Personal Ethics in Nursing Essay

Ethics is the discipline that waits in the wings as a health-restoring resource when moral guidelines fail to do the job alone. Ethics provides a language, along with methods, and tools for evaluating the components of personal, societal, and group morality to create a better path for yourself and others. Some of its most important uses are to clarify, organize, and critique morality to highlight what does and does not fit in a particular situation (Purtilo, 2011).

A nurse cultivates personal ethics through personal, cultural, and spiritual values which becomes a moral compass for their professional ethics.

Personal ethics in combination with the code of ethics often assist the nurses in personal and social decision making during ethical dilemma. This ability prompts them to better respond to needs of the suffering patient and their own well-being. Nursing ethics shares many principles with medical ethics such as beneficence, non-maleficience, and respect for autonomy.

Nursing ethics however, can be distinguished by its emphasis on relationships, collaborative care and human dignity, because the health care climate is regularly changing, as is our society, it is crucial that nurses have a grounded understanding of ethics (Ward, 2012).

Born in a middle-class Christian family from South India, the strict traditional values helped to embed the concept of service through family and friends who taught me trust, respect, integrity, and responsibility for my education and beliefs.

One of my major spiritual values that kindled the concept of service within me is “do unto others as you would have them do unto you” which is found in the Bible. At an early age I started to practice this concept by not only self-respect for myself but mainly treating others with respect. Individuals may build their moral values from listening to their parents, grandparents, religious beliefs, friends, books, their local societal values and even watching television. Moral values and enthusiasm help an individual to understand one’s accountability to their profession to deliver harmless, a compassionate work atmosphere.

This empowers nurses to raise their self-confidence in their profession. Maintaining the existing responsibilities in the nursing field is vibrant to assist patients, families, and the general public. Our ethnic standards play a big role in nursing life. Nurses however should not be judgmental of patient’s beliefs and force their own beliefs in patient care. Hospitals under Joint Commission are responsible for addressing and maintaining patient’s privileges. These privileges include the accommodation; divine, mystical, particular Cultural values and follows while providing care to patients from diverse faiths.

Nurses must have reverence and not put down the patient’s faith and values, and provide care consistently. Being acquainted with a variety of different cultures, languages, and religions influence worldly views and nursing decisions in providing culturally sensitive care. The traditional spiritual and cultural morals along with diverse worldviews became the directorial moral compass to take the right decision on behalf of the patients and personal life and empowered to improve the confidence and capability as a nurse.

Values, Morals, and Ethics are often thought of as interweaved and to have the same denotation when each of solely have a different meaning for themselves. Values are one’s fundamental beliefs developed from childhood through family and society. Morals are values that attribute to a system of beliefs. Values are the language that has evolved to identify intrinsic things a person, group, or society holds dear. Not all values are moral values either. For instance, some things are cherished for their beauty, novelty, or efficiency they bring to our lives (Purtilo, 2011).

When values, morals, and ethics of nurse influence his or her professional conduct, it often tips to conflicting situation in one’s nursing practices. For example, the topic of abortion is frowned upon when looked at from a spiritual Christian standpoint. When a nurses’ spiritual doctrine is against abortion, it would be against their moral to assist in decision making to abort the baby even when the fetus is deformed, thus arising an ethical dilemma between personal values and coming to an ethical conclusion on aborting the baby.

Hospital management may develop a strong Code of Ethics in order to help regulate and maintain a professional atmosphere for nurses so that their decision making will be easier when they incur ethical dilemmas. A Code of Ethics not only serves as a guideline for nurses but also sets a standard for them to abide by. Being in the nursing field my tasks vary from caring, communicating, teaching, bedside care, and even advocating therefore the likelihood of ethical dilemmas are inescapable. Thus far I haven’t been faced with any major ethical dilemmas that would violate my spiritual doctrines that I uphold.

Most commonly the ethical dilemmas I’ve seen care providers face are usually due to religious and spiritual backgrounds of the patient. Some religions do not support induced death by humans and nurses may have trouble supporting the patient and family about cases like abortion. Although it is the individual’s right to make decisions about their bodies, the religious values do not allow one to be apart of the procedure. Therefore when I’ve been in minor ethical dilemmas while being a care provider I go by what is medically and ethically correct.

Nurses are an important element of the health care field because their decisions along with commitment play an essential role for the welfare and safety of humanity. If their decision making is based on personal, cultural, and spiritual values then at times they may be faced with an ethical dilemma. In situations where they’re beliefs may be tested, nurses are expected to either follow the Code of Ethics set out by their management or they should be professional and do what is medically right in order to deliver quality care.

The Process of Decision Making in Nursing Essay

Critical thinking skills help nurses shape their actions. In other words, critical thinking is necessary to make good decisions. Good decision-making requires a good foundation of scientific knowledge. The nurse must also be aware of standards that should be followed. Internal and external variables such as the nurse’s personal experience, knowledge, creative thinking ability, education, self concept, as meshed with the nurses’ working environment, and situational stressors all can work to enhance or inhibit effective clinical decision making for a nurse.

Types of Decisions

Decisions can be grouped into two main types, programmed and non-programmed. programmed – meaning they are anticipated and routine. There are likely guidelines, policies, or procedures that can be followed. Non programmed – are unexpected, unique, and more complex.

Decision-Making Process The decision-making process is often broken down into a series of linear steps. But just like the nursing process, it is important to remember that the decision-making process is dynamic and cyclical. • Define the decision – Decision-making can only occur when there is a choice between actual alternatives.

• Gather information and deliberate – Data should be gathered about the alternative choices that are available. • Choose from among alternatives – Judgment about the merits of each alternative should lead to a preferred path. • Act – After a decision is made it must be implemented. • Evaluate – After taking a course of action, the results must be evaluated to determine if it was the best choice. This step is similar to the critical thinking skill of reflection.

Factors Affecting the Decision-Making Process There are numerous factors that can influence the decision-making process. These can be grouped into internal and external factors. • Internal factors include characteristics of the person making the decision. Critical thinking ability is paramount to making good decisions. • External factors relate to issues outside of the nurse that affect the decision.

Nursing Shortage Essay

Abstract

Compelling evidence suggests that regions of the United States face a nursing and physician shortage that our legislators, health officials, and medical professionals must address. To ensure that quality medical care is not harshly impacted, the hospitals and public health leadership, in general, will need to tackle the nursing shortage with solid long-term solutions.

It is no secret that the United States faces a critical nursing shortage, a trend that potentially threatens to undermine quality medical care. One single area of concern does not affect the shortage.

In fact, the hospitals, and nursing in particular, are witnessing a combination of problems that range in salary structure, medical economics/cost containment, post-graduate education, and an aging workforce (pending retirements of baby-boomers). The public health industry is not sitting idly by to address the shortage. It is critically reviewing the needs for both existing professions.

Definition of Nursing Shortage

Nursing shortage is defined as the inadequate number of qualified nurses to meet the projected demand for nursing care within a healthcare setting, where the demand for nurses is greater than the supply.

History of Nursing Shortage

Historical knowledge is important to analyze the present and prepare for the future. As we can see from the current shortage in America today, we learn that it is not a new problem. However what makes this current nursing shortage situation unique is that the causes are related to a multifaceted range of issues. The current nursing shortage is connected to supply and demand factors, demographic changes, population growth, and fewer students enrolling in nursing schools, RNs who are retiring or leaving the workforce and a growth in the baby boom population who will demand more healthcare services in the near future. These factors are occurring while many nurses are retiring and more jobs are being created. In addition, the nursing shortage is actually a worldwide phenomenon with areas like Western Europe, Australia, Canada and the Philippines facing shortages as well.

Economic factors have also contributed to the nursing shortage in the United States. Mark Genovese, spokesperson for the New York State Nurses Association explains, “For many decades the shortage was cyclical but as the economy tightened and as the insurance industry moved to a managed care model, there was less money in the system and hospitals had less money to work with and tighter budgets.”

Budgetary limitations affected the nursing workforce as many nurses began leaving the profession altogether. “They were forcing RNs to do more with less, handle more patients and work more hours. RNs started to leave the workforce because of the working conditions and fewer RNs entered the system,” explains Mark.

Americans are also demanding more quality healthcare services while many RNs are retiring, further exacerbating the problem. The HRSA has stated: “to meet the projected growth in demand for RN services, the U.S. must graduate approximately 90% more nurses from U.S. nursing programs.”

Decreased staffing means that there are fewer nurses to work with patients. This impacts job satisfaction and causes work related stress. In some cases it has led to many nurses leaving the profession altogether. A 2010 study published in Health Services Research found that over 75% of RNs feel that the nursing shortage is a huge problem that affects their quality of work as well as patient care and the amount of time that nurses can spend with individual patients.

Another important factor contributing to a lack of nurses is that there is a shortage of nursing school faculty to train a new generation of nurses in colleges and universities. The AACN’s 2008-2009 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing report found that nursing programs in the U.S. did not enroll 49,948 qualified students into their bachelor and graduate degree programs because they did not have an adequate number of faculty, clinical practice sites, teaching space, and were constrained by budgetary limitations. Two thirds of the nursing program respondents reported that a big reason for not accepting students was due to not having enough nurse faculty on hand.

The Southern Regional Board of Education conducted a study which found that the nursing faculty shortage in 16 states was caused by vacant faculty positions, retirements, resignations and a shortage of new candidates applying for faculty positions. Shortages like this pose a threat to the availability of nurse education. Defining the Problem

For those students interested in careers in healthcare, becoming a nurse right now could be the best decision for you. Currently, the United States is facing a severe nursing shortage. For several reasons, the number of nurses graduating and entering the workforce, and those already in the profession, is not enough to fill the growing demand. Currently, RNs are the largest group of healthcare workers in the US at roughly 2.6 million and that still isn’t enough to meet the need. According to experts, by 2012, there could be around 1.1 million unfilled nursing positions in the United States.

In the most basic sense, the current global nursing shortage is simply a widespread and dangerous lack of skilled nurses who are needed to care for individual patients and the population as a whole. The work of the world’s estimated 12 million nurses is not well understood, even by educated members of society. But nursing is a distinct scientific field and autonomous profession whose skilled practitioners save lives and improve patient outcomes every day in a wide variety of settings.

In the Truth’s view, the vast gap between what skilled nurses really do and what the public thinks they do is a fundamental factor underlying most of the more immediate apparent causes of the shortage. These causes include nurse short-staffing (due to inadequate pay and long work hours), poor work conditions, the aging nursing workforce, expanded career options for women, nursing’s predominantly female nature, the increasing complexity of health care and care technology, and the rapidly aging populations in developed nations, to name a few.

Other causes of the nursing shortage episode include: the aging baby boomer population and lack of employee incentives. There were seventy-six million Americans born between 1946 and 1964 and are now classified the Baby Boomer Generation. As this population reaches retirement age and beyond, they are requiring more medical treatments and nursing home and long term care facilities. This country is also seeing an increase in population in general, projected to grow 18% over the next two decades. With more patients flooding the healthcare system, there simply aren’t enough nurses to meet this growing need. However, those currently employed in the nursing field should be rewarded for being encouraged and motivated to stay in such a questionable field of employment.

In light of this nursing shortage, it should be relatively easy to find gainful employment after graduation should you choose to study nursing. According to the Bureau of Labor Statistics (BLS), more than 581,000 new Registered Nurse (RN) positions will be created through 2018, which will increase that workforce by an astounding 22%. The BLS also estimates that even as other sectors of our economy continue to suffer, the healthcare sector will only continue to grow. Since the recession began, more than 600,000 positions have been created in the healthcare industry. With so many Americans out of work in other fields, a career in healthcare, specifically in nursing, might be a viable career choice.

Literature Review

Today, the average age of nursing faculty in baccalaureate and graduate degree programs is 51.5 years and the rate of projected retirements will exceed the rate of re placements. Nurses enter the faculty role later in their careers and typically retire at an earlier age, around 62.5 years. More efforts need to be put into place to encourage those already teaching to remain in their positions even if it is in a limited capacity while future faculty are educated.

What factors are present that facilitate the desire for nursing faculty to retire? Kowalski, Dalley, and Weigand (2006) conducted a cross-sectional, randomized study of 129 nurse educators teaching in 61 schools of nursing to find out what personal decisions influenced their retirement plans. With a 37.6% response rate, results reflected that the mean age of planned retirement was 64.4 years. However, the mean age respondents would like to retire was 62.4. Factors influencing retirement included workplace issues, personal and family health, attitudes about retirement, and financial security.

One of the most important factors influencing retirement plans was financial security. Faculty members who were financially secure retired earlier. Job satisfaction was another important influencing factor resulting in early retirement. In lieu of the faculty shortage, the authors contend that studies such as this will offer insight into future retirement trends which may help bridge the gap between supply and the demand of nurse educators (Kowalski et al., 2006). From the results of this one study it may be important to consider the needs of the aging faculty by providing healthy, satisfying, and stimulating work environments, appropriate benefits packages, and relaxing mandatory retirement ages.

One serious factor contributing to the faculty shortage is financial. Not only are academic salaries much lower than they are for clinical practice and administrative positions of advanced practice nurses, but the cost of securing advanced academic degrees is costly. In 2004, the average salary of a master’s-prepared nurse practitioner in a clinical setting was $80,697 compared to $60,831 for that of a master’s-prepared nursing faculty member (Nevada Nurses Association, 2004). By increasing academic salaries and providing tuition allowances in return for teaching will indeed make teaching a more attractive career choice (Yordy, 2006).

Another important factor affecting the faculty shortage is that of job satisfaction, stress, and burnout. To maintain current faculty on the job, more research should be conducted on factors affecting job satisfaction and what works to provide a better environment. Gormley (2003) performed a meta-analysis study on nursing faculty job satisfaction and which factors had the greatest influence using a sample of six studies from 1976 and 1996. Nursing faculty are pressured not only to educate future nurses to provide safe and competent care, but also have many other professional responsibilities, such as publishing, conducting research, writing grants, performing community service, and maintaining their own competencies (Gormley, 2003). These responsibilities combined can become overwhelming and lead to job dissatisfaction especially as the faculty is aging.

In Gormley’s study (2003), factors that affected job satisfaction were perception/expectation of the leader’s role in curriculum and instruction, suggesting that the dean’s role has significant effects on faculty’s job satisfaction and role conflict/ambiguity. Shirey (2006) argues that prolonged stress can lead to burn-out in many faculty who then become “deadwood,” jeopardizing the quality and spirit of the institution. These faculty members can ward off potential new faculty who are even more vulnerable to the stresses of the teaching role.

It is imperative that academic institutions pay close attention to the needs of their faculty. Mentoring programs, self-renewal, and organizational engagement are key strategies to prevent burnout (Shirey, 2006). “A carefully structured and deliberate mentoring program can be an invaluable orientation as schools of nursing seek to provide an academic environment that is conducive to the professional and scholarly development of adjunct faculty members” (Peters & Boylston, 2006, p. 64).

One serious factor contributing to the faculty shortage is financial. Not only are academic salaries much lower than they are for clinical practice and administrative positions of advanced practice nurses, but the cost of securing advanced academic degrees is costly. In 2004, the average salary of a master’s-prepared nurse practitioner in a clinical setting was $80,697 compared to $60,831 for that of a master’s-prepared nursing faculty member (Nevada Nurses Association, 2004). By increasing academic salaries and providing tuition allowances in return for teaching will indeed make teaching a more attractive career choice (Yordy, 2006).

Program Analysis

Possible Solutions

For sustained change and assurance of evading the forthcoming shortage, solutions must be developed in several areas: education, health care systems, policy and regulations, and image. This shortage is not exclusively a nursing issue, but will require a collaborative effort among nursing leaders, practitioners, health care executives, government, and the media.

Creating Cultures of Retention

The American Nurses Association Magnet hospital program has had a proven success in raising the standards of nursing practice and improving patient outcomes. Currently there are 85 organizations that are designated Magnet hospitals. Magnet facilities are characterized by strong administrative support, adequate nurse staffing, strong communication, nurse autonomy, better control, and a vital focus on the patient and their family.

A growing body of research indicates that this program is making a positive difference for nurses, patients, and the hospitals as a whole. Research is proving that through this program, nurses are having increased satisfaction as well as increased perceptions of productivity and the quality of care given. Studies also indicate that these facilities have lower incidence of needle stick injuries, lower burn out rates, and double the retention of non-Magnet facilities. By adopting the characteristics of Magnet hospitals, facilities will be able to create a culture of retention that empowers and is respectful of nursing staff.

Strengthening the Infrastructure

In 2002 the Nursing Reinvestment Act was signed by President Bush to address the problem of our nation’s nursing shortage. This initiative was intended to promote people to enter and remain in nursing careers, thus reducing the growing shortage. The law establishes scholarships, loan repayments, public service announcements, retention grants, career ladders, and grants for nursing faculty. Many statewide initiatives are underway to address this issue as well.

In Pennsylvania, six new nursing education initiatives have been announced to address faculty shortage by encouraging current nurses to return to school, earn graduate degrees, and teach the next generation of nurses. Illinois is unveiling a plan to provide faculty scholarships and grants to nursing schools in order to expand student enrollment. California, whose nursing programs currently have wait lists over three years, is trying to expand nursing education through a $90 million initiative.

Nurse Staffing Essay

Adequate nurse staffing for patient care has been a major difficulty in the health care system . Patients’ acuity continues to grow at a fast rate while hospitals continue to struggle with the adequate number for nurse-to-patient ratio, leaving nurses in a very difficult situation while trying to provide the best care possible to their patients. The low nurse-to-patients ratio can be remedied when public and private hospitals realize the negative impact on the outcome of care.

This paper will try to point out the negative effects of low nurse-to-patient ratio has on outcome of care.

Like other professions that continue to face obstacles, nursing has its own obstacles that it must face from time to time. The world population increases so will the obstacles that nursing will have to face, but good administration can be used to defend the work conditions under which nurses are forced to work. Many studies have been done to point out the problem, with a pile of evidence to support the need to alleviate the burden on the nurses but to no avail.

A study conducted in the Chinese hospital by Zhu, You, et al. (2012).

Nurse Staffing Levels Make a Difference on Patient Outcomes: A Multisite Study in Chinese Hospitals proved, “more nursing staff per patient had statistically significant positive effects on all necessary nursing care, nurses’ reports of quality of care, their confidence on patients’ self-care ability on discharge from hospital, patient adverse events, as well as patients’ report of satisfaction (Zhu, You, et al, 2012, p. 266)”. The study was composed of 181 hospitals across mainland China. The sample that was used was 31provinces, municipalities and autonomous regions with level 3 hospitals.

To show the strength of the study, the researchers applied statistics to prove their results. As much as the hospitals may not see the need to improve on the nurse to patient problem, the evidence is there. It is something that must be dealt with because it is dangerous to both nurses and patients. Further studies were also conducted on the problem by Nantsupawat A, Srisuphan W, et al. (2011). Impact of nurse work Environment and Staffing on Hospital Nurse and Quality of care in Thailand. This study was to prove the impact of nursing staffing on the work environment, the cause of burnout and the impact on quality of care in Thailand.

Research elements was secondary data analysis of 2007 Thai Nurse Survey. The study took place at 13 general and regional hospitals in Thailand using a “multistage sampling”. Nurses were asked demographic questions about themselves both general and regional hospitals. Results shown the ratio of patient to nurse was 10:1. Nurses who worked in hospitals with fair patient to nurse ratio had less burnout. The study has great significance in nursing practice and can be used as proof to show the impact of high patients to nurses ratio. It was found that nurses in Thailand work environment have high burnout and great dissatisfaction of nurses.

Nurse to patient is very low with a total of 1:10 per shift. At times, a nurse ended-up having to care for more patients. The high patients to nurse ratio brought with it adverse outcomes on patients’ care and place the patients at high risk of occurrences such as: mistaken one patient for another, patient falls, medication errors, pressure ulcers, and urinary tract infection. Furthermore, in the study conducted by Cho, June, Kim, et al (2009). Nurse staffing, quality of nursing care and nurse job outcomes in intensive care units. This study measured the proportion number of patients to nurse.

As per the authors of the article, “nurses were more likely to rate quality of care as high when they care for two or fewer patients (odd ratio, 3. 26; 95% confidence interval, 1. 14-9. 31) or 2. 0-2. 5 patients (odd ratios, 2. 44; 95% confidence interval, 1. 32-4. 52), compared with having more than three patients (Cho, June, Kim, et al,, 2009, p. 1729)”. The research use for its design a “cross-sectional study with survey. Its method included 1365 nurses from 65 intensive care units in 22 hospitals in Korea, using “A Multilevel logistic regression model”.

Two indicators were used, which are the number of patients for each nurse on the ward and the way the staff viewed adequate staffing. The research took place in the ICU units. Hence, the study also reported that in table #4 in the Sole ICU, there were largest number of patient 2. 8 + or – 0. 4 ( Cho, June, Kim, et al, 2009, p. 1733)”.

What is proven is that when the ratio of nurses increases and the patient’s one decreases, there is a higher quality of care that takes place on the unit. This study has great significance to nursing and patient care, because nurses here in the U. S often have similar complaints. In addition, the study from Manojlovich & Sidani (2007). Nurse Dose: What’s in a concept. This is a pathway that the authors believed could alleviate the problem of nurse to patient ratio. The study provided an understanding between the link of nursing care and outcome of care. As stated by Manojlovich & Sidani (20097), “by clarifying the conceptual and operational definitions of nurse dose, we offer a unified view of the inter-relationships among variables, with the goal of advancing research on nurse staffing and patient outcome (p. 11)”.

With this concept of “Nurse Dose” future nurse staffing may greatly improve. Furthermore, in the research conducted by Al-Kandari &Thomas (2008). Perceived Adverse patient outcomes correlated to nurses’ workload in medical and surgical of selected hospitals in Kuwait. It is understood that the proportion of patient to nurse ratio plays a vital part on the outcomes of care. The study shown that there is clear correlation that exist between the work load of the nursing staff and the outcomes of care.

The research elements utilized for this study was “across-sectional survey conducted between RNs on medical and surgical units in five governmental hospitals. The result shown three major faulty outcomes were reported by nurses from their previous shift which were patients’ complaints and family concerns. The limitation of this study reports were only from the nurses on the units and future researches would need further details (Al-kandari &Thomas, 2007, p. 589). It is impossible for nurses to give adequate care and expect good outcomes when nurses are stocked with non-nursing tasks to do.

It was found that patients and families and medication miss dose were the two primary outcomes that added on the nurses’ workload. Second, occurrences tend to increase on the units as the workload of the nurses increased, and non-nursing tasks heavily impacted the workload of the nurses in Kuwait. The study shown great relevance to nursing practice, because it shows that hospitals need to employ other people to carry out non-nursing duties on the unit such as clerical work; which would alleviate the workload from nurses responsibilities.

Hence, the article Relationships between Registered Nurse Staffing, Processes of Nursing Care, and Nurse-Reported patient outcomes in Chronic Hemodialysis Units by Thomas- Hawkins, Flynn, &Clarke (2008) shown the importance of a high nurse to patient ratio in hemodialysis units. The authors reported in hemodialysis units, “higher RN staffing levels have lower odds of experiencing skipped dialysis treatments (Hawkins-T, Flynn, & Clarke, 2008, p. 124)”.

The study shows that it is to the benefits of the patients when there is a higher nurse to patient ratio on hemodialysis units because, patient will less likely experience any untoward events that are associated with the side effects of hemodialysis therapy. The study utilized a “cross-sectional method” for data collection which focused on the hemodialysis patient population. The study demonstrated the importance of having a high nurse to patient ratio in dialysis units. The higher the nurses to patient ratio, the less occurrences the patients will experience during hemodialysis treatment.

The research used a type of questionnaire in order to find the most accurate adverse events that took place in the dialysis units. The limitations of this study was conducted with nurses who belong to an organization, the adverse patients’ outcomes were gathered from the nurses’ reports. The findings from this research were as follow: the nurse staffing levels played a significant role on patients’ outcomes during treatment. The ratio between patients and nurses is high, and each nurse had a patient load that consisted of 12 patients and sometimes more.

This study has very good relevance to nursing practice due the fact that it shed light on a particular unit because it is a specialized unit. The study also demonstrated the importance of having professional RNs to perform such duties. Nurse staffing levels and Nursing outcomes: A Bayesian analysis, of Finnish-registered nurse survey data by Tero-h, Kiviniemi, et al (2009). Journal of Nursing Management, 17, 986-993. This report pointed out the impact of high patients to nurse ratio have on the nurses and their performance on the unit. Therefore, it is inevitable this kind of nurse staffing would bring negative patients’ outcomes.

The design of this study used a survey of date collection from RNs in 46 units at five hospitals. The study found that many elements were contributed to occurrences on the unit such as mortality, failure to rescue, had a very closed correlation to the number of patients to nurse ratio. The study relates significantly to nursing, because it displayed the stress levels that nurses experienced due to heavy patient load assignment. Macphee, Ellis, & McCutcheon (2005). Nurse Staffing and patient Safety. The Canadian Health Services Research foundation.

This article brought up evidences of events that may occur in relation to lower nurse patient ratio. It is evident that with a lower nurse to patient ratio, patients are at greater risk of adverse outcomes such as increased rate of mortality, nosocomial infections. It is also proven that with a higher nurse to patient ratio, incidents can be greatly reduced. The study utilized sets of data collected from other researches. No specific population group was chosen for this research but the impact of having high patient to nurse ratio were strongly presented. The article displayed its use to the nursing practice with enough substantial facts.

Ke-p. (2003) Relationships between Nurse Staffing and Patient Outcomes. Journal of Nursing Research, 11(3). The study was conducted on a medical –surgical unit in Taiwan with analyzed data from a “descriptive and multivariate inferential statistics”. The rational of this study was to demonstrate the co-relation that exised between high patients to nurse ratio and its impact on patient care outcomes. The results of this study were astounding. It was found that acquired infections, falls, pressure ulcers were the outcome results of inappropriate nurse to patient ratio.

This study definitely has very good relevance to nursing practice. Curtin L. (2003). An Integrated Analysis of Nurse Staffing and Related Variables: Effect on Patient Outcomes. Online Journal of Issues in nursing, 8(3), 10913734. In this his study, the author shows a good co-relation between nurse staffing and the outcomes of care on medical patients. He also pointed out an increase in nurse staffing, that was associated with a reduction of 3 to 12 % in occurrences on the hospitals units. (Curtin, 2003). Here again it shows that the greater is the nurse to patient ratio, the better the outcome.

Although, this study did not use a specific design, but the analysis it used shows the importance of having a low patient to nurse ratio. Therefore, it is vital for the hospitals to realize the great pain that are imposed on patients and nurses. It is time to remedy the problem. Aiken L. (2010). Safety In numbers: A mandatory minimum nurse to patient ratio improves outcome. Nursing Standard, 24(44). The author reported, “International Hospital Outcomes Study revealed that in England and the United States, hospitals with higher nurse staffing levels had lower mortality rates, nurse job dissatisfaction and burnout (Aiken, 2010, p. 2)”.

The study was conducted in five different countries which survey 22,000 RNs in 604 hospitals in California, Pennsylvania, and New Jersey. It was found that nurse in California and the two other states that are closed to California with similar staffing mandatory rules had decreased their workload subsequently providing better care. Duffield C, et al. (2010). Staffing, Skill mix and the model of care. Journal of Clinical Nursing, 19, 2242-2251 dio: 10. 1111/j. 1365-2702. 2010. 03225. The study design was based on secondary analysis collection of data on selected medical/surgical units in 19 hospitals in South Wales, Australia.

The experienced nurses worked during the night while the least experienced nurses worked day or evening shift. The limitation of this study was that skill mix RNs was beneficial to outcomes, but the number of years of experience on a unit were not studied. (Duffield, et al, 2010, pp. 2246, 2249)”. The relevance of this study to nursing was that it shows how a unit can benefit from having different levels of experienced skill nurses give care to patients. Sidani S, Manojlovich M, & Covell C. (2010). Nurse Dose: Validation and Refinement of a Concept.

Research and Theory for Nursing Practice: An international Journal, 24(3), dio: 10. 1891/154-6577. 24. 3. 159. The study used “Anonexperrimental, modified survey” a questionnaire was used with four sections that participants used to answer the questions. The targeted population was nurse researchers who are experts in services related to healthcare (p. 163)”. The result of this study shows how important it is for nurses to spend time with their patients to bring an effective outcome.

The study shows great significance of this study in nursing. Welton JM. 2007). Mandatory hospital nurse to patient staffing ratios: Time to take a different approach. Online Journal of Issues in Nursing, 12(3). (13p) (52 ref) This article did not show a specific design that was used. The article stressed another component of the problem, the fact that hospitals are being pressured to increase their staffing without any reimbursement. The article presented two arguments one for and the other against the problem. As a result, hospitals diminished their staff from other area which helped them to compensate for the deficit.

Although the acuity of patients continue to rise, hospitals failed to increase nurse to patient levels to enable good outcomes. Currie V, Gill V, et al. (2005). Relationship between quality of care, staffing levels, skill mix and nurse autonomy: Literature review. Journal of Advanced Nursing, 51(1) 73-82. Using a “cross-sectional analysis design and magnet hospitals, the article poke through between the problem of patient to nurse ratio and the level of occurrences such as, mortality and failure to rescue. The findings were that units with higher nurse to patient ratio experienced lower occurrences.

Yes, the article did prove its significance into nursing and patient care. In conclusion, studies are not always conclusive on a particular problem or issue. Further studies are often needed to shed new light on the problem. Hospitals have their parts to play in order to bring a higher nurse to patient ratio to fruition. It still remains that nurses have the responsibility to provide safe and effective nursing care to their patients, regardless of the environment. As a reminder, nursing is a humanistic profession, and its aim has always and will continue to focus on human needs, without regard to ratios.

Nonetheless, nurses own it to themselves to be steadfast and never to soften their stand on their demands. Nurses to patient ratio is of utmost importance in the health care and patient outcomes depend on safe nursing staff. It is undeniably true that most professions are facing their own obstacles, and nursing is no different. Nursing has its own obstacles that it has been fighting and must continue to fight for, but a higher nurse to patient ratio is a must win fight, because the end result will be good patients’ care.

Dark Age of Nursing Essay

During the late middle Ages (1000-1500) -the crowding and poor sanitation in the monasteries nurses went into the community. During this era hospitals were built and the number of medical schools increases. Between 1500 and 1860 (A.D.) -the Renaissance all affected nursing. As nursing was not valued as an intellectual endeavor it lost much of its economic support and social status. The nursing conditions were at their worst and have been called the dark period of nursing. New hospitals had been built but quickly became places of horror as unsanitary conditions caused them to be a source of epidemics and disease.

In 1545 -the council of Trent decreed that every community of women should live in strict enclosure. It took over 200 years of resistance for women to overcome this decree. The nursing sisters of France made little or no resistance such that their professional standards deteriorated. In the late 1500’s – several groups began nursing and tending the sick, poor, and dying. These groups were St.

Francis de Sales, the Order of the Visitation of Mary, St. Vincent DePaul, the Sisters of Charity, Dames de Charite’, Louise le Gras, Brothers Hospitallers of St. John, Albuquerque, Order of St. Augustine, St. Camillas De Lellis, Jeanne Biscot, and the Nursing Sisters of St. Joseph de La Fleche. Many of these people came from rich and influential families. The dark ages of nursing lasted for three centuries until the mid 2800’s when Florence Nightingale brought about a change.

Nursing during the Medieval Ages

Either done by charitable religious orders or by the poor who worked for the rich. Nuns or sisters in a cloistered order made up the nursing staff in hospitals. Late Middle Ages Repression of women and cloistered orders by the Protestant church for all who followed the churches standards closely affected adversely the standards of nursing that had existed. Protestant Reformation

The closing of monasteries during the Reformation by Luther and his views about the place of a woman caused many hospitals to shut to the sick and poor and further disrupted nursing care and quality. As women tended to hold the positions of nursing how women were treated and viewed strongly affected how nursing was viewed. During the 16th century Reformation and Catholic Counter-Reformation Religious orders were suppressed causing hospitals to become places of horror and a period of stagnation in nursing and health care followed. Because monasteries and hospitals were shut to the poor the sick were no longer separated from the healthy such that disease and epidemics spread.

The Wars

Florence Nightingale the “Lady with the Lamp” made history with her nursing work in the Crimean War and helped shake up the field of medicine. She is most remembered as a pioneer of nursing and a reformer of hospital sanitation methods. Nightingale pushed for reform of the British military health-care system and with that the profession of nursing started to gain the respect it deserved. Florence Nightingale’s two greatest life achievements–pioneering of nursing and the reform of hospitals–were amazing considering that most Victorian women of her age group did not attend universities or pursue professional careers. In 1854, after a year as a unpaid superintendent of a London “establishment for gentlewomen during illness,” the Secretary of War, Sidney Herbert, recruited Nightingale and 38 nurses for service in Scutari during the Crimean War. Nightingale was able to use the data as a tool for improving city and military hospitals. When Nightingale’s sanitary reform was implemented, the mortality rate declined.

The establishment of the Army and Navy Nurse Corps opened the door for women in the military but ever so slightly. Army and Navy Nurse Corps women served valiantly throughout the war, many received decorations for their service. At least three Army nurses were awarded the Distinguished Service Cross, the nations’ second highest military honor. Nurses were wounded, and several died overseas and are buried in military cemeteries far from home.

Helen Fairchild-the Army nurse (from 1917) Fairchild was one of 64 nurses from Pennsylvania Hospital who had volunteered to join the American Expeditionary Force after the United States entered World War I on April 6, 1917. Nurse Fairchild died on Jan. 8, 1918, while on duty with British Base Hospital Alexandra of Denmark – Queen

Queen Alexandra, the queen consort of Edward VII of Great Britain was known for founding Queen Alexandra’s Royal Army Nursing Corps. Margaret Sanger (1879-1966) Margaret Sanger was birth control pioneer and founder of Planned Parenthood Civil War Nursing Women played a major role in nursing and sanitation efforts during the Civil War, paving the way for their entry into the nursing profession in greater numbers after the war, as well as paving the way for further professionalization of the nursing field. Dorothea Dix – Social Reformer

Dorothea Dix was an activist who served in the Civil War as Superintendent of Female Nurses and she also worked for reform of treatment for the mentally ill. Clara Barton (1812-1912) Clara Barton was a Civil War nurse and founder of the American Red Cross. Harriet Tubman Harriet Tubman was an escaped slave who helped others escape from slavery and was known as the Moses of her people. She was also a spy, nurse, and speaker for women’s rights. African American Women Nurses

Black women who have served as nurses, often in wartime. The Army Nurse Corps was established in 1901 to provide a permanent active nursing corps. In World War II, the number of Army nurses by the end of the war was 57,000. The Army Nurse Corps has not only served the military by nursing wounded soldiers and reducing the death rate from disease, but has also served as a route for women to make a difference and build a career.

Nursing Home Visit Essay

As I visited RSL Anzac Village, Narraben, I have outlined the nurses performing their roles in communication and safety practice in a professional working environment. As I was bought up in Nepal, I was really surprised with my expectation comparing to what I have seen. In this reflective writing I am going to explain about how does my expectation meet the obesevatation communication and safety features. In my imagination, RSL could have been a hospital with many nurses, doctors and very filthy place with nonhuman behavior.

The patients could have been very old, weak and motionless, the atmosphere in an aged care centre might be heartbreaking and miserable. Soon after I started walking inside the care center, I was surprise with the way it was operated. I noticed a nurse using very soft tone with acknowledgement. She started with Good morning. How are you today? Even though the person she was addressing was non-verbal, she responded as if she was a normal women.

In reply, the person responded with the smile and head nodding. In fact, I was very impressed with the way conversation was made.

I think this has demonstrated good interpersonal skills including respect for the patient, patience and politeness, so these are few things that I learned about effective communication and it is necessary to communicate compassionately and effectively with residents. I agree with the Jasmine (2009) as she says therapeutic communication is most essential for nurses as they have care both physically and emotionally. On the second instance, I saw so many mobility equipments to transfer patient from bed to shower chair or from shower chair to bed.

After my tutor explained us importance of those equipment , which would simplify and breakdown the task and make our life easy. As a result these device provide mobility support for immobilized elders (Clarke, Chan, Santaguida and Colantonio, 2009). The second incident I got caught in made me to realize there are so many things I got to learn about safety features like, smoke detectors, all fire exist were clear and clearly marked, hall ways and toilets were wide enough for wheelchairs, hand rails provided in hall ways and in bathing areas, very high fence in balcony so that there will not be isk of fall, code access to entry and exit at doors so resident cannot escape, remote for attention or call nurse in need, zebra crossing inside the facility boundary for resident safety in road crossing, alcohol foam sanitizer for infection control. As an everyday routine, nurse visited the dinning room and greet all the residents. I suppose, this spiritual faith of residents and nurse has made this care harmonious and peaceful.

Furthermore, I agree with the point of view that one who has not clear understanding of their own spirituality are less likely to meet others spiritual support (McSherry,2006). Therefore, I realized the importance of spirituality in health care. To sum up, the way communication, use of mobility aids, safety features and spiritual support that I experienced in my visit made me explore further in this industry. Which also made me believes it is also a community which is “the home” of many old people.

Nursing Managment Essay

Article Review of “A Handoff Report Card for General Nursing Orientation This article examines the strengths and weakness of the orientation process of new grads or new nurses to a unit or hospital. By the use of a 100 point score report card containing a summary of the nurses skills, knowledge, and also use of the Benner which measure clinical performance and critical thinking. The article addresses the use of a report card to better communicate the strengths and weakness of the orientees’.

This report card is handed off to the next person in whom the new nurses will orient. The handoff is designed to create continuity and accuracy. An example of the type of data that would be measured by the handoff report includes items such as the nurses’ experiences and documentation of strengths and areas that need to be developed or improved. The report card is based on 3 assessments

1. The orientees own self-assessment
2. The instructor’s assessment
3. Competition of competencies

From the first day on the unit, the nurse identifies his/her learning type using Benner’s Theory.

This provides the nurse with a baseline of where their own individual level of development has reached, as well as, the preceptor, manager, or instructor. Secondly, the instructor assessment measures the orientees’ knowledge and performance. This report card is divided into 4 areas of measurement. The types of areas of measurement are areas such as: nursing interventions, documentation, critical thinking, nursing behaviors, clinical judgment, and several other areas. The last area of measurement is the nurses’ skill level. Several types of competencies were set up to determine if the nurse was competent to function on the unit. In conclusion, the report card was discussed with the leadership team, so that the orientation is more focused on the needs of the oreintee, based on the unit in which the orientee is being trained to work. As I was reading this article, it reminded me of an article that we had read at work.

In the American Journal of Critical Care 2009, there was a research study completed to determine the best way to evaluate the new grads, new nurses, and it also evaluated the current nursing staff. In the study, most of the data that was returned was from the new grads. The suspected reasoning was the enthusiasm of the new grads. But the overall outcome, was positive, but mostly helped the management team to better evaluate the competency of their nurses.

Currently, in the unit I work in we are challenged with determining the strengths and weakness of our newly hired nurses. Some of the nurses stated that they came to our unit with experience from different venues; however, their level of care has left us with many voids. I personally, enjoyed both articles and the effort of increasing critical thinking and professional behaviors on the clinical floor. Remember we all one day may be patients.

Hargraves, L., Nichols, A., Shanks, S., & Halamak, L. (2010). A Handoff Report Card for General Nursing Orientation. The Journal of Nursing Administration, 40(10), 424-431. Kleinpell, R. (2009). Evidenced Based Review Discussion Points. American Journal of Critical care, 18(3), 261-262.

Executive Summary: Streamline the Nursing Admission Process Essay

The health care industry continues to be challenged by daily patient turnover due to the number of admissions, transfers, and discharges (Spader, 2008). The increase in number of admissions, in turn, puts a high demand on nurses in keeping up with the pace resulting in nurse frustration and dissatisfaction. According to Lane (2009), a thorough and comprehensive admission process is critical in providing quality patient care. Completing the admission process in a timely, efficient, and comprehensive manner has been a challenge for nurses due to the increase number of admissions, and also the fact that the nurses still have to provide ongoing care to the other patients.

Creating a new position as the role of an admission nurse will help to combat some of the challenges associated with the admission process.

Purpose of the Project

The purpose of this project is to streamline the admission process. This can result in a decrease in nurse workload and improve patient flow. A reduction in nurses’ workload and demands can contribute to a decrease in nurse turnover and promote positive patient outcomes.

The role of the admission nurse provides an opportunity for a dedicated nurse to gather the pertinent information in order to complete a comprehensive admission process.

Target Population

The targeted population for this project is the direct care nursing staff. This nursing staff is currently responsible for the admission process. It is not unusual for a nurse to be interrupted several times while trying to admit a patient. It is also not unusual for a patient to be admitted and discharged from the hospital with an incomplete admission process. Regardless of what line of service, all nurses can benefit from streamlining the admission process

Benefits of the Project

An admission assessment in the admission process provides important details that are relevant to patients’ need. That is why it is critical that this information is completed thoroughly and accurately. Unlike the staff nurse, an admission nurse will have the necessary time to spend with patients and families. The role of an admission nurse can help to provide the comprehensive assessment associated with the admission process and also help to alleviate the nurses ‘stress associated with increased patient turnover. In addition to the benefit of the nurses, the hospital can benefit as well by potentially having a decrease in nurse turnover, increase patient flow, and an increase in patient satisfaction.

Budget Justification

The expense of losing an experienced nurse can be costly to the hospital. Not to mention the nursing knowledge and skills. Estimates of the actual dollar amount incurred by nurse turnover range from 10 to 20 thousand dollars per nurse to as much as well over the nurse’s yearly salary. According to Anderson (2004), Nurse Executives estimate that “…visible costs represent only 24 percent of total costs for medical/surgical nurses and only 18 percent for specialty nurses. A true total cost of $42,000 per medical/ surgical RN and $64,000 per specialty nurse is more close to reality.” Turnover costs, average approximately $47,403 per medical/surgical RN and $85,197 for specialty RNs. “A 400-nurse hospital with a 20 percent turnover rate is replacing 80 nurses per year. The direct costs might average $800,000 per year, but the true total costs are closer to $4 million.”

Project Evaluation

Currently there is not sufficient evidence -based data to on admission models. But, there are still a number of ways to evaluate the success and or outcome of this project. One way is to do a pre and post survey of the nursing staff regarding the admission process. Another way is to survey patients pre and post implementation of the proposed admission process to evaluate success. In addition, evaluating the costs associated with nurse retention would also be another mechanism in evaluating this project.

Conclusion

Working in a fast paced environment such as the hospital setting can be stressful. The number of daily patient turnover, admissions, and discharges are continues to be a challenge for nurses working in the hospital setting (Spader, 2008). The role of the admission nurse to streamline some of the challenges associated with the admission process. In essence, this will free up the staff nurse to provide ongoing care to the other patients. This will also result in increased satisfaction for both nurses and patients. Mechanisms and process improvements that can be put in place to help alleviate the stress and strain associated with the admission process due to increased daily turnovers can be proven beneficial.

References
Anderson, R. (2004). Complexity science and the dynamics of climate and communication: reducing nursing home turnover. Gerontologist, 44, 378-388
Lane, B. (2009). Nurse satisfaction and creation of an admission, discharge, and teaching nurse
position. Journal Of Nursing Care Quality, 24(2), 148-152.
doi:http://dx.doi.org.library.gcu.edu:2048/10.1097/01.NCQ.0000347452.36418.78 Spader, C, (2008). Admission RNs Make Fast-Paced Admits Less Stressful. Retrieved on January 24, 2013 from http://news.nurse.com/apps/pbcs.dll/article?AID=2008108110080

Personal & Societal Values Essay

When dealing with ethical decisions, it is very important that nurses maintain a nonjudgmental view. Each nurse comes into the career with their own set of personal values and beliefs. These may not coincide with the values and beliefs of patients and their families.

Nurses must be aware of the values that patients and families possess in order to reach ethical decisions.

Values are a learned trait throughout each individual’s life. Early on, influences come about from family. Over time, one will have experiences and possess influences brought about from society.

Values come about from cultural, ethnic and religious backgrounds. These are what affect our relationships with other people.

Nurses need to be aware of their personal values. They must be aware of how they perceive life, health, illness, and death (Blais, 2011). This becomes increasingly important during end-of-life care and planning. Nurses need to maintain a biased attitude in order to have an effective working relationship with patients and their families. There will always be encounters with patients who hold different values and beliefs.

When it comes to making ethical decisions, nurses need to have a reasonable thinking ability. Emotions and institutional policies should not be the basis of thought. A good decision is one that is made in the best interest of the patient and family. The patient’s well-being is most important. Autonomy of the patient is a factor also. The patient and family need to be allowed to be proactive in medical care decisions. Mutual respect must also be present.

Being involved in ethical committees and nursing ethics groups can help nurses become more aware of their own personal values. Ethics committees help to balance reasonable treatment and guidance with the respect and dignity that comes as a right to all patients.

Nursing Care Study Essay

The aim of this nursing care study is to demonstrate that, as a student nurse, the writer is capable of developing and delivering the skills needed for assessing and addressing each individual patient’s care needs. Included in these set of skills, is the ability to develop critical thinking, decisive decision making and the ability to reflect on events so as to become a better health care provider. The patient in which the writer will discuss was based upon an eighty three year old man, pseudonym Mr.

Scott who was admitted into accident and emergency via a referral from his general practitioner presenting with exacerbation chronic obstructive pulmonary disease (COPD) with a history of congestive cardiac failure (CCF). On admission to accident and emergency Mr. Scotts’ team took arterial blood gases, ordered a pulmonary function tests and a chest X-ray.

Prior to the exacerbation of Mr. Scotts’ condition he regularly attended a cardiac clinic due to being a long term sufferer of congestive cardiac failure and also attended pulmonary function clinic for tests (pulmonary function tests).

Through these clinics Mr. Scott was educated on his medications and current condition. On admission of Mr. Scott, the writer decided to use the frameworks Roper Logan and Tierney (2000); Orem’s Self Care Framework (1995) and Gibbs (1988); which incorporates each tool of assessment known as, plan, implementation, evaluation, educate and reflection. Using the above frameworks, an improvement of Mr. Scotts’ current exacerbation of chronic obstructive pulmonary disease (COPD) was seen to have been resolved and a new evaluation of Mr. Scotts’ care was developed.

The chosen tool of reflection used is known as the Gibbs cycle of reflection. The writer applied this tool in order to evaluate the patient care. The rationale behind this was to attempt to fully understand reflection so as to apply this to everyday practice, thus improving as a student nurse. The Gibbs cycle involves a description of the incident, feelings and thoughts experienced plus the evaluation and analysis of the incident, conclusions and action plan (Gibbs, 1988). According to Barnett (2005) using a tool of reflection, to give an account of experiences in the clinical setting can aid the nurse to analyse and explore their feelings regarding patient care.

Main body

Eighty three year old Mr. Scott was admitted to accident and emergency with a referral from his general practitioner, presenting with a recurrent upper respiratory tract infection and a history of exacerbation of chronic obstructive pulmonary disease (COPD) and congestive cardiac disease. Due to his history of chronic obstructive pulmonary disease (COPD), Mr. Scott was sent for a chest x ray to assess the deterioration of his lungs due to his condition. (Alexander et al. 2009) Post admission into accident and emergency, Mr. Scott was sent to St. Pat, Thomas, Johns’ ward where the writer was working at the time as a student nurse.

The writer found, when assessing Mr. Scott, that he lived alone, locally, was a widower of ten years and had two daughters who also lived near by. Although Mr. Scott had many concerns, he also had a good social network such as the support of family and a home help package of six hours a week, which included meals on wheels. The local public health nurse also called to see Mr Scott on a social capacity. Presently the main health concerns which faced both Mr. Scott and his family were; the deterioration of his dyspnoea, related to his chronic obstructive pulmonary disease; pressure ulcers, due to developing pressure ulcers while in hospital in previous years and anxiety from both Mr. Scott and his family due to the unknown. Reassurance was given and they were explained what care he was to receive.

Issue # 1 Breathing.

The key feature of chronic obstructive pulmonary disease (Barnett, 2009) is that of experiencing breathlessness. Being breathless for most patients can be both a stressful and frightening experience, which can raise anxiety levels. In past studies, men predominantly more than women were found to be affected by chronic obstructive pulmonary disease (COPD); but in a recent study carried out by Meilan et al. (2007); research has found that cases of chronic obstructive pulmonary disease (COPD) are increasing in women world wide. The care Mr. Scott received was split in two, short term and long term care; both of which were constantly re-evaluated to maximise efficiency and quality of care.

As part of the short term care plan the writer ensured that the bedside was set up with suctioning equipment help prepared for potential complications. To avoid complications, for example tachypnoea (rapid breathing) which is found to be an early indication of respiratory distress (Jevon and Evens 2001); the golden rule of thumb, depth and rate of breathing was monitored and recorded accurately (Jevon, 2010). Further reducing the risk of complications occurring, Mr. Scott was encouraged to sit up in a semi fowler position while enduring deep breathing exercises enabling him to breathe with greater ease and comfort. The rationale behind this was supported by a study carried out by Duggan et al. (2005).

The long term goal was to ensure that an oxygen saturation level between 88%-94% is maintained (Alexander et al 2009). To monitor oxygen saturations levels, a pulse oximeter was place on Mr. Scott’s finger. The rationale for this is to detect oxygen absorption of haemoglobin (Plaice &Graham, 2000). A study carried out by Groeben (2003) shows that administering high concentrations of oxygen to patients with chronic obstructive pulmonary disease (COPD) will reduce the respiratory drive, resulting in respiratory depression. This finding gives rationale to why a low flow of oxygen therapy is given to patients with chronic obstructive pulmonary disease (COPD). Humidification was added to Mr. Scotts’ oxygen therapy to warm and moisten the gas (Jevon and Ewens 2001) promoting secretions while enhancing patient comfort (Woodrow 2005).The rationale for this is that oxygen is known to dehydrate exposed membranes in the upper respiratory tract.

Issue #2 Pressure ulcers.

According to Lawrence et al (2010), every individual’s skin changes with time, this is a normal process of ageing. With this change comes a decrease in its elasticity and turgor, therefore with age one has to ensure that vital care of skin is given in an attempt to avoid skin breakdown. Due to Mr. Scott being an elderly man of eighty three, the writer was concerned about skin integrity. A tool known as the water low score was used in order to assess the likelihood of Mr. Scott developing any pressure ulcers during his stay in the hospital (Whiteing 2009). As Mr. Scott had developed pressure ulcers in a past experience, he would have an increased chance of a re-occurrence. In an attempt to prevent this situation the writer requested that Mr.Scott be nursed on an air mattress. (Stafford and Brower 2009). Issue #3 safety and delerium

Anxiety is an emotional state influenced by past experience, which exists at a given point in time with a level of intensity related to an upcoming perceived threat (Passer and Smith 2007) The provision of information is extremely important to the patient as studies from, Biswajit et al. (2009) has shown that an informed patient with a good understanding of their condition reduces anxiety. Harvey (2002), recommend shared control in patient-practitioner interactions in that patients effectively participate in controlling important events. After liaising with Mr Scott’s’ medical team regarding his anxiety, a low dose of Alprazolam brand name Xanax 5mg, was charted and given in an attempt to relieve his anxiety. Alprazolam reduces anxiety within patients (De Witte, et al 2002).

Medical care administered

On admission to the ward Mr. Scotts’ medical team ordered pulmonary function tests. These tests determine what type and extent of restriction the patient is experiencing (Alexander et al 2009); furthermore indicating any increase/decrease in their condition (Daly 2009). Arterial blood gasses were checked in order to determine the amount of O2 to be administered reducing the risk of hypoxia. The rationale for taking arterial blood gases was to determine the bloods Ph and the O2 levels circulating within the blood. (Alexander et al 2009). A sputum sample was also attained from Mr Scott and sent to the lab for culture and sensitivity testing to trace which bacteria is present in the sputum so as to treat the infection (Gray et al 2008). Through reflection the writer recalled that oedema may be present in the lower extremities secondary to Mr. Scotts history of congestive cardiac failure and chronic obstructive pulmonary disease (COPD) and recorded the findings.

The rationale for this was that, Mr. Scott suffered with congestive cardiac failure which increased the risk of developing oedema while in juxtaposition, putting increased pressure on functioning internal organs (Morley et al. 2009). During the writers assessment of Mr. Scott it appeared that he was suffering from a sudden onset of dyspnoea, (laboured breathing). Using critical thinking, the writer administered oxygen therapy at maximum of twenty four percent and immediately informed Mr. Scotts’ team on his condition. The rationale behind administering low dose O2 is due to the fact that the hypoxic drive can be decreased by administering a large dose of O2 leading to respiratory failure and the worsening condition of the patient, (Simmons et al. 2004). Using the Gibbs reflection cycle, the writer believes students should be under constant supervision in order to attain the knowledge of administering O2 to patients diagnosed with chronic obstructive pulmonary disease.

The medical team looking after Mr. Scott prescribed an antibiotic called Tazocin (4.5grams three times a day) to be given intravenously. The rationale for administering this antibiotic was to attempt to fight any infection that the patient may have developed. Also prescribed for Mr. Scott was a steroid and bronchodilator. The rationale for charting a steroid and bronchodilator was that, they are found to decrease inflammation in the air way and also to open up the airway (Greenstein et al 2009). Due to Mr. Scotts’ condition he was a long term user of oral Corticosteroids. Studies (Walters et al. 2008) have shown that, corticosteroids reduce the need for additional medical therapy while, also shorting hospital stay.

On previous reflection (Gibbs 1988) as a student nurse, the writers’ knowledge developed due to reflection from previous patient care. The writer knew that due to Mr. Scott being on steroids, his blood sugar levels needed to be checked once a day as to ensure it stayed within the normal range. The rationale behind monitoring Mr. Scott’s’ blood sugar once a day was due to the side effects that are directly related to the administration of corticosteroids. Such side effects are as mouth ulcers, weight gain and increased skin thinning (mayoclinic.com). The writer encouraged Mr. Scott to rinse his mouth out with water post administration of oral steroids to reduce the development of oral ulcers or a candida infection of the mouth, (Greenstein et al 2009).

The Roper, Logan, Tierney (RLT) 2000 nursing framework aided the writer in focusing upon the care study. This model encompasses key factors such as social status, environmental factors as well as the physical/ psychological factors which influence people in their daily lives (Roper et al 1991; 2003, Newton 1991). This model is designed to be adaptable to any patient and not for the patient to adapt towards the model of nursing; therefore it allows the nurse to care for each patient on an individual level (Roper et al 2000).

Nursing can therefore be defined through this model in terms of helping people to prevent, alleviate, solve or cope with problems (actual or potential) when relating to the activities of daily living, (Roper et al. 1990).

Conclusion

Although the Roper Logan and Tierney’s’ model of nursing covers a holistic view, a model known as the Orem’s Self Care Framework according to Fawcett (1995) concentrates on the individuals’ self maintenance and regulation through a type of action known as self-care. This model could be seen as beneficial to Mr.Scott as a patient whom has been diagnosed with chronic obstructive pulmonary disease as a main part in maintaining good health is a good understanding/ communication, knowledge and education of how to care for ones’ self (Eva et al. 2009).

The aim of this piece of work was to assemble while using tools of assessment an individual care plan. This was to be drawn up together with the patient and the writer so the system of care would be of an individual status. The writer also aimed to demonstrate that with critical thinking and decisive decision making the patient involved received intervention when needed.

As the writer worked on the ward mentioned a strong therapeutic relationship had been built between patient and student nurse, this allowed the patient to feel at ease when asking questions regarding his condition enabling the writer to educate the patient at a higher understanding. Upon Mr. Scott’s discharge he expressed a better understanding of his knowledge about his condition, he also felt that if or when he experienced another exacerbation he would not feel as anxious and be better able to cope with it. Hearing this as a student nurse the writer felt that it had enhanced professional development for further nursing practice.

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