...shift change; handoff report improvement Effective handoff communication among nurses is an important necessity for safe patient care. As described by Carroll et al “Communication quality is a key requirement of effective interdependent work processes in complex work settings such as hospital-based healthcare” (2011 p. 586). Handoff communication is the transferring of vital, relevant patient information to the next caregiver. Is occurs not only between nurses, but also physicians, and ancillary staff as well. Many studies have discovered the inconsistencies between information handed off to the next caregiver and the information documented on the patient. Healthcare staff has to improve this task by standardizing handoff report more than just the SBAR mnemonic. Within our current organization, implementation of a voice recorded report was established a couple of years ago. It has not been well received within the hospital. Different department have different request for information that they want to receive. This creates confusion and difficulty in following the unit specific format required. In the emergency department it does have some benefits. A nurse can record a report for the inpatient floor to receive when the nurse has a few minutes to perform the task. This was an improvement to the old process of trying to call report to the floor only to hear that the nurse was in a...
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...CASE STUDY SYNTHESIS PAPER GREG BOIVIE NURS 221 MAY 24th, 2011 Case Study Synthesis Paper Tami is a 56-year old woman, 5’6” tall and weighs 136 kg. She came in for an ERCP to remove gallstones at 0800. The surgery went well and she woke up at 1130 denying any pain. At 1300 she had abdominal pain of 9/10 and received Toradol 60mg IVP. By 1350 she was complaining of back pain of 9/10 and she was given Morphine 2mg IVP and denied any pain 10 minutes later. Come 1530 the patient’s vitals were stable on room air, she ambulated to the bathroom independently and at 1535 a loud thud was heard in the bathroom. The patient was found lying on the floor with a laceration above her left eyebrow, not responsive to verbal commands and breathing at a rate of 4 per minute. We will discuss the immediate concerns and treatment for the patient and then we will go back and see what could have been done differently with the patient to prevent the situation that occurred. The nurse immediately assessed the ABC’s and activated the MET team. The patient had an open airway, was breathing at 4 per minute and had a weak carotid pulse at a rate of 40 per minute and blood pressure of 82/44. The primary concern for the patient was Risk for Complications of Decreased Cardiac Output r/t bradycardia secondary to vasovagal stimulation while having a bowel movement. According to Kyrillos and Pineda (2005), vasovagal episodes are caused by triggering baroreceptors that increase vagal response leading...
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...Case Study – Chronic Bronchitis Admitting History A 68 year old retired geologist arrived in the emergency room with his daughter. Well known to the respiratory care consult team, he has a 40 year history of smoking 1.5 packs of cigarettes a day, is widowed, lives alone, and has difficulty managing his daily activities. For the past week the man has experienced increased dyspnea and cough and has been unable to care for himself. On observation, his personal hygiene appeared to have deteriorated. The man stated that he has been unable to get his breath or inhale deep enough to cough up secretions. He complained of mild nausea without abdominal pain or vomiting. His physician had given him an unknown oral antibiotic 3 days before this admission. The man was diagnosed with severe chronic bronchitis approximately 6 years ago and had an acute myocardial infarction 2 years ago. His pulmonary function studies 1 year before this admission showed severe airway obstruction and air trapping. He has a history of high blood pressure, congestive heart failure, chronic dyspnea on exertion, and chronic cough and he experienced two episodes of pneumonia within the last year. In recent months, according to a neighbor, he has become increasingly depressed. According to his daughter, his physical activity is minimal. He generally spends most of his days watching television, smoking, and napping. All his children, none of whom live in the immediate area, have tried to coax...
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...In this case study of a 78-year-old African American female, who lives with her husband Willie, in a rough part of town. Jane was admitted to hospice on December 23, 2017, for changes in the level of health-related illness. He had been living at home on hospice before going to the hospice facility. She had been living at home with her husband when he had hypertensive heart disease, acute or chronic systolic, unspecified atrial fibrilla, diabetes, major depressive disorder, cardiomyopathy, undefined, and angina pectoris, vague. There was some debate whether there had indeed been a change in the level of health-related issues. Jane, was currently not receiving the medication prescribed to her on a daily basis which caused some complication in...
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...IE. Total or partial publication of this document without the express, written consent IE is prohibited. INTRODUCTION Improving efficiency in health care is an acute issue. In the developed world this is due to increases in costs and quality issues (Aptel and Pourjalali, 2001; Spear, 2005); Western Europe currently spends 9% of its GDP on health care, and, if the trend continues, will spend over 20% by the year 2050 (Drouin et al., 2008.) In the developing world on the other hand demand exceed capacity; it was estimated that in 1997 over 12 million people were blind in India from cataracts, while a further 3.8 million new cases are developed each year, and current capacity for surgery is far below this level (Thulasiraj et al., 1997.) Better health care operations are clearly required to deal with issues of ageing population, increased costs and unmet demand. One case that provides clues to such means is Aravind, the largest eye care provider in the world, with over 2.5 million operations performed and 20 million patients treated in the last thirty years. An Indian non-for-profit organization in which two thirds of the patients are treated for free, Aravind attends its goals by strict attention to cost optimization. THE STORY OF DR. V Dr. Govindappa Venkataswamy (known as Dr. V) retired at age 58 from a life in public health as an ophthalmologist in India. He then started, with his sister and brother in law, an 11...
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...Pulmonary Disease Clinical Reasoning Case Study STUDENT Worksheet JoAnn Walker, 84 years old Overview This case study incorporates a common presentation seen by the nurse in clinical practice: community acquired pneumonia with a history of COPD causing an acute exacerbation. Principles of spiritual care are also naturally situated in this scenario to provide rich discussion of “how to” practically incorporate this into the nurse’s practice. Concepts (in order of emphasis) I. Gas Exchange II. Infection III. Acid-Base Balance IV. Thermoregulation V. Clinical Judgment VI. Pain VII. Patient Education VIII. Communication IX. Collaboration I. Data Collection History of Present Problem: Pneumonia-COPD JoAnn Walker is an 84-year-old female who has had a productive cough of green phlegm 4 days ago that continues to persist. She was started 3 days ago on prednisone 60 mg po daily and azithromycin (Zithromax) 250 mg po x5 days by her clinic physician. Though she has had intermittent chills, she first noticed a fever last night of 102.0. She has had more difficulty breathing during the night and has been using her albuterol inhaler every 1-2 hours with no improvement. Therefore she called 9-1-1 and arrives at the emergency department (ED) by emergency medical services (EMS) where you are the nurse who will be responsible for her care. Personal/Social History: JoAnn was widowed 6 months ago after 64 years of marriage and resides in assisted...
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...Asthma Case Study Lisa, a four-year-old with status asthmaticus, is admitted from the emergency room via a wheelchair to a medical pediatric unit. She is accompanied by her parents who both have anxious, tense facial expressions. Lisa’s vital signs are T-36.9° C, P- 140 (apical, regular), R 38 (regular but shallow), BP 118/78. She is pale but has no evidence of cyanosis. Her breath sounds are normal in upper lobes, with inspiratory and expiratory wheezing and scatter crackles in all lobes. Breath sounds in lower lobes are diminished. She has moderate intercostal retractions, some nasal flaring, and an occasionally loose, productive cough. Lisa has thin, whitish nasal discharge and tears are dried on her cheeks. She is irritable and appears frightened. Other significant data include: Wt 19 kg, Hemoglobin 12.5, Hematocit 37.3, theophylline level 10.5 mg/dl before treatment in ER. The chest x-ray films show that her lungs are hyper inflated with some infiltrates but no atelectasis or consolidation. Three days ago, Lisa came home from the day care center with the sniffles. By evening, she had rhinorrhea and a cough but no fever. This developed into a head cold. Two days ago, she helped her father rake leaves and then played in the leaves pile with a friend. About noon today, the day care center called Lisa’s mother because she said she couldn’t catch her breath and was tired. At home, Lisa’s mother gave her an Albuterol treatment, which helped for about 30 minutes...
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...cast was applied in the emergency room. reason for the nurse to elevate the casted leg is to A) Promote the client's comfort B) Reduce the drying time C) Decrease irritation to the skin D) Improve venous return The most important D: Improve venous return. Elevating the leg both improves venous return and reduces swelling. Client comfort will be improved as well. 2. The nurse is reviewing with a client how to collect a clean catch urine specimen. What is the appropriate sequence to teach the client? A) B) C) D) Clean the meatus, begin voiding, then catch urine stream Void a little, clean the meatus, then collect specimen Clean the meatus, then urinate into container Void continuously and catch some of the urine A: Clean the meatus, begin voiding, then catch urine stream. A clean catch urine is difficult to obtain and requires clear directions. Instructing the client to carefully clean the meatus, then void naturally with a steady stream prevents surface bacteria from contaminating the urine specimen. As starting and stopping flow can be difficult, once the client begins voiding it’s best to just slip the container into the stream. Other responses do not reflect correct technique 3. Following change-of-shift report on an orthopedic unit, which client should the nurse see first? A) B) C) D) 16 year-old who had an open reduction of a fractured wrist 10 hours ago 20 year-old in skeletal traction for 2 weeks since a motor cycle accident 72 year-old recovering from surgery...
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...Play Intervention in Preparing Children for Surgery: A Randomized Controlled Trial Study. RESEARCHER: 1. Cheung Li, PhD, is an Assistant Professor, Department of Nursing Studies, University of Hong Kong, Pokfulam, Hong Kong. 2. Violeta Lopez, PhD, is a Professor and Head of School, School of Nursing (NSW and ACT), Australian Catholic University, North Sydney, NSW, Australia. SUBMITTED DATE : January 25, 2007 ACCEPTED DATE FOR PUBLICATION : July 21, 2007 PUBLISHED DATE : April, 2008 JOURNAL : Journal for Specialists in Pediatric Nursing INTRODUCTION It can be observed today that nursing is a dynamic profession,both internally and externally due to constant change occurring in the profession. As a dynamic profession, nursing is responsive and is adapting to meets the needs of patients and the public.Nursing is a practice discipline, which is dependant upon a high level of professionalism,ethics and human values that demand for intellect, skills and a high sense of social responsibility.The knowledge and essential skill that increased dramatically make nurses leading and developing new services in health care delivery. Nurses roles and resposibilities will continue to change in line with the health reforms that are improving care for patients.Therefore, nurses need to be encouraged to integrate the best available evidence with clinical judgment and the current...
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...Patient Safety in Nursing Education Through Patient Simulation Carol Fowler Durham, Kathryn R. Alden Background The alarming rise in morbidity and mortality among hospitalized patients throughout the United States heightens concerns about professional competency.1 Nurses and other health care professionals are under increased scrutiny to provide safe, effective care. Likewise, nursing education programs are faced with increased pressure to produce graduates who are capable of providing safe patient care. Toward that end, nursing education programs develop curricula, hire qualified faculty, and select learning experiences for students in an effort to train and graduate competent, effective nurses. The instructional strategies utilized in both didactic and clinical components of nursing education courses are highly influential in determining critical thinking and clinical decisionmaking ability as well as in developing the psychomotor skill performance of new graduates. Of course, it is unrealistic to think that graduates of nursing education programs have received all the training they need when they depart the doors of academia. Orientation programs for new graduates and continuing education for nurses are essential tools to help practitioners improve their knowledge, skills, and expertise so that quality patient care is provided and outcomes are optimized while errors are minimized. Ongoing evaluation of nursing competence is necessary to promote patient safety...
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...The Sahlgrenska Academy Goteborg University ¨ Box 457, SE-40530 Goteborg ¨ Sweden Telephone: þ46 31 773 60 39 E-mail: margaretha.jerlock@fhs.gu.se 956 J E R L O C K M , G A S T O N - J O H A N S S O N F & D A N I E L S O N E ( 2 0 0 5 ) Journal of Clinical Nursing 14, 956–964 Living with unexplained chest pain Aim. The aim was to describe patients’ experience of unexplained chest pain, and how the pain affected their everyday life. Background. Chest pain is one of the most common reasons for patients to consult the emergency department. Often no clear ischaemic heart disease or any other somatic explanation is found. Exploring the pain experience and how the pain affects everyday life may provide insights into the patients’ perspective, fill the gaps in our knowledge about this condition and give needed direction for nursing practice. Method. The study sample (n ¼ 19) included 11 men and eight women admitted to the emergency department. An open-ended unstructured interview was conducted with each patient and the data were...
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...Case Study Pulmonary Tuberculosis Nursing Management 1 PULMONARY TUBERCULOSIS CATEGORY I, PLEURAL EFFUSION RIGHT ON TREATMENT, STATUS POST CHEST TUBE THORACOTOMY INSERTION Nursing Management of a Pulmonary Ward Patient Having Pulmonary Tuberculosis Category I, Pleural Effusion Right on Treatment, Status Post Chest Thoracotomy Tube Insertion S, J, S. Our Lady of Fatima University, Quezon City Nursing Management 2 Nursing Management of a Pulmonary Ward Patient Having Pulmonary Tuberculosis Category I, Pleural Effusion Right on Treatment, Status Post Chest Thoracotomy Tube Insertion Private P, A.B., a 25 year old male, single. He finished second year college (Bachelor of Science in Education). He lives in Barangay Monbon Irosin, Sorsogon City. Five months Prior to Admission, patient began to experience dry cough, general body malaise, back pain, low grade fever in the afternoon, hoarseness of voice and restlessness. At first, patient took solmux and amoxicillin three times a day for three days. The signs and symptoms still persisted. He sought consult to the Commission Army Station Hospital, Lucena City and underwent another chest x-ray and had nebulization to liquefy secretions. He then was advised to go home. His immediate superior (official) advised him to go to the Armed Forces of the Philippines Medical Center due to unavailability of a pulmonologist in the area. He then was transported via ambulance and was seen in Emergency Room and chest x-ray was...
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...happening at ThedaCare every day. I wish I could have read this book six years ago, as it might have prevented some of the mistakes we made in our lean transformation journey.” — John S. Toussaint, MD, President/CEO ThedaCare Center for Healthcare Value “Coupled with a foundation of alignment and accountability, the ideas in this book provide a powerful tool to help hospitals get closer to the goal we want – perfect care.” — Quint Studer, CEO, The Studer Group, author of Results that Last “Mark Graban is the consummate translator of the vernacular of the Toyota Production System into the everyday parlance of healthcare. With each concept and its application, the reader is challenged to consider what is truly possible in the delivery of healthcare if standardized systems borrowed from reliable industries were implemented. Graban provides those trade secrets in an understandable and transparent fashion.” — Richard P. Shannon, MD, Frank Wister Thomas Professor of Medicine, Chairman, Department of Medicine, University of Pennsylvania School of Medicine “There is an enormous shortfall between the healthcare we are promised and what we actually get. Mark Graban explains how those in the system can make care delivery better for everyone –patients, providers, and payers.” — Steven Spear, Senior Lecturer, MIT, Senior Fellow, IHI “Mark Graban’s work has been a steady companion in the three years I have been studying and applying lean in healthcare. He...
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..._______________________________________________ Dr. Gloria Gutman, Senior Supervisor _______________________________________________ Dr. Kate Oakley, Supervisor _______________________________________________ Dr. Robert Horsfall, External Examiner Date Approved: _______________________________________________ iii Abstract Due to the greater availability of community resources as well as changes in admission policies, seniors are entering care facilities at an older average age and with higher levels of health needs than was the case twenty years ago. The number of dementia cases has also increased dramatically as well as Special Care Units (SCUs) to house persons with dementia. The purpose of this study was twofold. First it described the physical and operational characteristics of a sample of SCUs for dementia currently in operation in the Lower Mainland area of British Columbia (n=29) and compared those built prior to and after 1995. Second, this study determined the extent to which Directors of Care and Head Nurses believed their SCU operationalized the nine therapeutic goals identified in the Professional Environmental...
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...SITUATION : Arthur, A registered nurse, witnessed an old woman hit by a motorcycle while crossing a train railway. The old woman fell at the railway. Arthur rushed at the scene. 1. As a registered nurse, Arthur knew that the first thing that he will do at the scene is A. Stay with the person, Encourage her to remain still and Immobilize the leg while While waiting for the ambulance. B. Leave the person for a few moments to call for help. C. Reduce the fracture manually. D. Move the person to a safer place. 2. Arthur suspects a hip fracture when he noticed that the old woman’s leg is A. Lengthened, Abducted and Internally Rotated. B. Shortened, Abducted and Externally Rotated. C. Shortened, Adducted and Internally Rotated. D. Shortened, Adducted and Externally Rotated. 3. The old woman complains of pain. John noticed that the knee is reddened, warm to touch and swollen. John interprets that this signs and symptoms are likely related to A. Infection B. Thrombophlebitis C. Inflammation D. Degenerative disease 4. The old woman told John that she has osteoporosis; Arthur knew that all of the following factors would contribute to osteoporosis except A. Hypothyroidism B. End stage renal disease C. Cushing’s Disease D. Taking Furosemide and Phenytoin. 5. Martha, The old woman was now Immobilized and brought to the emergency room. The X-ray shows a fractured femur and pelvis. The ER Nurse would carefully monitor Martha for which of the following...
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