...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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...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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...…………………………………………………………….…...9 Expected results …………………………………………………………………………………..9 References cited………………………………………………………………………………….10 Appendix A………………………………………………………………………………………13 Appendix B………………………………………………………………………………………14 Appendix C………………………………………………………………………………………15 Appendix D………………………………………………………………………………………16 Ventilator associated pneumonia and chlorhexidine use in the traumatic brain injured patient Ventilator associated pneumonia (VAP), is defined as, a nosocomial pneumonia that develops more than 48 hours following endotrachial intubation and mechanical ventilation, and is a common and serious intensive care unit (ICU) complication. VAP causes noteworthy morbidity, mortality, amplified hospital costs, and increased utilization of healthcare resources, prolonged time for ventilator support, as well as lengthened ICU and hospital stay (Caruso, 2009). Antibiotics (ATBs) have traditionally been used to treat VAP, but the occurrence of resistance...
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...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 obstruction. Moreover, this essay will discuss issues related to professional nursing boundaries such as boundaries...
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...Uyanga N Chapter 3: Case Study 4: “Worst Case Scenario” – The Nightmare 1. Overview of the issue: Small acute care hospital CEO received call from night supervisor. The 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...
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...Future of Nursing” Abstract Telenursing is changing the way patients receive care, and the way nurses deliver care. This technology has created new ways to do everything; such as give medications, chart, write out prescriptions, even just answer questions and do the essential nursing assessment. This article explores the wide range that Telenursing can achieve. From an introduction to what Telenursing is, to its ethical and legal considerations, and its use in the critical care settings. Telenursing is a benefit to the delivery of nursing care, and to the profession of nursing itself. With the help of this new technology, nurses are able to reach more patients at the same time, and even reach patients on the other side of the world. Introduction Since the early days of this new technology, the profession of nursing has taken advantage of Telenursing. The early beginnings of Telenursing were through the phone, where nurses were able to answer simple questions and ask questions about the patient’s health. As technology has advanced, so has Telenursing. And now, Telenursing has become a profession of its own, reaching people in all parts of the world, with the help of the Internet and video cameras. With this new practice, nurses are able to assess and help people that may not normally be able to access healthcare, or that are not able to make the trip to the hospital or doctor’s office. It helps nurses get in touch with more patients, and this promotes better nursing practice...
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...management by doctors combined with concerted nursing efforts have revolutionized the management of critically ill patients. With the persistent demographic trend towards an aging population nearing the age of 65 and above, the number of patients requiring critical care will rise but many patients who might have had no chance of survival can now be treated successfully. And during last two decades critical care medicine has undergone rapid changes and emerged as a discipline by itself. Intensive care units (ICU), also called critical care or intensive therapy departments, is highly specified and sophisticated area of a hospital which is specifically designed, staffed, located, furnished and equipped, dedicated to management of critically ill patients whose conditions are life-threatening and need constant, close monitoring and support from equipment and medication to keep normal body functions going. It is a department with dedicated medical, nursing and allied staff. It operates with defined policies; protocols and procedures, having its own quality control, education, training and research programmes. It is emerging as a separate specialty and can no longer be regarded purely as part of anaesthesia, Medicine, surgery or any other speciality. It has to have its own separate team in terms of doctors, nursing personnel and other staff who are tuned to the requirement of the speciality. Definition: “ICU is the specialty nursing unit designed, equipped, and staffed with specially...
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...Re-admissions back to the ICU is a growing problem in the United States which is of concern especially since these patients have higher in hospital mortality rates as well as longer inpatient length of stays. The objective of this study is to measure the incidence and determine the predictors of re-admissions to the Adult Intensive Care Unit. Methods: Medline (1946-present) was searched using combinations of the following search terms ‘Intensive Care Units’ OR ’Critical Care’ AND ‘Patient re-admissions’. The searches were limited to abstracts in English language between 1990 and 2014. This search was then narrowed to ‘core clinical journals’ to increase the quality of the articles but this limitation cut the number of articles down to 2/3rd and even though these articles were saved under a separate folder, eventually all 91 articles were included in the final search. The term ‘Intensive Care Units’ were narrowed to include only ‘burn’, ‘coronary’ and ‘respiratory’ care units. The CINAHL and Cochrane Database search failed to reveal any relevant results. Results: My search generated 33 articles and their review shed light on a few recurrent themes identified as being the reason for early re-admissions. Premature discharge, time gaps between reaching the wards and being seen, lack of attention by ward nurses, lack of experience of medical staff in the wards were some of the themes identified. Conclusions: For a patient, coming back to the ICU is always a cause of concern...
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...Daily goals for Intensive Care Unit Ventilated patients Brea Blais Southern New Hampshire University Advanced Nursing Concepts Dr. Bladen May 13, 2015 Jean Watsons: Daily goals for ICU Ventilated patients An estimated 85% of errors occur in care when communication is not clear (Pronovost et al., 2003). When Nurses or doctors do not know how to properly care for their patients, then these patients cannot recover in an appropriate time frame (Pronovost et al., 2003). “At baseline less then ten percent of nurses and residents understand the goals of care for the day”(Pronovost et al., 2003, para. 2). After the implementation of a daily goals worksheet 95% of nurses and residents understood the goals of care for the day, length of stay was decreased, and other critical care patient problems were decreased. (Pronovost et al., 2003). Jean Watson’s human caring theory was the foundation of the daily goals, created in Johns Hopkins Hospital, in 2003. The daily goals sheet was developed in a 16 bed surgical oncology ICU to improve patient outcomes by improving communication between the members of the healthcare team (Pronovost et al., 2003). Transpersonal relationships and a caring relationship were used when creating the Daily goals sheet (Fawcett & DeSanto Madeya 2013). Daily goals were used in the ICU setting, with any patient population that may present to the ICU with an acute or chronic problem (Fawcett & DeSanto Madeya 2013). Content and format of the tool. The daily...
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...settings and can cause many complications, increasing length of stay, and could even cause death. The goal of this paper is to provide a policy to make changes to the Intensive Care Unit (ICU) at Mercy Hospital in Coon Rapids, Minnesota. The ICU has struggled with preventing and eliminating the spread of CDI from patient to patient. The unit has implemented many changes to increase hand hygiene, improve cleaning techniques of equipment, and increase staff knowledge and awareness without improvement of the CDI rates. By reviewing policies provided by the Agency for Healthcare Research and Quality (AHRQ) there can be changes made to improve the CDI rates at Mercy Hospital. Policy changes can be implemented and staff can be educated on proper hygiene techniques and other policies that the AHRQ will provide. The ultimate goal is to eliminate hospital acquired CDI’s and with the policy changes this can be a possibility. Policy Implementation The main focus area for this patient safety policy change will be focused on the Intensive Care Unit (ICU) at Mercy Hospital. Mercy Hospital is part of the Allina Health organization which serves the northeastern suburbs located in Coon Rapids, Minnesota. Mercy is a level II trauma hospital with an estimated 255 inpatient beds. The ICU has 19 beds that serve a multitude of patient ranging...
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...documentation shows that the master alarm panel for medical gasses was not tested annually per policy. This is a policy written by the hospital that is not being met. They are to follow the policies that they set for themselves. The Fire Drill History Report showed that the fire drill process is not adequate and does not meet standards. Quarterly fire drills are to be conducted as regulated by the Life Safety Code (TJC, 2013). Clutter was found in the hallways of 3E, 4E, OR and telemetry this could restrict people from leaving the floor safely in case of fire or smoke. Accreditations function of Nursing Leadership it was discovered that Nurses on 3E were not documenting in a timely manner. When questioned they responded that they were “too busy”. Resulting in overtime and low morale on the unit causing discussion about staffing, staffing patterns and nurse to patient ratio. This is all established in a guideline for delivery of nursing care, treatment, and services (TJC, 3013). Accreditation function of...
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...Research Proposal Running head: RESEARCH PROPOSAL 1 Research Proposal Kathryn Keiper Duke University School of Nursing Research Methods N307-01 Dr. Carla Gene Rapp Apr 20, 2005 Research Proposal Table of Contents 2 Introduction……………………………………………………………………………….3 Review of the Literature…………………………………………………………………..4 Purpose……………………………………………………………………………………8 Methods……………………………………………………………………………………9 Design and research questions…………………………………………………….9 Sample……………………………………………………………………………..9 Survey instrument……………………………………………………..…………10 Research procedures……………………………………………………………..10 Informed consent and IRB approval……………………………………………..11 Strengths and Weaknesses……………………………………………………………….11 Timeline and Cost Considerations……………………………………………………….12 Conclusion……………………………………………………………………………….13 Concept Model………………………………………………………………..Appendix A Sample Questions……………………………………………………………..Appendix B References……………………………………………………………………………….18 Research Proposal Research Proposal Introduction Intensive care units (ICUs) were designed to provide highly skilled, lifesaving nursing care to viable patients with acute illnesses or injuries. Patients with chronic and/or terminal illness were not expected to be admitted to these units, with the possible exception of acute exacerbations of reversible complications. Patients whose care needs changed from curative to palliative were intended to be transferred out of critical care to patient care environments more suited to end-of-life care. However...
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...Telenursing: Is It in my Future? Devry University Telenursing: Is it in My Future I remember the first time I heard of telenursing. It was about 4 years ago and I was still new to home health nursing. My director informed the office that we would be having an in-service on a new telehealth monitoring device we would be using for our high risk patients. We were shown how to operate the monitors and was demonstrated all of its capabilities. The telephone based devices had an interactive voice response system that could remotely monitor a patient’s blood pressure, heart rate, O2 saturation, weight and blood sugar via a telephone connection. The devices were recommended for all cardiac and respiratory patients who were at high risk for re-hospitalization since the devices would be able to recognize early symptoms and help the nurses to make quick decisions about the patients’ plan of care. So what is telenursing and telehealth? Hebda & Czar (2013), states that “telenursing is the use of telecommunications and information technology (IT) for the delivery of nursing care”. Telehealth is “the use of telecommunications technologies and electronic information to exchange healthcare information and to provide and support services such as long-distance clinical healthcare to clients”. Although, telenursing is still a fairly new concept to me, there is documentation of telenursing in the 1970’s. The first published telenursing article was written by Mary Quinn, RN in 1974...
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... 8 Conclusion 10 Action Plan 11 Reference 12 Introduction Nursing is a great discipline and nurses have the honour and expertise in healing humans and bringing them back to normalcy (Reed P G, 2006). In discharging their duties effectively there is always a question that remains unresolved whether nursing should be approached as a science or an art or both? Academicians and practitioners stand on both sides and some tow along the middle path. Gary Rofle (2002) suggests that it’s not a pure science and discounts the opinion that nursing reflects technical rationality. He suggests that reflective learning, learning as an outcome of doing, which is closely related to art and which differs from individual to individual, dimension should also be considered. From the above discussion we can conclude that nursing is both art and science. In the words of Florence Nightingale ‘it requires preparation and dedication as hard as any sculptors work and its one of the finest fine arts’. In yet another instance she highlights the science behind the practice; ‘the most important practical lesson that can be given to nurses is to instruct them what to observe’, observation being a primary...
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...CONCEPT OF CRITICAL CARE Critical care nursing is that 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...
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