The Manual Process of Detection of Sickle Cell Anemia
Lack of enough healthy blood cells causes anemia since the red blood cells are responsible in transporting the oxygen to all parts of the body. The inheritable disease is caused when a person gets two abnormal genes from each of the parents. Red blood cells are elastic and move easily through the blood vessels, but in sickle cell anemia, the red blood cells are crescent-shaped (Vasundhara & Krishna, 2018). The sticky cells can be stuck to form small blood vessels that block or slow the blood and oxygen flow to the bodys parts. There is no cure, but treatment that can only prevent complications and relieve pain for the people living with sickle cell anemia.
The granulometric analysis is implemented to separate the red blood cells from the other components of the blood. Then, an improved watershed transform algorithm is used to separate the cluster cells (Vasundhara & Krishna, 2018). Even though red blood cells are considered cells, they lack a nuclear of the Deoxyribonucleic acid and the components to express and synthesize proteins. It then shows the exact separation of the red blood cells into getting the blood cell count splitting the groups. It improves the accuracy making the results to 98.5% in identifying sickle cell anemia and 97.6% in the separation of the red blood cells (Nacif et al., 2018). The techniques and physical processes to detect anemia needs proper pipetting, hence, are unspecific.
Liver Transplantation from a Deceased with Sickle Cell Anemia
Liver transplantation has been successful due to advances in technology and has increased the value of immunosuppressive drugs and improved the quality of life of the patients. The article supports the importance of using safe donors and uses an example of a deceased liver donor involved in liver transplantation (Nacif et al., 2018). The liver donor was a young male twenty-two years old who had complications with his brain that later stopped functioning completely. The donor surgery was successful and was not associated with any difficulties, and both of the deceased patients kidneys were donated to different recipients and centers. Liver transportation was done, and the recipient was a thirty-seven-year-old woman who had the same blood group as the donor and was diagnosed with hepatitis B virus. She received four units of red blood cells, three units of platelets, and eight plasma units during the surgery (Nacif et al., 2018). She received proper postoperative care, but still developed an acute kidney failure. After successful liver transplantation between the woman and the deceased, doctors reported that sickle cell anemic patients could help in liver replacement, however, it is advised to use safe donors.
Understanding the Complications of Sickle Cell Anemia
To improve the quality of life and health results, correct educational information should be given by the nurses who look after anemic patients. Many people worldwide have sickle cell disease, most commonly from Saudi Arabian dessert, India, Caribbean, United States of America, and Central America. Patients mainly experience acute severe difficulties, such as chest syndromes and kidney failures, throughout their life (Tanabe et al., 2019). People who have sickle cell anemia are commonly to have priapism, and the healthcare providers should remind the patients to pay attention to the causing factors and let them know it is a complication for anemic patients. For effective management of anemia is usually aimed at avoiding pain and relieving symptoms hence regular check-up by the healthcare team is necessary. Patients are advised to have a healthy diet and take folic acid to boost their immunity and manage the disease. Bone marrow transplant is the only cure for anemia though not done very often because of the weighty risk involved. Anemic patients should be active but intense and avoid strenuous exercise. They are also advised to avoid smoking for lung conditions, and alcohol that may cause dehydration.
Conducting a literature search is essential for evidence-based nursing practice as it helps improve the quality and cost-effectiveness of care via the combination of current research evidence with clinical expertise. According to Gray et al. (2016), the focus of clinical research in the 21st century has shifted from the treatment of health issues to their prevention, along with the promotion of patient education. The process of literature search might be challenging for several reasons, especially if the research requires the highest level of evidence on a specific topic. On the one hand, many current resources containing high-quality evidence are still dedicated to the treatment of diseases rather than patient education. Moreover, the sources with relevant information and evidence might be outdated. Therefore, the challenges of performing a literature search are associated with finding a current source that contains high-quality evidence related to a particular research topic and combines all aspects of a particular issue. Since secondary sources are not evidence, I used primary sources, including two peer-reviewed scholarly articles, for my EBP project research based on the clinical practice problem of patient non-compliance with VTE prophylactic treatment.
The search terms and keywords I used during my online search included VTE patient non-compliance risks , VTE patient compliance management and improvement , and VTE prophylaxis non-compliance complications . The nature of the research topic required finding resources focused on the management of patient non-compliance and thromboembolism prevention rather than the treatment of VTE. Systematic reviews are at the top of the evidence pyramid, so I began my literature research with the PubMed database looking for systematic review articles. During the literature search process, I came across multiple systematic reviews examining VTEs problem but disregarding patient non-compliance and VTE prophylaxis. PubMed database search eventually led me to one critically-appraised, peer-reviewed individual article investigating the risks of VTE non-compliance and the improvement of health outcomes via patient education on VTE prophylactic measures. Since Google Scholar includes articles from many databases and scholarly journals, I decided to search for additional literature sources there. Google Scholar helped me to find the article listing the risks and outcomes of VTE non-compliance, including the increased expenses for healthcare providers and the significant number of preventable deaths caused by hospital-acquired VTE complications.
The easiest step in the process of the literature search was selecting the database. Brown (2018) claims that PubMed is one of the most accessible online databases containing primary and secondary healthcare sources. As the systematic reviews available in the database did not meet the requirements for my research, I had to move down the evidence pyramid and search for critically-appraised individual articles. Choosing the proper database and expanding my search by including peer-reviewed articles helped me to save time and effort as I found the relevant article in about 20 minutes. However, I had difficulty finding another primary source to support my research, so I had to look for it using additional resources. While the topic of VTE was frequent in the database search results, there were little to no sources on patient non-compliance with VTE treatment. When I entered the search terms, Google Scholar displayed the list of current articles, including one primary source related to my research topic and covering the most important aspects of VTE patient non-compliance. Overall, I had to spend about an hour completing the literature research.
References
Brown, S. J. (2018). Evidence-based nursing: The research-practice connection (4th ed.). Jones & Bartlett Learning.
Gray, J. R., Grove, S. K., & Sutherland, S. (2016). The practice of nursing research: Appraisal, synthesis, and generation of evidence (8th ed.). Elsevier Health Sciences.
Addressing the needs of inpatients is a rather intricate task. On the one hand, the identified setting offers opportunities for establishing tighter control over the way in which crucial services are delivered, and the instructions are followed. On the other hand, with a large number of inpatients, making sure that individual needs of each are met accordingly is very difficult, especially given the shortage of nurses and the schedule issues in the modern healthcare environment (Wakabayashi & Sashika, 2014). Therefore, numerous issues from comorbid complications to nosocomial infections to other possible concerns may need to be addressed. Malnutrition in hospitalized patients is one such problem, and it has to be detected at the earliest stages of development so that it could be eliminated successfully. Otherwise, the chances for the patients recovery are likely to drop significantly.
Problem Description
Characteristics
Malnutrition is becoming an increasingly large concern in hospitals, especially in the acute care environment (Wakabayashi & Sashika, 2014). Despite often being associated with undernourishment, malnutrition may also be caused by an overly large intake of food (Zhai, Dong, Bai, Wei, & Jia, 2017). Furthermore, malnutrition can occur if the patient consumes food that does not provide the right balance of nutrients, i.e., the patient may lack only some components of a healthy diet (Wakabayashi & Sashika, 2014). In any of the cases mentioned above, though, the regular pattern of food consumption is disrupted, which triggers malnutrition. Apart from the identified definition of the disorder, malnutrition can also occur in case patients cannot process food due to health issues (e.g., diarrhea) (Haque et al., 2014).
Impact
Malnutrition has a detrimental effect on patients immune systems, thus, reducing their ability to resist diseases. Studies show that there is a direct correlation between the quality of nutrition and the patients ability to resist infections (Bindels & Delzenne, 2013). Furthermore, malnutrition may serve as the factor contributing to the aggravation of inflammations (Bindels & Delzenne, 2013).
In addition, the threat of muscle wasting increases once the patients are undernourished. The phenomenon of muscle wasting occurs as a result of a change in the microbiota of the patients gut. The identified phenomenon is termed dysbiosis and is defined as alterations in the composition and/or activity of the gut microbiota in association with pathological features (Bindels & Delzenne, 2013, p. 2187).
Therefore, an increase in the length of hospital stays and the mortality rates should be viewed as the key impact of malnutrition. The prolonged hospital stays, in their turn, are bound to cause a drop in the speed of the patients recovery rate. Furthermore, the patients are likely to be exposed to the threat of nosocomial infections to a greater degree when staying longer in the hospital setting.
Significance
Even though there is a range of screening options for detecting the threat of malnutrition, including the Malnutrition Screening Tool (MST) (a basic three-question test), a more recent Nutritional Risk Screening (NRS-2002), the Graz Malnutrition Screening (GMS), etc. (Roller, Eglseer, Eisenberger, & Wirnsberger, 2016), malnutrition is very difficult to spot. Therefore, the subject matter remains a major problem due to the lack of chances to determine it at the earliest stages of its development.
Thus, exploring the issue of malnutrition among hospitalized patients is likely to have a rather high significance. Particularly, options for detecting the problem at the earliest stages of its development and introducing the tools for its successful management can be identified. As a result, the negative consequences of malnutrition among inpatients can be prevented and managed successfully. Particularly, the recovery process and the length of stay in the hospital will be reduced significantly.
References
Bindels, L. B., & Delzenne, N. M. (2013). Muscle wasting: The gut microbiota as a new therapeutic target? The International Journal of Biochemistry & Cell Biology 45(10), 2186-2190. Web.
Haque, R., Snider, C., Liu, Y., Ma, J. Z., Liu, L., Nayak, U.,& Petri, W. A. (2014). Oral polio vaccine response in breast fed infants with malnutrition and diarrhea. Vaccine, 32(4), 478-482. Web.
Roller, R. E., Eglseer, D., Eisenberger, A., & Wirnsberger, G. H. (2016). The Graz Malnutrition Screening (GMS): A new hospital screening tool for malnutrition. British Journal of Nutrition, 115(4), 650-657. Web.
Wakabayashi, H., & Sashika, H. (2014). Malnutrition is associated with poor rehabilitation outcome in elderly inpatients with hospital-associated deconditioning: A prospective cohort study. Journal of Rehabilitation Medicine, 46(3), 277-282. Web.
Zhai, L., Dong, Y., Bai, Y., Wei, W., & Jia, L. (2017). Trends in obesity, overweight, and malnutrition among children and adolescents in Shenyang, China in 2010 and 2014: A multiple cross-sectional study. BMC Public Health, 17(1), 151-157. Web.
The purpose of this dissertation is to tackle why a simple solution like living a hygienic life is so misunderstood and overlooked. It gives a clear and concise understanding of what is meant when we hear the words nerve energy habits such as pure air, sunshine, exercise, clean air, cleanliness, proper diet, sleep, rest, correct temperatures, relaxation, poise, and a good mental and spiritual attitude. Moreover, it touches on nerve energy robbers such as un-cleanliness, unclean air, impure water, inadequate rest and sleep, Standard American (SAD) diet, inadequate sunshine, and natural light, abnormal temperatures, lack of regular exercise, emotional unbalance, and slavery to addictions, low self-esteem and a purposeless life without meaningful goals, and toxic relationships. It will explore the basics of how to solve bad behaviors associated with depleting good nerve energy habits in life, along with how to embrace glorious health effectively through living a hygienic life while associating healthy nerve energy habits in daily life. Let me be clear on what living a natural hygienic life means: a hygienic life is simple. There are no cryptic, baffling, or confusing processes to follow. Natural hygiene has nothing to conceal for there is no secret potion that is packaged and sold in bottles as an incredible miracle drug that for just three payments of $19.95 plus shipping and handling you too can have marvelous health. No, nature hygiene is clear, concise, and easily understood because the laws of nature enable us to acquire and maintain pristine health.
Introduction
Today I will be addressing the topic of nerve energy and the two different parts that fall under nerve energy, viz. nerve-energy habits, and nerve-energy robbers. In a bid to explore further each part, I asked a diverse group of fifteen individuals, ranging from thirty to eighty years, if they were given the chance to make one health wish, what it would be. Interestingly, twelve out of the fifteen said they would like to have more energy. We do not think or view nerve energy as having a cause-and-effect flow on our body, but it does. Whenever there is an act of stimulation demanded of the body, whether physical, mental, or chemical stress, there will always be an equal depletion of ones nerve energy. Next, I asked the same diverse group of fifteen people to think of a person who has admirable nerve energy and what stands out in that person. Eleven out of fifteen responded, That person looks healthy , while the remaining four responded, That person does not have a nervous disposition .
A key to nerve energy success is recognizing that proper diet, good and positive mental attitude, pure air, sunshine, exercise, clean air, cleanliness, sleep, rest, correct temperatures, relaxation, and poise are critical elements of healthy living. According to the Health Seekers Yearbook,
Nerve energy can be looked at from two different views. These views include the energy enhancers: cleanliness both external and at the level of bodily tissues and fluids, pure air, pure water, adequate rest and sleep, ideal diet, adequate sunshine, and natural light, right temperatures, regular exercise, emotional balance, and freedom from addictions, with high self-esteem and a purposeful life with meaningful goals, nurturing relationships. Versus the energy robbers: un-cleanliness both external and at the level of the bodily tissues and fluids, unclean air, impure water, inadequate rest, and sleep. Others include the Standard American Diet or SAD Diet, inadequate sunshine and natural light, abnormal temperatures, lack of regular exercise, emotional unbalance and slavery to addiction, low self-esteem and a purposeless life without meaningful goals, toxic relationships.
Until we start to look seriously into our daily routines, the activities we choose to do, and items that we mindlessly consume without pausing and thinking of the nerve energy, we will inevitably face some serious consequences as we continually take diet drinks, alcohol, coffee, tea, soda pop, milk-based drinks, fruit drinks, and other artificial drinks. We are unknowingly contributing to the stress and stimulations in our lives and have more than likely kicked off many health challenges to come. By making an effort to keep the cause and effect nerve energy balance, we need to make the right steps to rebuilding our nerve energy coupled with finding and keeping a nice balanced life.
True SAD follower
I am 510 and before the year 2000, I weighed 170 pounds. I was a true follower of depleting and robbing my physical, mental, and spiritual self of good nerve energy. Some of the nerve-energy robbers that were part of my every day life and thus draining me of any and all good nerve energy included unclean air due to allowing my body to be exposed to second hand smoke consistently and smoking for a short period. Another nerve energy robber that I encountered frequently was inadequate rest and sleep, as I could not allow myself to rest in any form. I would work two or three jobs at any given time and during my free time, I would party wildly. This lifestyle would drain any positive nerve energy, which I thought I had kept in a false reserve bank. I also believed whole-heartedly in the SAD Diet, I was a consumer and lover of foods that contained hydrogenated oil, fructose corn syrup, acryl amide, and sodium nitrate. My poor body was lacking in essential vitamins and minerals, but I did not care because I was addicted to fatty foods. At a personal level, I can confidently say that the hydrogenated oils, which I loved, contributed enormously to my obesity, and that trans-fats probably contributed to my infertility. The thought of even considering cutting out high fructose corn syrup seemed entirely wrong to me, not to mention that it is practically in every food nowadays and most likely, it contributes to type II diabetes and heart diseases as well.
Fortunately, after realizing the downside effects of high fructose corn syrup, I vowed never to touch it again in my life, and I have kept this vow to this date. I conferred with all fifteen individuals and all agreed, myself included, that fried or deep-fried foods are the best. Who wants to think of the downside of fried food and how it is fully packed with acryl amide? Yes, eating anything with carbohydrates gave way to high temperatures, which results in eating acryl amide. What is this acryl amide and why should anyone care? Acryl amide damages our nervous system, and can possible be linked to cancer and I did not bat an eye at this reality, until I received results that came back with pre-cancerous cells and I had to have a biopsy done to confirm if I had cancer or not. Fortuitously, I tested negative for cancer. However, having a scare like that, I had no problem with never consuming another yummy funnel cake for the rest of my life. Sodium nitrate is another substance is consumed every day, sometimes twice a day for years. Sure, I knew processed meat was not good for me. Honestly, I chose to ignore sodium nitrate knowing it was the main ingredient in processed meat and I did not give it a damn or the consequences of the health challenges I might possibly have to deal with later in life.
Nope, not a second thought at all, for I was an expert with justifying why I was eating it. Such times were tough, and so was my budget, and that is why I needed to eat processed food it had a longer expiration date so my grocery bill would not be so high. Given my narrow-minded view at the time, I convinced myself that I was not exposing my body to any type of possible colon, breast, and pancreas cancer. I was becoming a pro in being able to eloquently justify the why . However, I never truly accepted the why , especially when I had to deal with abdominal pains, dizziness, nausea, and rapid heartbeats due to the excessive consumption of sodium nitrate I was forcing my body to process. I decided that I needed to counter these symptoms, thus I started consuming large doses of vitamin C and E before I ate processed meat or any food containing sodium nitrate. I believed that the vitamins could possibly inhibit the conversion of the normal sodium nitrate to nitrosamine, its carcinogenic form, and thus my symptoms would vanish. Ultimately, this experiment did not work and I realized it would be best to eliminate all forms of hydrogenated oil, fructose corn syrup, acryl amide, and sodium nitrate. Simply put, ever since I took this bold step, the state of my body and spirit has been improving, and I know if you choose to make these eliminations from your life, the state of your body and spirit would also improve tremendously.
Overly Excessive Chaotic Life
As I continued to excessively party and work three different jobs, I missed getting any form of adequate sunshine and natural light, and I certainly did not do any consistent form of regular exercise. I liked to drink and would drink during the week and on over the weekends. My mornings would start with pots of coffee and tea, which would carry on all day long until I would crawl into bed at night and the vicious circle would start all over again less than five hours later. This trend underscores why I maintained a steady and unhealthy weight of 170 pounds for many years. By my own admission, I made a choice to live a chaotic lifestyle, and drained all positive nerve energy out of my life and at the time I did not want to know how to properly eliminate the excessive stimulation and stress that kept me emotionally unbalanced and thus, ultimately, I ended up becoming a slave to my addictions. Instead of investigating why my own internal integrative balance was in disharmony and learn how to build up good nerve energy habits, I felt much more comfortable with keeping my own addictive habits of diet pills, drinking, and purging after I ate. I broke the limits of what is considered excessive with stress and stimulations in my life.
During this time, I felt that I was only good enough to surround myself with toxic relationships, which led me to dropping out of college and forfeiting my music scholarship, having my identity stolen, coping with infertility, and being taken advantage of financially, physically, and emotionally. Each year, I continually encountered chronic sinus infections, pneumonia, migraines, and strep throat. I was severally diagnosed with some form of autoimmune disease such as Graves disease, Celiac disease, and Shingles, and at this point I started to realize that excess stress and stimulation had taken over my everyday life. Panic attacks, sever agitation, nervousness, anxiety, and insomnia would start immediately I wake up in the morning and I suddenly realized that my life had become unmanageable. I was not doing things for my own highest good and in the year 2000, I became a vegan and started living a hygienic lifestyle, and by following the nerve energy habits, I have dropped over 45 pounds and have maintained it for the last twelve years.
To Accept
Until you manage to see yourself at a higher level of healthy living and resolve to accept and apply the positive nerve energy habits, your life will continually challenge you by putting different forms of nerve energy robbers into your life. Nine of the fifteen individuals told me that whenever there is an event like a company picnic, barbeque, or a gathering at the local restaurant, they feel a tug towards being people pleasers and surrendering the proper diet nerve energy habit so that they do not offend or stand out from the crowd. This scenario boils down to being questioned and explaining the food choices of why they forgo certain items. Sadly, at times we so easily abandon our own self-care by throwing what is best for our own personal highest good to appease those around us, which is definitely a nerve energy robber.
Simplest Form
As a Hygienic Doctor, all I want is for others to see how simple it is to live and uphold hygienic life. I like to use my own life as an example and help others to learn how to unlock their one-sided view and realize that living a hygienic life is not as difficult as we convince ourselves. Looking at it in its simplest form, it is all about aligning and balancing our creative capacity, psyche, physical body, and the human spirit from within our core. When this happens, we all can successfully free ourselves of any physical, emotional, mental, and spiritual addictions.
Now, let us look at the nerve energy habits, proper diet, a good positive and mental attitude, pure air, sunshine, exercise, clean air, cleanliness, sleep, rest, correct temperatures, relaxation and positive poise in life and how these elements can be applied to every day living. We are so accustomed to seeing the Federal Drug Administration (FDA) food chart pyramid, we have assumed that this chart underlines what having a proper diet means and thus anything that deviates from it makes no sense in terms of healthy living.
I often encounter the question: how do you maintain 125 pounds with a 510 frame? Well, I tell them that as a vegan, I eat mono-meals every day and I apply nerve energy habits to my daily routine. I do this by always keeping focus on balance for my highest good and applying it in every action I do throughout the day. If I am not present with each decision, especially around food and stress, my nerve energy robbers could easily win and slip back into my old habits, and thus I can quickly find myself back in the negative zone. The follow up question is If you only eat fruit and vegetables, then where do you get your daily protein. For some, when they hear that being a vegan entails eating fruits and vegetables mostly, there is an overwhelming and almost paralyzing fear of, oh no, I am going to have a protein deficiency. However,
Protein deficiency does not exist. On a whole-food diet that provides sufficient calories, there is no such condition as a protein deficiency. A brochure from the Vegetarian Society of Colorado says, Studies in which humans have been fed wheat bread alone, or potatoes alone, or corn alone, or rice alone, have all shown that these plant foods contain not only enough protein, but also enough of all of the essential amino acids, to support growth and maintenance of healthy adults. It is much more likely however, that a person would run into a huge host of other social, health, and nutritional problems long before developing the dreaded protein deficiency. Protein deficiency simply is not part of our reality. So,
on a diet of fruits and vegetables only, it is likely that your total protein intake will average about 5 per cent of calories or slightly higher. Adding a small quantity of nuts or seed results in a slight increase in protein intake percentage, for example:
A meal of 10 peaches (420 calories) yields 7 grams of protein.
Another meal of 10 bananas (1,085 calories) supplies 12 grams of protein
A bowl of soup made from 3 tomatoes blended with 2 cucumbers (150 calories) supplies more than 7 additional grams of protein
A pint of fresh-squeezed orange juice (225 calories) offers nearly 3.5 grams of protein
One medium head of lettuce (about 50 calories) provides about 5.5 grams of protein
Though we have only eaten 1,930 calories so far, the total protein consumed is 35 grams (over 6% of calories).
Pursuer of Truth
As a Hygienic Doctor, I am a pursuer of truth with seeking a healthier and more holistic lifestyle not only for myself, but also for those who also want to embrace the hygienic lifestyle. For me, I started to become clearer, more conscious, and slightly stricter with my eating regimen, which included more simplicity when it came to daily mono-meals. Next, I focused on getting 20 minutes of sunshine every day and I carved out meditation and rest time each day to quite my mind. Things like sitting outside and being with nature will help with your mental and spiritual attitude.
Applying the nerve energy habits to your life is not difficult, it is empowering yourself to recognize that, by self-sacrificing yourself by freely giving your nerve energy to others or to your addictions, you are not doing yourself or anyone any favour. Some of my family members and friends, which I have successfully worked with, have learned this lesson by fully understanding the true meaning of living a hygienic life because one individual has lost 18 pounds in seven months and the rest have an accumulated loss of 70 pounds in fifteen months. By allowing yourself to maintain a good balance of nerve energy in your life, positivity will overflow with helping others to realize and recognize the true benefits of living a hygienic lifestyle.
Nomadic Life
In the last 41 years, I have lived in eleven states. I change states after approximately every four years. One of the challenges I have found with living a nomadic lifestyle is surrounding myself with correct temperatures. The correct temperature Table 1 reflects five of the eleven states that I have lived in coupled with anywhere from one to four of the cities, which I have resided in, in each state. The reason why I included both the overall population and the city population is to show that, no matter the population size, we can still successfully live a hygienic life and learn how to interlink the nerve energy habits with our day-to-day routine.
I currently reside in Gillette, Wyoming, and as demonstrated below, I have encountered a variety of temperatures of each of the states, which range from the desert, south, and the mid-west. I have relocated due to a number of reasons, sometimes due to work, but other times for emotional and spiritual balance. As much as we would like to reside in an ideal climate that would best serve us together with our highest good, sometimes that is not good enough. The good that comes out of living in countless environments is that I have gained a deep appreciation of not only understanding, but also following the nerve energy habits. I continue to appreciate that making provisions to our lives and proper application we can learn how to take exceptional care of our own regardless of the state or city in which we live. It is possible to learn how to balance our positive nerve-energy habits. For me, learning to dress properly, for each of the four seasons, helps with embracing all the positive nerve energy habits in my everyday life.
Table 1. Correct Temperatures in Selected States: United States 2011.
Towards Wellness
I participate in women and non-profit groups where I direct, teach, mentor, and speak to others toward wellness and how to enhance the quality of their lives while emphasizing on personal motivation to improve behaviours, education, and awareness. I accomplish this objective through many ways; for instance, I post my quarterly newsletter and get my articles published for magazines on how you too can master living a hygienic life by maximizing nerve energy through daily living. I also give my full attention to what other people say, and thus I take time to understand the points made and I ask questions. I am aware of others reactions and understand why they react as they do. I follow up to determine if the needs of my clients have been met and their progress with identifying and undertaking the nerve energy habits. I counsel others to improve their lifestyle behaviours, which contribute to poor health and most importantly, I make sure that the goal is understood. Through adherence to the nerve energy habits, you will regain and rebuild you own internal integrative balance.
Works Cited
Graham, Douglas. The 80/10/10 Diet: Balancing Your Health, Your Weight, and Your Life, One Luscious Bite at a Time. Florida: FoodnSport, 2006. Print.
Vetrano, Vivian. The Health Seekers Yearbook: A Revolutionists Handbook for Getting Well & Staying Well without the Medicine Men. Mississippi: Institute of Hygiology, 1994. Print.
The event that this reflection essay will focus on is the International Womens Day that took place in Belmore Sports Ground. This gathering celebrated mothers and daughters roles in society by involving the local community in competitions, creative activities, life-skills workshops, and discussions. International Womens Day in the city of Bankstown aimed to encourage local women to play an independent and active part in the life of society. I have attended the event as a spectator and a participant as I took part in many workshops and sports activities.
Description of Professions
The four professions that can significantly benefit in organizing and conducting an event similar to this one are therapeutic recreation, public health, health service management, and health promotion disciplines. Firstly, therapeutic recreation is concerned with providing care and psychosocial, spiritual, social, and physical guidance (Weiss, Tilin, & Morgan, 2014). It encourages well-rounded welfare through recreational programs among vulnerable populations (Weiss et al., 2014). Secondly, health services management is responsible for cultivating and directly facilitating the creation of empowering and health-oriented leadership (Weiss et al., 2014). Thirdly, health promotion professionals focus on improving the individual and community access to healthcare via political, economic, organizational, and educational approaches (Weiss et al., 2014). For instance, this position involves spreading awareness of health topics, engaging community, and policymaking. Fourthly, a public health professionals role is encompassed by the populations well-being through prevention, recovery, and rehabilitation (Weiss et al., 2014). It focuses on monitoring individuals and groups health, facilitating the treatment of and minimizing the health hazards when necessary.
Observation
One of the professionals whose role was prominent throughout the event was the health service management specialist. Health service management tackled the training of the influential figures and hosts of the event. This role greatly influenced the tone of delivery of the message and its direction towards encouraging social and psychological well-being. For instance, the discussion leaders were inclusive and encouraged meaningful participation, which enforced a feeling of emotional empowerment that many local female communities lack.
Another discipline that contributed to the creation of the event was the therapeutic management position. The person responsible for that role had to ensure that the attendees developed the emotional intelligence skills necessary for societal integration and success. They conducted health-related activities that enhance an individuals self-esteem and personal fulfillment. For example, the creation of sports activities with prizes that helped participants physically and emotionally engage in a positive environment helped boost their feeling of being loved and appreciated.
Health promotion specialists made the third significant contribution. Their role was especially prominent in life skills workshops since the specialists created and conducted interactive counseling sessions to help participants learn coping mechanisms and empowerment techniques for their integration in everyday life. Given that women are often oversexualized, assaulted, and discriminated, the health promoter tried to cope with the issue by providing wyas to address the problem and allow women to recover or avoid the trauma.
The role that was not present in the International Womens Day is the public health position. If it had been represented, the public health representative would have addressed the prevalence of community welfare hazards such as sexism and sexual assault that women deal with every day (Brunton et al., 2017). The specialist would have implemented more specific workshops and the presence of help centers to help spread the awareness of the issues, equip women to cope with the problem, and mitigate the problem of low self-esteem and trauma.
Observation Findings
To start with the area of therapeutic recreation, the event showed that this position is essential in ensuring inclusivity during public gatherings. For instance, Potash, Burnie, Pearson, and Ramirez (2016) argue that the involvement of people with disabilities in art activities to reduce social stigma and enhance individuals well-being is the responsibility of therapeutic recreation specialists. García, Wolff, Welford, and Smith (2016) agree with this statement and prioritizes disability engagement in sports. These findings correlate with my observations since therapeutic recreation was used throughout the event to equalize the access to all activities and enable people with disabilities and other special consideration to participate. The surprising aspect is that therapeutic recreation can influence ones access to healthcare in casual settings with underlying benefits for physical, social, and psychological health.
As it concerns health promotion, it amazed me that the field of health work is responsible not only for policymaking but also for ensuring change on an individual level, explicitly through the use of empowerment. To my surprise, empowerment is reflected as an essential technique in community support and health promotion in the academic literature. For example, Cyril, Smith, and Renzaho (2016) state that empowerment, a multi-level construct comprising individual, community and organizational domains, is a fundamental value and goal in health promotion (p. 809). Thus, the discovery of empowerment being a part of health promotion was a valuable experience.
Lastly, health service management played an unexpected role in preparing the events hosts and leaders to engage in meaningful and fruitful interactions with participants. According to Karimi et al. (2018), health service management is essential in encouraging leaders to make a positive change in a community by cultivating healthcare skills and awareness of different health necessities. Health service managers equipped leaders with emotional intelligence skills and knowledge of specific populations attending the event.
Reflection on the Chosen Career Field
Through this reflection, I have acquired additional knowledge in the field of health promotion. According to one of this semesters readings, while access to health is a fundamental human right that many people exercise daily, some still lack the fulfillment of essential human needs (World Health Organization, 2020). Through this observation, I have learned that health promotion specialists role involves both political lobbying and community involvement. Simple steps such as organizing a life skills workshop during the Internal Womens Day can promote psychological and physical health, making a difference in peoples lives (Evangelidou, 2019). While I was previously interested in the policymaking side of the role, I am now aware of and excited about different health promotion approaches, such as community involvement and help on an individual level.
Conclusion
The reflection helped me reassess health promotion, health services management, public health, and therapeutic recreation and their active roles in the community. Although studying their theoretical frameworks is helpful, observing the real-life change is empowering and educational. While theory might create a vague understanding of ones duties and responsibilities, engaging in a conversation with actual professionals helps contextualize the findings and apply them in real-life scenarios. As for me, I realized that the health promotion discipline is broader than I expected, which fuels my interest further.
References
Brunton, G., Thomas, J., OMara-Eves, A., Jamal, F., Oliver, S., & Kavanagh, J. (2017). Narratives of community engagement: A systematic review-derived conceptual framework for public health interventions. BMC Public Health, 17(1), 944-950. Web.
Cyril, S., Smith, B., & Renzaho, A. (2015). Systematic review of empowerment measures in health promotion. Health Promotion International, 5(9), 809-825. Web.
Evangelidou, S. (2019). Community engagement towards the development of health promotion tools: Summary findings of Metaplan sessions in Barcelona. European Journal of Public Health, 29(4), 87-101. Web.
García, B., de Wolff, M., Welford, J., & Smith, B. (2016). Facilitating inclusivity and broadening understandings of access at football clubs: The role of disabled supporter associations. European Sport Management Quarterly, 17(2), 226-243. Web.
Karimi, L., Dadich, A., Fulop, L., Leggat, S., Eljiz, K., & Fitzgerald, J. (2018). Brilliant health service management: Challenging perceptions and changing HR practices in health services. Asia Pacific Journal of Human Resources, 57(2), 174-190. Web.
Potash, J., Burnie, M., Pearson, R., & Ramirez, W. (2016). Restoring Wisconsin art therapy association in art therapy history: Implications for professional definition and inclusivity. Art Therapy, 33(2), 99-102. Web.
Weiss, D., Tilin, F, & Morgan, M. (2014). The Interprofessional health team. Burlington, Canada: Jones and Bartlett Learning.
The general purpose of treatment for multiple sclerosis (MS) is to diminish warning signs and to get better results for individual clients. Three interferon-beta (IFN²) remedies are existing for taking care of MS, and in close to comparisons high-dose, regularly apply as a medication course of therapy (250 ¼g IFN²-1b subcutaneously [sc; Betaferon/Betaseron] every other day [eod] or 44 IFN²-1a [sc; Rebif] three times weekly) were established to be better to once-weekly treatment (30 µg IFN²-1a intramuscularly [IM; Avonex] once weekly) (Durelli, 2000). Though, individual effectiveness and reactions to the management of this remedy are significant when taking into consideration their treatment (Panitch, 2002).
The type I and type II interferons were created for the cure of the disease in many diseases as well as multiple sclerosis (MS) (Rudge, 2004). Beta-interferon was combined in two essential structures: one that is caused by bacteria in which there was a lone amino acid replacement and without glycosylation (beta-interferon 1b), and the other in mammalian cells, which created a glycosolated and accurate amino acid chain (betainterferon1a) (Rudge, 2004).
Three main crucial tests of type I interferons have been performed in relapsing/remitting MS (PRISMS, 1998) and two in secondary progressive disease (SPECTRIMS, 2001). All the testing in which relapses were taking place has verified a moderate decrease (a fifth to a third) in relapse rate and associated factors, with several confirmations that recurrent (three times a week) administration is improved than weekly dosing, whereas higher dosage than the usual at each inoculation makes little, or a small, difference (Panitch et al, 2002).
Body of the paper
Multiple sclerosis (MS) is a crippling continuing disease of unsure diagnosis. Since 1993, patients have been taken care of with immunomodulatory drugs (beta-interferon (IFN) or glatiramer acetate), which have been made known to lessen relapse rates but have an incomplete effect on disability progression (Rudick, 2004). These days, the curative spectrum has been widened with the possibility of more vigorous drugs, but with an increased possibility of severe unfavorable events, such as natalizumab (Polman et al, 2006) or mitoxantrone (Hartung et al, 2002). These drugs are designated for patients who are unsuccessful to react to a complete and sufficient course of immunomodulatory treatment (natalizumab), exacerbating relapsing-remitting MS (RRMS) patients (natalizumab and mitoxantrone) or secondary progressive and advancing relapsing disease with gradual increasing disability (mitoxantrone).
Therefore, the early recognition of IFN-treated patients on the danger of increasing sustained progression is necessary in order to make the most of treatment alternatives. Medical reactions to IFN in RRMS can be thought about at different stages, relapse rates, disability progression, or a mixture of these. Lately, it was reported that the decisive factor of response to IFN treatment in RRMS using early disability progression is further clinically applicable than those stands only on relapse rate for predicting long-term disability (Río et al, 2006). On the other hand, relapse rate can be more simply distinguished and at an earlier stage than disease progression.
The two essential scientific occurrences of MS are relapses and progression. Relapses are considered to be the clinical expression of swelling in the central nervous system, while progression is believed to reflect the incidence of demyelination, axonal loss, and gliosis (Confavreux, 2000). The effect of relapses on the time course of permanent disability remains contentious, though it appears that several distinctiveness of relapses (as the amount of recuperation from the primary relapse, the number of setbacks in the first 5 years of the disease, and the occasion concerning the first and second decline) could influence the time from the beginning of MS to the assignment of a determined deficiency, but not the succeeding development of permanent disability (Confavreux, 2003).
A current report demonstrates that the disability progression in the first 2 years of treatment had advanced sensitivity, specificity, and accuracy to foresee the growth of noticeable disability after 6 years of management than the occurrence of relapses (Río et al, 2006). on the other hand, the mixture of disability sequence in the first 2 years and the occurrence of any relapse illustrate the uppermost specificity, accuracy, and hazard percentage; and the mixture of disability progression in the first 2 years or the occurrence of any relapse explained the maximum sensitivity to forecast long-term disability, which proposes that the relapses have to reflect on when assessing treatment responses.
Supported by several studies, first, the examination of IFN reactions in a 2-year placebo-controlled scientific examination of IFN-² 1a demonstrates that subgroups with elevated relapse information had more disease progression in both IFN and placebo arms (Rudick, 2004). On the other hand, patients who did not have a decreased relapses rate on IFN compared with the year previous to IFN treatment demonstrate an elevated amount of disability increase and conversion to secondary progressive MS (Waubant et al, 2003). In adding up, a current investigation recommended that the breakdown of IFN treatment to suppress relapses was the most important predictor of disability (ORourke, 2007).
Side effects
Patients who happened to stop IFNB treatment because of the side effects did so considerably before than patients who stopped IFNB treatment because of the treatment breakdown. The usual side effects primary to IFNB termination in was influenza-like symptoms, depression, and fatigue, and injection site reactions.
Adverse drug reactions for the MS IMDs
Together beta-interferon and glatiramer acetate continue to be essentially inadvisable during pregnancy and there have been no well-controlled studies in humans to sufficiently assess their protection (Copaxone monograph, 2006). Several few post-marketing studies have assessed the IMD use in pediatric MS (. Pohl, 2005).
ADRs are mainly challenging in the elderly, characteristically by now faced with additional co-morbidities and numerous treatments. OlderOlder age and increased amount of associated drugs havehave been time after time revealed to enhance the threat of an ADR (Thurmann, 2001). However, others have pointedpointed out that an increased threat of cancer connection with IMD use (Achiron et al, 2005), demanding more examination.
Drug interactions
No official drug relations studies have been accomplished with the beta-interferons or glatiramer acetate. Based on recent facts, the interferons main potential for a drug-interaction most likely stems from its capability to slow down the cytochrome P450 enzymes which possibly will decrease the chemical processes that occur in living organisms, resulting in the growth of other hepatically metabolized drugs (and therefore boost the threat of the degree to which a substance is toxic (Baxter, 2006).
The relations linking lithium are complex by the related use of a thiazide diuretic, by now identified to effect in reduced emission and possible for lithium toxicity (Martindale, 2005). Potential recognition and administration of such unfavorable events will rely on the continuous controlled participation and awareness of health professionals (Gehshan, 2003), which must be confident.
Conclusion
In summing up, patients that have undergone one or more deteriorations in the first 2 years of IFN management developed a previously constant development of the disability, which may well be used as a clinical indicator to make possible treatment choices when disability is still small.
Reference Cited
Durelli L, Verdun E, Barbero P et al. Every-other-day interferon beta-1b versus once-weekly interferon beta-1a for multiple sclerosis: results of a 2-year prospective randomised multicentre study (INCOMIN). Lancet 2002; 359: 145360.
Panitch H, Goodin DS, Francis G et al. Randomized, comparative study of interferon beta-1a treatment regimens in MS: The EVIDENCE Trial. Neurology 2002; 59: 1496506.
Rudge, Peter. Interferon antibodies: do they alter the beneficial effects of beta-interferon upon relapse rate in multiple sclerosis? Mult Scler 2004; 10; 123 DOI: 10.1191/1352458504ms1017ed
PRISMS (Prevention of Relapses and Disability by Interferon b-1a Subcutaneously in Multiple Sclerosis) Study Group. Randomised double-blind placebo-controlled study of interferon b-1a in relapsing/remitting multiple sclerosis. Lancet 1998; 352: 1498¡/504.
SPECTRIMS (Secondary Progressive Efficacy Clinical Trial of Recombinant Interferon b-1a in Multiple Sclerosis) Study Group. Randomised controlled trial of Interferon b-1a in secondary progressive multiple sclerosis: clinical results. Neurology 2001; 56: 1496¡/504.
Panitch H, Goodwin DS, Francis G, Chang P, Coyle PK, OCooner P et al . Randomized, comparative study of interferon b-1a treatment regimens in MS. The EVIDENCE Trial. Neurology 2002; 59: 1496¡/506.
Rudick, RA, Lee, J, Simon, J, Ransohoff, RM, Fisher, E. Defining interferon beta response status in multiple sclerosis patients. Ann Neurol 2004; 56: 548555.
Polman, CH, OConnor, PW, Havrdova, E, Hutchinson, M, Kappos, L, Miller, DH, et al. A randomized, placebocontrolled trial of natalizumab for relapsing multiple sclerosis. N Engl J Med 2006; 354: 899910.
Hartung, HP, Gonsette, R, Konig, N, Kwiecinski, H, Guseo, A, Morrissey, SP, et al. Mitoxantrone in progressive multiple sclerosis: a placebo-controlled, doubleblind, randomised, multicentre trial. Lancet 2002; 360: 20182025.
Río, J, Nos, C, Tintoré, M, Téllez, N, Galán, I, Pelayo, R, et al. Defining the response to interferon-beta in relapsingremitting multiple sclerosis patients. Ann Neurol 2006; 59: 344352.
Confavreux, C, Vukusic, M, Moreau, T, Adeleine, P. Relapses and progression of disability in multiple sclerosis. N Engl J Med 2000; 343: 14301438.
The IFNB multiple sclerosis group. Interferon beta-1b is effective in relapsingremitting multiple sclerosis. I: Clinical results of a multicenter, double-blind, randomized, placebo-controlled trial. Neurology 1993; 43: 655661.
Dubois, BD, Keenan, E, Porter, BE, Kapoor, R, Rudge, P, Thompson, AJ, et al. Interferon beta in multiple sclerosis: experience in a British specialist multiple sclerosis centre. J Neurol Neurosurg Psychiatry 2003; 74: 946949.
Liu, C, Blumhardt, LD. Assessing relapses in treatment trials of relapsing and remitting multiple sclerosis: can we do better? Mult Scler 1999; 5: 2228.
Sorensen, PS, Ross, C, Clemmesen, KM, Bendtzen, K, Frederiksen, JL, Jensen, K, et al. Clinical importance of neutralising antibodies against interferon beta in patients with relapsing-remitting multiple sclerosis. Lancet 2003; 362: 11841191.
Sorensen, PS, Deisenhammer, F, Duda, P, Hohlfeld, R, Myhr, KM, Palace, J, et al. Guidelines on use of anti- IFN-beta antibody measurements in multiple sclerosis: report of an EFNS Task Force on IFN-beta antibodies in multiple sclerosis. Eur J Neurol 2005; 12: 817-827.
Confavreux, C, Vukusic, S, Adeleine, P. Early clinical predictors and progression of irreversible disability in multiple sclerosis: an amnesic process. Brain 2003; 126: 770782.
Rudick, RA, Lee, JC, Simon, J, Ransohoff, RM, Fisher, E. Defining interferon beta response status in multiple sclerosis patients. Ann Neurol 2004; 56: 548555.
Waubant, E, Vukusic, S, Gignoux, L, Durand-Dubief, F, Achiti, I, Blanc, S, et al. Clinical characteristics of responders to interferon therapy for relapsing MS. Neurology 2003; 61:184189.
ORourke, K, Walsh, C, Antonelli, G, Hutchinson, M. Predicting beta-interferon failure in relapsingremitting multiple sclerosis. Mult Scler 2007; 13: 336342.
Copaxone® monograph. In Repchinsky C ed. Compendium of pharmaceuticals and specialties. Canadian Pharmacists Association, Webcom Ltd, 2006.
Pohl D, Rostasy K, Gartner J, Hanefeld F. Treatment of early onset multiple sclerosis with subcutaneous interferon beta-1a. Neurology 2005; 64: 88890.
Thurmann PA. Methods and systems to detect adverse drug reactions in hospitals. Drug Saf 2001; 24: 96168.
Achiron A, Barak Y, Gail M et al. Cancer incidence in multiple sclerosis and effects of immunomodulatory treatments. Breast Cancer Res Treat 2005; 89:26570.
Baxter K, Stockley IH. Stockleys drug interactions: a source book of interactions, their mechanisms, clinical importance and management, 7th edition. Pharmaceutical Press, 2006.
Martindale. The complete drug reference. Pharmaceutical Press, 2005.
According to a study by Farber (2010), approximately 12% of the US population (37 million people) is aged 65 years and above (p.313). Conservative estimates reveal that this population cohort will increase to about 71 million people or 20% of the nations population by 2030. As a result, the demand for outpatient surgical facilities is expected to increase in the future. These projections are corroborated by the American Hospital Association which reported that the demand for outpatient services increased from 20% to 60% between 1981 and 2006 respectively (Farber, 2010, p.313). Whereas the construction of more ambulatory facilities is underway to satisfy the escalating demand for outpatient care, provision of healthcare services have turned competitive as healthcare organizations face immense pressure to attract more patients to their facilities. Given the escalating demand for ambulatory surgery services, healthcare facilities have explored various way to improve low patient/family satisfaction score (Farber, 2010, p.313). It is against this background that the current paper will develop a plan (based on Kurt Lewins Theory of Change) that could be used to improve patient satisfaction outcomes with respect to services dispensed by ambulatory surgery centers.
Kurt Lewins Theory of Change
Kurt Lewins Theory of Change asserts that you cannot understand a system until you try to change it (Weick & Quinn, 1999, p. 363) espouses three phases of change (unfreeze, change, and refreeze) that can be employed for quality improvement within ambulatory surgery centers. From an organizational viewpoint, change (espoused in Lewins theory) is defined as a collection of science-oriented procedures, strategies, values and theories directed at the premeditated change within the working environment of an organization with the aim of promoting individual and organizational performance. This change is achieved by adjusting work-related performance of employees within an organization (Weick & Quinn, 1999, p. 363).
Problem Identification
I initiated weekly meetings for my project with hospitals leaders and ambulatory surgery center (ASC) and OR nurse leaders to evaluate potential areas for quality improvement (QI). The main goal of these meetings was to assess weekly survey scores of the hospitals ambulatory surgery center and establish priorities for quality improvement. These meetings also sought to establish ways to enhance survey scores; adopt improvement plans with relevant ASC and OR nursing staff; study weekly PG data; and share the outcomes with nursing staff members. In addition, the relevant nursing staff members were provided with score analysis revealing the least scores at the beginning of the quality improvement plan. Impediments to QI consisted of ASC nurses lack of information regarding the facilitys use of PG surveys to enhance scores as well as patient/family satisfaction.
To begin, ASC and OR nurse managers appraised the hospitals ambulatory surgery report for the third quarter of 2010 (3Q10) and identified five priorities for setting up a baseline. The five priorities identified (in order of merit) were: information regarding delays; response to complaints by patients/family; waiting-time in x-ray; information regarding the day of surgery; and simplicity of setting up an appointment. Lewins theory of change lends credence to QI because it provides models of processes that emphasize on the appropriate types of variables that must be observed and conceptualized. For instance, Lewins model of the change process can be used to evaluate various phenomena (in human systems) since it lends emphasis on elaboration and refinement (Schein, 1996, p.59).
We opted to focus on ways to improve the three priorities with the least scores: information regarding delays; response to complaints by patients/family; and waiting-time in x-ray. Press Ganey (PG) was used to compute average score in every category and establish the percentile yardstick rank of the hospital. The 3Q10 ambulatory surgery survey report (see table 1, appendix) revealed that the score levels in the three areas were below the 90th percentile target score. The OR nurse managers decided that remedial measures were required to achieve the targeted percentile score. Consequently, clinical educators and OR leaders formulated the objectives of the QI plan: scheduling the process; explaining a vision; determining main stakeholders; sketching a plan; adopting the plan; and gathering data using comment cards and PG ambulatory surgery survey instruments.
When I presented my report regarding the problem of low PG scores to the ASC and OR leaders, all relevant ASC nursing staff members were invited for a series of in-service meetings to brainstorm ways to enhance scores and patient satisfaction. Participants were encouraged to express their concerns and ideas. OR managers and educators assessed major organizational impediments (i.e. communication barriers among staff, incorrect medical procedures, and delays in surgical start-time) that would potential cause delays and result in patient dissatisfaction. In addition, the ASC managers evaluated the national patient satisfaction PG scores (which ranged from 90.6% to 91.4%) published by PG Physicians and Outpatient Pulse Report in 2008. Our ASC report revealed similar trends (90.7% to 91%) for the previous fiscal year. The dedication of ASC and OR nursing staff members generated optimistic changes in the three categories targeted in our quality improvement plan.
Plan of Action
My QI plan is based on Lewins theory of change since his assumptions regarding change are compatible with my proposed plan. His assumptions include: goal assumption (movement is in the direction of a defined end-state); progressive assumption (movement from an inferior state to a superior state); linear assumption (movement is in a forward direction, from inferior state to superior state); separateness assumption (movement is premeditated and administered by humans, not system); and disequilibrium assumption, where movement entails disequilibrium ((Weick & Quinn, 1999, p.372).
There are various approaches used for QI in ambulatory surgery centers. For instance, SBAR (Situation, Background, Assessment, and Recommendation) is a controlled communication system used to package patient data in a conventional format (Haig et al., 2006, p.167). Since the information is well-framed, pertinent and brief, SBAR is an excellent instrument for updating patient information. SBAR has been employed successfully in ambulatory setting to relay important information to patients/family thereby reducing waiting time. However, SBAR is susceptible to communication mishaps, especially when incorrect data is captured and relayed to waiting patient/family members (Barenfanger et al., 2004, p. 802; Sutcliffe, 2004, p.186).
Whiteboard is also frequently used in ASC as visual communication system to relay crucial information about patients (Mohr et al., 2004, p.34). The whiteboard system has a daily program relating to surgical procedures for each patient. ASC and OR nursing staff use the whiteboard frequently to relay crucial medical information to patients/family in real-time (Chaboyer, 2008, p.137). However, whiteboard system has some aspects that can potentially result in communication blunders (i.e. patient flow faults) and increase the time taken to relay information to anxious patients and family members. In addition, some complex features of the whiteboard system can hamper staff productivity, especially if it is not updated in real-time (Chaboyer, 2009, p.138).
Clinical Team Leadership and Membership is another approach used for quality improvement in the ambulatory surgery environment. Teamwork is an important facet of this approach since both ASC leaders and nursing staff members must work together as a team to ensure that change is implements in an effective way and improve patient/family satisfaction (Salas et al., 2007, p.62; Burke et al., 2005, p.11). Lewins theory of change also lends credence to the role of teamwork in implementing change. He asserts that an individual ought to be rewarded for his/her valuable contribution as a team player (Schein, 1996, p. 61). Under the teamwork approach, ambulatory surgery center leaders and nurses within the ambulatory environment have an ample opportunity to comprehend problems (unfreeze), develop goals for change and adopt the best approach (refreeze) to improve patient satisfaction. Nonetheless, lack of leadership skills and competition among team members can potentially increase waiting-time and result in patient dissatisfaction (Burke et al., 2005, p.11).
Although whiteboard system and Clinical Team Leadership and Membership are effective tools, SBAR approach stands out as the best instrument for QI in ambulatory setting. By implementing this approach, I expect to increase the score levels (above 90%) of the three priority areas identified earlier: information regarding delays; response to complaints by patients/family; and waiting-time in x-ray.
Implementation
As mentioned previously, the unfreezing stage is where the resistant forces are established and a plan is devised to alleviate or reduce them. During this stage, staff meeting is held where the proposed change is presented. Staff members who are against the proposed plan are identified and their arguments against the change are also considered. In the second phase (change), ASC nurses will be trained on how to implement the proposed change in order to reduce waiting-time and improve patient satisfaction. During the refreezing stage, we will continue with the strategies identified in the moving stage so that these new procedures are permanently adopted within the ambulatory surgical setting to reduce patient/family delays.
According to Lewins theory of change, the successful implementation of the proposed change starts with identifying the driving forces to push the resistant forces toward change (see figure 1). In this scenario, the driving forces toward change are ASC leaders and hospital administrators. The resistant forces are ASC doctors and nurses who have hectic schedules and must create time to attend weekly meetings in order to adopt the proposed changes. It is worthy to mention that doctors and nurses who have been practicing for many years are extremely resistant to change.
An in-service meeting for staff members was held at the beginning of the implementation phase to notify them about the low scores on Personal Issues Category/Patients Satisfaction. A brochure was developed with vital information about patients surgery/procedure and issues they need to know, both in Spanish and English. This brochure is to be given to the patient/family when they visit the doctors office.
I created a Standard Operating Procedure/Protocol for pre-admission testing and for day of surgery. This protocol will be used to notify the ASC staff on guidelines to be followed when preparing patients for surgical procedures.
A patient/family update protocol and update for was also developed. These forms provide guidelines to be followed by all ASC and OR staff on how to communicate with patient/family using AIDET (Acknowledge, Introduce, Duration, Explanation, & Thank You) guidelines.
The ASC nurses and clinical care extenders will use the AIDET guidelines to talk to the family, answer any of their questions, make frequent visits to the OR to receive updates and then share them immediately with family members in the waiting lobby.
The updates received from the OR should be documented in nursing notes.
Families in the waiting lobby are to be updated every 2 hours (or less) through the Family Update Form.
If the patient/family has presented a complaint against the care at the hospital, the nursing staff should listen carefully and take accurate notes on the back of the Family Update Form.
ASC nursing staff should use the Principles of Service Recovery (4As): let the patient/family know you accept their concern; acknowledge mistake without making excuses; make a sincere apology for not meeting service expectation; and make amends by communicating your resolution. If necessary, initiate a chain of command (with relevant RN leaders) to address the matter.
In order to improve patient/family response to concerns, the relevant RN manager will be informed about the complaint so that Service Recovery can be implemented immediately. The Service Recovery should be adopted when patients/families report an incident that produces dissatisfaction.
We are in the process of implementing our new plan. Nonetheless, our objective is to raise our Press Ganey scores by a starting point of 82.3.
References
Barenfanger, J., Sautter, R. & Lang, D. (2004). Improving patient safety by repeating (read-back) telephone reports of critical information. Am J Clin Pathol, 121, 801 803.
Burke, C., Salas, E. & Wilson-Donnelly, K. (2004). How to turn a team of experts into an expert medical team: Guidance from the aviation and military communities. Qual Saf Health Care, 13, 96-104.
Chaboyer, W. (2009). Whiteboards: one tool to improve patient flow. Medical Journal of Australia, 190(11), 137-140.
Farber, J. (2010). Measuring and Improving Ambulatory Surgery Patients Satisfaction. AORN Journal, 92(3), 313-321.
Haig, K., Sutton, S. & Whittington, J. (2006). SBAR: A shared mental model for improving communication between clinicians. Jt Comm J Qual Patient Saf, 32,167-175.
Mohr, J., Batalden, P. & Barach, P. (2004). Integrating patient safety into the clinical microsystems. Qual Saf Health Care, 13, 34-38.
Salas E., Wilson, K. & Murphy, C. (2007). What crew resource management training will not do for patient safety: Unless&. J Patient Saf, 3, 62-64.
Schein, E. (1996). Kurt Lewins Change Theory in the Field and in the Classroom: Notes Toward a Model of Managed Learning. Reflections, 1(1), 59-74.
Sutcliffe, K., Lewton, E. & Rosenthal, M. (2004). Communication failures: An insidious contributor to medical mishaps. Acad Med, 79, 186-194.
Weick, K. & Quinn, R. (1999). Organizational Change and Development. Annu. Rev. Psychol. 50, 361-86.
Cost analysis is an activity that uses engineering, time and motion studies, timekeepers records, and planning schedules from production supervisors. Cost analysis techniques include break-even analysis, comparative cost analysis, capital expenditure analysis and budgeting techniques. After determining what is happening, management should identify available alternatives. Professional judgment is then needed to apply and interpret the results of each costing technique.
In an organization, there is a direct relationship between the amount of time (that the funds management is willing to spend on cost analysis) and the degree of reliability desired. If a company wants detailed records with a high degree of accuracy, managers should provide additional time and money for compiling and maintaining cost information. Managers should only use cost analysis and control techniques when anticipated benefits in helping achieve management goals exceed the cost.
In undertaking this project cost analysis of a womans cardiac screening program, it will involve utilizing a budget that was developed based on share allocation amongst four different health system facilities. The analysis will consider certain aspects of the cardiac program and more specifically, the cost items that will be derived from the budget. These cost items will be covered by reviewing two sections, section one will cover the budget line items consisting of FTE full time, travel, medical director fee, purchase of screening tool, space modifications and renovations of the four hospitals, equipment, marketing and print material (education).
Section 2 will deal with the offsetting direct revenue model and consist of the charge (screening or counseling), the total number of screenings per week for four hospitals, weeks Open and total Screenings per year. The comparison of all the above items in the two sections will be the sole basis for the cost analysis of a womans cardiac screening program.
Broad Scope of Analysis
In the estimation of the analysis of cost in a womans screening program, we need to consider a certain aspect of the cost that are vital and they include making a comparison of the cost of doing a cardiac screening procedure within the four hospitals under consideration. It also includes the cost of a woman not seeking the cardiac screening procedure in a hospital and prefers having prescription drugs, going for ED visits and hospitalization.
The summary of the cost of this project, as outlined in the comparison above, can be as follows. The total estimated cost of screening as per the planned project is $57,600. This figure is based on the total yearly projected screenings and charge per screening. The total estimated cost of the planned project as outlined by the budget is $261,424, while the one-time expense will be estimated to be $59,000.
There are legislative bills on womens heart diseases that also outline the relevant cost criteria that should be adopted in certain screening and heart procedures. This can be listed as follows. The Heart for Women Act authorized the expansion to all 50 states of the Centers for Disease Control and Prevention (CDC). The funded WISEWOMAN program provides screening for low-income, uninsured women at risk for heart disease and stroke. The CDC Heart Disease and Stroke Prevention appropriations bill allow CDC to add the 9 states that receive no funding for the competitively awarded Heart Disease and Stroke Prevention Program. It elevates up to 18 states to basic program implementation and supports the other funded states.
Estimation of Program
Cardiac disease is said to be one of the leading causes of death in women in the United States, though most women do not know of this fact as it is. There are certain factors that women also seem to forget, and these factors are about symptoms. The symptoms of heart disease in men and women vary so much and in essence, women overlook this fact and sometimes ignore the signs. This explains why it is important to visit a hospital for a necessary check-up.
Certain factors are also important when dealing with women cardiac problems and how they can be addressed. These include aspects such as chest pain, cardiac workup and the length of time a woman would stay in the hospital for such problems to be addressed. The number of medications prescribed especially when a patient is not educated on certain diet plans might be a major cause of cardiac diseases. Risk assessment and prevention utilize the procedures for assessing an individuals risk factors for heart diseases. It also proposes the possible ways of managing those risks. Cardiac diagnostic evaluation deals with the review of medical history and diagnostic tests if necessary.
Pregnancy care is also a factor that is overlooked in many cardiac issues since it makes a woman know whether (or not) it is safe to have a baby. Lifestyle is also a way of helping women manage their risk factors for heart diseases (Stampfer, Hu, Manson, Rimm, & Willett, 2000).
All the above factors are considered in coming up with the proper cost estimation for a womans cardiac screening program. However, reasons for visiting the ED may vary and most commonly include Stomach and Abdominal Pain, Cramps, Spasms, Chest Pain and Related Symptoms, Back Symptoms, Headache, Pain in the Head, shortness of Breath, Vomiting, Pain, Site Not Referable to a Specific Body Part, lacerations, cuts, and upper extremity.
Estimate the monetary value of outcomes
In coming up with the estimate of the monetary value of outcomes, there is a need to estimate certain incremental costs that will arise as a result of implementing the program and comparing it with the benefits of not implementing the womans cardiac screening program. This will include calculation of the general cost for an individual within the program, other program costs, drug costs as well as the cost of other health services within the program.
The estimated cost of an ED visit will thus be calculated based on the hospital budget line items. The cost of each day in the hospital will depend on the total hospital expenditure and the number of women that turn up for cardiac screening. The monetary value of outcomes as a result of the screening program and the visit of women to this program will be estimated based on the projection listed in the following manner. The estimated costs per year using the sum of $6,680 per testing and cardiology referral will total the projected earnings of $793,604.
If women fail to turn up for cardiac screening, it will highly affect the sustainability of the program and potentially affect its existence since it will make the running of the facility very challenging since the necessary funds would not be available. However, the cardiac screening program will make the women realize potential heart problems early in advance and thus enable proper treatment to be actuated in time. This will reduce the ED visits of women to hospitals and decrease the number of nights spent in hospitals. This is because they will be able to manage their conditions in the comfort of their home.
Account for Effects of Time
The introduction of the womans cardiac screening program will have a lasting effect on the saving of money associated with visits to the hospital. The womans work productivity will increase and provide a real-life balance to a woman with cardiac problems. It will enable women to manage their cardiac problems more effectively since they will be aware of the risks they are already exposed to.
The cardiac screening program will also increase the womans overall productivity in terms of measuring her efficiency in the available resource inputs. It will ensure maximization of outputs from scarce resources, measure the effectiveness of achieving her goals and objectives towards health issues as well as the overall wellbeing.
Distributional Consequences
The benefits that accrue from the introduction and usage of the cardiac screening program has been far reaching in term of improving the quality of life, reduction in cost, education pertaining the cardiac complications and reducing stress level.
Women who are at risk of heart diseases will be in a more convenient position by undertaking the cardiac screening since this will enable them to know of the potential risk and seek medical intervention and care. This will save her a lot of trouble when the family is for emergencies due to admission to the hospital. Another trouble that they will be delivered from is the taking of leave days from work by spouses to cater for them.
Insurance companies, on the other hand, also stand a chance of benefiting especially as pertains to paying claims to the medical insurance holders. This occurs when a woman is admitted as a result of a cardiac illness. The cardiac screening will enable insurance companies to foresee the event of cardiac risk in women and adjust their policy requirements or simply save costs of risks being incurred in future when the cardiac disease is discovered early in advance. Therefore it becomes easily treatable and with less money from the insurance company.
The cost of teaching and education using RNS concerning cardiac ailments will gradually decrease and most nurses and doctors end up having more time to do other duties and follow different patients.
The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) was meant to elaborate on the problems experienced by very sick patients in acute care settings. The idea was that, if physicians, nurses and families had adequate information about the chances of death, care could be appropriately adjusted and decisions on proper care enhanced. This will lead to a decreased length of stay in the hospital as a result of proper care and in turn, resource utilization will be decreased in terms of the number of hours allocated per patient in a day. Resource utilization is measured differently in different hospitals. However, it is generally measured using hospital charges.
Sensitivity Analysis
Sensitivity analysis is the test of how certain changes in resources affect the optimal solution. In sensitivity analysis, we consider the effect of additional limiting or non-limiting constraints in these situations salaries, foundation funding, and efficiencies of scale by using technology. These are some constraints in question.
This is the analysis of the effect of adjusting variables or constraints and determining whether the objective solution will be affected. It shows how much of the objective coefficient (or the maximum available amount of a constraint) can be reduced or increased without affecting the objective solution.
Salaries, as seen in the program budget, are as follows. The regular Labor salary for a full-time nurse practitioner is rated at $118,300. The additional compensation for PRN vacation coverage for a full-time nurse practitioner cost $55.00 per hour to cover 4 weeks per year. The paid time-off for full-time nurse practitioners is at a total of $8,800. When it comes to travel costs, one hospital charges $ 3,124 per trip to each site. This occurred 48 weeks a year and makes the labor expense to total $ 130,224. If the salaries increase, then the total labor cost increases. This will change the cost estimation and thus the cost analysis of a Womans Cardiac Screening Program.
This can be seen from the fact that if an element of cost changes be its labor cost, funding, use of technology the overall cost and budget of the project change and so this affects the cost evaluation and determination especially on the screening of women in the cardiac screening program.
Qualitative Residual
The womens cardiac screening program has brought about a lot of benefits to both the patients and their families. The patients get to realize their ailment early in advance and thus have proper treatment procedures that are both costs effective to the family and the patient.
Cardiac disease management appears effective in reducing dangers associated with heart ailments and improving quality of life. Most clinical trials of heart failure disease programs that have been completed over the past several years have become successful in changing womens lives. Womens cardiac screening program is one of those programs that have facilitated an improvement in the way of life of most women in terms of seeking treatment and better living conditions. Although the designs of these programs vary, education and support have been incorporated to enhance the quality of patient self-management as the key thing in the program.
The content of self-management education normally includes teaching on aspects like taking medications, maintaining a healthy weight, regular health screenings, checking on a diet, exercise and smoking cessation, and recognizing the symptoms (Finkelstein, Troped, Will, & Palombo, 2002). Many of the follow-up programs include engaging at a personal level with the patients. This includes visiting the person at his or her home or contacting the person.
This program assists clients to be aware of the signs and symptoms of the disease. They are educated on how to know when the heart conditions are worsening. They are taught to do self-adjustments that include watching their weight. Otherwise, they could be accorded with alternative treatment procedures. However, some nurses are usually reluctant to educate some patients. The patients with low literacy levels are most vulnerable.
Studies have shown that those patients that have undergone rigorous training readily accept to undertake the exercise themselves. They do this at daily intervals and it has been considered successful since there has been an improvement in their self-care behaviour. Practicing self-care by the patients has been fuelled by the desire to maintain normal body weight. This has seen this kind of treatment to be more successful than when nurses are relied upon as the care providers.
It is important to train patients on the proper dosage that is applied in the self-adjustment program. This is one of the most important aspects of this program. There are other programs to improve patient self-management. However, they are not entirely focused on empowering patients to become self-reliant. The results from this exercise may be comparable to others but it is much preferable since the power is vested upon the patient. The patient is in control of his health.
This program can be seen to have a very close relationship with the early womans cardiac screening, which normally has an impact on the womans health in terms of controlled BP and weight, a more productive regimen and improvement in quality of life. Only a decade ago, many people were heard talking of women health issues and giving their take on those issues. They were mostly in favor of the women going for mammograms. No one disputes this, of course, but we simply cannot stop there since it truly has an impact on womens health. Certain questions that would address every aspect of a womans life must be raised.
For instance, a question that seeks to discover the percentage of women who smoke can be asked. If the number is high, then this means that the chances of more women being at risk of contracting cardiac disease are high and vice versa. There is a question that seeks to find out whether young ladies go for regular screening for such complications as cardiac ailments. If this were so, cardiac diseases could be arrested. Various factors influence a womans health. These include the environment, various responsibilities in the home and at work, her lifestyle and various other factors.
As much as the mothers care dearly about their daughters, they may lack some important knowledge that they need to pass to them. It is for this reason that the girls lead lives without knowing how to make the correct choices. She may lack the knowledge to make certain decisions that are not only crucial to her future but also her health in general. This may develop from a tender age and those decisions may affect a girls future health and put her at risk of having heart complications, which could have otherwise been prevented if she received the right information at the right time.
However, some women may be well of and have plenty of economic resources. They may have the capacity to get very well paying jobs due to their high levels of education. They may also have the capacity to support the family. Women of this caliber are most likely to have the time, money and emotional energy to be concerned about their health since they have too much at stake to lose. Thus, they may engage in practicing regular exercise programs, taking healthy meals every day and having a regular doctor check-up all of which reduce the chances of having heart disease,
This program was designed to help prevent cardiovascular disease. Studies suggest that African American women are at a high risk of dying of heart-related ailments. These include heart disease and stroke. Their numbers exceed those of white women. Hence, the Centre of Disease Control normally works with urban church ministers in a program to make African American women more aware of cardiovascular disease preventive behaviors, which include aspects like nutrition, exercise and not smoking (Walker & Reamy, 2009).
Conclusion
In conclusion, the extent of health issues associated with women led to the creation of the Womens Health office in 1994. However, as time passes, more and more pressing health issues such as cardiovascular disease continue to evolve. This makes all stakeholders, including the government, private sector, public sector, media as well as women themselves to be involved in the process of ensuring that this change in health issues as well as the cost factors are constantly being reviewed and closely monitored. This would be to provide the required support and information needed to prevent all sorts of diseases through all the stages of their lives.
References
Finkelstein EA, Troped PJ, Will JC & Palombo R. (2002). Costeffectiveness of a cardiovascular disease risk reduction program aimed at financially vulnerable women: The Massachusetts WISEWOMAN Program. Journal of Womens Health & Gender Based Medicine, 11(6):519526.
Stampfer, M., Hu, F., Manson, J., Rimm, E., & Willett, W. (2000). Primary Prevention of Coronary Heart Disease in Women through Diet and Lifestyle. New England Journal of Medicine, 343(7):16-22.
Walker, C & Reamy B. (2009). Diets for cardiovascular disease prevention: what is the evidence? Journal of Am Family Physician, 79 (7): 5718.
Patients admitted to an intensive care unit need to be intubated to keep their airways patent. This procedure is called endotracheal suctioning and implies inserting a tube into the patients trachea and connecting it to a ventilator. The suctioning is performed to remove secretions that tend to accumulate in the airway because the presence of the endotracheal tube results in patients loss of ability to cough. An impaired mucociliary function can also contribute to the generation of secretions, as well as, the tube itself may be instrumental to the airway irritation (Ayhan et al., 2015).
Such circumstances can lead to potentially life-threatening conditions such as ventilator-associated pneumonia, which may develop in patients as a result of poor suctioning management by medical personnel. Saline installation is a procedure that has been used by nurses for several decades to facilitate the process of removing secretions with the help of the solution. Numerous studies are exploring the topic of using saline instillation during suctioning, and the use of the PICO method as part of the search strategy can help find the most relevant ones.
Main body
During the research phase, four databases have been chosen as the primary resources for conducting the search for articles dedicated to the topic of best practices concerning suctioning and the use of saline. The first and the one which returned the largest number of relevant sources was PubMed, which has more than thirty million citations and helps conduct searching across other resources such as Medline. Another database used in the search was ScienceDirect, which contains articles from more than two thousand scholarly journals, and allows users to easily find evidence and information for their research. Finally, the last database utilized in the search was BioMed Central (BMC), which is part of Springer Nature, this platform offers access to a wide variety of quality peer-reviewed journals.
I used the population, intervention, comparison, and outcome (PICO) method to find research and evidence concerning the best practices of endotracheal suctioning and the use of saline. Before beginning the search, the following PICO question was formulated In ventilated patients is saline instillation during endotracheal suctioning harmful? Based on the question, keywords were then identified for each of the PICO elements, which was performed to conduct a successful search (CKN, n.d.). The following keywords were used in the search saline instillation, endotracheal suctioning, and ventilated patients. The search across three databases has yielded a total of twelve articles, and the four most recent were eventually used as sources.
All of the four studies chosen for the research had similar findings and noted adverse effects of saline instillation on the health of patients. Giakoumidakis et al. (2011) studied two different approaches to suctioning involving with and without saline and measured oxygen saturation, as well as the volume of drained secretions. The result showed that saline instillation was associated with a lower level of oxygen saturation, which did not return to the baseline even after fifteen minutes. Similarly, Wang et al. (2017) reviewed five control trials that demonstrated significantly low oxygen saturation in patients following the saline instillation procedure.
These findings are in line with the results of a survey conducted among ninety nurses and ninety therapists who, apart from low oxygen saturation, also reported patient agitation (Leddy & Wilkinson, 2015). Moreover, one study found that saline instillation can displace bacteria down the airway and increase the risk of ventilator-associated pneumonia (Franchi et al., 2015). Thus, according to the evidence of the most recent studies, it can be concluded that saline instillation during endotracheal suctioning has harmful effects on patients and must not be utilized in the modern clinical setting.
PICO is a helpful method in my nursing practice, and I plan to use it more often now since this study has expanded my understanding of how it can be implemented. Currently, I have a problem concerning patients with diabetes and the right approach to their treatment. Generally, people with this disease are told to perform physical activity, but it is unclear which type of exercise is more likely to be more beneficial.
I have developed a question using the PICO method to facilitate my search across different databases. After choosing the best structure for my inquiry, I created the following question In patients with type 2 diabetes, does resistance exercise compared to aerobic exercise increase quality of life? Thanks to the PICO approach, I managed to discover relevant sources and relying on the evidence presented there improved my clinical practice.
Conclusion
There is a variety of studies containing evidence about the use of saline instillation during the endotracheal suctioning procedure, and the PICO method can be an effective way to find the most relevant sources. The search for sources in this paper was performed utilizing a PICO question and keywords based on it. All articles used in the research reported low levels of oxygen saturation in patients after saline instillation, which makes this procedure potentially harmful and unacceptable in practice. The PICO method helped me find the necessary information on diabetes and considerably facilitated my search, and positively affected my expertise.
Introduction: The Purpose of Evaluation and Related Issues
People need standards. Even when these standards are too high, they are still, crucial for the development of society; unless there are certain levels of assessment, there is nothing more to strive for, which leads to stagnation. Moreover, in such spheres as nursing, the lack or inconsistency of standards can lead to the untimely death of a patient. Therefore, the existing measures must be evaluated accordingly. Taking a closer look at the Evaluation Grid provided for the nursing staff will help understand whether the current standards suffice to help the nursing staff deliver top-notch services.
Completeness and Relevance of the Information for Learning Assessment
First and foremost, the level of the grid completeness must be considered. It is important to mention that the grid has its limitations; one of the most evident is the limitation in space. The room for making plans is rather small; therefore, the information must be concise, specific and at the same time embrace the relevant aspects. The first five columns seem to provide ample information in a relatively short form.
However, when it comes to follow-up plans, the section under the name Maintain & Monitor or Improve immediately falls into the eye. To start with, the instructions are very repetitive: Revise curriculum as needed, which erases the uniqueness of the plan. Moreover, it is not clear how to detect when amendments to the plan must be made. The column By Whom, How & When does not clarify much either; the means of making changes have not been stated. Though minor nitpicks, the issue concerning the Follow-up Plans needs revision.
Before proceeding to the consideration of the weak aspects of the grid (if there are any), it is also required to check the relevance of the information provided in the assessment grid. The data represented in the grid is admittedly relevant; moreover, the fact that the actions described in the grid are to be taken annually, the information becomes somewhat timeless, meaning that it can be applied literally whenever needed. As a result, the information represented in the grid can be viewed as a guide for the traditional course of actions within a certain group of students. For example, such guidelines as delete outdated practices and add new practices. Action plan based on root cause analysis can and, quite honestly, must be carried out regularly. Therefore, the evaluation grid seems flawless in terms of the relevance of the information that it provides.
Weak Areas/Areas not Addressed to: What Could Have Used More Focus
Giving the credit to where it belongs, one must admit that the provided grid offers a fairly clear structure of evaluation and can be used as a guideline for establishing the action plan in the field of nursing. Nevertheless, certain aspects of the plan seem much weaker than the other ones. As it has been mentioned above, the Follow-up Plans section could have been articulated more clearly. To make matters more complicated, in the section Reports and Recommendations, the reasons for the recommendations have not been stated. While the suggested course of action seems reasonable, certain elements included in the recommendations section still need commentaries. For instance, the application of analysis for nursing practices is a necessity, yet the choice of a root cause analysis has not been explained.
Other rubrics could also have been more specific. For example, the fact that the standards for the nursing practice are supposed to undergo a systematic annual check does not seem to comply with the rules established for a nursing plan. As Gard, Flannigan and Cluskey claim, the timeline should be split into shorter periods:
Developing a timeline to facilitate the collection of data for the development, maintenance, and revision of the program evaluation plan is recommended. [&] The timeline should be developed to fit the nursing programs academic calendar (e.g., semesters, quarters, trimesters) (Gard, Flannigan & Cluskey, 2004, 177)
Another minor drawback of the given evaluation grid concerns the numerical information or to be more exact, its absence. Although in most cases, such information is not necessarily required for the grid, there is a particular aspect that needs at least approximate numbers; Criteria, Outcomes or Benchmarks, intersecting with Support Systems, could have used exact information on the minimal number of resources. Instead, the evaluation grid states that sufficient human (and other) resources are available for the students. While the given issue cannot be considered a major flaw, some clarity concerning the number of resources would be appropriate.
The Grid as a Key Assessment Tool: Adapting the Grid to a Program
No matter how well written and generally reasonable an evaluation plan might seem, its effects are still a question as long as its stays a concept. To figure out whether the instructions work and what can be improved, one has to put the postulates of the plan to practice. Therefore, it is necessary to decide whether the given system is going to work as an assessment tool, comparing it at the same time to what is considered an ideal nursing assessment tool.
According to what the existing sources say, a perfect nursing assessment tool must incorporate the use of both independent and dependent variables (Shulker, Conjeski & Hamilton, 2011). Thus, the evaluation tool can be considered objective. Since the grid includes the check of both the outer and the inner factors, i.e., the infrastructure and the employees, it can be considered that the grid meets the basic demands. However, according to Cervo et al. (2007), the tool should also include a measurement system, which the given grid lacks. In addition, the grid could have included the feedback from alumni (Keating, 2006).
Thus, a more objective evaluation could be achieved. Finally, I would like to consider the option of managing the curriculum content as a student. Though the given idea might sound unrealistic, it does provide for more objectivity and a customized learning process that presupposes adopting a unique approach to each student.
All in all, the given grid can be used as an assessment tool once minor corrections are introduced and a more detailed plan concerning the improvements of the nursing services is provided.
Conclusion: Recommendations and Further Improvements
Even though the program could use some improvements, there are many good ideas in it, and these ideas can and must be used to create an evaluation system for a specific program. While the follow-up plan could use more details and be more creative, the grid still offers a strong and at the same time flexible system of evaluation, which is important when working in a mixed group with students who have different skills and require a unique approach each. Therefore, it can be concluded that the provided evaluation grid can be used as a means to assess the students skills in Nursing.
Reference List
Cervo, F. A. et al. (2007). Use of the Certified Nursing Assistant Pain Assessment Tool (CPAT) in nursing home residents with dementia. American Journal of Alzheimers Disease and Other Dementias, 22, 112119.
Gard, C. L., Flannigan, P. N., & Cluskey, M. (2004). Program evaluation: An ongoing systematic process. National League for Nursing, 25(4), 176179.
Keating, S. B. (2006). Curriculum development and evaluation in nursing. Philadelphia, PA: Lippincott, Williams & Wilkins.
Shulker, Conjeski & Hamilton (2011). Incorporating the WHO FRAX assessment tool into nursing practice. American Journal of Nursing, 111(8), 5962.
