Comment 18983671

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COMMENT1

Ulcerative colitis (UC) and Crohns disease are inflammatory bowel diseases, not to be confused with inflammatory bowel syndrome (IBS). Describe the differences in symptom manifestations, and how those manifestations relate to where the disease presents in UC and Crohns. What patient education is important for each and what treatment options are available? I look forward to reading your comments!

COMMENT2

GI bleeding can occur in the upper or lower GI tract and can be acute or chronic. What are the different manifestations of GI bleeding and how can you determine where the bleed originates based on the symptoms? Discuss the common diagnostics, treatment and patient education for GI bleeding.

 
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Comment 18980607

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comment1

Hypertension, high cholesterol and triglycerides, type 2 diabetes, sleep apnea are actual health risks that Mr. C. has. He is also at risk for cancer, cardiovascular disease, stroke, and death as a result of his obesity as well (Cleveland Clinic, 2018).

~Is bariatric surgery an appropriate intervention? Why or why not?

At 68 in. and 134.5 kg Mr. C. has a BMI of 47.8. According to the Cleveland Clinic a BMI greater than 40, and negative health effects such as hypertension, diabetes as a direct result of this morbid obesity, makes you an ideal candidate for bariatric surgery (2018). As Mr. C. has many of these negative health effects it would be appropriate for him to have the gastric surgery.

Mr. C. has been diagnosed with peptic ulcer disease and the following medications have been ordered:

Magnesium hydroxide/aluminum hydroxide (Mylanta) 15 mL PO 1 hour before bedtime and 3 hours after mealtime and at bedtime.

Ranitidine (Zantac) 300 mg PO at bedtime.

Sucralfate/Carafate 1 g or 10ml suspension (500mg / 5mL) 1 hour before meals and at bedtime.

comment2

Problem number one that I identified for Mr. C is the desire for bariatric surgery without any expressed attempts at losing weight. He has been heavy most of his life which may indicate some genetic predisposition but even with the surgery it is very important that patients practice self-control in making better choices with diet and exercise (Mayo Clinic, 2017).  Problem number two is type two diabetes. Mr. C would require some more testing to diagnose (A1C) but with the lifestyle choices he has made he along with other comorbidities such as obstructive sleep apnea, low HDLs and high triglycerides, he is definitely at risk for decreased insulin sensitivity leading to a whole host of problems (Mayo Clinic, 2017). Problem number three is the hyperlipidemia  as evidence by the lab values provided. Hyperlipidemia can lead to atherosclerosis, which in turn can lead to much more serious problems like stroke, heart attack, and death (Lewis, Bucher, Heitkemper, & Harding, 2017). Problem number four is the potential for coronary artery disease (CAD). Mr. C displays a lot of risk factors associated with CAD such as obesity, sedentary lifestyle, hyperlipidemia and hypertension (Lewis, Bucher, Heitkemper, & Harding, 2017). Problem five is his mental well-being. Stress is a risk factor for all of the other problems listed before this point. Physiologically cortisol levels increase the way the body stores fat, decreases metabolism, decreases the secretion of testosterone all of which contributes to Mr. Cs eating habits, weight gain, blood glucose, and perpetuates the whole negative state of health and of consciousness (American Psychological Association, 2018).

 
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Comment 19028129

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Comment1

My personal preference for scholarly databases, of those listed by GCU, is the CINAHL Complete. It is described as “the definitive research tool for nursing and allied health professionals with access to the top nursing and allied health journals” (Grand Canyon University, n.d., para 1). I have found that using the CINAHL database has provided me with the most comprehensive articles and information throughout the duration of my career as a nurse. I also tend to utilize the Joanna Briggs Institute EBP alongside the CINAHL database. The Briggs database “is a recognized global leader in evidence-based healthcare resources…[including] evidence summaries, evidence based recommended practices, best practice information sheets, etc…” (Grand Canyon University, n.d., para 3).

These databases, and those listed in the GCU Library are far superior to using Google Scholar or a general internet search. The databases listed above are first and foremost, medical specific. The information obtained in a search on either database will reveal only articles and information related in a medical aspect. Secondly, the use of traditional search engines, like Google Scholar, does not allow for the user to apply as detailed specificity to the search as could be in a database search. This in turn results in a “grab bag” of results that make it difficult to determine what is accurate information and what is not (LibGuides, 2018, para 5). Lastly, the use of databases remains consistent; meaning that standard web searches and results found on those websites can change without notice. This leaves room for error and for a loss of content to occur; you may not see the same information twice with a Google Scholar search (LibGuides, 2018, para 6)

comment2

The first one that I found helpful in aiding my research is the CINAHL database.  There are more than 4 dozen nursing specialties that are covered in the journals on their engine.  It provided you with the most current practices, continuing education and evidence base best practices (Grand Canyon University, n.d).  Secondly, the Joanna Briggs Institute will also help me in finding scholar information to support my EBP proposal.  It offers the best evidence base practices and systematic reviews.  These two databases are better than google scholar articles because it has been researched by specialist and proven before publication.  Articles that are found on google scholar or internet may not reliable because they can be written from opinions.  Since being a student at GCU, I have also found the databases to be valid, the peer review articles have reliable sources and have been thoroughly researched.  By also filtering it to what you are looking for, you can also find the most current practices.

 
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Comment 19022271

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Comment1

How we present as leaders is very important. A nurse leader should possess traits that allow them to be effective, a nurse leader exhibits:

                Passion and positivity

                Sensitivity to others needs including patients, colleagues and all staff

                Decisiveness in actions

                Supportiveness to staff goals and career moves

                Solution-oriented

The nurse leader that has these qualities grooms others to grow and accept change, which encourages working together to create positive change.

When attempting to implement change in the work place it is important to recognize and reward individuals when good performance is demonstrated.

Comment2

Moving stage—The change agent clarifies the need to change, explores alternatives, defines goals and objectives, plans the change, and implements the change plan. The change agent develops a plan of action after identifying possible objections and reasoning and includes all parties that will be affected by the plan. The change agent serves as a resource and point support during the implementation of the plan, then evaluates the efficacy of it, and modifies if applicable.

3. Refreezing stage—The change agent integrates the change into the organization so that it becomes recognized as the status quo. If the refreezing stage is not completed, people may drift into old behaviors. Rather than the plan being identified as new, the change agent ensures that it is recognized as the standard of care. Involvement and education are key to successful change. To be effective clear, two-way communication and a concerted effort to garner information and feedback from all affected parties are needed. Education and training also are important components of effective change as it can reduce fear of the unknown and allow the staff to feel prepared and comfortable with taking on new or different responsibilities (Cherry & Jacob, 2016).

 
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Comment 19021199

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Comment1

Clinical nurse leader role (CNL) is  a new specialty developed in nursing to prepare highly skilled nurses    to focus on the improvement of quality and safety outcomes for patients. According to IOM report on 1999 large number of death occurred as result of avoidable medical errors. In response to this   American Association of Colleges of Nursing(AACN) launched the role of clinical nurse leader ,to educate and strengthen nurses to improve safety, quality and better outcomes of care delivered. The CNLs provide education to all and corporate with evidence based practice (“Clarifying the clinical nurse leader role: guardian of care – American Nurse Today”, 2018).

 The clinical nurse leader (CNL) is an advanced clinician with master’s level education. Education is necessary to bring clinical competence and knowledge to serve as a resource to entire nursing team. CNLs  who works with multi-disciplinary team of physicians, pharmacists, social workers clinical nurse specialists’.CNL collect and evaluate treatment results .CNLoften manages other nursing staff and even serve as a resource to the entire team.CNL s require strong problem  solving and critical thinking skills to evaluate the quality of patient  care (2018) .

Comment2

Clinical nurse leaders (CNL) are nurses that can be described as advanced generalists. They serve general populations within medical care. CNLs will deal with oncology patients, bariatric patients, cardiology patients, etc. These patients will have a variety of diagnoses and treatment plans that the CNL will have to be familiar with. As such this places CNLs as prime educators within the medical system that educate the groups with whom they work on the most current evidence based practice. As a result this improves the delivery of patient care. For example, CNLs will work with clinical nurse educators (CNE) to address areas of educational gaps for the staff. They will then assess the feedback given by the staff to note areas of improvement and/or success (Monaghan, 2011).

In order to become a qualified CNL, one must have a nursing degree and  complete a master’s degree in order to ensure clinical competency and mastery. After which, a program designed to teach the role of CNL to the students (Stanley, 2018).

The success of CNLs has been quantified many times over particularly in the Veterans Health Administration (VHA). With the implementation of CNL roles, the VHA has documented an increase in nursing hours per patient day, reduction of sitter hours for patients with dementia, decrease in preoperative and gastrointestinal patient cancellations, and increase in the compliance of providing discharge teaching by the nursing staff, reduction in ventilator-associated pneumonia, reduction in falls, nosocomial infections, and pressure ulcers” (Monaghan, 2011).

 
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Comment 19019239

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comment1

Since the inception of CNL’s, documentation shows patients have shorter hospital stays, reduced readmission rates, and improved quality of care. Infection rates and falls decreased. Patient satisfaction increased, and nurse turnover rate decreased (HealthLeaders, 2009). Clinical Nurse Leaders had such a positive impact on patient care by applying evidence-based practices. This includes but is not limited to planning, implementing and evaluating patient care. Working across the different disciplinaries, coordinating, delegating and supervising patient care has benefitted patients and hospitals alike (Vadurro, 2018).

This leadership position works directly with the patients, so it is important the CNL enjoys direct patient care, as well as mentoring fellow nurses. The CNL should have qualities such as strong problem-solving skills and critical thinking (RegisteredNursing.org, 2018).

Formal education requires the RN to BSN, passing the N-Clex, and continuing to a Master of Science degree. The advanced courses include pathophysiology, clinical assessment and pharmacology. After successful completion of those requirements, an RN is able to obtain the CNL Certification from the Commission on Nurse Certification (RegisteredNursing.org, 2018).

comment2

Clinical nurse leader influences the direct patient care in the hospital settings. For example they give patient education including individuals, families and other care givers. They will be part of the ongoing assessment and modification if necessary of the plan of the care. They perform a comprehensive assessment of the client and family/caregiver upon initial contact. A Clinical Nurse Leader acts as a systems analyst or risk anticipator by anticipating patient safety risks, reviewing critical incidents, and evaluating client care delivery options. The CNL is also work with other care providers go for day-to-day information or issues related to the care of the specified patient cohort in the hospital settings. CNLs are also uniquely positioned to plan and coordinate care across entire patient populations or service lines, working with the multidisciplinary healthcare team across the care continuum, and helping organizations reduce length of stay and prevent readmissions. Clinical Nurse Leaders are also adept at using technologies and information systems to improve healthcare outcomes for their units and patients (Eira I. & Klich, H (n.d.). According to a study in University Hospital in Augusta, GA, piloted a CNL role in an acute care environment and documented significantly improved, patient-centered care through CNL assessment and advocacy. These CNLs communicated carefully with patients to determine their needs other than those specific to the current medical diagnosis. In each case the CNL’s ability to assess the patient’s unique needs and advocate with the healthcare team led to significant realignment of the treatment plan with the patient’s needs and preferences (Reid, & Dennison 2011).

 
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Comment 19015761

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Comment1

The National Quality Forum (NQF) published a report on 27 adverse events that were serious and preventable, “Never Events”.  In 2008, Medicare stopped payments to hospitals for any additional care needed resulting from 11 of the 28 “Never Events.”  These 11 conditions were identified by the NQF as patient safety events that are entirely preventable.  These “never events” for which hospitals no longer receive Medicare reimbursement include the following: 

1. Surgical-site infections after certain orthopedic and bariatric surgeries

2. Blood incompatibility 

3. Pressure ulcers

4. Vascular catheter-associated infection 

5. Deep-vein thrombosis or pulmonary embolism after total knee and hip replacements 

6. Falls/trauma 

7. Objects left in pt during surgery 

8. Catheter-associated urinary tract infection 

9. Air embolism 

10. Surgical-site infections after coronary artery bypass graft 

Comment2

CMS reimbursement rules regarding never events forced changes in the hospitals and methods of caring for patients in positive ways. While the term “never events” was coined by advocacy groups, CMS refers to these types of events as “reasonably preventable by following evidence-based guidelines” (Lembitz & Clarke, 2009). This indicates that sometimes, even if the best of care is delivered, patients may still develop complications like DVTs, CAUTIs, CLABSIs, and the like. However, it is less likely that these events will occur if the practitioners follow the most recent evidence based practices for prevention. For instance, starting patients on heparin, early mobilizations, and wearing SCDs after surgery to prevent a DVT instead of allowing the patient to lay around all day. When CMS altered their reimbursement protocols, it forced hospitals to enforce the following of safety protocols and checklists by those delivering care to minimize the occurrence of these events. While, sadly, money was the motivator in order for this to come to fruition, it cannot be denied the positive impact it has had on patient care.

 
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Comment 19013153

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Comment1

The Centers for Medicare and Medicaid Services (CMS) implemented a non-reimbursement policy for certain never events(serious hospital acquired conditions) to encourage hospitals to fast track improvements of patient’s safety by applying standardized protocols.  The newly defined never events limits the hospitals to bill Medicare for adverse events and complications that are deemed reasonably preventable using evidence-based guidelines (Lembitz & Clarke, 2009).

CMS adopted the non-reimbursement policy for certain “never events” – defined as “non-reimbursable serious hospital-acquired conditions” – in order to motivate hospitals to accelerate improvement of patient safety by implementation of standardized protocols. These newly defined “never events” limit the ability of the hospitals to bill Medicare for adverse events and complications. The non-reimbursable conditions apply only to those events deemed “reasonably preventable” through the use of evidence-based guidelines (Lembitz & Clarke, 2009).

The Centers for Medicare and Medicaid Services (CMS) implemented never events in 2008 as non-reimbursable hospital acquired conditions to create motivation for hospitals to improve patient safety.  Never events are medical errors that should never happen to a patient.  The list includes events which are chiefly avoidable and are obvious negligence.  The Centers for Medicare and Medicaid Services (CMS) adopted never events in 2008 as non-reimbursable hospital-acquired conditions in to create motivation for hospitals to improve patient safety (Votroubek, 2018).

Comment2

Patients have turned to hospitals, especially via emergency departments, as a result of lack of access to health care at a much higher cost than primary care. This has forced hospitals to provide care at a portion of the expense used to being the safety net of health care. In the beginning of this surge, organizations could not foreseen the financial brunt this would cost. Patients went from wanting to be cared for at home by loved ones, to expecting end all care at the hospitals taking a toll on such organizations. Many providers loathe and accept the endless cycle of patients returning to the hospital for care. The U.S Centers for Medicare & Medicare recognized that many of these return visits in short time frames, less than a month, are a reflection of lack of adequate care, education, and resources, so they created policies that hinder repayment for the diagnosis that were recently treated. “These patient safety policies are part of CMS’ efforts to promote higher quality, more efficient health care through value-based purchasing, which are initiatives use performance-based financial incentives and public reporting of quality information to encourage improvement in all aspects of quality, including patient safety” (CMS, 2008). These new reimbursement rules guide providers towards holistic patient care, driving them to decrease readmission rates, diagnostic imaging rates, and focusing on closing the loop in health care.

 
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Comment 19011787

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Comment1

 More and more nurses are getting involved in politics and represent the profession as nobody else can. Nursing representation, and being the voice of the profession as legislators, can have a positive impact on the laws that are made that govern the profession. Laws, at times, can have a negative effect on the way nursing care is delivered and the day-to-day responsibilities of the nurse. Having representation in politics can be beneficial as nobody else understands the challenges that face a nurse in healthcare today. There are both registered nurses and licensed practical nurses involved in politics. Nurses that are currently involved in politics encourage all nurses to vote and to testify in public hearings on issues that interest them or involve them (Larson, 2016).

            Adults with cognitive or physical disabilities are protected under a law authored by Senator Pat Vance in Pennsylvania.  Hearing about abuse is common now in families and health care settings.  It is mandatory to report abuse even if it is susceptive.  The law created an Adult Protective Services system with clearly defined procedures for filing complaints of abuse, neglect and exploitation against adults ages 18 to 59 with disabilities.  This law also provided for investigation of complaints and the development of service plans to remove the adult from imminent harm and provide for long-term need.

comment2

Nurse legislatures can represent the nursing profession because they understand the challenges that nurses face in the current health care environment.  Nurse legislatures are in the unique position of representing the interests of nurses and the health care needs of the public.  Mary Ann Dailey, RN, DNSc, a member of the Pennsylvania House of Representatives approaches the job from the perspective of a nurse and says that nurse legislators can represent the interests of the nursing profession in ways that no one else can.  They understand the challenges that nurses face in today’s health care environment in a world in which hospitals desperately need more nurses and nurses agonize about being overworked (Larson, 2016). 

Daley has been involved in efforts to pass a bill allowing prescriptive privileges for nurse practitioners in Pennsylvania and a bill that affects the usage and education of unlicensed assistive personnel. She is currently working on a bill to give whistleblower protection to nurses and other health care professionals who are concerned about issues that have happened in their hospital and may be too afraid of repercussions to speak up.  Daily and other nurses serving in state and federal levels agree that more nurses should get involved in politics and encourage volunteering for others who are in office.  She further states that it could be running for office, contacting their representatives with concerns, voting regularly, or volunteering for others who are in office and could even mean paying closer attention to issues that involve nursing 

 
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Comment 18998073

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comment1

Retail clinics have become a more mainstream part of
healthcare than previously thought possible. The idea of retail clinics was
initially downplayed by the healthcare industry. Retail clinics offer basic
services, from immunizations to walk in clinics for basic needs such as sore
throats or bladder infections. One will see retail clinics in places like
Walgreens, that offer a multitude of immunizations, no appointment necessary,
and will submit claims to insurance companies as well so that portion is not an
issue. Another example of retail clinics are similar to places like Urgent
Care, or Quick Care, FastCare, where local hospitals have an extension of
themselves placed in a retail space for patients to walk in. This usually
includes hours that the retail space is open for business, clients can walk in
and have a throat culture done, or a urinalysis to determine if they have
infections. Immunizations can be given. If someone is sick or injured instead
of going to an emergency room clients can utilize one of these retail clinics.
Retail clinics usually have hours that appeal to clients that work during the
day, that can not get into see their own doctor or those that want to avoid the
cost or wait in an Emergency Room setting. The retail clinics are overseen by
an interdisciplinary health care team, depending on the setting, there are
medical assistants, nurses, nurse practitioners, pharmacists, all overseen by a
specific doctor, reviewing cases as they occur.

comment2

ACOs is a group of care providers, who willingly come together, to help provide the best care to a patient while working together as a team (Daly, 2013). ACOs stands for Accountable Care Organizations. ACOs work together to take care of Medicare patients, while planning to providing the right care for patients, helping manage chronic illnesses, and attempting to prevent duplications of medical treatments and preventing medical errors (Centers for Medicare and Medicaid services, 2018).

                This approach to care can greatly improve the quality of patient care and increase safety. By having all cares provided by one group, it can cut down on many different problems that could arise. By getting all cares done by one group, medication errors and prescribing can be controlled by limited number of providers. This can decrease risks of drug interactions and medication errors. Also by having all cares done by one group, all medical treatments and cares records are readily available to the providers at this facility. By having all the care providers in one group, communication of care can easily be spread between the group, which can help improve care and help the care team. By using the group care, overall care of the patient can improve and improve safety of the patient.

 
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