week or seventy-five minutes of vigorous activity. They recommend limiting sedentary activity. They recommend limiting processed food, increasing fruits and vegetables, and choosing whole grain foods (American Cancer Society, 2019). I think all of these recommendations would be important to educate patients in order to decrease their risk of cancer. Even if some of these changes might be difficult for patients to make, if they could start to incorporate some of these behaviors, it could help to make a difference. 

References:  

American Cancer Society. (2019). Summary of the ACS g

 

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1-While there are many types of quantitative research designs, they generally fall under one of two umbrellas: experimental research and non-experimental research. The four most commonly used designs for research studies are descriptive, correlational, quasi-experimental, and experimental.”(Grove, Gray & Burns, 2015).

In experimental design researchers uses random assignment and they manipulate an independent variable around a controlled variable. It is an objective, systematic, and highly controlled investigation conducted for predicting and controlling phenomena (Grove, Gray & Burns, 2015). A true experimental design there must be randomization, a control group and manipulation of a variable when examining the direct cause or predicted relationships between variables. In a quasi-experiment one of these aspects is missing (Sousa, Driessnack & Menders, 2007). As noted in Research Designs: Non-Experimental vs. Experimental (2018), When an experimental research is done correctly, experimental designs can provide evidence for cause and effect. Because of their ability to determine causation, experimental designs are the gold-standard for research in medicine, biology, and so on.

Descriptive and correlational designs can be referred to as non-experimental designs because the focus is on examining variables as they naturally occur in environments and not in the implementation of a treatment by the researcher. Non-experimental research, on the other hand, can be just as interesting, but you cannot draw the same conclusions from it as you can with experimental research. Non-experimental research is usually descriptive or correlational, which means that you are either describing a situation or phenomenon simply as it stands, or you are describing a relationship between two or more variables, all without any interference from the researcher. This means that you do not manipulate any variables (e.g., change the conditions that an experimental group undergoes) or randomly assign participants to a control or treatment group. Without this level of control, you cannot determine any causal effects. While validity is still a concern in non-experimental research, the concerns are more about the validity of the measurements, rather than the validity of the effects.

References

Grove, S., Gray, J., & Burns, N. (2015). Understanding Nursing Research, 6th Edition. Saunders, 092014. VitalBook file.

Research Designs: Non-Experimental vs. Experimental. (2018, July 19). Retrieved from http://www.statisticssolutions.com/research-designs-non-experimental-vs-experimental/

  

2-Experimental research is based around a test having a notable result. Basically, you test a hypothesis out and if the desired effect appears, it may be accurate. Essentially cause and effect. Normally this research will have controls and variables to help clarify the nature of the results. This kind of research is highly controlled to help prevent false conclusions. An example of experimental research would be common drug trials. During these trials, researchers are hoping to either discover new information about their drug or create further confirmation of what they already believe to be true. These tests are highly controlled.

Non-experimental research is based around the observation of behavior in a non-scientific setting. By this I mean that researchers look for possible data correlations by collecting information rather than testing a theory. An example of this would studies where researchers try to connect things like high mortality to a certain lifestyle or food choice. Because of the obvious risk to the patients, they would just collect information rather than staging experiments. The non-experimental model of research is much laxer and not as controlled.

Reference

Grove, S., Gray, J., & Burns, N. (2015). Understanding Nursing Research: Building an Evidence Based Practice (6th edition). St. Louis,MO. : Elsevier.

  

3-  direct experimentation is indeed an excellent ways to obtain and analyze data. The observational changes observed can also be used to plan further studies. However, the preparation and execution of such experimentation is costly and time consuming. In contrast, lived experience of conditions suggested by numerical values found in experimental research is found in qualitative data. This data can be collected in fairly cheap and easy ways. However, the vastness of it and varying nature means that it has to be documented and analyzed by people, with little assistance from a machine (as various responses can be linked to one general value and that may not be easily programmed an algorithm to understand.The essential issues become: 1) Are you looking for qualitative or quantitative data? and 2)What does the data obtained say about the focus of the study? Ultimately, both types of research are necessary and valuable and allow problems to be considered in a detailed manner, differentiating the minutiae. 

 

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1-A stakeholder is an individual, group, or organization who may affect, be affected by, or perceive itself to be affected by a decision, activity, or outcome of a project. Stakeholders are either directly involved in the project or have interests that may be affected by the project’s outcome. Internal stakeholders, such as the administration within the hospital, are essential to the success of any project. External stakeholders, such as suppliers and the community may depend on the success of the project and be affected by the outcome of the project (Harrison, Freeman, & Abreu, (2015).

For the success of my Capstone, internal stake holders need to be informed on the impacts that childhood obesity has and will continue to have on the healthcare system. By managing to decline childhood obesity, the end result will be a reduction in healthcare costs. The external stakeholders in this situation are the people in the community. By developing healthier habits, they can have a healthier population that has less strain on the local healthcare system which will free up more resources for the local facility.

In order to secure the support of internal and external stakeholders, the message will be the same. Educating the population through public health clinics, child care facilities, schools, and churches can have an enormous impact financially and on the lives of the children that are in the community.

References

Harrison, J. S., Freeman, R. E., & Abreu, Mônica C, S. (2015). Stakeholder Theory As an Ethical Approach to Effective Management: applying the theory to multiple contexts. Revista Brasileira de Gestão de Negócios, 17(55), 858-869. https://dx.doi.org/10.7819/rbgn.v17i55.2647

 

 

2-Stakeholders are some of the most important parts of any organization, they can either be internal or external stakeholders but the facility cannot exist or even work without them. This also means that it is very important to involve them in the process of any project being implement in the facility. They are very core at making decisions on what is allowed in the facility and what is not. This is because they have to determine whether that is the right use of their resources, whether it is the right direction for their facility to take (Harrison, 2016). Therefore, they have a very strong position in the facility. For this reason, one needs to gain their support in any project. Without their support, it is very likely that the project will fail. For example, without support of internal stakeholders, implementation will almost be impossible. External stakeholders will also not allow their resources to be used in the project. For this reasons it is important that one gets the stakeholders to support them.

The best way to secure their support is through first looking for evidence to support the project. The stakeholders can be easily being convinced using evidence that supports the project. For the external stakeholders, it is important that one is able to show them how they will benefit from the project. The external stakeholders will do anything that benefits them. Therefore, having evidence that they can benefit from the project is key to gaining support from them. The internal stakeholders can be convinced through showing them that the project is a part of the facility being able to achieve its mission and vision (Blackburn, Blackburn, & Williamson, 2017). The internal stakeholders work to be able to achieve the vision and mission. Therefore, being able to relate the project to the facility’s vision and mission is enough to ensure that the internal stakeholders support the project.

References

Blackburn, R., Blackburn, B. R., & Williamson, R. (2017). Internal and External Stakeholders. Advocacy from A to Z, 47-50. doi:10.4324/9781315647470-9

Harrison, J. S. (2016). Stakeholders. Management. doi:10.1093/obo/9780199846740-0096

 

 

3-Great post. Internal and external stakeholders are equally important for different reasons. The internal stakeholders are your cohorts that can assist you in facilitating the implementation of your evidence-based proposal. The support of your coworkers and their adoption of your initiative is what will help ensure that it remains in place long after the implementation process. External stakeholders include interested parties that benefit from the success of your project. You stated that your project reduces the incidence of maternal death. Insurance companies benefit from projects that aim at preventative measures versus tertiary as they are cost effective. A health insurance company would be interested in the success of your proposal because healthier patients equal less expenditure on their part. Either way as you pointed out communication and support are both necessary to be successful. Thank you for your post!

 

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1-One of the issues that is facing the small community hospital where I live is nursing shortage. Around the world, it seems that larger hospitals are more immune to this problem versus small community hospitals (Cha B. & Choi J., 2015). One way that this affects nurses is in the ED setting. The ED was just added onto to make 23 beds. This is up from 8 beds. Travellers were used for a short time but staff was told that this was not sustainable and the decision was made to only use the correct amount of beds for the amount of nurses that were on shift. The MD’s and other providers insist on filling every room. Two implications for nurses are safety and staff retainability. It is hard for the nurses to feel safe when patient ratios are far above recommended national guidelines. This in turn puts patient’s wellbeing at risk. Secondly, the hospital is having a hard time hiring new staff and retaining current staff. Staff satisfaction has dramatically declined and the word is travelling through the nursing community that it is not a good place to work. 

References

Cha B. & Choi J. (2015).  A Comparative Study on Perception of Patient Safety Culture and Safety Care Activities: Comparing University Hospital Nurses and Small Hospital Nurses. Journal of Korean Academy of Nursing Administration21(4), 405-416. https://doi.org/10.11111/jkana.2015.21.4.405

2-Developing Pediatric Transfer Guidelines based on our available resources and Evidence based practice.

“Additionally, inappropriate transfers to trauma centers may be impacting this finding as well. In a study of patients with orthopedic injuries transferred to Level I trauma centers, Thakur, et al. reported that 52% were inappropriate transfers, and that the majority of inappropriate transfers were uninsured. This transfer effect was not found in Level III or IV trauma centers. Hospitals receiving a larger percentage of transferred patients also have higher proportions of patients requiring critical trauma resources. This is not surprising, as severely injured patients are typically transferred to higher levels of care for specialty expertise and for the management of complex injuries” (Faul, 2015). Nursing staff should be able to ensure the accepting facility has the right resources for the patient.

Developing a Simple SBAR type tool with Standards of Practice for use in outlying facilities and our ED during Transfer Calls. The concept is to improve communication and continuation of care for transferring patients. (ie: if they have give 3 units of RBC, we need to start with plasma.)

“The Joint Commission (2008) has identified effective communication as one of its National Patient Safety Goals. Communication tools like SBAR (Situation, Background, Assessment and Recommendation) can help nurses focus communication to improve the effectiveness of information transfer. SBAR is especially important in urgent or high-acuity situations where clear and effective interpersonal communication is critical to patient outcome” In high acuity, fast paced scenarios a lot of information can be lost or forgotten leading to patient harm (Dunsford, 2009).

Implementing PECARN Imaging guidelines for trauma in the ED & inpatient settings. Leadership from Radiology has asked to be a part of this project.

These are the 3 clinical problems our organization would like us to research and gain positive outcomes from. Clear communication plays a big part in all of these.

Dunsford, J. ( 2015). PubMed. Structured communication: improving patient safety with SBAR. retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/19821914

Faul, Mark (2015). PMS. Trauma Center Staffing, Infrastructure, and Patient Characteristics that Influence Trauma Center Need. retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4307735/#b34-wjem-16-98

3-During this practicum, the clinical problem identified within the organization is a lack of musical intervention to reduce agitation, anxiety, and aggression associated with dementia. The first nursing implication for this topic is non-pharmacological musical intervention to reduce behaviors in dementia patients to improve their quality of life (Millan-Calenti, Lorenzo-Lopez, Alonso-Búa, de Labra, González-Abraldes, & Maseda., 2016) The second nursing implication is a reduction of negative side effects associated with the use of pharmacological interventions to treat agitation, anxiety, and aggression in dementia patients (Ridder, Stige, Gunnhild, & Gold, 2013). Current research supports positive outcomes when musical intervention is utilized as a non-pharmacological intervention in the reduction of negative behaviors seen in dementia patients and this organization and its residents could benefit from the implementation of this evidence-based practice.

References

Millán-Calenti, J. C., Lorenzo-López, L., Alonso-Búa, B., de Labra, C., González-Abraldes, I., & Maseda, A. (2016). Optimal nonpharmacological management of agitation in Alzheimer’s disease: challenges and solutions. Clinical interventions in aging, 11, 175–184. doi:10.2147/CIA.S69484

Ridder, H. O., Stige, B., Gunnhild, L., & Gold, C. (2013). Individual music therapy for agitation in dementia: an exploratory randomized controlled trial. Aging & Mental Health, 17(6), 667–678. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4685573/

 

 

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