Nursing Sensitive Indicators free essay sample

Nursing-sensitive indicators can be an important tool in identifying patient care issues that could potentially arise during a hospital stay. By analyzing the data on specific nursing-sensitive indicators, the quality of patient care can be optimized and patient satisfaction can be improved. The American Nurses Association (ANA) and the National Database of Nursing Quality Indicators (NDNQI) are two sources of information and guidelines for nurses and nurse managers to use in planning patient care and workloads for each nursing unit. The use of available resources, staffing by acuity and patient needs, appropriate referral indicators, and cooperation among colleagues are all necessary components in providing ethical, safe, and patient-centered care in the hospital setting. Care of the patient should always center on the individual needs, wishes and cultural practices, within the framework of evidence-based patient care interventions. Nursing Sensitive indicators â€Å"Nurses use theoretical and evidence-based knowledge of human experiences and responses to collaborate with healthcare consumers to assess, diagnose, identify outcomes, plan, implement, and evaluate care. We will write a custom essay sample on Nursing Sensitive Indicators or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Nursing interventions are intended to produce beneficial effects, contribute to quality outcomes, and above all, do no harm. † (American Nurses Association, 2010) There are several nursing sensitive indicators that were either ignored or overruled in the case of Mr. J. Falls risk, dementia diagnosis, pain medications, immobility and cultural or religious values are all indicators that special steps must be taken in the care of this patient to avoid further harm and achieve quality patient care. Mild dementia can create problems in some patients with their ability to reason, make sound judgment, and respond appropriately to requests and interventions. The simple fact that he fell, has mild dementia, and is drowsy does not, according to ANA standards and the Joint Commission, make him a candidate for use of restraints. Falls risk indicators should be assessed on admission and at least every 24 hours post admission. Optimally, the falls risk should be addressed each shift, as in some patients with dementia there can be marked differences in cognitive levels of function at different times of day, making them more susceptible to falls at night. Unless a patient is in immediate danger of harming self or others, such as pulling out IV lines, trying to remove breathing or feeding tubes, or striking out at staff without being able to be redirected, there is no indication that restraints should be used. There are many restraint alternatives that can be employed in the care of patients who are at risk for falls, have cognitive issues, or are combative. Use of bed alarms, personal alarms, active listening, direct observation, one-to-one sitters, family visits, and redirection should all be attempted prior to obtaining a physician order for restraints. Restraints should never be applied without the knowledge of the attending physician, and there are very strict guidelines in place for frequent skin checks, restraint-removal trials, and frequent vitals and welfare checks. All staff, whether licensed care professionals or unlicensed assistive personnel should be aware of the institutional policies regarding use of restraints. Likewise, the development of pressure ulcers while hospitalized is greatly increased by immobility. It takes only two hours of lying in one position for skin to begin breakdown, especially over bony prominences such as the buttock/coccyx area. This can also be exacerbated by incontinence, whether the incontinence is due to lack of control or simply lack of staff to assist in toileting needs. Quality patient care in the case of Mr. J would have to include restraint alternatives, falls prevention care plans, frequent skin checks, and frequent (every two hours) turning or repositioning to avoid skin breakdown. A toileting schedule would also be helpful in this case, to assure the patient and his family that basic needs will be met. My recommendation for the care plan of Mr. J would include restraint alternatives consisting of bed alarm, active listening, rounding at least hourly by nurse or CNA, toileting assistance and repositioning every two hours, and reassurance or redirection as needed if confused. I would encourage family visits if possible, and even suggest that if a family member felt comfortable rooming in with patient for reassurance all effort would be made to accomplish that scenario. It is common for patients with dementia to become more confused and distressed in the later evening hours, so having family or a one-to-one sitter would be a very effective way to reduce the chance of fall and to reassure and redirect as needed. Also, the CNA should not have ignored the growing sign of skin breakdown on Mr. J’s lower spine. The depressed, reddened area is a precursor to a stage one pressure ulcer. Due to his age, injury, and lack of mobility, a pressure ulcer prevention care plan should have been initiated on admission. When the evidence was brought to the attention of the CNA , she should have immediately informed the primary care nurse of her findings. Following the evidence-based practice of frequent repositioning, padding bony prominences, and the use of products designed specifically for prevention and healing of compromised skin areas will dramatically reduced the incidence of hospital-acquired pressure ulcers. Research and use of data on prevention and avoidance of falls and pressure ulcers can make a remarkable difference in the cost of patient care. Reimbursement to hospitals by Medicare often depends on the use of proper care planning and documented use of nursing sensitive outcome indicators. A second very important rule of quality patient care was violated with the incident of Mr. J receiving the wrong type of meal on his tray. When it was discovered by the nurse that the pork had been given to and eaten by the patient, the nurse did the right thing by notifying her supervisor. However after that, the cascade of events was a dismal failure as far as transparency, customer service, and patient satisfaction are concerned. The supervisor was negligent in telling the staff to â€Å"keep it quiet†. Although she did the right thing by notifying the kitchen supervisor, she should have immediately apologized to the patient himself, and then informed the patient’s daughter of the incident. An apology to the family, along with an outlined plan of how such a mistake would be avoided in the future would have most likely helped to avoid the hard feelings and complaints that followed. What the nurse later said to the patient’s daughter was not therapeutic, in fact it was belittling of the religious and cultural beliefs held by this family. Culturally sensitive care dictates that even if healthcare workers do not agree with or fully understand the religious and cultural beliefs of the patient, they must still honor and accommodate whenever possible within the confines of sound medical practice. Failure to provide meals that are culturally appropriate was apparently an ongoing problem at that hospital. Resources, Referrals and Colleagues â€Å"Nursing practice respects diversity and is individualized to meet the needs of the healthcare consumer or situation. Healthcare consumer is defined to be the patient, client, family, group, community, or population who is the focus of attention and to whom the registered nurse is providing services† (American Nurses Association, 2010) As a nursing shift supervisor, there are many resources available to assist in achieving quality, culturally appropriate care for patients. In the case of Mr. J, there are many online resources that could have been used to familiarize staff with the dietary requirements of Jewish who keep kosher. Also, the dietician should have been consulted to set up kosher menus, and kitchen staff should be educated on kosher dietary requirements. The entire facility could benefit from education regarding dietary differences of different cultures and religions, and about cultural practices that may affect care interventions at all levels of care. Perhaps the nursing supervisor could facilitate training and education for all staff, with the help of the Jewish physician that would improve the level of satisfaction for the Jewish patients and their families. Other resources that the nursing supervisor could employ would be to coordinate with the attending physician to obtain consultation and/or treatment for physical therapy, occupational therapy, wound care nurse, dietician, palliative care nurse, chaplain, and social worker. For immediate resolution of the issues with Mr. J, a personal apology from hospital administration, along with assurance that the complaints are being taken seriously and plans are being made to avoid such problems in the future would be a good start. As for future patients, creating and following policies, care plans, and evidence-based guidelines for patients with dementia, patients at risk for pressure ulcers, patients at risk for falls, and patients with special dietary needs are a necessary step to insuring quality patient care. All staff, at every level of care, needs to be held accountable for following policies and guidelines, with clear expectations and consequences for deviation from policy. It seems that there were many opportunities to provide quality patient care that were either overlooked or ignored in the case of Mr. J. Identifying risk for falls, risk for pressure ulcers, and risk for culturally inappropriate care at time of admission and addressing in advance possible issues that could arise could have resulted in a much safer and acceptable patient stay. Early use of assessment tools, referrals, and ancillary resources is essential to ensuring the safety and quality care of all patients. Communication between colleagues and communication with patients and families is paramount and transparency when errors do occur is necessary to create the trust that is so essential between patient and all care providers. According to the ANA, â€Å"nurses must be as proficient in communication skills as they are in clinical skills†, and â€Å"must be relentless in pursuing and fostering a sense of team and partnership across all disciplines†. (American Nurses Association, 2010). It is only by becoming true collaborators that nurses can be seen as effective, valued, and committed partners in healthcare.

Medicinal Marijuana †Health Essay

Medicinal Marijuana – Health Essay Free Online Research Papers Commonly known as marijuana, cannabis is the worlds most used illicit drug. [ACDE] Dating as far back as 2500 B.C., Marijuana has not only been used for its feeling of euphoria, but also for medicinal purposes. The plant was first documented being used in the ancient Chinese cultures as an effective pain killer when ingested. [Rawson] Texts from Pakistan confirm that marijuana was used to treat illnesses such as gastrointestinal disorders, insomnia, headaches, and pain relief; especially in childbirth. In the 1800’s, Marijuana was used throughout the world as a general pain reliever before the invention of Aspirin. Then, in 1937, the United States passed the Marijuana Tax Act to ban marijuana, becoming the third country to do so. Its only protestor was the American Medical Association; how ironic. [Rawson] Delta-9 tetrahydrocannabinol (THC) is the mind altering and relaxing ingredient found in marijuana. On average, the THC content of marijuana is 4% but may vary slightly on the conditions of the plants growth surroundings. Sinsemilla is a form of marijuana made from just the buds and flowering tops of the female plants and averages 7.5% in THC. [ACDE] In the 1970’s, a synthetic version of THC was designed in pill form known as Marinol. [ACDE] It has been used to treat Glaucoma, people undergoing chemotherapy and in some cases, for AIDS patients. Marinol has worked not only as a pain reliever but also to control nausea and increased appetite. Marinol is easy to regulate dosages and does not get the patient a high feeling, which may or may not affect the patient’s routine day. [Grinstead] Marijuana is known as a gateway drug and may lead to an addiction or a dependency. Marijuana is mostly smoked which may lead to heart and lung disease, throat cancer and a decreased memory capacity. [ACDE] While driving under the influence of marijuana, the user is ten times more likely to get into an accident due to perception distortion. [Rawson] Smoking marijuana may create the user to experience paranoia as well as hallucinations. Frequent marijuana users achieve a higher likelihood of getting chest colds, bronchitis, emphysema and bronchial asthma. Regular use from males may even reduce sperm count. Women who smoke while pregnant have the risk of premature babies or babies with lower birth weights as well as possible health problems. [Grinstead] Marijuana is classified as a Schedule 1 substance, meaning it has no acceptable medical use. [ACDE] Although there are some who believe that Marinol works great, most users who have also tried marijuana state that the drug is not nearly as effective. Many chemotherapy patients found that they were not able to ingest the pill due to vomiting and even swallowing the pill was difficult for some. [Grinstead] Many users also reported severe problems with Marinol, including side effects and announced to leaving the pill to smoke marijuana instead. [Wikipedia] Although there is no evidence supporting this claim, many patients have stated that smoking marijuana has helped them deal with many medical problems ranging from pain relief to even helping with the downfall AIDS provides. [ACDE] Researchers who were testing for marijuana intoxication found that smoking the drug actually reduces intraocular pressure which can cause blindness in glaucoma patients. THC may also aid in the prevention of atherosclerosis. [Wikipedia] Marinal itself can cost a patient thousands of dollars annually while growing a plant which slightly easier. Immediate relief is sent to the patient when smoking marijuana therefore making the drug easily dosed. [Wikipedia] While many will argue that marijuana is an addictive drug and will lead to dependency, the same can be said about almost all prescription painkillers such as: Vicoden, Oxycontin, Oxycodone, Valium and Xanax which have been major drugs leading to admissions in rehabilitation centers. [Grinstead] In a study approved by the Food and Drug Administration, 250 patients were used to determine what worked better for them: Marinol or smoked marijuana? All patients had been referred by a doctor and had failed to reduce or control vomiting while having tried at least three other alternatives. In conclusion, marijuana seemed to be the favored treatment. A direct quote from the magazine, Compazine, states, â€Å"More than ninety percent of the patients who received marijuana reported significant or total relief from nausea and vomiting.† [Wikipedia] In America alone, more than 700,000 citizens are arrested annual on charges of marijuana. [Grinstead] Not all of these â€Å"criminals† were using marijuana for medicinal or pain relieving purposes, but the knowledge that some aching man was arrested trying to soothe his pain is disturbing. Marijuana is a very debatable topic and will remain to be a very debatable topic due to the fact that not all people will agree with one another. Unlike many other drugs, marijuana provides a relief for suffering patients and many people have already agreed, including six U.S. states as well as the District of Columbia. [Wikipedia] The idea that it is not only a drug but an illegal drug is what is stopping many people from making the right choice and deciding that marijuana should be used to help suffering people dealing with problems that the majority of us could not even imagine. 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Summary the aticle Essay Example | Topics and Well Written Essays - 500 words

Summary the aticle - Essay Example Jean Gregoine disagreed with this view. He believed that the technique on which the utilization of material depends should be progressive and hence beauty would change too. Aesthetic qualities are expendable and liable to wastage of effect. For instance, the part to be repaired in Bugatti is hidden for the sake of beauty, which makes repairs difficult to be conducted in contrast to Buick where the stress is not on the beauty but practical performance and repairs. In Buick the technical and aesthetic qualities have been given equal importance whereas Bugatti is a monument of abstract art. The criticism of popular art depends upon the analysis of content which lends appreciation to superficial qualities. The industrial designer should have the ability to design a product that is good, desirable, and exciting. This trend becomes more pronounced as culture becomes mechanized when the middle-class people become educated. The designer has to be in touch with the masses and determine to what extent fine arts can be integrated with popular art and what will sell. This alone can bring out innovative, aesthetically appealing, and functionally good product. During the Second Industrial Age there was a connection between design practice and the theoretical self-awareness. With the development of design management, changes took place in the management of machinery design. Brown & Sharpe Manufacturing Company, brought about innovation in design management. They were market leaders in machine tool manufacturing in 1900. They brought changes with non-mechanical decoration in 1911. All designs had to conform to a style manual issued by the Chief Draughtsman and the purpose was to create artistic machines with analytical engineering. This means the process by which the machines were designed and manufactured were transformed. This involved book learning and shop