Falls are one of the major causes of mortality and morbidity in older adults. Every year, an estimated 30–40% of patients over the age of 65 will fall at least once. Falls lead to moderate to severe injuries, fear of falling, loss of independence and death in a third of those patients. Falls account for 87 % of all fractures in the elderly. These fractures are almost always due to low impact injuries in osteoporotic bones. Several organizations have recommended screening older patients to identify those with a high risk of falling and, or fractures.

Working in the long term setting I have witnessed so many preventable falls in elderly population. Currently our fall numbers are very high. I would like to implement my plan on a group of patients like 30 patients at time. Just to see how it works. I will really like to involve my CNA’s for that station and have meeting with them to know more basics to prevent those falls. Reason involving CNA’s, I want to reach to root cause of fall and wants to plan individualized interventions.

References

Ambrose, A. F., Cruz, L., & Paul, G. (2015). Review: Falls and Fractures: A systematic approach to screening and prevention. Maturitas, 82, 85–93. https://doi-org.lopes.idm.oclc.org/10.1016/j.maturitas.2015.06.035

 

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National initiatives driven by the American Nurses Association have determined nursing-quality outcome indicators that are intended to focus plans and programs to increase quality and safety in patient care. The following outcomes are commonly used nursing-quality indicators:

• complications such as urinary tract infections, pressure ulcers, hospital-acquired pneumonia, and DVT

• patient falls

• surgical patient complications, including infection, pulmonary failure, and metabolic derangement

• length of patient hospital stay

• restraint prevalence

• incidence of failure to rescue, which could potentially result in increased morbidity or mortality

• patient satisfaction

• nurse satisfaction and staffing

SCENARIO

Mr. J is a 72-year-old retired rabbi with a diagnosis of mild dementia. He was admitted for treatment of a fractured right hip after falling in his home. He has received pain medication and is drowsy, but he answers simple questions appropriately.

A week after Mr. J was admitted to the hospital, his daughter, who lives eight hours away, came to visit. She found him restrained in bed. While Mr. J was slightly sleepy, he recognized his daughter and was able to ask her to remove the restraints so he could be helped to the bathroom. His daughter went to get a certified nursing assistant (CNA) to remove the restraints and help her father to the bathroom. When the CNA was in the process of helping Mr. J sit up in bed, his daughter noticed a red, depressed area over Mr. J’s lower spine, similar to a severe sunburn. She reported the incident to the CNA who replied, “Oh, that is not anything to worry about. It will go away as soon as he gets up.” The CNA helped Mr. J to the bathroom and then returned him to bed where she had him lie on his back so she could reapply the restraints.

The diet order for Mr. J was “regular, kosher, chopped meat.” The day after his daughter arrived, Mr. J was alone in his room when his meal tray was delivered. The nurse entered the room 30 minutes later and observed that Mr. J had eaten approximately 75% of the meal. The meal served was labeled, “regular, chopped meat.” The tray contained the remains of a chopped pork cutlet.

The nurse notified the supervisor, who said, “Just keep it quiet. It will be okay.” The nursing supervisor then notified the kitchen supervisor of the error. The kitchen supervisor told the staff on duty what had happened.

When the patient’s daughter visited later that night, she was not told of the incident.

The next night, the daughter was present at suppertime when the tray was delivered by a dietary worker. The worker said to the patient’s daughter, “I’m so sorry about the pork cutlet last night.” The daughter asked what had happened and was told that there had been “a mix up in the order.” The daughter then asked the nurse about the incident. The nurse, while confirming the incident, told the daughter, “Half a pork cutlet never killed anyone.”

The daughter then called the physician, who called the hospital administrator. The physician, who is also Jewish, told the administrator that he has had several complaints over the past six months from his hospitalized Jewish patients who felt that their dietary requests were not taken seriously by the hospital employees.

The hospital is a 65-bed rural hospital in a town of few Jewish residents. The town’s few Jewish members usually receive care from a Jewish hospital 20 miles away in a larger city. 

REQUIREMENTS

Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. An originality report is provided when you submit your task that can be used as a guide.

You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.

Analyze the scenario (suggested length of 2–3 pages) by doing the following:

A.  Discuss how the application of nursing-quality indicators could assist the nurses in this case in identifying issues that may interfere with patient care.

B.  Analyze how hospital data of specific nursing-quality indicators (such as incidence of pressure ulcers and prevalence of restraints) could advance quality patient care throughout the hospital.

C.  Analyze the specific system resources, referrals, or colleagues that you, as the nursing shift supervisor, could use to resolve an ethical issue in this scenario.

D.  Acknowledge sources, using in-text citations and references, for content that is quoted, paraphrased, or summarized.

E.  Demonstrate professional communication in the content and presentation of your submission.

 

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 1)

For my final assignment I have chosen to talk about how hackers have gained access to hospital computer software and manipulated systems. This trend has the ability to place patients at harm.   The best way to prevent these kind of attacks is to educate our healthcare professionals on what to look for.

       ‘To solve these problems, there are many levels of technology, such as cryptography technology, network security technology and so on.”(Ming, Chen, Guo, 2019). Cryptography is the art of writing or solving codes. Network security technology is also another way to prevent hackers from manipulating systems. Healthcare professionals also have a responsibility in detecting possible computer hackers as well. Upon employment, employers are educated on not opening suspicious emails   that maybe an attempt  for hackers to gain access into computer software. Healthcare employers who use screens and monitors in their field of work, also need to be educated on how to recognize when software has been manipulated. For example, areas of care that use monitors for diagnosing purposes need to be able to decipher  actual patient data from manipulated   data possibly shown on screens and monitors.

       Other ways to prevent software attacks are to keep computer software updated frequently. Companies and organizations should invest in the latest computer security programs. Never use open wi-fi on a computer router, always update your password frequently and create a password that does not involve birthdays or any significant events in your life that will be easy to figure out,  and do not wander on websites that are not allowed by the organization.

       Preventing computer hackers is the responsibility of everyone in an organization. On going computer education  training is  a must in order to prevent computer hackers  and software malfunctions.

2)

 

I selected to do my final assignment on universal electronic health records. I would say there is a lot of misconception out there regarding these records and just the terminology that a lot of caregivers use interchangeably.  Before this course I thought the electronic medical record and the electronic health record to be virtually the same. I know differently now and the way I find it easiest to remember is that the electronic medical record is basically a digital version of the paper chart. It contains basic past medical history and is held and collected in an office or medical organization. The electronic health record is an oversight of the whole health of a patient. It goes wherever the patient goes and can be shared by healthcare providers. An all-inclusive patient record has more benefits for sicker patients that will hopefully improve outcomes.

 The first part of training of electronic medical records would be the security aspect of sharing data electronically.  This would be ongoing annual training as well as training updates for employee’s that might have a breach of confidently. The Health Insurance Portability and Accountability Act  of 1996 set forth rules and regulations to protect medical records and other health information that could identify an individual. The penalties for known violation of HIPAA can be processed criminally.  A fine can be imposed up to $50.000 dollars and up to one year and jail  according to an article in Hospital Access Management (2018). This in my opinion is much worse than just losing your job.

         The actual training would be required on the version of the electronic record itself that is currently being used in the organization where you might be employed. This subject is very current with me at present due to being thirty days out from our EPIC conversion. Training on EPIC modules has been ongoing over the last five weeks. There have been zero tolerance measures for tardiness and cell phone disruption. The first day of training 7 people that were not quite in the door were turned away with two of those being physicians.  That information spread quickly across the hospital that the trainers meant what they said about being on time.

 After the completion of the modules with the trainers from EPIC ongoing practice as well as system update training will be required to stay current with the records. Super Users have been selected from all departments that will help with training as well as when new employees are hired. The use of any electronic record is a better value purchase for an organization when people are trained properly. When users are aware of the information that they can pull out for reporting purposes and use the system at a high functioning level it is beneficial for all.

200 words each

 

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200 words for each response.

1) 

Social Determinants and Disease Development

       Social determinants of health are conditions in which a person is born in to – social, economic and physical conditions to include resources and daily needs, biases, crime and violence statistics, community support, availability of sending and receiving communication, education quality and community, etc., each impacts an individuals daily activities, health, wellness and evidence of disease.  Individual behaviors will also support or not, the chain of events that lead to health or illness.  Although many circumstances may prevent wellness, it is up to the individual how these circumstances will impact their life.

Chain of Infection

       The chain of infection is comprised of six units; the infectious agent or the germ; the reservoir or where the pathogen lives; portal of exit, why and how the infectious agent exits it reservoir; mode of transmission, how it is passed on; portal of entry, how the infectious agent enters its new host; and the susceptible host which can be any person or animal.

How the Community Health Nurse Can Break the Chain of Infection

       Community nurses and education are at the center of breaking communicable disease processes from spreading, surveillance of and prevention.  In order to stop the infectious agent from spreading it is imperative to break the link of transmission.  Hand hygiene, vaccination, prevention of spreading an organism could include education on the importance of covering your cough or sneeze, isolate the person or persons infected, use of personal protective equipment when indicated, especially in healthcare settings, utilizing antibiotics wisely.  At home and beyond, maintain and clean your home especially the high use areas such as countertops, faucets, light switches, bathroom surfaces, keyboards or cell phones, doorknobs or the steering wheel of your car.  In grocery stores, utilize the antiseptic wipes to wipe down cart handles, etc.  If you find yourself or a loved one as a patient in a hospital or clinic setting, speak up, call out anyone who enters your room to utilize hand sanitizers prior to engaging in your care.  All are ways to break the link and to prevent spread of infectious agents.

       Improve community knowledge and information of possible outbreaks and the steps needed to contain the infectious agent.  Through collaboration with local healthcare professionals, social media or television, provide hyperlinks to public health forums or available telephone numbers for social support services.  Community health nurses need to be well informed and educated in surveillance statistics of their local area in order to break the chain of infection.

References

Clark, M. J. (2015). Population and community health nursing (6th ed.).  Boston, MA: Pearson

     Chapter 3

Infection Prevention and You.  Break the Chain of Infection.  Retrieved from (professional.site.

     apic.org)

Prevention by Breaking the Chain of Infection.  Retrieved from (cdn.ps.emap.com)

Social Determinants of Health.  Retrieved from (healthypeople.org)

2) 

Social determinants of health can be connected with a person’s culture. The way that a person’s culture views healthy habits can impact their health. Social determinants of health can be defined as conditions that people are born and function in (Healthy People 2020, n.d.). Some examples of social determinants are the availability to meet daily needs (Healthy People 2020, n.d.). This means that a person access to healthy food, health care, safe housing, social support, etc. (Healthy People 2020, n.d.). I believe that social determinants of health can have a major development to disease. When someone has access to clean water, air, and food it can make a difference in the spread of disease. Florence Nightingale believed in this theory as well and made sure that soldiers had access to clean water, air, and food. Nightingale found that 10 times more soldiers died of “filth disease” than died of bullets (Markel, 2017). Nightingale believed that the reason so many soldiers died was because of the filthy conditions that they were living in. These soldiers did not have access to clean conditions during the war, if these soldiers were born in these conditions, I am sure that they would find that many of them would be sick throughout their life.

            The chain of infection is how infection is spread from person to person. The reservoir is where the infection normally lives and grows (Centers for Disease Control, n.d.). These reservoirs can be environmental, human, or animal. Next in the chain is the portal of exit. This is how the infection leaves a host. A mode of transmission is how a pathogen is spread from host to host (CDC, n.d.). A portal of entry is how the infectious agent enters a host (CDC, n.d.).  The final link is to have a susceptible host (CDC, n.d.). The Center for Disease Control (n.d.) suggests that preventing the spread of infection can be done by protecting the portal of entry, increasing a host’s defenses, and finally by eliminating at transmission. A community health nurse can help break this chain by studying the different parts of the chain of infection and how to adequately stop the spread of infection. If a nurse wants to break a link in the transmission, they can protect the way that the infection is spread. For instance, when at the hospital and a patient has an infection with a disease that can be spread by direct contact, we make sure to dress in gloves and a gown to make sure that we are protecting ourselves from the spread of disease. If someone in the community has an airborne disease like tuberculosis, the community health nurse can prevent the spread of infection by making sure the infected person does not leave their house.

Reference:

Centers for disease Control. (n.d.). Principles of epidemiology | Lesson 1 – Section 10. Retrieved

from https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section10.html.

Healthy People 2020. (n.d.). Social determinants of health. Retrieved from

https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health.

 

 

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