...requiring optimal patient outcomes in shorter amount of time period. Patients are requiring more advance care for more complex issues hospitals are now in need of highly skilled, trained professionals to provide this level of care. The quality of patient care and outcome of the patient depends a lot on the level of education of the nurse. Case studies have proven that where positive patient outcomes have been linked to nurses that have a higher level of education Baccalaureate prepared. With that being said one of the main differences between the ADN vs. the BSN is the level of education. There are three educational pathways to become a Registered Nurse 1. Three-year diploma program. 2. Two year Associate Degree program offered at a community college 3. Is a four year program Baccalaureate Degree program. (AACN, 2014, #3) An Associates degree in nursing is earned over a course of two years and the curriculum is more technical and bedside focused (Creasia &Friberg, 2011). The Bachelor of Science in nursing includes the same course work as the ADN. The BSN is more in depth in the treatment of the physical and social sciences, nursing research, public and community health, nursing management and humanities (AACN, 2014, para#4) According to the AACN “ The additional course work enhances the students professional development, prepares the new nurse for a broader scope of practice, “ and allows the baccalaureate graduate to” better understand the many social, cultural, economic...
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...Mechanically ventilated patients may experience increased levels of stress due to various environmental factors in the ICU. These include equipment/alarm noise, invasive nature of treatments and the inability to communicate verbally. These stressors can cause non-favorable effects such as increased anxiety levels which can subsequently lead to somatic reactions such as tachycardia, dyspnea, increased blood pressure and patient-ventilator dyssynchrony. Prolonged anxiety levels can also induce psychological effects such as increased fear and inhibitions. This can ultimately affect the patient’s overall capacity to cope with difficult emotions and situations (Richart-Martinez & Perpina-Galvan, 2009). These effects can lead to the need for more sedation which can hinder weaning attempts. The longer a patient is mechanically ventilated the greater the risk of developing Ventilator Associated Pneumonia, (VAP), and Adult Respiratory Distress Syndrome (ARDS). VAP is a pneumonia that develops 48 hours or longer after mechanical ventilation. It results from the invasion of the lower respiratory tract and lung parenchyma by microorganisms. Intubation compromises the integrity of the oropharynx and trachea and allows oral and gastric secretions to enter the lower airways. ARDS is a life-threatening lung condition that prevents enough oxygen from getting into the blood. The purpose of this study is to evaluate the effectiveness of stress reducing, non-pharmacologic interventions on mechanically...
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...tolerates the SBT for 30-120 minutes prompt discontinuation should be considered, but does not give parameters for tolerance (Haas & Loik, 2012). The fourth recommendation is if the SBT is tolerated an assessment of airway patency and the ability of the patient to clear their own airway (Haas & Loik, 2012). Recommendation five stated if the SBT is failed, the trial be completed every 24 hours (Haas & Loik, 2012). The sixth recommendation is if the SBT is failed the patient should then receive support that is non-fatiguing and comfort measures addressed (Haas & Loik, 2012). Recommendation seven stated that sedation and ventilator management for postsurgical patients should be aimed for an early discontinuation of MV (Haas & Loik, 2012). Recommendation eight stated protocols for the use of nonphysician healthcare works should be created for the discontinuation of MV and sedation while MV (Haas & Loik, 2012). Recommendation nine stated that after the patient is stabilized on the MV and is requiring extended assistance a tracheostomy should be considered (Haas & Loik, 2012). Recommendation 10 stated a patient should not be considered ventilator dependent until they require MV for greater than three months with weaning attempts made or there is clear evidence of irreversible disease requiring MV (Haas & Loik, 2012). Recommendation 11 stated that when...
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...Latosha Cooper Karen Newson RESP 1135 2/6/2017 Preventing Ventilator-Associated Death and Injury Mechanical ventilation is a technique used in hospitals and other healthcare facilities to offer life support to patients with respiratory complications by either supporting or entirely controlling their breathing and also, depends on the condition of the patients There is a rising concern, however, over the injuries and deaths associated with ventilation, and, therefore, prevention of ventilator- associated deaths (VADs) is critical. To come up with workable prevention strategies, the associated risk factors must be carefully analyzed (John Davies MA, RRT, FAARC, 1). In this paper, I will discuss some of the factors leading to ventilator- associated death and injury, the prevention strategies that may be put in place as well as how to care for the respiratory patient. Ventilator- associated deaths or injury usually result from unplanned extubation, whether it be by the patient as in accidental or deliberate self- extubation, or extubation by the nurse. Staffing is the major contributor to VADs. When the respiratory therapists are not adequately trained or oriented on the proper operation and monitoring of ventilators, they may fail to recognize when the...
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...A. Root Cause Analysis A root cause analysis (RCA) is a “systematic approach to understanding the causes of an adverse event and identifying system flaws that can be corrected to prevent the error from happening again” (Huber & Ogrinc, 2010). The root cause analysis is used to determine why the problem occurred in the first place and to identify the cause of a problem using a specific set of steps (Mind Tools, n.d.). The RCA team which consists of interprofessionals who are knowledgeable of the issues and processes related to the incident and the people who are involved in the incident should be formed first before the RCA meeting takes place (Huber & Ogrinc, 2010). In the given scenario, the team includes the emergency department (ED) physician (Dr.T), the RN (Nurse J), the LPN (Mr.B’s LPN), the risk manager, the ER nurse manager, the ER nurse educator, and the quality improvement professional. These members would meet and would discuss the causative factors, errors and hazards that caused Mr.B’s sentinel event. The root cause analysis process has five steps. The first step in conducting a RCA is defining the problem (Mind Tools, n.d.). In the given scenario, the problem is the unexpected death of Mr.B. The second step is collecting the data (Mind Tools, n.d.). It is very important to record and report the data as accurately and as completely as possible. Mr. B’s vital signs, pain scores, laboratory values, and history of medication administered during the situation must...
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...A. The sentinel event was related to respiratory arrest secondary to conscious sedation procedure. There were several factors that played a role which included high patient census, poor staffing, alarms dismissed by staff members, patient was left unmonitored, and no supplemental oxygen initated prior to the procedure. When the patient was pulseless no CPR was initiated until the code team arrived and critical interventions were delayed by the emergency room staff. The patients medication reconciliation or history weren’t reviewed by the emergency room physician. Tripple doses of intravenous valium and dilaudid were given without a lapse in time. The patient was elderly and on chronic oral opioid medications. “Normally these types of medications are administered with low doses and titrated per patient’s sedation level. Patient, monitoring or sedation level weren’t assessed between doses. This event is known as a sentinel event. In any situation that causes injury, or death a root cause analysis must be completed and reported to the Joint Commission. B. To implement a change in the conscious sedation procedure a team or committee needs to be established. All staff in the emergency room can become active participants by joining a committee or subcommittee. These main categories may include patient characteristics, task factors, individual staff members, team factors, work environment, and organizational management (IHI, 2014)...
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...and determine things to do to prevent a reoccurrence. * At 3:30pm a patient arrived to the Emergency Department with a dislocated hip and was experiencing elevated respiration rate of 32 and a significant pain score of 10/10 * At the patients time of arrival there was 1 RN, 1 LPN, 1 Secretary, 1 Emergency room physician, and an in house respiratory therapist on staff at the time of the patient’s arrival and there were two other patients being cared for. * The physician decides to do a reduction of the patients left hip and need to have the patient at an appropriate sedation level * At 4:05pm the nurse administered Diazepam 5mg IV per the physicians order. * At 4:15pm the nurse gave Hydromorphone 2mg IV per the physicians order. * At 4:20pm the patient is still not sedated enough and the nurse gives an additional Diazepam 5mg IV and Hydromorphone 2mg IV. * At 4:25 Proper sedation is achieved and the physician performs a reduction of his left hip. * At 4:30pm the procedure was complete and the nurses are alerted to another patient in route to the ER in acute repertory distress and the nurse places the patient on an automatic blood pressure machine to monitor B/P and pulse oximetry. * At 4:35pm the patient had a B/P reading of 110/62 and O2 stat of 92% * The nurse and LPN receive the ER transport patient and are now discharging the other two patients but the ER has filled with new incoming patients. * The patients O2 saturation alarm is showing...
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...fall in his home. The sixty-seven-year-old man arrived to the 6 bed, small town ER with his son and neighbor in a severe amount of pain in his left hip and leg area. There are several unfortunate reasons that lead to Mr. B’s demise. The information gathered to complete the RCA will determine the causation of this ill-fated situation. I will discuss these factors in further detail ahead. The first factor in this case I will discuss is the lack of education on hospital policies and procedures. Mr. B was placed under conscious sedation and therefore he should have received increased assessments and observations. There was a policy in place that was not followed as directed. From the story told it appears the patient was neglected in terms of evaluating him before the procedure and kept a close watch of during and following it. Secondly, there should be guidelines put into place when the ER is inundated with patients and more staff is needed to care for...
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...exam the causative factors that led to this unfortunate sentinel event. Then I will identify the errors or hazards in the care of Mr. B. A change theory will then be utilized to establish a useful improvement plan that would hopefully decrease the chances of a repeat of the outcome in the Mr. B scenario. A Failure Modes and Effects Analysis (FMEA) will then be used to project the likelihood that the suggested improvement plan would not fail. In conclusion key roles of the nurses involved in the care in the Mr. B scenario will be discussed. I have completed the RCA considering: causative factors, errors and hazards that had unfortunately lead to the death of the 67 year old patient that was brought to the ED. By performing the RCA we start at the beginning with the causative factors, we list staffing levels, who was there and who was not. The participants during the root cause analysis would be the emergency room physician (Dr. T.), the LPN and RN (Nurse J) the respiratory therapist who was in house but not in the ED at the time of this sentinel event, and the unit secretary. As we read through the scenario we discover that conscious sedation was used for Mr. B. Conscious sedation should never take place without a qualified Respiratory Therapist (RT) present. We know that there was an RT in the building at the time of the procedure. Conscious sedation should always include the use of supplemental oxygen with continuous monitoring, as well as careful monitoring of the patients...
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...improved. The first step in a RCA is to identify what happened. In the scenario, presented in this task, the patient was over sedated and subsequently died. Step two is to identify why this happened. There were preventable causative factors, or errors, that led to this sentinel event. The hospital’s conscious sedation policy requires that the patient remains on continuous BP, ECG, and pulse oximeter throughout the procedure and there was no mention that this was performed at all throughout the procedure. It was not until after the procedure that Mr. B was placed on continuous BP and pulse oximeter, and at that time, the patient was left in the room, with only a family member while Nurse J attended to another patient. When the alarm is heard that the patient has low O2 sats, the LPN, enters the room and resets the alarm and repeats the B/P reading. His oxygen level was not rechecked, nor was he placed on supplemental oxygen, nor was the RN informed at this time, and the patient was once again left unmonitored. The conscious sedation policy also states that all practitioners who perform moderate sedation must first successfully complete the hospital’s moderate sedation training module, which includes drug selection and acceptable dose ranges. There is...
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...identify the flaws in a system that can be corrected to prevent this error from occurring in the future. A mix of different professionals from all levels of the organization comprises the team conducting the RCA. IHI 2019, Patient Safety 104. Explain each of the six steps used to conduct an RCA, as defined by IHI. 1. What is the difference between a. and a. Identify what error occurred, in the order of occurrence. 2. What is the difference between a'smart' and a'smart'? In ideal conditions, determine what should have happened, in comparison to what happened. 3. What is the difference between a'smart' and a'smart'? Determine the cause of the error by asking why, to find the root cause. Identify the other causes of the error by asking the health care team to explain their role in the event. Look into the workplace environment, and the management factors. 4. What is the difference between a.. A cause statement is developed. It explains how the list of...
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...the airway places the children at higher risk for adverse airway events during the postoperative period. Any airway complications, regardless of the severity, can lead to morbidity and mortality among children. The airway is the most critical safety issue among children, and any adverse events can result in prolonged recovery time or even inpatient hospitalization. The anesthesia provider and PACU personnel carry a high level of vigilance to minimize airway complication among postoperative children. Anxiety is one of the most challenging aspects of pediatric surgical patients, and apart from behavioral and psychological therapy, midazolam plays an enormous role during the preoperative period. Apparently, midazolam sedation impairs the swallowing reflex under therapeutic doses.10 The cerebral centers have some degree of voluntary control over the laryngeal reflexes during conscious state, resulting in regaining control of respiration after a potential aspiration episode.11 Sedation can cause altered pharyngeal functioning and altered swallowing breathing coordination, leading to an increased risk for aspiration. Midazolam causes a decrease in the frequency of spontaneous swallowing.10 Propofol also proven to cause swallowing impairment during sedation.9 The duration of swallowing impairment related to propofol is unknown. AT surgical children are prone to airway complications during immediate postoperative period.6,8,13,15,16 Pain is an inevitable natural component of any surgery...
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...severely restrict or take away their right to think” (kindle Fire, Location 142). Therefore, restricting access to “strategic planning”, employee rights have been taken away. Wells (1998), also points out “that the only limit” to an organization’s possibilities is “the mind of it’s people and what they are able to conceive (Kindle Fire, Location 46). In part, this reasoning could account for my lack of knowledge. However, reflecting back over the past 38 years leads me to the realization that I am equally guilty of my lack of knowledge pertaining to “strategic planning”. I began nursing at the age of 17, at that time I was certainly more of a follower than a leader. By 1986, I obtained an Associate’s Degree in Nursing, specialized in critical care. I began leaning how lead by being...
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...therapist, a pharmacist, hospital administrators, and patients not involved in the case is assembled to work through the process. The team begins by interviewing patients and staff involved to gather as much vital information as possible. Once all necessary information is compiled, the team works together to get to the root(s) of the problem. In the case of Mr. B, there were multiple issues that led to the adverse event as opposed to one root problem. In the process of defining the problem, several causal factors were identified. The error was a result of both facility and human error. Mr. B, a 67-year-old patient, presented to the small, six-room, rural hospital ED due to severe pain in his left hip following a fall. In his quest for care, he came across some hurdles that eventually led to his death. Amongst one of the many issues that led to complications was the fact that the hospital was short staffed with only one RN, Nurse J., and one LVN on shift. There was also only one ED physician, Dr. T. At the time of Mr. B’s arrival, two other patients were being...
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...Analysis of Pain BLK, RN, BSN The University of Texas at Arlington College of Nursing In partial fulfillment of the requirements of N5327 Analysis of Theories in Nursing Xxxx, xx October 8, 2013 Procedural Pain Management for the Early Childhood Patient Children presenting to the emergency department are often subjected to painful and anxiety-producing procedures, both for diagnostic purposes and for treatment of symptoms. Historically, pediatric patients have not been afforded the same level of care as adults with regard to the management of procedural pain. Pain in the young child age group (1-7 years) has often been under-treated, resulting in increased fear of the healthcare setting and postponement of necessary immunizations and procedures by the patients and parents. Close examination of the concept of pain – specifically, procedural pain in the young child age group in the emergency department (ED) setting, is necessary for understanding how nursing practice may be improved in order to produce a more positive patient experience. A thoughtful review of current literature will provide insight into the concept of pediatric pain, permitting a detailed analysis. This analysis will assist in the formulation of theoretical and operational definitions of the concept for use in further study. Review of Literature A review of literature was conducted to compare and contrast views of the concept of pain across multiple disciplines. The disciplines chosen are nursing...
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