...KING’S THEORY OF GOAL ATTAINMENT EXEMPLIFIED FROM THE INTRAPARTUM NURSE’S PERSPECTIVE By Jacqueline L. Karlin The model of nurse-patient transaction from King’s Theory of Goal Attainment was employed to explore the impact of the nurse-patient transaction as it relates to primiparous patient satisfaction with the childbirth process. In this descriptive study, intrapartum nurses were interviewed regarding their perception of primiparous patient’s childbirth experience. The interviews were reflected upon to develop a better understanding of the impact of the nurse-patient transaction on achieving patient satisfaction with coping strategies. The findings revealed that although only one-half of the patients had participated in formal childbirth classes, effective nurse-patient transactions were successful in goal attainment of satisfaction with coping strategies in labor and delivery. TABLE OF CONTENTS Page LIST OF FIGURES ........................................................................................................... iii CHAPTER 1 – INTRODUCTION ......................................................................................1 CHAPTER 2 – THEORETICAL FRAMEWORK AND LITERATURE REVIEW ..........3 Personal System ..............................................................................................................3 Interpersonal System .......................................................................................................5 Social System...
Words: 8099 - Pages: 33
...| CASE: KEEP PATIENTS WAITING? NOT IN MY OFFICE | BUSN 6110/ME – OPERATIONS & PROJECT MANAGEMENT | | | CASE KEEP PATIENTS WAITING? NOT IN MY OFFICE 1. What features of the appointment scheduling system were crucial in capturing “many grateful patients”? By seeing patients at their “exact” appointment times, the patients were very grateful. It is rare that the doctor did not see the patients during their allotted time. The key to ensuring appointments remained on schedule was to book appointment realistically. By allotting the proper amount of time for each visit (this was tied to the services require) this kept the schedule on track. Patients are also given a specific time, e.g., 10:30 or 2:40 vice the usual come in 10 minutes or 30 minutes. There was an adequate number of examining rooms and her 2-3 assistants depending on the workload were well instructed on the standing operating procedures. New patients were asked to arrive in the office early to get their initial paperwork completed. New patients were also told about the strict adherence to appointment times. 2. What procedures were followed to keep the appointment system flexible enough to accommodate the emergency cases, and yet be able to keep up with the other patients’ appointments? The doctor felt that most doctors used them having an emergency as an excuse not to stick to their appointment times and felt this would not work in her practice. If it was a true emergency...
Words: 730 - Pages: 3
...Obstetric Consent for the Use of Epidural Anesthesia Sharon Lopez Apollo College Obstetrics Professor Scherer October 8, 2009 Nurse Perspective Epidural anesthesia is a procedure utilized frequently, for pain relief, by woman enduring the labor process. There are many considerations that the nurse is responsible for prior to, during, and after the procedure is performed. Knowing what these assessments, provisions, interventions, and evaluations are will prevent harm of the patient and ensure suitable pain relief measures are successful. According to Wong, epidural is the most effective pain relief measure used for labor (Wong, Perry, Hockenberry, & Deitra Leonard Lowdermilk, 2006). Epidural by Definition Epidural anesthesia involves the process of placing a needle fed catheter into the epidural space of the spinal column in between the L4 and L5 lumbar vertebrae. The purpose of this placement during labor is to block the T10 to S5 required for pain relief of all body areas involved in labor without suppressing organ function and decreasing LOC (Wong, Perry, Hockenberry, & Deitra Leonard Lowdermilk, 2006). The quantity and type of medication used determines the inhibitory effects on motor function and activity. This is a consented procedure which requires adequate education. Assessment Upon admission to the labor and delivery unit, the nurse should be attentive to any surgical history, allergies, obstetrics history, current medications...
Words: 1702 - Pages: 7
...Absorbable Sutures versus Staples for Cesarean Sections Victoria Fath Kent State University Absorbable Sutures versus Staples for Cesarean Sections Introduction The Merriam-Webster Dictionary (n.d.) defines a Cesarean section as, "A surgical operation for giving birth in which a cut is made in the mother's body so that the baby can be removed through the opening." "Cesarean delivery is the most common major surgical procedure performed in the United States and elsewhere. Currently, approximately a third of pregnant women in the US and 15% worldwide deliver by cesarean, and this prevalence is on the rise" (Dana Figueroa et al., 2013, p. 33). Since Cesarean sections are incredibly common and are only increasing, the risks for complications, such as infections, increase with it. To try and decrease the risks as much as possible, this study aims to look at the differences between two types of closing material used in Cesarean sections; absorbent sutures and staples. Are absorbable sutures more effective and safer than staples for Cesarean sections? The purpose of this study is to compare absorbent sutures and staples for clients undergoing a Cesarean section and to see which material has a lesser risk for infection and wound complications, which is more cost effective for the hospital, and patient satisfaction. This paper will help shed light on this subject by compiling multiple research articles and journals to create a better understanding on which...
Words: 2144 - Pages: 9
...TUI UNIVERSITY Module 2 Case Assignment Intro to Operations Management Dr. Bowersox 26 October 2012 As Diane’s new assistant just looking at the way they have the flow of the mother that is in labor is confusing. There are too many floors for the Labor and Delivery process which has the mother bouncing all over the hospital. If the pregnant mother is in distress she has to be moved to too many different floors. By moving the mother to all the different floors it could risk valuable time. I would suggest reorganizing one specific floor of the hospital for Labor and Delivery only. By having only one floor would help speed up the process for the delivering mothers. The way I would adjust the flow chart for women that are delivering via caesarean section would skip step one and go straight to step seven. I would do this because a mother that knows she’s having a caesarean section delivery would know the exact date of the delivery. She would have pre-registered prior and be ready for her operation when she walks into the hospital. Once the operation is complete with no complications, then step 6 would be next. After monitoring the mother and newborn then step 8 would be the next step. The mother would be extremely happy to be discharged with her new baby. If all mothers were electronically preregistered the flow chart would change. It would eliminate the need to register the day of the delivery and allow a smoother transition to the delivery...
Words: 296 - Pages: 2
...experience during childbirth, especially in regards to pain management (Hidaka & Callister, 2012). However, research does not describe women’s childbirth experience using pain management methods. By obtaining this information, nursing care for the pregnant patient can be improved. Epidurals have become popular over the years, and although they provide effective pain relief, they can cause complications and may not always result in a satisfactory childbirth experience (Hidaka & Callister, 2012). In many cases, pain management education is lacking or provided during labor, which is not an ideal learning environment, and may create a feeling of ambivalence (Hidaka & Callister, 2012). Nurses can improve their plan of care, for the pregnant patient, by understanding the experiences women had after receiving an epidural. A qualitative study, “Giving Birth With Epidural Analgesia: The Experience of First-Time Mothers”, was conducted to understand the childbirth experience in women who received epidurals. A thorough examination of the problem, purpose, literature and framework used is warranted to improve the clinical practice of nurses. Problem Statement The qualitative study, “Giving Birth With Epidural Analgesia: The Experience of First-Time Mothers” needed to be conducted because previous research on childbirth experiences fail to include childbirth satisfaction in regards to pain management (Hidaka & Callister, 2012). The significance of this study is that, “nurses and childbirth...
Words: 338 - Pages: 2
...Natural Childbirth or Medical Intervention 1 A Choice Between Natural Childbirth or Medical Intervention BUSN 410 A Choice Between Natural Childbirth or Medical Intervention 2 INTRODUCTION Since the beginning of time, women have bravely conquered one of the most difficult jobs on the planet. That job is giving birth. Known to be exhausting, demanding, and painful both physically and mentally, it has been no easy task. Yet, they do it admirably time and time again. Given how demanding pregnancy and birth is on the body and mind, it should come as no surprise that medicine has come a long way in making pregnancy easier, quicker, and less painful. Many women have found these methods to be a wonderful way to give birth. Spinal epidurals are used for pain relief, while cesarean sections to get the baby out quick and (generally) painless barring any complications. These have saved many women tremendous amounts of pain, and have saved the lives of many babies and mothers due to complications in natural birth. It should be no wonder, though, that there are those on each side of the argument, whether to give birth naturally or with medical intervention, making an argument as to why their method is the best. Both methods do have their particular advantages and disadvantages. The question remains, who is right? Is anyone right? Can there be a middle ground? There are several questions that arise when asking the question, which is why I will be breaking down both sides of the...
Words: 2731 - Pages: 11
...1500 First reported successful Cesarean section (mother and child surviving). Jacob Nufer 1701 First successful ovariotomy. Robert Houstoun 1795 Pueperal sepsis first proposed to be due to infectious contagion as a result of observational, epidemiologic study in Aberdeen, Scotland. Alexander Gordon 1809 First ovarian cystectomy (Danville, Kentucky). Ephraim McDowell 1812 First recorded vaginal hysterectomy (performed accidentally and unplanned). Palletta 1813 First modern, documented total vaginal hysterectomy (though certainly not the first). C.J.M. Langenbeck 1825 First ever blood transfusion, performed for postpartum hemorrhage. James Blundell 1827 Fetal heart tone auscultated for the first time. John Creery Ferguson 1833 First detailed account of fetal heart tones made. Evory Kennedy 1843 First abdominal hysterectomy (the patient died). Charles Clay 1846 Ether first administered to a woman in labor. Crawford Williamson Long 1847 Puerperal fever shown to be caused by infectious contagion through interventional trial proving that it could be prevented. Ignaz Semmelweis 1847 Chloroform first used as an anesthetic, used during labor. James Young Simpson 1849 Vesicovaginal fistula successfully treated with surgery. J. Marion Sims June, 1853 First successful adbominal hysterectomy...
Words: 518 - Pages: 3
...Corticosteroids in Treatment of Neuropraxia Corticosteroids are a medication that reduces inflammation and in turn relieves pain. They are sometimes used in the treatment and management of cervical nerve root injuries. Other usages include treatment of joint arthritis, bursitis, tendinitis, and many other painful conditions. Nerve injuries such as brachial plexus neuropraxia, also known as a “stinger” or “burner”, involve the cervical nerves usually 5 through 7 and the brachial plexus. Stingers can be caused by stretching, traction or compression of the brachial plexus nerves. Injury results in shooting pains from the neck down the arm out to the fingertips. Sometimes numbness and muscle weakness are present in the affected area. These injuries may produce severe complaints, as they do cause very sharp pain to radiate through the arm. When treating a stinger the first goal is to relive that pain. When physicians are presented with that task some evidence is showing that corticosteroids may be a safe way to successfully return an athlete to play following one of these injuries. There is an increased risk of getting a “stinger” in sports such as football and wrestling. The cervical nerve roots and the brachial plexus come in contact with a lot of stress during these competitions. In football we see that contact from hard hits or direct blows to the neck and shoulder cause traction or compression to those nerves causing damage. In wrestling it is common to see cervical...
Words: 829 - Pages: 4
...Labor with Epidural 1. What are the advantages of having an epidural as compared to narcotic analgesic? One of the advantages of using an epidural during birth is it allows the client relief of pain because it blocks the nerve impulses in the lower region. The client does not feel any pain only a numbing sensation. However, a narcotic does not offer that extend of relief. It is designed to take some of the pain away but does not provide complete pain relief. For clients whose labor is prolonged an epidural provides extensive relief of pain which is an advantage over narcotic analgesic. Another advantage that epidurals offer over narcotic is that with an epidural the client is conscious and can actively be a part of the birthing experience. Narcotic analgesic can create a feeling of sedation that...
Words: 804 - Pages: 4
...Comparison of Delayed Versus Immediate Pushing During Second Stage of Labor for Nulliparous Women with Epidural Anesthesia Comparison of Delayed Versus Immediate Pushing During Second Stage of Labor for Nulliparous Women With Epidural Anesthesia The research was done by Erica Gillesby, BSN, RNC, is a staff nurse, Labor & Delivery, Exempla Lutheran Medical Center, Wheat Ridge, CO, Suzan Burns, BSN, RN, is a staff nurse, Labor & Delivery, Exempla Lutheran Medical Center, Wheat Ridge, CO, Amy Dempsey, MSN, RNC, is a clinical nurse specialist, Labor & Delivery, Exempla Lutheran Medical Center, Wheat Ridge, CO, Kami Mogensen, BSN, RNC, is a staff nurse, Labor & Delivery, Exempla Lutheran Medical Center, Wheat Ridge, CO and other registered nurses to determine if the use of delayed pushing after the onset of the second stage of labor decreases the time of active pushing and maternal fatigue. Participants were randomly selected from nulliparous women, with continuous, standard dose, lumbar epidurals who reached the second stage of labor and assigned to two different methods of pushing, randomized by computer. The first group was the immediate pushing with a sample of 39; the second was the delayed pushing with a sample of 38. The participants were older than 16 years, viable, vertex singleton fetus and fetal age of 36 weeks or older. Cesarean delivery, samples with a maternal weight ≥275lbs, due to increased risks for both mother and fetus, magnesium sulfate...
Words: 792 - Pages: 4
...Epidural and PCA Quiz Please answer the following True or False questions 1. The epidural space is a potential space that lacks free- flowing fluid, but contains blood vessels and fat. True or False 2. When given by a single epidural bolus, fentanyl and morphine have similar onsets and duration of action. True or False 3. Clinicians perform a sensory (dermatome level) and motor assessment (Bromage score) when opioids are administered via epidural. True or False 4. It is possible to produce analgesia without sensory and motor blockage with low doses of local anesthetics. True or False 5. Pruritus is a common side effect of epidural opioids and is manifested most often by a generalized rash. True or False 6. Administration of antiemetic, ordered by the anesthesiologists, and decreasing the epidural analgesic continuous rate is an appropriate treatment for a patient with Epidural Analgesia who is reporting adequate pain control but continuous nausea. True or False 7. The best way to prevent clinically significant opioid-induced respiratory depression is nurse observation to monitor for sedation and respiratory status. True or False 8. The appropriate nursing response would be to stop the patient’s epidural analgesia immediately if the patient reports a metallic taste and ringing in his ears. True or False 9. Intravascular or subarachnoid catheter migration could cause a previously alert patient to become excessively sedated. True or False ...
Words: 253 - Pages: 2
...The funny thing about that night is I told them I wasn’t sure I was going to be in for work the next morning; (NAME) had laughed at that and said she would see me in the next day. I guess I proved them wrong. I walked out of (JOB) at 10pm after I had worked an eight hour shift at customer service, half of that trying to train a couple cashiers that would take my place during my leave. It was still 2 days before my due date and everyone at work was convinced I was going to be past my due date and would go into labor at work. Truthfully, there were running bets about who was going to drive me to the hospital so they too could get out of work. Needless to say, I spent way too much time at my job, but I love the girls I work with and didn’t want to leave them stuck for 8 weeks Christmas season, though I knew that it was inevitable. It was warm for mid-October though, I remember driving home with the window a quarter of the way down and singing to the radio. Without a doubt I was singing some country song and dreaming of getting my shoes off, sitting down, and having one of the only things that didn’t make me feel sick as a dog; a peanut butter and jelly sandwich. Twenty minutes and I would finally get to relax. At the house I was so uncomfortable, even in my favorite gray yoga pants and a tank top. I told my significant other, (NAME); I might go into labor that evening, though I had absolutely no proof or reasoning to this other than a feeling. No more than an hour later I started...
Words: 2441 - Pages: 10
...Indian Camp The short story “Indian Camp” is written by Ernest Hemingway. The topic of the text is coming of age, which is represented by Nick’s maturity, he went from a naive, insecure, independent little boy, to a boy who can face the world with a knowing of life and death, he develops independence throughout the history by realising that life isn’t an easy thing, you sometimes have to deal with something bigger than you can imagine when you are a little boy. “Indian Camp” begins at the lake shore, Nick, uncle George and his father, which is a local doctor, are summoned to an Indian reservation to assist a woman whom had been in an agonising labor for two days. As they managed to come across the lake, Nick, uncle George and his father are led to the Indian reservation, where they find the woman recumbent in the shanty. Beside the woman, they find her husband, which has an injured foot as a result of working with an axe. However Nick’s father concentrates on the reason he has gotten to the Indian reservation, but on the given time, the complications of the childbirth is already enough, which leads to his decision of making a caesarean section. During the operation, the woman wrenches in agony and therefore all the men in the reservation help holding her. He delivers the baby boy safely. Furthermore Nick’s father asks him to attend when he is going to sew up the incision he has made, but Nick declines. Given that Nick’s...
Words: 929 - Pages: 4
...Pain Physician, Volume 4, Number 4, pp 343-348 2001, American Society of Interventional Pain Physicians® ISSN 1533-3159 Case Study Radiation Exposure to a Physician Performing Flouroscopically Guided Caudal Epidural Steroid Injections Kenneth P. Botwin, MD*, Eric D. Freeman, DO, Robert D. Gruber, DO, Francisco M. Torres-Ramos, MD, Constantine G. Bouchlas, MD, Joseph T. Sanelli, DO, and Ashraf F. Hanna, MD This study was designed to investigate radiation exposure to a physician performing fluoroscopically guided caudal epidural steroid injections. The prospective study design included 100 consecutive fluoroscopically guided caudal epidural steroid injections performed on patients with radiculitis from either herniated nucleus pulposus or lumbar spinal stenosis. Radiation exposure was monitored with the assistance of a radiological technologist (RT) who allocated four dosimetry badges to all physicians performing fluoroscopically guided caudal epidural steroid injections on consecutive patients being treated for radicular pain. The badges were placed on the ring finger, glasses and both the inside and outside of the lead apron worn by the physician. In addition, the RTs also wore a marked badge outside his/her lead apron. A control badge was placed 67 inches away from the fluoroscopy table, and a second control badge was located in a desk over 500 feet away from the procedure, to monitor ambient radiation. The average fluoroscopy time per procedure was 12.55 seconds. The...
Words: 3891 - Pages: 16
