Free Standardizing Nurse Preceptor Training Essay Sample

Free Standardizing Nurse Preceptor Training Essay Sample

– What might happen if you did not achieve the defined outcome for the solution? What alternatives might be considered
Every individual is entitled to quality health care services irrespective of the financial status, race, ethnicity, tribe and social status. Offering a standard training program to nurses will ensure equal delivery of services to people and minimize the number of complains found in our health care centers. The defined outcome of this project was to promote preceptor training programs to nurses in order to improve the health care sector and meet the World Health Organization standards. Failure to attain the expected outcome would result into a health care industry that faces the same problems as before. In addition, according to Spetz (2014), the U.S Bureau of Labor Statistics expects to increase the number of registered nurses by 26% by the year 2020. Failure to achieve the outcome would limit the following expectations leading to inadequate number of registered nurses in the country.
Some of the best alternatives to be considered in order to achieve the outcomes would include the following. Firstly, the government should introduce a law that requires every nurse to undergo preceptor training course before being registered as a practicing nurse. Secondly, health care centers should offer scholarships to their staff that have not undergone the training in order to acquire the required skills for the improvement of health care services in the future.
– How did the literature support this particular outcome over another?
The literature review played a vital role in supporting the outcome of the project by providing a wide range of options to select from. The literature on different training programs and their effects to the health care industry have helped in determining the best approach to follow that has limited challenges and best arrives at the expectations of the training. Moreover, the literature has offered a strong basis for determining the best approach in terms of cost, reliability, effectiveness, and professions in the area of preceptor training.
– How did the change process or theory enable you to develop the appropriate outcomes for the problem/concern?
The change process has assisted in developing the appropriate outcomes for this problem because it provides the basic ideas on how to promote change in a society and make people understand the need for change. This theory enables an individual understand the aspects of change management and how to use them in the organizational context (Myers & Hulks, 2012). Through this theory, I could manage to convince a number of health care centers to implement the preceptor training for their nurses using the learned literature to base my arguments.

References
Myers, P., & Hulks, S. (2012).Organizational change: perspectives on theory and practice. Oxford: Oxford University Press.
Spetz, J. (2014). Economics of Health Care and Nursing: How Will Health Reform Affect Demand for RNs? Nursing economic, 32.

 

Community Health Nurse Essay Examples

Community Health Nurse Essay Examples

Community Health Nurse
Miami is a growing city in Florida, with an estimated population of 362, 000 people. The health status of the area has been particularly devastating, and health need assessment was carried out to verify the actual needs of the society, and how to meet them. The assessment was based on a plethora of facets, which entailed; finding out the number of people who suffered from various diseases, achieved through selection of few random Miami residents, representing a diverse cross section of the population. In conjunction to this, the relative need for the treatment was also identified, which incorporated the urge of better working nation, and the attainment of a good life. Further, there was the determination of the health services, both in existence and non-existence, comprising of a requisition for more health facilities, trained personnel, and faster and automated systems. In tandem to this, the core issue depicted from the assessment was the lack of proper information on the available health facilities and resources that could facilitate a better provision of healthcare to the residents of Miami. Provision of adequate information on health facilities and resources, is paramount to the provision of proficient health care to a given community, achieved through detailed awareness.
Over the years, the foremost, leading health issues in Miami has been chronic diseases-cancer and heart diseases-, mental health and stress levels, overweight, drug use, tobacco use, and injuries arising from frequent violence (Health Council of South Florida, 2007). The health issues have been profoundly attributed to lack of adequate information or lack of awareness on how to access medical facilities or the resources. In accordance to Health Council of South Florida (2007), the lack of effective spread of information about the health resources can be highly ascribed to the disparities in cultural and language aspects that construct barriers to the spread of information. In line with this, racial segregation, economic factors, for instance, poor housing and poverty, have also contributed to the enormous lack of spread of information on the availability of health resources (Health Council of South Florida, 2007).
Many attempts have been put in place in order to curb and solve the strenuous issue of the provision of better health care, and availing all the necessary and relevant information to the residents of Miami. However, most of the formulated principles and processes are quite ineffectual, ascribed to the fact that they are non educative, non informative, non evaluative, and less competent. This is depicted by the increase rates of tobacco consumption especially in high school students, which is a clear concept on lack of education and information on the dangers of tobacco (Florida Department of Health, 2006). Moreover, most of adults and parents with children suffering from various diseases are likely not to report the daily health problems to medical practitioners, indicating high levels of ignorance ascribed to lack of effective and relevant information (Health Council of South Florida, 2007).
In light with this, provision of adequate information on the availability of health resources for proficient health care can only be attained through aggressive processes of assessment, composed of detailed monitoring of health, diagnosis and investigation of health associated problems (Lundy & Janes, 2009). An aggressive assessment will aid in the understanding of certain health facets grappling the community, and consequently, how the environmental, economic and social factors affect them and how to solve them and inform the people (Lundy & Janes, 2009). The only set back will be consumption of a lot of time in undertaking the whole process. In addition to this, the policy making should be rigorous, so as to capture aspects like educating, empowering, and informing the society, mobilizing the community, and developing relevant policies, so as to engage the community on health associated issues, for the achievement of an adept health care and access to medical facilities (Lundy & Janes, 2009). The constrain, which can be, exhibited in the process is prospects of illiteracy, and non-cooperation by the community members. In addition to this, assurance should also be emphasized upon the community members, highlighting the following; enforcement of the formed policies, provision of care, assurance of competent work force, allowing better coordination of the health facilities, and the addressing all forms of health disparities (Lundy & Janes, 2009).
The most effective solution is the formulation of policy that consists of educating, empowering, informing the society, and mobilizing the community to participate in health related issues and report any health concern, for proficient achievement of appropriate health system and care (Lundy & Janes, 2009). In line with this, the policy will offer an efficacious opportunity to monitoring of diseases, provision of predictive information, on which to base treatments, types and lengths of care, and level of provider needed to achieve positive outcomes (Lundy & Janes, 2009). Conversely, the essential role of a nurse in a community is to position himself/herself at the interface between the community and the strategic decision so as to be able to transmit information about the community, also observe the impacts and interventions of the policies in the community (Sines, Saunders, Forbes-Burford, 2009). Thus with the suggested solution, the community nurse will be in a position, of effecting the solution in the community.
Concisely, lack of adequate information on health resources, has led to the death of quite a number of residents of Miami, due to ignorance about some preventable diseases. Besides, the inefficient spread of information has been due lack of the strong emphasis on the importance accessing medical facilities, language and cultural factors, racial discrimination and poverty. Nevertheless, the formation of quality policy that entails; educating, empowering, and mobilizing the community, provides an ultimate and sound solution to the problem of inefficient spread of the required information about health resources. The role of the community nurse as an intermediary between the decision makers and the community is also remarkably indispensable since it will allow the implementation of the suggested solution.

References
Florida Department of Health. (2006). Florida Youth Tobacco Survey Bay County Changes and Trends from 2000 to 2006. Retrieved from http://www.doh.state.fl.us/DISEASE_CTRL/EPI/Chronic_Disease/FYTS/2006_FYTS_County_Reports/Bay_County.pdf
Health Council of South Florida. (2007). Living Healthy, Living Longer: Translating Research into Action. A Guide to Health Improvement Opportunities in South Miami-Dade. Retrieved from http://www.healthymiamidade.org/system/js/back/ckfinder/userfiles/files/Living%20Healthy%20Living%20Longer%20in%20South%20Miami-Dade.pdf
Lundy, S. K. & Janes, S. (2009). Community Health Nursing: Caring For the Public’s Health (2nd Ed.). Sudbury, MA: Jones and Bartlett Publishers, LLC.

 

Example Of Essay On Discussing Medicare

Example Of Essay On Discussing Medicare

Medicare refers to a program of federal health insurance for individuals who are 65 years and above, some young persons having disabilities, as well as individuals with terminal diseases as permanent kidney failure needing transplant or dialysis at times, referred as ESRD (Kronenfeld, 2011).
Medicare does not offer comprehensive coverage to all needs of health care. However, it caters for certain preventive services, besides, covers a number of medically significant services. Medicare does not cover many routine services, for example, yearly physicals, or things such as hearing aids, glasses, or long run care within a nursing home or at home.
Medicare can be described in sections or parts, each referring to a distinct aspect of drug delivery or medical. The parts include Medicare part A or hospital insurance, Medicare part B or Medicare insurance, and Medicare advantage plans or Medicare part C, as well as Medicare part D or prescription drug coverage. Hospital insurance covers inpatient hospital/facility stays, care within a skilled hospice care, nursing facility, and certain home health care. In addition, medical insurance covers some services of doctors, medical supplies, outpatient care, and preventive services.
Medicare part C denotes a Medicare health program/plan given by a private firm, which contracts Medicare in giving clients all part A as well as part B benefits. Part C involves Health Maintenance Organizations, Special Needs Plans, Preferred provider Organizations, Medicare Medical Savings Account Plans, and Private Free-for-Service Plans. A client enrolled within part C is covered via the plan, which are not serviced for in Original Medicare. Part C gives prescription drug coverage (Kronenfeld, 2011).
In part D, prescription drug coverage is added to original Medicare, Medicare Private-Free-for-Service, Medicare Cost Plans, plus MMSAP (Medicare Medical Savings Account Plans). Insurance firms give the plans as well as other private firms approved by Medicare. Besides, prescription drug coverage is offered by Medicare Advantage Plans and follows similar rules as Medicare Prescription Drug Plans (Kronenfeld, 2011).

References
Kronenfeld, J. J. (2011). Medicare. Santa Barbara, Calif: Greenwood.Read more at: https://www.wowessays.com/free-samples/example-of-essay-on-discussing-medicare/

Discrimination Against Women Essay

Discrimination Against Women Essay

Discrimination against women is a subject that has been discussed for many years now. Since the Suffragette movement in the early twentieth century, equality between the sexes has been getting closer. However, there are still many areas of life in which women are discriminated against. Two examples of these are in economic institutions and in education. These two areas are interlinked and influence each other. It seems that if women are to reach a time when they are paid as highly as men, and are accepted into as many highly skilled professions as men, subtle discriminations need to be eradicated, from the time when a child is born and throughout their childhood.
According to Dictionary.com (2011), discrimination can be defined as: “treatment or consideration of, or making a distinction in favor of or against, a person or thing based on the group, class, or category to which that person or thing belongs rather than on individual merit.” It is common knowledge that women have been discriminated against for centuries and were, for a long time, considered as lesser citizens to men. Within the employment realm, discrimination still exists.
According to the National Organization for Women website (2011), “For full-time, year-round workers, women are paid on average only 78 per cent of what men are paid; for women of colour, the gap is significantly wider.” Such a gap seems strange, given that in 1963 an Equal Pay Act was passed and among its legislation, discrimination was banned. Nevertheless, equality between men and women in the workplace is still a long way from being standard, especially if such figures regarding wages are to be focussed on.
Women are still much likely to work in jobs which are of low skill and which are, correspondingly, on low wage. Examples include the childcare industry and the healthcare industry: both of these jobs do not require high qualifications and are not overly highly paid. As women tend to work in jobs such as these, it is unsurprising that they earn less than men, many of whom may be in highly skilled professions. However, the women are being paid less than men, even when working in the same job. It has been shown that among men and women who do the same kind of work, with the same value, men are being paid significantly higher in terms of salaries. When the Equal Pay Act was agreed, women were being paid fifty-nine per cent less than men in equal roles. This means that in over forty years, only nineteen per cent of this gap has been closed (National Organisation for Women, 2011).
Family responsibilities provide another reason for women faring badly in the employment market. It seems that women are much more probable than men to take time out of work to care for children and other family related duties. According to the National Organisation for Women website (2011), when discussing a period of fifteen years, “the more likely a woman is to have dependent children and be married, the more likely she is to be a low earner and have fewer hours in the labor market. The opposite holds true for men: marriage and dependent children make it much more likely that a man has higher earnings and works longer hours.”
When women take time out of employment, this can also have consequences regarding their earning abilities. When women return to work following a period of not working, they are generally expected to start on a lower wage than if they had not taken time out of work. Women who continue to work after giving birth are more likely to earn more money. However, for some women, staying in work is not possible, and especially if there is no one else available to care for her child. Studies show that a woman who is married and has children is predicted to earn less than she would otherwise. While this is not discrimination against women in itself, the research also shows that men who are married and have children tend to earn a higher wage than their single counterparts (National Organisation for Women, 2011). When both parts of this research are examined, it is clear to see that discrimination exists in this respect.
A woman’s ability to earn is largely dependent on her education. Education is another example of a setting in which women are discriminated against. Admittedly, education has progressed a great deal over the years but, in certain countries in particular, there are still differences in the opportunities given to girls and those given to boys.
Even today, many girls and boys are raised and taught that some professionals are suitable for them and others are not. For example, many young girls believe that nursing is appropriate, and obtainable, as a future career, whereas becoming a doctor of medicine is not. Some girls are even brought up to think that all they should aim for is to be a successful wife and mother. In this way, distinctions between the sexes are identified and adopted early, and it can be difficult to change such strong perspectives.
Within elementary schools, research has revealed that teachers are still inclined to spend more time with boys when teaching subjects of sciences and mathematics. Subjects such as these are imperative to careers like medic ne and architecture and, interestingly, these professions are both strongly male dominated (Wolfe, 201).
According to Lahle Wolfe (2011) in her article, Gender Discrimination Against Women: From Cradle to CEO, girls in middle and high school tend to be encouraged to join societies such as volunteering and social activities, but discouraged from joining in sports societies and clubs like debate. Being encouraged or discouraged, however subtly, regarding participation in certain activities furthers the message being sent to girls about what is and what is not appropriate for them.
Following schooling, young women are more often urged to continue their education but to do so in the direction of professions that fit the gender stereotype. Examples of these are, once again, nursing and teaching (Wolfe, 2011). Men, on the other hand, may be discouraged from such professions and pressurised into more highly skilled, and highly paid, professions.
Education and employment are closely related. Therefore, what a woman is taught in childhood is likely to still influence her in adulthood, especially while making life-changing decisions such as which subjects to study and whether to have children young without having a career in place. It seems that girls and women are both being encouraged into certain academic subjects, and then professions, and this is contributing to their lifelong inequality to men.

References
Borade, G. (2011). Gender Discrimination in Education. Buzzle. Retrieved from
http://www.buzzle.com/articles/gender-discrimination-in-education.html
Dictionary.com. (2011). Discrimination. Retrieved from
http://dictionary.reference.com/browse/discrimination
National Organisation for Women. (2011). Women Deserve Equal Pay. Retrieved from
http://www.now.org/issues/economic/factsheet.html
Union CSW. (2011). Women, Economic Crisis and Recovery: Growing Discrimination in Canada and Comparative Perspective: FAFIA. Retrieved from http://unioncsw.world-
psi.org/2011/02/women-economic-crisis-and-recovery-growing-discrimination-in-
canada-and-comparative-perspective-fafi.html
Wolfe, L. (2011). Gender Discrimination Against Women: From Cradle to CEO. About
Women in Business. Retrieved from
http://womeninbusiness.about.com/od/challengeswomenface/a/genderdiscrim.htm

 

Evidence Based Maternity Care: Postoperative Pain Management After Caesarean Section Essays Examples

Evidence Based Maternity Care: Postoperative Pain Management After Caesarean Section Essays Examples

Postoperative Pain Management after Caesarean Section
With the rising number of cesarean deliveries, postoperative pain management poses as a major clinical challenge. Various methods of pain management have been introduced in an effort to relief cesarean patient’s pain due to factors related to related possible complications as well as for neonatal and maternal wellbeing. Despite the advances made in development of new delivery and analgesic techniques and on pathophysiology of postoperative pain, most patients still suffer from moderate to severe postoperative pain. The United States surveys indicate that 50-70% of women have a high likelihood of experiencing moderate to severe pain after a C-section (Gilmour, 2005). The high risk factor is associated with poor pain management by clinical personnel as well as negative attitude towards pain by the patients. Postoperative pain presents unique risks as opposed to other surgeries as there is increased risk of thromboembolic events which may cause immobility. This is caused by excessive sedation from Opiods or inadequate pain control. The need for adequate pain control should also be emphasized as to enable the mother to be energetic for the care of her new born. Surgical pain is the result of inflammation caused by tissue trauma or direct tissue injury (Carvalho, et al 2011). Tissue trauma can result from dissection, surgical incision and burns while nerve injury maybe the result of nerve stretching, compression or transection. Pain in felt via the afferent pain pathway and can be altered through several pharmacologic agents. The Visual analogue scale (VAS) is used to assess and manage pain in the postoperative period. The objective of this paper is to provide evidence based review of various methods that can be used to relieve off postoperative pain by understanding the causes of the pain and postpartum pain management (Tagaloa, Butwick and Carcalho, 2009 p.1).
Pain is defined as a bio psychosocial and complex phenomenon occurring amongst a diverse group of patients including expectant mothers. Pain is a sensation that serves to protect the body from further damage. If postoperative pain is poorly managed, it could lead to complications resulting in reduced quality of life for the patient, physical and emotional stress. It may also cause hypoxia, hypothermia, and delay in wound healing besides predisposing the wound to infection. According to the Joint Commission on Accreditation of healthcare Organizations (2001) commissioned pain management standards in which the body emphasized the need for appropriate care and management of pain on the basis that it is a patient’s right. Reports by the World Health Organization in 2003 reported that pain remains the leading cause of disease burden and death in the world. While childbearing is supposed to be a pleasant time, postoperative pain may make the event unpleasant. Few studies have been conducted in recent years to investigate the different methods of pain relief in CS patients. According to JCAHO the team responding to acute pain in patients should include nurses, surgeons, physiotherapist and anesthesiologist. The process by which pain is conveyed is known as nociception; a process that begins with the activity of neurotransmitters leading to the production of agents such as potassium, bradykinin and substance P. From the point of injury three phases of the pain process ensue: transduction, transmission and perception (Abdo, 2008; JCAHO, 2001).

Instruments of pain assessment
Several assessment instruments have been developed due to the unique nature of pain. One such instrument is the visual analogue scale. The horizontal version of the scale is 10cm long where the left hand anchor represents “no pain” while the right anchor represents “intense pain.” This is an ordinal scale with a sample pain intensity scale of between 1 and 10, “no pain” to “worst pain possible.” The second version is a face pain scale which contains six facial expressions depicting the level of distress due to pain. The scale is administered to a patient where one is asked to point the face that bests describe the intensity of their pain (Ismail, Shahzad and Shafiq, 2012).
According to Diane Gilmour, 2005, in his production of Perioperative care, effective pain management begins with pre-empting pain. Although pain is subjective, it is crucial to accurately assess its severity to each patient. This may be hampered if the patient is drowsy, crying or confused. Recovery nurses should then resort to non-verbal cues such as the degree of restlessness or hyperventilation (Avidan, 2003). Effective pain management also involves prior discussions on the possibility of pain after surgery and the duration and likely intensity of the pain. According Wee and Reynolds (2005), pain may be reduced based on the patient’s perception and expectation of the pain. While there are pharmacological methods of dealing with the pain, investigations have revealed that other non-pharmacological therapies are available such as foot and hand massaging among others (Gilmour, 2005). Analgesics are administered through various routes such as injection, intravenous patient controlled analgesia (PCA), intravenous bolus or rectally. PCA is common with clinicians as it gives the patient control over the pain (Gilmour, 2005).

Pain management modalities
A systematic search of various journals such as Nurse Media, Journal of anesthesiology clinical pharmacology, medical publications such as the National Guideline clearing house, books and online sources has been conducted on various pain modalities. There has been considerable evolution of pain management after a cesarean section. Many of the institutions which conduct intravenous PCA and neuraxial opioids have shifted away from opioids based therapies to multimodal approaches. A multimodal approach involves the use of opioids based regimen and PCA in combination with other classes of analgesic drugs (Tagaloa, Butwick & Carcalho, 2009 p.1). A multimodal approach reduces the side effects associated with one class of analgesics due to the fact that smaller doses of each drug are administered. This approach also synergized reduction of pain. However, the transition stage by the patient from the high potent opioids dependency into oral analgesics complicates pain relief strategies despite the advances (Jacques, 2009; Tagaloa, Butwick & Carcalho, 2009 p.1). All of these medications have life threatening side effects that include respiratory complication, nausea and vomiting, urinary complications that decrease urinary output, constipation and hypertension. The nurse should look out for these side effects in patients and advance non-pharmacological therapies (Carvalho, Stetka and Sullivan 2011). Complimentary therapies such as foot and hand massages, music and guided imagery can be applied (Good 2001 p. 61 -70; Khoshtarash, 2012). The non-pharmacological therapies can be conducted independently by the nurse without the need to consult.
– Nonsteroidal Anti-inflammatory Drugs (NSAIDS)
NSAIDS work by inhibiting cyclo-oxygenase (COX). This is an enzyme that regulates the production of Prostagladin which results from inflammation or trauma on tissue. COX is of two types: COX-1 which is involved in causing prostaglandin formation (Kogler, Bandic et al. 2009) . Prostaglandin maintains physiologic functions of platelet formation and increasing gastric mucosal blood flow. Intravenous administration of these drugs starts 30-60 minutes before the estimated end of the C-section. It is highly dangerous to administer intramuscular analgesic as a post-operative measure due to the pain caused by the injection as well as the variability of the concentration level of serum drug. NSAIDS decrease the need for the administration of opioids (Jacques, 2009 p.1)
– Opioids
These are safe and used as a first line postoperative treatment of acute pain. These can be administered orally, intravenously, rectally, through transdermal, intraspinal and intranasal routes. The choice of the route of administration is unique to each patient (Jacques, 2009 p.1). Methadone is one of the most commonly opioids to be administered due to its analgesic properties. It has a long plasma half-life and can be used on hospitalized patients as it is considered relatively safe (Daesh, Ghaedi, and Jabalameli. 2012 p. 143-7). The use of opioids should anticipate side effects with the key principle for effectiveness being achieving a titration of pain relief and reducing its effects. The neurological and behavioral effects on the newborn and ease of elimination from the body should be considered before administration of opioids (National Guidance Clearinghouse, 2013; Daesh, Ghaedi, and Jabalameli. 2012 p. 143-7; NICE). Patient controlled Analgesia. PCAs are used to manage chronic pain while allowing the patient to control the administration of their own medication based on predetermined limits. This approach can be used with opioids as well as Oral Analgesics for effective pain relief. Systematic intravenous administration of PCAs improves patient satisfaction while reducing chances of respiratory complication.
– Epidural analgesia
Neural stimuli and activation of the nervous system releases endocrine-metabolic responses. Regional continuous techniques lead to reduction of surgical stress. Epidural analgesia such as patient controlled epidural analgesia (PCEA), relieve postoperative pain excellently while reducing the need for use of opioids. This intervention is common as it permits individualization of medication; it decreases the use of drugs while providing greatest patient satisfaction (National Guideline clearinghouse, 2013 p.1)
– Paracetamol can be singly used to alleviate mild pains. Its use in pain management reduces opioids consumption.
– Metamizole is also used for mild pain and renal colic though it is prohibited in most European countries and in the USA; it continues to be used in other countries. Prolonged use of the drug should be avoided.
In recent years, there have been studies into complementary therapies of pain management that include relaxation, music and reflexology therapies. Particularly, foot and hand massage is used an alternative pain relief therapy by encouraging relaxation, promoting sleep, reduces swelling and increases oxygen circulation in the blood.
According to Wang and Keck 2004, Classical massage techniques involve effleurage, pertrissage, friction and kneading applied to the feet and hands of the patient. Effleurage refers to a gliding manipulation of superficial tissue by spreading lubricant and warming the surface layer of the tissue. Stroking is then done with the effect on easy blood circulation to the heart and to the skin. Skin temperature increases and causes the subcutaneous tissues to be stretched thus preventing formation of fibrosis. It also stimulates the flow of lymph liquid hence enhancing drainage of waste products (Abdo, 2008). Secondly, petrissage generally includes kneading, skin rolling, compression, wringing and squeezing
This technique uses finger to make circles on the patient’s hands. The message should be conducted for at least 5 minutes on each hand and leg while making sure to avoid catheter areas. The pillow support ought to be removed to aid in relaxation. Similar research interventions have been conducted by (Degirmen et al, 2010 and McDonald, Mitchell and Kreutz 2012); with the common finding that foot and hand massage and relaxation lead to the reduction in the intensity of patients enrolled in their studies.

Mechanism of foot massage on acute postoperative pain
Postoperative pain results from the release of chemical mediators such as histamine and bradykinin cytokines among others. The pain impulses are transmitted through A-Delta and C nerve fibers and eventually activate the T-cells. Foot massage activates primary afferents through the stimulation of cutaneous mechanoreceptors. Afferents releases endorphins which serve to inhibit the transmission of neurotransmitters. Massage also causes second transmission neurons to be blocked thus preventing noceptive information reaching consciousness. The pain is the result of impulse transmission from the small and large diameter nerve fibers. When massage is applied the tactile stimulation produced moves very fast through the large diameter fibers. This is deemed a race with the brain as the fibers carry a faster signal. Pain sensations to the brain are blocked since massage sensation have already closed the gate (Degirmen et al, 2010 p. 41 and McDonald, Mitchell and Kreutz 2012 p. 23, and National Guideline Clearinghouse, 2013). This is the gate theory.
According to the review on literature and evidences, postoperative pain following a cesarean section remains an unresolved consequence for clinical practitioners. Postoperative pain may adversely affect the wellbeing of the newborn and the mother. To the mother, it may result in respiratory complications, ambulation impairment, thromboembolism and atelectasis. It may also affect the newborn’s feeding. In this study we have examined various pain management strategies for cesarean recovering patients. The role of nurses is to ensure control and relief of acute postoperative pain through pharmacological and non-pharmacological interventions. The use of oral opioids in pain management is common in the United States and European countries. PCAs are also common among practitioners as it does not use injections and can be quickly administered without delay. Non-pharmacological interventions have also been seen to help in relieving pain in patients. Massages, music and other mind-body techniques are effective in pain management. Ongoing monitoring and assessment of pain relief efficacy evidenced by the patient’s ability to take deep breaths, feel less stressed or anxious, stand and walk (Gilmour, 2005 p. 12).

References
Abdo, R 2008, Factors affecting pain intensity post cesarean section in Government Hospitals in the West Bank-Palestine, An-Najah National University, Palestine.
Carvalho, B, Stetka, B & Sullivan 2011, A proven Approach to reduce Post cesarean Pain, Retrieved from <http://www.medscape.com/viewarticle/736231>
Daesh, S A, Ghaedi, S & Jabalameli, M 2012, Pain relief after cesarean section: Oral Methadone vs. Intramuscular pethidine, Med science 2012 17(2).
Degirmen, N, Ozerdogan, N, Sayiner, D, Kosgeroglu, N & Ayranci, U 2010, Effectiveness of foot and hand massage in post cesarean pain control in a group of Turkish pregnant women, Applied Nursing Research, 23, 153-158.
Gilmour, D 2005, The basis of surgical care: Perioperative care
Good, M, Anderson, C G, Hicks, S M, & Makii, M 2002, Relaxation and music after gynecologic surgery, Journal Pain Management Nursing, 3.
Ismail S, Shahzad, K & Shafiq, F 2012, Observational study to assess the effectiveness of postoperative pain management of patients undergoing elective cesarean section, J Anaesthesiol Clin Pharmacol vol 28(1).
Jacques, D 2009, Impact of opioids rescue medication for breakthrough pain on the efficacy and tolerability of long acting opioids in patients with chronic non-malignant pain, British journal of Anaesthesia.
Joint Commission on Accreditation of healthcare Organizations (JCAHO) 2001, Facts about Pain Management, The Joint Commission.

 

Evidence Based Practice And Research In Nursing Practice Research Paper Examples

Evidence Based Practice And Research In Nursing Practice Research Paper Examples

There is a need to offer quality health care that is safe and effective. This can be done through implementation of evidence based care under which all nursing interventions and decisions regarding patient care are based on evidence drawn from credible research and not only on hospital culture. A recent case in my hospital that demonstrates the need for evidence based care is that of Mark, a 9 year old boy who presented in the ER with pain in the right ear and was diagnosed to suffer from recurrent otitis media. Otitis media is the inflammation of the middle ear that is common in children. Being an inflammation, the hospital guidelines recommend use of decongestants and antihistamines. Mark’s mother reckoned that antihistamines have not worked in the past. In addition, the reviewed evidence did not support use of decongestants and antihistamines in the management of otitis media due to low efficacy and significantly larger risk (Coleman & Moore, 2008). Therefore we opted to offer analgesics such as ibuprofen which have proven efficacy, safety and tolerability in the management of otitis media in children (Sattout & Jenner, 2008).
Implementing EBP is challenging due to barriers such as resistant to change, time constraints in generating evidence, limited knowledge in research among nurses, and limited capacity for nurses to influence hospital guidelines (Shaheen et al., 2011). The challenge of having limited time on the job to implement new EBP ideas can be addressed in various ways. First, the government should employ more nurses to reduce workload on individual nurses. The second solution is on training nurses on IT skills to enhance collection and evaluation of evidence through use of medical databases such as Cochrane which evaluates medical evidence.

References
Sattout, A.; Jenner, R. (February 2008). “Best evidence topic reports. Bet 1. The role of topical
analgesia in acute otitis media”. Emerg Med J 25 (2): 103–4.
Coleman C, Moore M (2008). “Decongestants and antihistamines for acute otitis media in
children”. In Coleman, Cassie. Cochrane Database Syst Rev (3): CD001727.
Shaheen, M., Foo, S., Luyt, B., Zhang, X., Theng, Y-L., Chang, Y-K., & Mokhtar, I. A. (2011).
Adopting evidence-based practice in clinical decision making: Nurses’ perceptions, knowledge, and barriers. Journal of the Medical Library Association, 99(3), 229-236.

 

Example Of Essay On Nursing: Healthy People 2020

Example Of Essay On Nursing: Healthy People 2020

Nursing: Health People 2020
Objective: Improving health of Americans
I choose this objective because when an evaluation of Americans health is undertaken there needs to be improvement regarding accessible healthcare. The situation affecting health care in America is that while it is available it is not accessible. Adequate health insurance coverage is one of the greatest hindrances to quality health care. 60% of the nation is uninsured. It is my opinion that even when all Americans become insured there will still be low quality of health care for the majority.
Since healthcare is based on a capitalistic model the objective is to increase surplus and not quality of care. The systems combining accountable care principles into strategic interventions puts recipients of care at odds with the system since some of them are designed to benefit physicians. Therefore, two internal factors affecting access to health care are financing and payment displacements. Without adequate health insurance people die, much more when they do not have any at all. Medicare and Medicaid offer limited coverage and many employer/employee subscriptions plans embody a series of pre-approved and pre-certification dilemmas in accessing quality health care in America. In situations when there is no coverage patients are asked to either pay out of pocket or co-payments are exhaustive.
In 2004 the Institute of Medicine reported that United States of America was among few industrialized nations in the world, which cannot guarantee access to health care for its population (Institute of Medicine, 2004). Physically, there are available health care services, but access barriers to those services have been created through financial impositions. Importantly, analysts have advanced that America’s health care system is the most expensive among developed nations in the world (DeNavas-Walt, 2011).

References
DeNavas-Walt, C. Proctor, B., & Smith, C. (2011). Income, poverty, and health insurance
coverage in the United States: 2010. U.S. Census Bureau: Current Population Reports,
P60-239. Washington, DC: U.S. Government Printing Office.

 

Example Of Challenges In The Assessment Of The Abdominal And Neurological System And Why Case Study

Example Of Challenges In The Assessment Of The Abdominal And Neurological System And Why Case Study

Question 1.
– Location of pain, intensity and duration of pain can be misleading. Various causes of acute abdomen include appendicitis cholecystitis, hernia and other gynecological causes may be difficult to distinguish and diagnose.
– Uncertainty of diagnosis and difficulty to identify abdominal pathology owing to the many organs within the abdominal viscera. An examiner will occasionally miss a diagnosis by mistaking the affected organ with an adjacent organ.
– Pregnancy – pregnant women are usually difficult to examine per abdomen owing to the physical and physiological changes e.g. enlarged uterus.
– Small children might be difficult to examine – they are usually uncooperative and their systems are not well developed.
– Use of narcotics and strong analgesia may hinder definitive diagnosis of both abdominal and neurological systems.
– Mental status, dementia and decreased sensation of peripheral nervous system in older patients can reduce perception of pain.
– CONCLUSSIONS ABOUT K.B’s DIETANY RECALL ON THE FOOD PYRAMID
– K.B’s dietary recall includes many unhealthy food contrary to recommendations and objectives of food pyramid to prevent obesity, chronic diseases and dental caries
– She takes highly refined foods, fatty foods, free sugars and all have very high in glycemic load that expose her to health problems. Her diet predisposes her to lifestyle diseases e.g. type II diabetes, heart diseases, hypertension, cancer etc. owing to her genetic relationship with these diseases and the sedentary lifestyle that she leads.
– She does not balance the food she eats with physical activity to help maintain or improve her weight. Her BMI indicates that she already obese.
– Her foods do not include vegetables and fruits which are highly recommended in people at risk of developing lifestyle diseases.
– Her meals do not include the right portions or servings for every major food group. For adult women living a sedentary life 1600k/cal is what is required per day compared to her meals, which includes too much unrefined sugars, carbohydrates and saturated fats.
– ELEMENTS OF NUTRITIONAL ASSESMENT
– These include; anthropometric, biochemical, clinical and dietary assessments.
– Anthropometric assessment includes; weight, height and skin fold measurements e.g. Mid upper arm circumference. Weight and height are also used in calculation of body mass index (BMI)
– Biochemical assessment, involves laboratory test and food analysis.
– Clinical assessment involves collection of data and information about individuals’ medical history and examination.
– Dietary assessment – documentation of data on the type of food, food portion and frequency.
– CONCLUSSION ABOUT CLIENT’S DIET.
The client has a very unhealthy diet that comprises of mainly refined foods, saturated fats, carbohydrates and free sugars. She has some hereditary/ genetic relationship that predisposes her to diabetes and hypertension and therefore must be very particular about her diet to avoid her diet developing these diseases.
– ORDER OF ASSESMENT TECHNIQUE
– Inspect – palpation – discussion – percussion

This applies to gastro- intestinal system and genital urinary systems.
– ASSESMENT, FINDINGS DURING ABDOMINAL EXAMINATION
– Inspection – abdominal distension, rate of respiration, visible peristalsis, scalps, veins enlarged liver and spleen.
– Palpation – tenderness localized organized, enlarged organs, mass, herms, pulsating vessels.
– Percussion – extent of liver and spleen enlargement, detecting peritoneal fluid, resource and dullness.
– Auscultation – bowel sounds, continuous murmurs.
– NURSING DIAGNOSIS:

Nutritional imbalance – related to poor dietary planning and increased risk of lifestyle diseases
FACTORS CONTRIBUTING TO CLIENT’S PROBLEMS.
– Sedentary life style work environment gender, age, physical activity, and other environmental factors.

A NEUROLOGICAL ASSESSMENT IN CEREBRAL VASCULAR ACCIDENT.
– Glasgow coma scale
– History taking – history of seizures, headaches, vision, and hearing problems.
– Mental status assessment – state of consciousness, orientation, mood, thought process, memory, practical skills etc.
– Assessment of the peripheral and motor nerve function- reflexes,tetany,sensory evaluation etc
(B) CEREBRAL, COGNITIVE AND NEUROLOGICAL ASSESMENT AND THE RATIOANALE
– CVA disease is a risk factor to cognitive functioning of an individual, patients of CVA will usually present with dementia and attention deficit. Deficits in memory, circulation, reasoning and orientation are greatly affected.
– Neurological based anomalies that one may observe include developmental disabilities, muscle weakness & numbness. Others develop flaccidity, spasticity, hemiplegic, reduction of sensation, decreased reflexes balancing problem, dropping of the tongue.
– Cerebral deficits – breathing problem, difficulty with verbal expression, hearing, motor speech disorder, altered voluntary movement, memory deficits.
( C ) FINDINGS THAT WILL DEVIATE FROM THE EXPECTED FINDINGS IN A NORMAL PERSON
– Patient present with face dropping, arm weakness and speech difficulty
– Sudden numbness or weakness of the leg
– Mental confusion and a problem understanding
– Vision with one or both eyes may be affected
– Loss of balance and coordination, trouble walking
– Severe headache of unknown origin
– Hemiplegic
(D) WHY IS IT NECCESSARY TO INCLUDE MUSCULO SKELETAL ASSESMENT
– CVA is a physically disabling neurological condition that result in secondary musculoskeletal complications of the patient.
– Assessment of the muscular skeletal system will help to recognize and treat complication of CVA and improve patient functioning
– In order to plan for rehabilitation of patients and to to avoid development of secondary musculo skeletal complications and degenerative disorders of the system.
– Treatment and rehabilitation focuses on improving and helping the patient to regain function and prevent secondary disability.
(A) INSPECTION
– Yellowish discoloration of the eyes/sclera
– Patient presents with abdominal distension
– Lying supine, the flanks are pushed further upwards due to excess fluid
– Visible bulging abdominal veins.
(B) AUSCULTATION
– Reduced bowel movements.
– Tachycardia in case of an infection
– High blood pressure related to portal hypertension
– Tarchypnoa, due to increased respiratory activity and pressure on diaphragm
(C) PERCUSSION
– Direct percussion on the abdomen – there is direct transition from tymphani to dullness as you precise further downwards.
– Shifting dullness – when patient lays on the side these is a shift of tymphani to the top and dullness to the bottom of the belly.
– Fluid wave – when you tap one side of the abdomen with your finger tips there is a shock wave felt on the opposite side of the abdomen.
(D) PALPATION
– Palpate the liver for enlargement and spleenomegally. The liver can be palpated 2 – 3 cm below the lower costal margin. If there is a liver pathology you can feel the texture of the liver i.e. softness, hardness, nodular swelling etc.
– It might be impossible to palpate for other organs in the abdomen owing to the large amount of fluid in the cavity.
(A) HEALTH QUESTIONS I WILL ASK THE MOTHER WHO BROUGHT HER CHILD TO THE ER WITH VOMITING AND DIARRHOEA
– For how long has the child been vomiting and passing diarrhea
– History of fever and other symptoms related for infections
– The color and consistency of stools.
– Type of food given to the child lately.
– Is the child drinking water? Are there signs of thirst
(B)ORGANS AND SYSTEM TO FOCUS ASSESMENT ON
– Check the child’s general condition – is the child lethargic, restless or irritable
– Look at the eyes; are they sunken
– Are the fontanel’s of the head bulging or sunken
– Check for skin turgor and dryness push the skin on the abdomen and check whether it goes back easily
(C)ASSESSMENT RESULTS
– Inspection – child general condition, whether lethargic, irritable inspect the eyes for jaundice, pallor, dryness or sunken are the fontanel’s of the skull sunken or bulging. Check the skin for dryness, edema, and turgor.
– Auscultation – auscultation of the chest for respirations, cardiovascular system for rate of heart beat, murmurs etc. check the abdomen for bowel sounds
– Percussion – percussion of the chest, abdomen for tymphany and resource
– Palpation – palpate the abdomen for tenderness, liver and spleen for enlargement.
– COMPLICATIONS
– Several dehydration
– Metabolic hypo kalemia and hyponatraemia
– Shock acidosis
– Electrolyte imbalance
– hypoglycemia
– Malnutrition
– Death

REFERENCES
– http://connection.lww.com
American Journal of Gastroentology.
– American Academy of Nursing Practice. By Ambrose,M., &Decker,H.M.(1996)
– Healthy Eating Plate and Healthy Eating Pyramid.( Harvard School of Public Health)
www.hsph.harvard.edu/nutritionsource/pyramid
Boston 2013
– Textbook of Clinical Neurology. 3rd Edition
Saunders Elsevier.( 2007) chapter 45.
– www.paediatrics.about.com
Treatment of vomiting and diarrhea in children

 

Nurses’ Uncertainty Article Review Examples

Nurses’ Uncertainty Article Review Examples

The study is “Recognizing and Responding to Uncertainty: A Ground Theory of Nurses’ Uncertainty” (Carnley, Doran, Tourangeau, Kushniruk, and Nagle, 2012).
The study was conducted to develop a substantive theory to help understand nurses’ experience and respond to uncertainty in practice. The aim was to explain how nurses seek information when uncertain and experience uncertainty (Carnley, Doran, Tourangeau, Kushniruk, and Nagle, 2012).

The study is a qualitative study since it was developed to explain nurses’ behaviors in uncertain situations.
This is a descriptive study. The researchers used all methods used in descriptive statistics. They used registered nurses working full- or part-time and not a probability. They also included age group and gender in their study.
The variables used were two. The first variable was the two classes of nurses (full and part time). This was important since the decisions made by the nurses are different. The nurses’ experience was the second variable. A decision made by a “more” experienced nurses cannot be the same as a “less” experienced nurse.
The convenience method of sampling was used since the participants volunteered themselves. This was not appropriate as it is bias. The view of the volunteers may not represent the views of the other people.
The data collection used was face-to-face interviews. An advantage of this method is that when is able to gather different opinions. However, the greatest limitation is that it is based on the individual wiliness to give the information.
Open-coding was used to analyze the recorded interviews. This is a descriptive method. They also used rigor method to confirm the credibility of the information. The researchers used a sample hence it is an inferential method.
The study contributes to the improvement of nursing care. Nurses’ decisions are very important when attending to a patient. The theory teaches nurses to recognize, manage, and strategies to apply when face with uncertainty (Carnley, Doran, Tourangeau, Kushniruk, and Nagle, 2012).

References
Carnley, A., Doran, M., Tourangeau, E., Kushniruk, A. & Nagle Lynn (2012). Recognizing and Responding to Uncertainty: A Ground Theory of Nurses’ Uncertainty: Worldviews on Evidence-Based Nursing. Indianapolis: Sigma Theta Tau International.

 

Essay On Evolution Of Healthcare Marketing

Essay On Evolution Of Healthcare Marketing

Major Historical Development of Hospitals in the United States
During the 18th century, the United States did not have the formal institutions of health care that are commonly referred to as hospitals. As a result, the sick were attended to by the medical practitioners at the comfort of their homes. There were numerous challenges that characterized by this form of health care provision (Jonas, 2003). For instance, the majority of the medical practitioners did not own the necessary expertise and equipments that are applied in the administration of health care. This is an attribute that had negative implications on the standard of health care that was being rendered by the medical practitioners.
Additionally, most of the equipments employed in the provision of health care were not mobile. This attribute greatly impaired rendering of timely and high standards of health care to the patients. Boston was the United States’ largest city at the time and had a population of approximately seven thousand people. All these people relied on the aforesaid form of health when they had health needs (Jonas, 2003). Another major challenge was based on incidences when people ailed from communicable diseases. Such medical conditions necessitated for the segregation of the affected people from the general population through a process known as quarantine. Such individuals were normally confined in locations that were remote from the city. This is because such areas were not easy to access thus they were suitable for carrying out such activities. These stations of isolation served as the first form of hospitals.
During the seventeenth century, mental illness was considered a major illness and special places were designed for the purpose of dealing with these people. Such places formed the basis of establishing hospitals, such as the Bellevue Hospital, which was established in the year 1736. The fundamental mission of the institution was to cater to the needs of the aged, mentally ill, and the poor. In the year 1789, a hospital was established in Baltimore and it was known as the Public Hospital of Baltimore (Raffel, 2005). This hospital remained in operation for a century and it was improved to its current status and name referred to as the Prestigious Johnson Hopkins Hospital. The number of institutions for health care increased significantly during the 19th century. Pest houses were established in most of the major cities across the nation and almshouses were also established to cater for the poor within the society. It is also during this era that some of the Almshouses and Pest house were equipped with infirmaries. During this era, most of the hospitals were extremely unhygienic and they led to the contraction of various hygiene related infections. This is an attribute that made many people resent visiting the hospitals.
In the year 1850, the protestant movement from Germany launched its operations in Pennsylvania. This movement revolutionized the entire health care industry within the United States. This is largely because it introduced the formal training of nurses. These nurses underwent training on the provision of health care (Raffel, 2005). The nursing profession was extremely upheld and developed during the civil war. This is because the nurses who were trained by this movement were providing health care services to various soldiers that had been injured during the war.
The twentieth century was marked by a wide range of major advancement in the health care sector. This is the era which health care insurance was introduced and marked a major advancement in the health care industry. The popularity of this product has been increasing over the years. This product managed to move from a preference product to the basic product that people required. This implies that it graduated from being a luxury into being a necessity. It is also during this phase that hospitals ceased being viewed as charitable institutions that addressed the needs of the low income earners (Raffel, 2005). This phase was characterized by the commercialization of hospitals. This is an attribute that facilitated a broad range of development to take place within this sector. Through the commercialization of the health care services that were being rendered by the hospitals, the standard of health care being rendered immensely improved. This is because the availability of funds facilitated hospitals to carry out research on various fields of health care.
In addition, it also facilitated the development and procurement of high technology equipment that was employed for the provision of health care. It also catalyzed the growth of the number of hospitals across the nations. This is primarily because there was a comparatively large population of people in demand of the health care services. This population could not be adequately catered for by the number of hospitals that were present at the time (Jonas, 2003). The rise in the number of hospitals facilitated the rise in the population of people that had access to relatively high quality health care. The private, public and non-for-profit hospitals that were set up, contributed to these significant improvements in the provision of health care across the United States.

The major historical events in Health care and hospitals in the UK
The Voluntary Hospitals were established in the United Kingdom, during the medieval age. These forms of hospitals completely relied on voluntary services as well as funding from well wishers. These hospitals were set up with the objective of supplementing the nature of health services that were being rendered by the hospitals present in the nation. These hospitals provided training for most of the medical practitioners and attended people who were suffering from long term illnesses. The popularity of these hospitals continued to increase progressively to a point whereby they were considered essential in the provision of health care within the United Kingdom (Pickstone, 1985). However, this situation was set to change in the course of the forthcoming years. The members of the general public started mounting pressure on the government to review the health care policies. The government succumbed to the pressure, thereby reviewing the health care policies, which led to the establishment of hospitals in all cities and major towns across the United Kingdom. This was a move geared towards enhancing the prevailing degree of access to a high standard of health care.

A Comparison of the US and the UK History of Health Care and the Evolution of Hospitals
Evidently the history of hospitals in the United States evolved more efficiently than in the United Kingdom. This is mainly because the growth was progressive and it took place over a relatively long duration (Pickstone, 1985). Although the history of hospitals in the two countries is considered comparatively long, the history of the United States is based on a long, enduring and difficult process that led to numerous developments in the health care sector. This effort was primarily geared towards enhancing the standards of health care that were being offered (Jonas, 2003). For instance, the introduction of the medical insurance policy played a central role in enhancing the quality of health care being rendered in the United States.
In conclusion, the health care industry has undergone a major revolution and since the 17th century, when it was informal and based on traditional practicians, to the current modern status of the sector. There were major events in the United States history, such as the American civil war, which shaped the health care industry immensely. For example, it led to the introduction of nursing as a professional, which has been imperative in the industry. In comparison with the UK, the US health care system developed radically and immensely leading to the development of the major foundations in the sector.

References
Jonas, S. (2003). An Introduction to the U.S. Health Care System: Fifth Edition. New York: Springer.
Pickstone, J. (1985). Medicine and Industrial Society: A History of Hospital Development in Manchester. Manchester: Manchester University.