...PHYSICAL FACILITIES OF ICU: Physical facilities can be classified as: * Patient Area. * Auxilary Area. * Entrance to the ICU. * Ancillary Area. 1.ENTRANCE TO THE ICU: 2.PATIENT CARE AREA: 3.AUXILLARY AREA: 4.ANCILLARY AREA: LEVELS OF ICU: There are five different types and levels of ICU defined according to three main criteria: the nature of the facility, the care process and the clinical standards and staffing requirements. All levels and types of ICU must be separate and self-contained facilities in hospitals and.The five types of ICU are briefly described below: * Adult intensive care unit, level 3: must be capable of providing complex, multisystem life support for an indefinite period; be a tertiary referral centre for patients in need of intensive care services and have extensive backup laboratory and clinical service facilities to support the tertiary referral role. It must be capable of providing mechanical ventilation, extracorporeal renal support services and invasive cardiovascular monitoring for an indefinite period; or care of a similar nature. * Adult intensive care unit, level 2: must be capable of providing complex, multisystem life support and be capable of providing mechanical ventilation, extracorporeal renal support services and invasive cardiovascular monitoring for a period of at least several days, or for longer periods in remote areas or care of a similar nature (see ACHS guidelines). * Adult intensive...
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...PROVIDING QUALITY CARE Nurse staffing, quality of nursing care and nurse job outcomes in intensive care units Sung-Hyun Cho, Kyung Ja June, Yun Mi Kim, Yong Ae Cho, Cheong Suk Yoo, Sung-Cheol Yun and Young Hee Sung Aim. To examine the relationship between nurse staffing and nurse-rated quality of nursing care and job outcomes. Background. Nurse staffing has been reported to influence patient and nurse outcomes. Design. A cross-sectional study with a survey conducted August–October 2007. Methods. The survey included 1365 nurses from 65 intensive care units in 22 hospitals in Korea. Staffing was measured using two indicators: the number of patients per nurse measured at the unit level and perception of staffing adequacy at the nurse level. Quality of care and job dissatisfaction were measured with a four-point scale and burnout measured by the Maslach Burnout Inventory. Multilevel logistic regression models were used to determine the relationships between staffing and quality of care and job outcomes. Results. The average patient-to-nurse ratio was 2Æ8 patients per nurse. A fifth of nurses perceived that there were enough nurses to provide quality care, one third were dissatisfied, half were highly burnt out and a quarter planned to leave in the next year. Nurses were more likely to rate quality of care as high when they cared for two or fewer patients (odds ratio, 3Æ26; 95% confidence interval, 1Æ14–9Æ31) or 2Æ0–2Æ5 patients (odds ratio, 2Æ44; 95% confidence interval, 1Æ32–4Æ52), compared...
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...Advancing Your Nursing Education Michelle C. Ozark Grand Canyon University: Professional Dynamics 09/09/2015 Advancing Your Nursing Education When I made the decision to become a nurse I hadn’t realized that there were several different routes in choosing how I would receive my education. I knew I wanted to at least get my ASN, but wasn’t sure what the difference between ASN vs. BSN really was. I had spoken to several nurses and no one seemed to be able to give me much of a difference that would make me sway one way or another. I did some internet research and my big sell was for going with my ASN. I could do it faster and cheaper than my bachelors and I didn’t have to spend extra time taking classes that at the time I felt were not going to be important in my becoming a nurse. However, after being out of school for several years and functioning as an ASN nurse and working with a variety of nurses with various degrees of ASN vs. BSN, I can understand and appreciate the differences and know now that the knowledge and skills obtained by completing the BSN program are not only important in enhancing personal growth and development, but are also important in providing better patient care. There are some significant differences between the ASN and BSN programs of study, despite the fact both degrees require taking the same licensure test in the NCLEX. The ASN programs provide a cheaper route that students can take through a community college...
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...Introduction Every day, dozens of unintended incidents done by nurses, happen to patients during their hospitalization globally. I will be talking about one memorable incident, which happened to me during a busy afternoon shift in the Emergency Medicine Department (EMD). Using the Gibbs Reflection Cycle (Jasper, 2003) to guide me in this essay, I will be discussing about how my nursing managers practice transformational leadership in this reflection essay to motivate me to improve me as a better critical thinking registered nurse in EMD. Description This unfortunate incident happened in my work area, where patient with critical conditions receive treatment, Patient Acuity Category (PAC) 1. It was a busy shift and there were dozens of critical cases coming in...
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...baccalaureate degree educations main forum is a university where the program is 4 years. It encompasses the essentials of the associate degree and expands the focus on physical and social sciences, research, theory, public and community health, management and humanities. A BSN education provides more for students and can create the nurses needed in today’s expanding health care system. (Lane and Kohlenberg, 2010) Research is linking nursing education to patient outcomes. Many surveys and researches have verified that higher levels of education impact the quality of care that patients receive to their outcome and whether their nurse possessed an associate or baccalaureate degree. In the October 2012 issue of Medical care, researchers from the University of Pennsylvania found that surgical patients in Magnet hospitals had 14% lower odds of inpatient death within 30 days and 12% lower odds of failure-to-rescue compared with patients cared for in non-Magnet hospitals. The study authors conclude that these better outcomes were attributed in large part to investments in highly qualified and educated nurses, including a higher proportion of baccalaureate prepared nurses. (American Association, 2012) Associate degree programs were developed in 1951 by Mildred Montag when there...
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...Throughout the country there is a shortage of nurses in the (ICU) Intensive Care Unit. ICU nurses must possess strong critical thinking skills and provide critical care, treatment, and monitoring for people who are in a critically ill or unstable condition. All of which could led to nurse burnout. According to the US National Library of Medicine, “Critical care nurses are particularly vulnerable to developing burnout due to the chronic occupational stressors they are exposed to, including high patient acuity, high levels of responsibility, working with advanced technology, caring for families in crisis, and involved in morally distressing situations, particularly prolonging life unnecessarily”. It is also important the nurse recognize warning signs and prevent the nurse burnout syndrome from becoming more complicated....
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...In Collaboration with Malaysian Allied Health Sciences Academy, Malaysia BSC (HONS) NNURSING DEVELOPMENT PRACTICE COHORT 30 PP 0613 PROFESSIONAL NURSING BOUNDARIES University Student Number : 12040383 ID Number : 901003-07-5656 Word Count : 1999 Balanced therapeutic nurse-patient relationship can only be achieved through a controlled adherence to professional nursing boundaries. According to the National Council of State Boards of Nursing (NCSBN) professional boundaries are “the spaces between the nurse’s power and the patient’s vulnerability. It is the space between nurse and patients, doctors and other professionals bound to healthcare. “Similar to the fence around one’s yard or the walls around one’s house, metaphorically boundaries mark the parameters of the professional’s role”(Baron, 2001). In this essay, I will discuss professional nursing boundaries in the context of ICU nurse’s role in performing tracheal intubation in emergency. According to Wikipedia, tracheal intubation or usually intubation, is the placement of a flexible plastic tube into the trachea (windpipe) to maintain an open airway or to serve as a conduit through which to administer certain drugs. Moreover, Wikipedia also states that intubation is frequently performed in critically injured, ill or anesthetized patients to facilitate ventilation of the lungs, including mechanical ventilation to prevent the possibility of asphyxiation or airway...
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...four-bed intensive care unit (ICU) was full and the supervisor asked the CEO if one of the ICU patient could be transferred elsewhere to receive car accidents victim from Emergency Department (ER). One of the ER patient’s injuries was so severe that she had to get into the ICU in less than two hours because only the ICU had the necessary technology to keep this patient alive. Since there are no funds to add ICU beds, what steps should the CEO of this hospital take to plan for the worst case for a full ICU bed scenario? (Longest, & Darr, 2008) 2. Statement of the questions: 1) Steps CEO should take in the planning process Systems and processes are critical in decision making process for the worst case for a full ICU bed scenario (Hick, Barbera, & Keken, 2009) . First of all, CEO should have a meeting with all managers to discuss the issues and develop strategic plan to solve this problem. Planning the worst case for a full ICU bed scenario is affected by many variables. There are four key interdependent factors that contribute to an effective full-bed response: system, space, staff, and supplies (Hick, Barbera, & Keken, 2009). Moreover, managers should consider the underlying system components during their planning process such as command, control, communication, coordination, continuity of operations, and community infrastructure (Hick, Barbera, & Keken, 2009). Secondly, the CEO should formalize final policies for worst case scenario for full ICU bed by having inputs from...
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...We chose the article, “The Role of the Non-ICU staff Nurse on a Medical Emergency team: Perceptions and Understanding ” because the importance of knowing a nurse’s role in activating a rapid response or a code can mean the difference between life and death. Implementing proper training and a standard protocol in each hospital should minimize confusion and areas of human error. We, as humans, can be placed in a position where we feel insecure about our role and are afraid when it comes to the possibility of looking incompetent and making a mistake. So has the proper training been implemented consistently in each hospital? Has the message been clear? Do the nurse’s feel confident in knowing when and how to call Rapid Response? In the end, it’s the patient’s safety that most important, and every staff member should know their role and what is expected to ensure the best possible outcome. So many preventable errors happen during codes/ Rapid Response due to the lack of knowledge, training, and communication. Before the Joint Commission implemented Rapid Response training as part of their National Patient Safety Goals, survival rates were poor with non-ICU patients who experienced in-hospital cardiac arrests. Now there is common model in place called MET, the Medical Emergency Team. Once implemented, extensive training was provided for current nurses in new hires which included seminars, unit meetings, and campaigns that included flyers and t-shirts. Such training included...
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...Degree versus Associate Degree in Nursing Nursing has been regarded as the most trustworthy profession year after year in the United States (Laidman, 2012). Prior to the modern era of Nursing that began with Florence Nightingale, there was no specific profession of Nursing. (Grand Canyon University, 2011, para. 4) Nursing is an evolving profession and its demand for educational requirements is increasing. In the past, nurses held hospital-based diplomas or associate degrees in Nursing. Now the expectation for education of nurses has been increased which is shown by hospitals only hiring bachelor degree nurses. The comparison between associate degree nurses and bachelor degree nurses remains a constant discussion in healthcare. Do bachelor degree nurses provide a higher quality of care to their patients and are they better equipped to do so with their two year extended length of study? Associate degree programs are 2 years in length and have a heavy focus on technical and hands-on bedside training. This type of training is sufficient for nurses in areas such as secondary care settings and was brought about due to the nursing shortage in the 1950’s. (Creasia & Friberg, 2011, p. 27) This type of training is to the point and is good in task-oriented positions. According to the American Association of Colleges of Nursing (AACN, 2012): Baccalaureate nursing programs encompass all of the course work taught in associate degree and diploma programs plus a more in-depth...
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...specialty within nursing that deals specifically with human responses to life-threatening problems. * As defined by the World Federation of Critical Care Nurses: Specialized nursing care of critically ill patients who have manifest or potential disturbances of vital organ functions. Critical care nursing means assisting, supporting and restoring the patient towards health, or to ease the patient’s pain and to prepare them for a dignified death. Aim To establish a therapeutic relationship with patients and their relatives and to empower the individuals’ physical, psychological, sociological, cultural and spiritual capabilities by preventive, curative and rehabilitative interventions. Illnesses and injuries commonly seen in patients on critical care units (CCUs) Gunshot wounds Traumatic injuries Cardiovascular disorders Surgeries Respiratory disorders Shock THE EVOLUTION OF CRITICAL CARE * Forty years of development in critical care and critical care nursing has given rise to a recognized specialty in nursing practice . * Critical care units have evolved over the last four decades in response to medical advances . HISTORICAL PRESPECTIVES * Florence nightingale recognized the need to consider the severity of illness in bed allocation of patients and placed the seriously ill patients near the nurses’ station. * Modern medicines boomed to its higher ladder after world war 2 * Dr. Walter E. Dandy 1886-1946 First pioneer of intensive care in...
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...Experience One of the hallmark studies in nursing providing keen insight into understanding the influence of experience was a qualitative study of adult, pediatric, and neonatal intensive care unit (ICU) nurses, where the nurses were clustered into advanced beginner, intermediate, and expert level of practice categories. The advanced beginner (having up to 6 months of work experience) used procedures and protocols to determine which clinical actions were needed. When confronted with a complex patient situation, the advanced beginner felt their practice was unsafe because of a knowledge deficit or because of a knowledge application confusion. The transition from advanced beginners to competent practitioners began when they first had experience with actual clinical situations and could benefit from the knowledge gained from the mistakes of their colleagues. Competent nurses continuously questioned what they saw and heard, feeling an obligation to know more about clinical situations. In doing do, they moved from only using care plans and following the physicians’ orders to analyzing and interpreting patient situations. Beyond that, the proficient nurse acknowledged the changing relevance of clinical situations requiring action beyond what was planned or anticipated. The proficient nurse...
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...MANAGEMENT OF DELIRIUM IN THE ICU Colleen Gottlieb Erica Powell Mary Tool July 16, 2013 **think this has to be double spaced Management of Delirium in the ICU Introduction Delirium is a serious condition that can affect patients in and outside the hospital. With its presence being unknown to many nurses and providers, delirium has significant long term complications that can last well beyond discharge. Noise, medication, and infection are significant in the development and progression of delirium and these are more than abundant within intensive care patients. The importance of nurse’s knowledge cannot be stressed enough regarding the assessment, symptoms, and interventions of delirium, in an effort to decrease its occurrence and the implications thereafter. With the proper assessment and improved nursing interventions, data should display an increase in patient safety, decrease in prevalence, and reduce costs related to longer hospital stays. The state of being delirious occurs with a sudden decrease in a patient’s level of consciousness. It may be accompanied by inattention directly related to the care being given or by a change in cognition. (cite AACN practice alert) There are a variety of possible causes of delirium. These causes include: alcohol withdrawal, sepsis, pneumonia, electrolyte imbalances, liver failure, encephalitis, head trauma, meningitis, the use of many medications and abrupt withdrawal of medications. Most medical diagnosis and their possible...
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...As a nurse one runs into some very saddening/ maddening situations, some that cause not only the individual nurse, but the entire nursing staff to be thrown into conflict with their beliefs of non-maleficense and a patient’s right to autonomy. I always strive to never cause any harm to a patient and treat them kindly despite behaviors that could lead one to not want to act or treat someone is such a manner. Additionally I believe an individual should also have the right and be supported in making decisions about their healthcare, but when the decision is in effect, taken away from them, who has that right? When the nurse and stand staff struggle with the decision that is being made, it complicates the picture, leads to a lot of frustration and nurses feel helpless Several years ago there was an incident of a pt that received a kidney transplant, but during the immediate post operative course the patient, suffered a respiratory arrest, was anoxic for a period of time leaving the pt with anoxic brain damage. This was an individual who, prior to surgery, was a fully functional person. After time in the ICU the patient was able to be on the nursing floor; trached, unable to swallow, g-tube, very limited ability to walk, or transfer to a chair w maximal assistance of typically 2 staff members. The individual also tended, what seemed to be intentional, to try and injure nursing staff, by pinching, kicking and biting.. I was often assigned to this pt, and on several occasions...
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...Running head: Executive Management Project Code 100 Chamberlain College of Nursing EX630: Executive Practicum Professor Valda Upenieks 6/16/2012 The Master of Science Nursing student with the collaboration of my nurse executive mentor Mrs. Darville created a project that is valuable for the facility and a rewarding experience for me as a graduate student. My personal practicum experience took place at St Elizabeth’s Hospital, which is a small 90 bed community hospital located in Gonzales, La. St Elizabeth’s Hospital is a part of the Franciscan Missionaries of Our Lady Health System which was organized in 1984 to unite with three existing hospitals in Louisiana which were already a part of the system extending the healthcare of Jesus Christ to those most in need. The facility serves the people of Ascension Parish and surrounding areas (St Elizabeth, 2010). St Elizabeth’s Hospital has hundreds of outpatient and inpatient services that include: Cancer Center, Cardiopulmonary, Laboratory, MRI Center, Telemetry, Intensive Care, Weight Loss Surgery, Surgery, Ambulatory Surgery Center, Emergency Department, After Hours, Community Clinic and Physician Tower. St Elizabeth’s Hospital is a very small hospital compared to most but it is outstanding in all it does, they have been recognized for contributions to community, large business of the year, best place to work, performance excellence, capstone quality award, just to name a few (St Elizabeth Hospital...
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