...problem works best for which patients.2 Evidence-based practice encompasses implementing the best-known practices into the clinical setting using a scientific approach. It evolved from evidence-based medicine, which was developed in Canada to teach medical students. “Evidence-based medicine has been defined as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.”3, p. 3 The National Quality Forum’s report A National Framework and Preferred Practices for Palliative and Hospice Care Quality is a consensus report that is a first step toward introducing evidence-based measures into palliative practice on a formal, national level.4 The Agency for Healthcare Research and Quality (AHRQ) supports organizations in their efforts to improve the quality and efficiency of healthcare by facilitating the use of evidence-based research findings in clinical practice.5 The nursing discipline has also embraced evidence-based practice over the past 25 years, initially through its support of “research utilization,” the integration of research into nursing curricula, and the education of nurse scientists. Sigma Theta Tau International, the Honor Society of Nursing, considers evidence-based nursing “as an integration of the best evidence available, nursing expertise and the values and preferences of the individuals, families, and communities who are served.”6...
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...Nursing staff deliver primary care throughout treatment working autonomously to build relationships, provide expert crisis and symptom management, and provide patient and family education about disease processes, treatments, and quality of life concerns. There are two social workers, four case managers, a nurse manager, two palliative care doctors, and one clinical nurse specialist (CNS) assigned to the clinic. Patients are assigned to a primary team upon diagnosis or beginning of care at the clinic. Although the staff is separated into different care teams, there is a strong collaborative effort amongst the staff focused on providing the highest level of evidence-based, patient family centered...
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...Cancer Control Knowledge into Action WHO Guide for Effective Programmes Diagnosis and Treatment Cancer Control Knowledge into Action WHO Guide for Effective Programmes Diagnosis and Treatment WHO Library Cataloguing-in-Publication Data Diagnosis and Treatment. (Cancer control : knowledge into action : WHO guide for effective programmes ; module 4.) 1. Neoplasms – diagnosis. 2. Neoplasms – therapy. 3. Early detection. 4. National health programs. 5. Guidelines. I.World Health Organization. II.Series. ISBN 978 92 4 154740 6 (NLM classification: QZ 241) © World Health Organization 2008 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: bookorders@who.int). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: permissions@who.int). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may...
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...Analyzing and clarifying the concept of managing acute pain can increase the healthcare provider’s knowledge of acute pain management, define the concept of managing acute pain, and expand the understanding of the concept of managing acute pain. The aim of this analysis is to clarify the defining attributes of managing acute pain, identify antecedents that influence the perception of pain and the possible consequences of acute pain. Review of Literature To increase the understanding of the concept of managing acute pain, it is important to explore the definitions of pain to gather basic information about managing acute pain. For this analysis pain will be defined from a professional dictionary, and a thorough review of literature from the disciplines of psychology, medicine, and nursing. Definition of Pain from Dictionary Mosby’s Medical, Nursing, and Allied Health Dictionary (2001) was used to define pain because it delineates pain by...
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...Multidisciplinary Concept Analysis Acute pain following a surgical procedure is one of the most common stimuli experiences by pediatric patients. Pediatric postoperative pain management has long been overlooked and treated differently than adult pain management. There tend to many misconceptions when it comes to pediatric pain management stemming from the belief that children do not experience pain the same way as adults. Since the pediatric population is not legally allowed to make medical decisions, guardians must make these decisions for them. Postoperative pain in the pediatric patient may be hard to assess and therefore healthcare professionals have begun to involve family members and caregivers in the pain management process. Pain can stem from many sources and thus must be holistic, involve multiple disciplines, provide education and apply to each individual patient. In practice, advocacy for these young children is important in helping them and their families understand about the situation and make education decisions on how to proceed with care. The concept of postoperative pediatric pain management must be analyzed to help resolve these misconceptions and not ignore the population who at times cannot speak for themselves. Review of Literature After a surgical procedure, the pediatric patient will come into contact with many healthcare professionals including nurses, doctors, and psychologists. Each of these disciplines plays a key role in aiding the pediatric patient...
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...transformation process. According to the Institute of Medicine’s report on nursing’s future, nurses will play a critical role in providing quality care at a lower cost. As legislation is moving health care away from acute and specialty realms, there is a higher demand in primary care centered environments. (“Future of Nursing,” 2010). There is also a substantial aging population with the baby boomer generation that will need long term and palliative care. (“Future of Nursing,” 2010). According to three health care systems, Veterans Affairs (VA), Geisinger Health System and Kaiser Permanente, emphasis has been put on registered nurses and nurse practitioners to see if moving them into primary practice environments would assist in the delivery of their outcomes. The results from all three health systems showed impressive results with the end result being that of higher quality care and lower economic costs. (“Future of Nursing,” 2010). In order to achieve this outcome, patient to nurse ratios would need to be decreased to meet the demands needed by other disciplines to ensure that optimal care is being given to the patient. With a lower patient load, there would be more time available to focus on the patient from all aspects of care. Implementing a discharge nurse to facilitate the needs of the patient in a timely manner would assist in keeping costs down. The collaboration of case management and the discharge nurse working together would help alleviate the need for readmission. These implementations...
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...Case: Ledina Lushko The case of Ledina Lushko, a patient enrolled in a Blue Cross and Blue Shield of Illinois individual plan, highlights many of the issues that have plagued the United States healthcare system for some time. As an insurance plan provider, BCBS of Illinois takes pride in the health outcomes of our members and has a responsibility to contribute positively to their care. The fractured, ineffective care Mrs. Lushko received is disappointing, however, this case provides strong support for a shift in focus towards managed care and specifically, the Accountable Care Organization structure. The following details several aspects of Mrs. Lushko’s experience and how her care could have been improved by enrollment in BCBS of Illinois’ private ACO plan. 1. Issue: Repeat & Poorly Documented Testing One concerning aspect of Mrs. Lushko’s experience was the lack of proper organization of test results and test history. Beginning very early within her first contact, a repeat abdominal CT was performed after this test was already carried out just a few weeks earlier by a health system in Albania. Although there is not an obvious connection or relationship with an overseas health system of this sort, Mrs. Lushko had no knowledge that repeat tests could have been avoided prior to the appointment if she had obtained her files ahead of time. Additionally, there were several occasions throughout her care where providers did not have readily available access to recent...
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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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...Nursing has been struggling to be recognized as an academic discipline ever since the 1960s, when the American Nurses Association published a position paper that supported baccalaureate education as the entry level to practice (McCance & McKenna 1999). Previously, most nursing education took place in hospital schools (diploma programs), and the profession was very much under the control of medicine. Now, there's a lot to be said in favor of diploma programs, mostly the fact that diploma graduates usually have much more clinical experience, and are therefore more technically skilled than other entry-level graduates. However, the biggest disadvantage of these schools was that they did not teach nursing theory. Florence Nightengale was incorporated somewhat but the majority of the curricula were medically based. Nurses depended heavily on physiology, sociology, psychology, and medicine to provide academic standing and to inform practice (McEwan and Mills 2014). Some of the nursing classes were taught by the physicians, namely physiology and pathophysiology, and anatomy. Therefore, nurses were taught and trained to be the handmaidens of the physicians. In many circumstances, they were taught precisely what their doctors wanted, and how to anticipate and execute their doctors’ orders. They were also taught how to care for their doctors' patients. The regulatory and professional organizations in nursing education have required that critical thinking be essential to all nursing...
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...Concept Analysis: Healthcare Related Quality of Life Tarren Evans, RN BSN APSU/RODP NURS 5000 March 21, 2015 Quality of Life Concept Introduction The phrase “health care related quality of life” (HRQOL) or “quality of life” (QOL) is often used in healthcare. The perceptions of the meaning can vary depending on who is explaining it. The reason for this selected topic is to research other disciplines and see if indeed significant variations in the meaning exist. The purpose of this concept analysis is to define, research, and analyze if the dissimilarities improve or hinder a patient’s plan of care. This paper will examine the significance of a concept to advance understanding (McEwen, 2014). Literature Review Can quality of life be defined to have a uniformed definition? The first known research on quality of life was published in 1957 that surveyed mental health adults in the USA. The Oxford English Dictionary (2010) defines QOL as “the standard of health, comfort, and happiness experienced by an individual or group”. There are several influences that can alter the definition of QOL. The acronym “HRQOL” is a narrowed term when characteristics relating to an individual’s health status are likely to be affected (Sandau, 2014). The literature review discussed some domains that render the effects on the perception of this concept. A collaborative study done by doctors and nurse practitioners discussed that physical, social, emotional, cognitive, and spiritual...
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...JAN REVIEW PAPER Measurement of empathy in nursing research: systematic review Juping Yu & Maggie Kirk Accepted for publication 16 July 2008 Correspondence to M. Kirk: e-mail: mkirk@glam.ac.uk Juping Yu MSc PhD RN Research Fellow Faculty of Health, Sport and Science, University of Glamorgan, Wales, UK Maggie Kirk BSc PhD RN Head of Research/Leader Genomics Policy Unit and Lead Professional Specialist (Nursing Professions) NHS National Genetics Education and Development Centre Faculty of Health, Sport and Science, University of Glamorgan, Wales, UK YU J. & KIRK M. (2008) Measurement of empathy in nursing research: systematic review. Journal of Advanced Nursing 64(5), 440–454 doi: 10.1111/j.1365-2648.2008.04831.x Abstract Title. Measurement of empathy in nursing research: systematic review. Aim. This paper is a report of a systematic review to identify, critique and synthesize nursing studies of the measurement of empathy in nursing research. Background. The profound impact of empathy on quality nursing care has been recognized. Reported empathy levels among nurses range from low to welldeveloped and there is clearly debate about what constitutes empathy and how it can be measured and improved. Data sources. Searches were made of the CINAHL, MEDLINE and PsycINFO databases, using the terms ‘empathy’, ‘tool’, ‘scale’, ‘measure’, ‘nurse’, and ‘nursing’, singly or in combination to identify literature published in the English language between 1987 and 2007. Methods...
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...ETHICAL DILEMMAS FACING NURSES ON END-OF-LIFE ISSUES BASED ON CONFERENCE PROCEEDINGS HELD IN ELDORET, KENYA Author: Kamau S. Macharia: BScN (Moi), MSc (studying) Nursing Leadership & Health Care Systems Management (University of Colorado, Denver), Higher Dip. Critical Care Nursing (Nbi). Graduate Assistant, School of Nursing & Biomedical Sciences, Kabianga University College (A Constituent College of Moi University), . P 0 Box 2030 20200 Kericho, Kenya , Tel +254 722224577, Email: symomash@gmail.com ETHICAL DILEMMAS FACING NURSES ON END-OF-LIFE ISSUES BASED ON CONFERENCE PROCEEDINGS HELD IN ELDORET, KENYA ABSTRACT Problem Statement: A conference to discuss on ethical dilemmas is thought to be a good way of airing out issues. It is unfortunate that at times a patient in our care may die no matter what we do. Profound ethical questions on end of life issues confront the medical personnel as they watch and wait helplessly. This paper touches on ethics, law, social and public policy as they affect nursing practice. Setting: This is a conference proceedings report augmented with a case study of Nelly from a local setting and compares it with two others from elsewhere which were also presented during the conference. Conference was organized by Federation of African Medical Students Associations (FAMSA), Eldoret 2011. The author was a presenter...
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...something that has evolved and continues to change each and every day. In fact the meaning of the word human can be described differently by nearly everyone who is asked. Dr. David Livingstone Smith, an associate professor at University of New England, states, “ answering this question is not as straightforward as it might appear,” when asked, what it means to be human (Smith, 2012). It can therefore be said that as the definition of being human changes and evolves so does the way we care for others in medicine. Dr. Larry Dossey describes three eras of medicine, each evolves from ideas of the previous and has changed over the years. In the first era, medicine has a “mechanical” approach which only involves drugs, procedures, and surgical intervention (Dossey, n.d.). In era two Dr. Dossey discusses a change that began to appear in medicine, that is, “that disease has a ‘psychosomatic’ aspect: that emotions and feeling can influence the body’s functions,” (Dossey, n.d.). Finally in era three it is said that, “ an individual’s mind may affect not just his or her body, but the body of another person at a distance, even when that distant individual is unaware of the effort,” as well as the idea of the consciousness having a bigger impact in life and the the human body (Dossey, n.d.). It is evident that in each era change began to impact the thinking in medicine as did the idea that healing can come from more than just “mechanical medicine”. There are multiple models...
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...NCLEX-RN® DETAILED TEST PLAN 2010 NCLEX-RN Detailed Test Plan ® Effective | April 2010 Item Writer/Item Reviewer/Nurse Educator Version Mission Statement The National Council of State Boards of Nursing, composed of member boards, provides leadership to advance regulatory excellence for public protection. Purpose and Functions The purpose of the National Council of State Boards of Nursing (NCSBN ) is to provide an organization through which boards of nursing act and counsel together on matters of common interest and concern affecting the public health, safety and welfare, including the development of licensing examinations in nursing. ® The major functions of NCSBN include developing the NCLEX-RN and NCLEX-PN examinations, performing policy analysis and promoting uniformity in relationship to the regulation of nursing practice, disseminating data related to NCSBN’s purpose and serving as a forum for information exchange for NCSBN members. ® ® Copyright© 2010 National Council of State Boards of Nursing, Inc. (NCSBN) All rights reserved. NCSBN , NCLEX , NCLEX-RN and NCLEX-PN are registered trademarks of NCSBN and this document may not be used, reproduced or disseminated to any third party without written permission from NCSBN. ® ® ® ® Permission is granted to boards of nursing to use or reproduce all or parts of this document for licensure related purposes only. Nonprofit education programs have permission to use or reproduce all or parts of this document...
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...This material is protected by U.S. copyright law. Unauthorized reproduction is prohibited. To purchase quantity reprints, please e-mail reprints@ons.org or to request permission to reproduce multiple copies, please e-mail pubpermissions@ons.org. FEATURE ARTICLE Building Comfort With Ambiguity in Nursing Practice Kalli Stilos, RN, MScN, CHCPN(C), Shari L. Moura, RN, MN, CONC(C), CHCPN(C), and Frances Flint, RN, MN Current nursing literature recognizes the need to honor the concept of ambiguity. Nurses experience uncertainty with handling or honoring complexity and ambiguity when confronted with times of struggle. Traditional models of care fall short as patients and families define their expectations of the healthcare system. Nurses bear witness to the discomfort caused by the unknown in their daily practice. They are challenged to address their feelings, unsure of what to anticipate, what to say, or how to respond to their patients. Uncertainty diminishes the opportunity for meaningful dialogue between nurses and other people. Nurses attempting to ease the discomfort of ambiguity by providing patients or families with reassurance, offering advice on how to fix problems, or avoiding talking about situations often express dissatisfaction. Nurses should be invited to explore ambiguity and seek understanding through dialogue and nursing knowledge. Encouraging nurses to define the meaningfulness in nursing practice that embraces human science theory will help relieve some of...
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