...Identify a current nursing practice within your healthcare setting that requires change. DEVELOPING OR CREATING AN INDEX TO MINIMIZE RISKS OFPRESSURE SORE 1. Describe the current nursing practice. An instrument specifically designed to aid health care workers evaluate the dangers of pressure sores that a patient faces is called the Braden Scale. After assessment, the victim is categorized depending on six aspects: capability of physical activity, hydration and nutrition status, capacity to alter position, the ability to respond after sensing discomfort related to pressure, shearing or exposure of the skin to friction during locomotion, and skin exposure to moisture. If the overall score is lower it means the risk of pressure sore is higher (Changing Practice, Changing Lives: 10 Landmark Nursing Research Studies, n.d). Prior to this Change, Skin assessment was based on non- formalized risk assessment which varies with each clinical practice. 2. Discuss why the current nursing practice needs to be changed Using non-formalized risk assessment in Predicting pressure ulcer resulted in non-uniformity and personal clinical judgement which varies from one person to another. Using Clinical judgement is more effective where the staffs are experienced and their experience assist in appropriate predictability, but with novice staff, the use of clinical judgment is inappropriate. In a multisite trial, Braden scale was tested by clinics bringing together skilled nursing facilities, Veterans...
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...Evidence Based Practice & Pressure Ulcers Matthew Slawter Chamberlain College of Nursing NR451 RN Capstone Course November 2014 Evidence Based Practice & Pressure Ulcers Evidence based practice (EBP) gives nurses a method to use critical appraised data and scientific evidence that is proven to confirm the delivery of quality health care to a patient population. Pressure ulcer prevention continues to be a major and growing concern among todays patients and healthcare providers. This problem is a concern because prevention of pressure ulcers can be accomplished through good skincare techniques and increased education of nurses. The field of nursing along with the healthcare industry can benefit from simply decreased the occurrence of pressure ulcers. The general purpose of this proposal is to determine if the value nurses place on skincare and pressure ulcer prevention can decrease the incidence pressure ulcers. Change Model Overview The John Hopkins Nursing Evidence-Based Practice Process is simply related to the complex challenges organizations and nurses face with the implementation of evidence-based practice and translation. Furthermore, this process provides guidelines for managing the process, structure, and evidence translation among various healthcare settings and outcomes of EBP projects. Nurses should use this process as a guide to facilitate change as it suggest leadership and planning for EBP measurement, identification, evaluation and monitoring...
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...Terminologies in Practice Evidence based interventions are playing an increasingly more important role in nursing practice. With the increased utilization of nursing research comes a need for a form of communication that classifies diagnosis, applies interventions, and expected patient outcomes. In order to unify nursing communication and support nursing practice, standardized terminology has been developed. This paper will introduce three forms of standardized terminologies in nursing which are the North American Nursing Diagnosis Association (NANDA), Nursing Outcome Classification (NOC), and Nursing Intervention Classification (NIC). The purpose of this paper is to define the three standardized terminologies, processes developed, and to provide and example of their useful application in patients at risk for or diagnosed with pressure ulcers. The NANDA was established with the goal of enhancing all aspects of nursing practice by refining and promoting terminology to accurately reflect the clinical judgment of nurses (Azzolin et al., 2013). The mission of NANDA if to facilitate the refinement, dissemination, and development, and utilization of nursing standard terminology (Peres et al., 2015). Their main focus is to utilize this communication to promote evidence based practice and care, thereby improving care for everyone. NANDA promotes their missions and goals by publishing the world leading evidence based nursing diagnosis, funding research, establishing a global nursing network...
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...The Significance of Having a Multidisciplinary Team 3 Abstract The growing prevalence and hospital acquired pressure ulcers is an immediate concern. The major challenge is the A major challenge is the lack of knowledge and skills in wound identification, management, treatment and prevention. This, along with other factors, creates poor patient care and vast costs to the pertinent facilities. The solution is to have interprofessional collaboration. The utilization of current advanced practice nursing staff as a resource for floor nurses and other involved healthcare workers is a must. This would obtain certification in wound care and be responsible for the ongoing continued education for wound prevention, monitoring and maintenance. The staff will be educated and trained at quarterly intervals on wound identification, staging, prevention, maintenance and monitoring. Key words: wound care, evaluation, pressure ulcers, multidisciplinary, specialist, evidence The Significance of Having a Multidisciplinary Team 4 Problem Identified The Centers for Medicare & Medicaid Services (CMS) declared in October of 2008 that it will no longer provide reimbursement for hospital acquired pressure ulcers (HAPUs) because it is a preventable occurrence (CMS, 2014). Even though the percentages of occurrences have declined since then, HAPUs continue to cause financial strain on institutions (estimated $9.1- $11.6 billion dollars loss annually)...
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...this assignment, the author would be presenting a critical reflective version of Braden Scale (BS) used in Scenario Two. This assignment includes a detailed discussion on the benefits and disadvantages of BS using clear evidence to support...
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...Design for Change in Practice Dustin Ashenfelter Chamberlain College of Nursing Capstone in Nursing NR 451 Professor Linda Fry Winter 2011 Design for Change in Practice The increasing prevalence of Hospital Acquired Pressure Ulcers (HAPU) is a problem that is plaguing hospital’s across the nation. The estimated added expense in managing a single full thickness pressure ulcer can be as high as $70,000.00, and the total cost to hospitals across the nation could be as high as $11 billion/year (Lynch & Vickery, 2010). Initial identification of at risk patients has been one of the keys to successfully reducing stage 3 and 4 reported pressure ulcers. The Braden scale for predicting pressure sore risk is a universally accepted tool used to help nurses identify patients who are at risk of developing pressure ulcers. The scale evaluates each patient in the following six areas exposure to moisture, sensory perception, activity, and ability to change positions, nutrition, and exposure to shear (Rosenfeld, 2010). The identification of unit specific champions is a key strategy for the continued reduction of the prevalence of pressure ulcers. These leaders on the units serve as the educators for the remaining staff on the unit. These champions would be part of a multidisciplinary team, which reviews all new research, assistive devices, and evidence-based practice concerning the treatment and prevention of pressure ulcers. The multidisciplinary team would focus on key...
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...RESEARCH STUDY Quantitative Research Study Knowledge Pressure Ulcer Prevention among Nursing Professionals Jeamol Joseph Grand Canyon University NRS-433= Introduction to Nursing Research 24 July, 2011 Quantitative Research Study Nursing research is a process which helps to improve the patient outcomes through a thorough analysis of data collected and making new contributions to the healthcare field. Evidence based nursing is the process by which nurses make clinical decisions using the best available. In quantitative studies researchers identify the problem and collect relevant data from subjects. The researchers plan in advance the steps to be taken and collect data in numerical form. In qualitative studies, researchers collect narrative descriptions. Data is collected and progression takes place as the research is continuing. Nursing research is systematic search to develop evidence on problems of nursing profession. Now days hospitals deliver higher quality care to critical patients .In hospital settings these patients are more susceptible to hospital acquired infections and injuries. All the institutions have used effective strategies to avoid complications that keep their patient’s safety at risk. Quality improving programs and patient safety committees are available in all hospitals to promote patient safety. Pressure ulcer or bed sores are important problem in hospitals and nursing homes. Pressure ulcers prolong the hospital stay of hospital. They increase...
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...Evidence Based Nursing Practice Morise Oluwole Walden University Nurs 4000- Research and Scholarship for Evidence -Based Practice September 6, 2015 PRESSURE ULCERS An essential part of nursing care of hospitalized patients is skin integrity maintenance. As markers of the values or products of care most affected by the assessment and interventions delivered by nurses, the rate of PUs is being screened thoroughly now than ever before (Manning, 2015). Pressure ulcers (PUs) are preventable, but PU rates persist to increase disturbingly fast, according to an article by Gary and Hampton published in 2015, the incidence of PUs has increased in the US between 1995 and 2008. The purpose of this paper is to review the incidence of PUs and how to prevent its occurrence and nurses’ responsibility. Practice Setting Problem Pressure ulcer occurs when part of the skin and the tissues underneath are impaired as a result of being placed under enough pressure to impair blood supply. Immobility-related pressure ulcers are defined as localized areas of tissue damage that develops when soft tissue is compressed between a bony prominence and an external surface for a prolonged time. The most common sites were the sacrum, the heel, the ischium and the trochanter. Pressure is where the weight of the body squeezes the tissues between a bony prominence (such as heel, elbow, sacrum or ischials etc) and a hard surface (such as bed, chair or, in the case of heels, the floor). There are four...
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...Background: Compression bandaging is required for venous leg ulcers, which is due to damage and loss of skin above the ankle that is the result of a problem with the veins in the leg. Although leg ulcers are not a life-threatening condition, it can have considerable effects, not only on health, but also on the quality of life, self-esteem and healthcare cost. Method: Extended literature review, to extrapolate best available evidence, in order to address the focus question. Computerised and manual searches of previous literature were used; refining searches by means of constantly re-evaluating inclusion and exclusion criteria. Results: Eight (8) articles were decided upon, seven (7) of which were quantitative and one (1) which was qualitative in design. Two main themes emerged from these articles, that of management strategies for leg ulcers and technique of applying compression bandages. Recommendations: Episodes of venous ulceration can be reduced with management strategies, such as graduated compression therapy with comprehensive technique. However, without further education for nurses and patients towards compression therapy, venous ulceration will prolong and management strategies will fail. Conclusion: Knowledge of compression bandaging technique needs to be increased through further training/education. KEY WORDS Compression Therapy • Prevention • Technique • Venous Leg Ulcer • Management INTRODUCTION The primary aim of this extended...
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...essay is a critique based on a pilot study carried out on ‘patient stories of living with a pressure ulcer’ and I will be using Caldwell, K. et al. (2005) as a structured research framework to carryout the evaluation on this study. First and foremost a definition of what research, (nursing research in particular) and research critique entails will give a greater understanding of what this essay aims at addressing. On one hand, Polit and Beck (2006, p4), defined research as a systematic inquiry that uses disciplined methods to answer questions or solve problems, while on the other hand they define nursing research as a systematic inquiry designed to develop knowledge about issues of importance to nurses, including nursing practice, nursing education and nursing administration. The importance of having research carried out in the nursing field can only be emphasised as it is the key element in generating and guaranteeing evidence to guide nursing practice and improvements to care and quality of life of both clients and service users as claimed by Polit and Beck (2006, p4). However once the research is undertaken and published, great emphasis is placed in finding out or identifying the strengths and weaknesses through critique. Polgar and Thomas (2000), point out that critiquing research entails identifying the strengths and weaknesses of research publications to ensure that patients/clients receive assessments and treatment based on the best available evidence. This evaluation encompasses...
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...Leadership Task 1 A. Nursing Sensitive Indicators Nurses are integral key players in multidisciplinary teams caring for patients in complex healthcare systems. Hospitals, a primary care delivery portal within the health system, are inundated with patients requiring higher acuity care. Nurses must be prepared to recognize patients’ health care needs and provide quality patient care outcomes. The knowledge of nursing sensitive indicators can be helpful in providing the care which meets quality standards. Nursing sensitive indicators rely on evidence-based practice. The American Nurses Association created a repository for implementing, developing, and storing nursing sensitive indicators in the National Database of Nursing Quality Indicators, or NDNQI. The nursing sensitive indicators are a set of standardized performance measures intended to help hospitals assess the extent to which nursing interventions have an impact on patient safety, quality, and the professional work environment (Erickson, J. 2011). Nurses directly impact these measures and when evidence-based practices are adopted, patient care improves as shown in historical outcomes data. In the scenario of Mr. J there were multiple failures to recognize and use nursing procedural sensitive measures to improve his safety, quality of care, and patient satisfaction. Although Mr. J had mild dementia, he was appropriately responsive, cooperative and was not a danger to himself or others. Evidence based practice does not support...
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...Task 1 Nursing-sensitive Indicators Nursing- sensitive indicators are defined as those outcomes that improve in the presence of greater quantity(higher staffing ratios) or quality(educational levels and competence of nursing staff) of nursing care (www.nursingworld.org). These nursing-sensitive measures help healthcare organizations to analyze the quality and quantity of nursing care services. (www.americansentinel.edu )Nursing sensitive-indicators (NSIs) are characterized by measures that are in the realm of nurses to improve and control. According to the website www.nursingworld.org , in 1998, the National Database of Nursing Quality Indicators was established by the ANA so that nurses would have a national benchmark to reach they can compare the outcomes. This has given the profession of nursing a solid core of benchmark capital nursing sensitive indicators that are totally nursing care dependent. This database provides benchmark performance with which the individual healthcare institution can compare its performance to similar institutions across the nation. These nursing sensitive indicators result in patient outcomes that are influenced by nursing care decisions and actions. Research has indicated that patient outcomes improve, complications and mortality are reduced, costs can be reduced, and patient and professional nurse satisfaction can be enhanced with strong performance on nursing-sensitive indicators. These patient outcomes may not because the nursing but is associated...
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...A written assignment that evaluates comprehensive approaches to nursing assessment for an older person with multiple health problems. The account should reflect on how the multidisciplinary team and other agencies including the family, may contribute to these assessment approaches. Particular attention should be paid to national policies in this area and evidence of best practice. The patient that will be discussed within this assignment is a 70 year old male admitted to hospital following a stroke. Pressure ulcer risk assessments and nutritional risk assessments will be discussed within this assignment looking at how they are used in the assessment of an older people with multiple health problems. A stroke occurs when there has been a disturbance or cut off of blood flow within the brain, this disturbance damages or destroys brain cells preventing these cells from doing their job. Damage to the brain causes problems with bodily functions and can also affect mental processes (Stroke Association, 2010). A stroke can cause sudden weakness or paralysis which often only affects one side of the body and is one of the most common symptoms of a stroke. It can also cause swallowing difficulties (dysphagia), speech and language (dysphasia) can be affected also, patient may have difficulty in understanding and basic things such as reading and writing following stroke. Problems with eyesight, perception and interpretation, mental processes, bladder and bowels, mood swings, sensation and...
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...differences in competencies between nurses prepared at the associate-degree level versus the baccalaureate-degree level, by using research from different nursing organizations found online. Also identifying a patient care situation in which I will describe how nursing care or approaches to decision-making may differ based upon the educational preparation of the nurse. Differences in competencies between ADN versus BSN In conducting the research for this paper I was a little biased in my opinions of this topic and had to keep an open mind. I am an associate-degree level nurse, and have been for six years. I feel that my experience has taught me a lot about critical thinking, and helping patients improve their outcomes. I felt pressure in to completing my baccalaureate-degree level of education before I felt that I was ready to complete the education. I now have a better understanding into baccalaureate education as being the accepted minimum requirement for nurses. Much research has been done, relating to BSN versus ADN nurses and better patient outcomes. In Grand Canyon University College of Nursing Philosophy, it states “Baccalaureate nursing practice incorporates the roles of assessing, critical thinking, communicating, providing care, teaching, and leading.” I feel that no matter what education level one has after nursing programs that this is a baseline for nurses. It was hard for me to see that nurses who graduate with their BSN were better at bedside care than one who...
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...A. Nurse sensitive indicators are factors that are directly impacted by nursing. There indicators fall into three categories; structure, process and outcomes of nursing care. The structure indicators are the organizational piece of nursing care. These relates to the amount of staff on duty at a given time, how many RN's are on duty and experience level of the staff. For example, evidence indicates institutions with a higher number of RN’s possessing a Bachelor Degree in nursing result in improved patient outcomes. The process indicators measure nursing care such as patient assessment, patient care and intervention. These are the organizational policies and procedures of nursing. The patient outcomes are indicators directly related to nursing care and quality of care provided. Patient satisfaction, pain management or infections rates are some examples of patient outcome indicators. In the case provided, knowledge of nursing sensitive indicators would have assisted the nurses in several ways to provide a positive patient outcome. First, if the nursing assistant had knowledge of pressure ulcer prevention, sign and symptoms and treatment of pressure ulcers, the pressure ulcer on the patient’s sacrum may have been prevented. In this case, the nurse assistant did not recognize the patient had the first stages of a pressure ulcer developing. When the assistant got the patient up for toileting she should have checked his bottom and upon seeing the red area on his sacrum, she should...
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