Category: Health & Medicine 13691

Introduction

Over the past 2530 years, there has been a steady increase in the number of patients with CKD in the world. This increase is considered to be connected majorly to an improvement in the detection of directly independent nephropathies. Additionally, higher life expectancy of the population, as well as an increase in the prevalence of cardiac pathology, diabetes mellitus, metabolic syndrome and other conditions, also contribute to the expansion of kidney diseases. Lately, peritoneal dialysis (PD) has become one of the main treatment methods in the urology practice  mostly due to the higher safety and efficiency of it. However, studies show that the mortality rates of the patients who receive PD have a direct correlation to the choice of catheter used for the procedure.

Significance to Nursing

Comparison of hemodialysis and PD reveals several medical and social benefits of PD. Among the clinical advantages, most researchers prioritize the longer  in comparison with hemodialysis  preservation of residual renal function in patients with CKD. Moreover, the absence of serious hemodynamic changes in PD conditions is also a serious argument in favor of choosing it as a treatment method in patients with severe cardiac pathology. Thus, it is of crucial importance for the nurses to learn how to choose the correct catheter to ensure the safety and the best quality of life of the patients.

Literature Overview

Critical studies have explored different aspects of CKD treatment, including the effects the peritoneal dialysis has on both the efficiency and comfortability of it. Several researches highlight the importance of prevention measures for kidney diseases, as the penetration of any kind, including the peritoneal dialysis, ultimately results in the degradation of patients overall health. In addition, findings indicate an increased risk of mortality from coronavirus in CKD patients (Gansevoort & Hilbrands, 2020). Comparative studies of mortality rates associated with catheter choice for peritoneal dialysis reveal the factors that might affect the doctors perspective when choosing the correct catheter.

Research Design and Methodology: Sampling Procedure

The research is a longitudinal study of the patients with chronic kidney disease. These patients receive peritoneal dialysis as a part of treatment for a long period of time. An age- and gender-diverse sampling pool is required to properly measure the impact of the catheter choice on PD patients quality of life.

Research Design and Methodology: Data Collection Procedures

During the stage of data collection, several methods were used. The patients who gave consent to participate in the research were interviewed with the EQ-5D questionnaires. Test-retest procedure and alternative-form testing ensured the quality and reliability of the data. To objectively evaluate patients current condition, electronic health records were also employed, providing the research with medical data such as lab test results and medication prescriptions. Detailed information about the use of various types of catheters will also be scrutinized (Shimizu et al., 2020).

Research Design and Methodology: Data Analysis Overview

Regressive analysis method would be the most suitable for this research, as it measures the association between variables, especially the numerical ones (Hocher & Adamski, 2017). Moreover, this method of analysis implies the use of a variety of specific tools, ranging from least squares to polynomial regression, which allows an in-depth study of the subject. The relationship between independent and dependent variables is examined closely through the regression analysis, thus providing the base for prediction and correlation studies.

Ethical Considerations

Patients should be aware of the multiple responsibilities that participation in this research requires. Therefore, it is important to acquire informed consent from them, as it allows the patients to recognize and understand different aspects of the research. Additionally, through informed consent, patients can learn risks and benefits associated with their participation.

Conclusion

Due to the improvement of early recognition and treatment methods for the CKD, as well as the introduction of new protocols for the dialysis therapy into clinical practice, the diseases frequency has decreased in recent years. However, to date, the mortality rates associated with the choice of catheter continue to pose a certain problem when employing PD, affecting the technical survival of this method in patients with CKD. Numerous studies show that the use of PD in patients with CKD can significantly increase the effectiveness of the treatment. However, it is also noted, that the indications and contraindications reflected in the current clinical recommendations should be taken into account when choosing a catheter type for PD. Additionally, the initiation of treatment on time, as well as adherence to the protocols for the prevention and treatment of its complications, also proved to be of crucial importance to the treatment success. Still, further study of the subject is highly recommended.

References

Gansevoort, R. T., & Hilbrands, L. B. (2020). CKD is a key risk factor for COVID-19 mortality. Nature Reviews Nephrology, 16(12), 705-706. Web.

Hocher, B., & Adamski, J. (2017). Metabolomics for clinical use and research in chronic kidney disease. Nature Reviews Nephrology, 13(5), 269-284.

Kim, D. H., Park, J. I., Lee, J. P., Kim, Y.-L., Kang, S.-W., Yang, C. W., Kim, N.-H., Kim, Y. S., & Lim, C. S. (2019). The effects of vascular access types on the survival and quality of life and depression in the incident hemodialysis patients. Renal Failure, 42(1), 3039.

Ng, J. K. C., & Li, P. K. T. (2018). Chronic kidney disease epidemic: how do we deal with it?. Nephrology, 23, 116-120.

Vonesh, E. F., Snyder, J. O. N. J., Foley, R. N., & Collins, A. J. (2004). The differential impact of risk factors on mortality in hemodialysis and peritoneal dialysis. Kidney International, 66(6), 23892401.

Shimizu, Y., Nakata, J., Yanagisawa, N., Shirotani, Y., Fukuzaki, H., Nohara, N., & Suzuki, Y. (2020). Emergent initiation of dialysis is related to an increase in both mortality and medical costs. Scientific Reports, 10(1), 1-8.

The main measurable patient-centered practice problem I encounter in our Med-Surg/Covid/Cardiovascular unit is the frequency of falls. The problem of falls is related to safety and leads to negative outcomes for both patients and healthcare providers. Falls occur relatively often (once or twice a week) in my practice setting and might be considered as a common preventable hospital-acquired condition (HAC). The Centers for Medicare and Medicaid Services (CMS) determined falls as a never event (King et al., 2018). Yoder-Wise (2019) states that adequate nursing care is associated with decreased falls and increased patient satisfaction. Thus, the measure implemented by CMS encouraged many hospitals to adopt zero fall strategies and increase nurse staffing levels to reduce patient falls.

The problem was selected because it influences safety and impacts patient outcomes. Considering the current healthcare burden of the COVID-19 pandemic and a significant number of high-risk elderly patients, I would like to see improvements in the patient fall rates. The interview with the key leader confirmed my assumption that the issue of fall rates is relevant in the Med-Surg/Covid/Cardiovascular unit. Recent falls data analysis from my practice area demonstrates that the total number of inpatient and outpatient falls in April 2021 was 25 (versus 26 in March 2021). The total number of falls on NDNQI-reporting units was 24 (versus 21 in March 2021).

The overall rate of falls per 1,000 patient days decreased from 3.45 in May 2020 to 2.01 in April 2021. The percentage of RNs in the zone at the time of fall was 58%, with only 8% of assisted falls. The problem might be prevented by increasing nurse staffing levels or by purchasing additional bed alarms (Spath, 2018). Therefore, the quality improvement strategy should recognize the progress achieved by April 2021 and continuously address the issue of inadequate nurse staffing.

References

King, B., Pecanac, K., Krupp, A., Liebzeit, D., & Mahoney, J. (2018). Impact of fall prevention on nurses and care of fall risk patients. The Gerontologist, 58(2), 331340. Web.

Spath, P. (2018). Introduction to healthcare quality management (3rd ed.). Health Administration Press.

Yoder-Wise, P. S. (2019). Leading and managing in nursing (7th ed.). Mosby.

Introduction

Sepsis remains a global public health problem that has not lost its relevance throughout the entire period of the project of this pathological condition. One of the primary goals of nursing care is to minimize the risks associated with complications, such as bacterial infections. In the case of sepsis, it can cause a severe immune response and even death. Therefore, it is important to design and develop effective preventative measures in order to ensure that the septic shocks and related fatalities are reduced by implementing improved evidence-based interventions and protocols by identifying major risk factors.

Purpose and Rationale

The given scholarly project will primarily focus on the lower sepsis mortality rates. The key purpose of the project is to assess and analyze the mortality rate due to sepsis and develop and design measures on the basis of recent interventions, such as EGDT, vasopressin therapy, SOFA with its variations, and biomarker analysis, to prevent, predict, and reduce the severity of the issue. The problem is highly significant in the nursing community since nursing specialists are the main sources of care provision for patients with sepsis, and thus, any form of sepsis-related death reduction strategies cannot be properly implemented without the invaluable input of nursing professionals.

The key benefit of the project will be manifested in the fact that there will be improved outcomes among patients with sepsis in terms of mortality rates, and key risk factors will be identified in order to achieve the overall objective of reduction. The PICOT question: Among older individuals aged 60 and older, how does the use of novel intervention protocols, such as EGDT, vasopressin therapy, SOFA, and its variations, and biomarker analysis, compared to traditional approaches influence the sepsis mortality rates over the course of the disease over 30 days? The scope of the project will aim to cover the selected age group through databases and death certificate information alongside treatment procedures revolving around EGDT, vasopressin therapy, SOFA and its variations, and biomarker analysis in order to determine whether there are critical risk factors, which need to be considered in order to improve the clinical outcomes. The resources required for the project will be mainly allocated for data analysis efforts and data acquisition through various official sources.

It should be noted that the key rationale for the assessment is manifested in the fact that it will benefit in regards to the implementation of best and most effective practice as an intervention to reduce risks associated with septic shock, which will subsequently improve the overall awareness about the problem. The proposed interventions will be focused on recent evidence-based intervention protocols, which include EGDT, vasopressin therapy, SOFA, and its variations, and biomarker analysis. It is important to assess and analyze as well as understand the intricacies of the lower sepsis mortality rates due to the evidence of epidemiological data on the basis of randomized control trials. Research suggests that RCT data analysis demonstrates a gradual decline in septic shock mortality rates for the past two decades, but no major improvements were made when controlling for severity of inclusion in studies (Luhr et al., 2019). In other words, the most accurate and reliable sources of primary data are indicative of the fact that mortality rates did not decline significantly despite all the advancements made in the field of medicine and healthcare in the past decades. Therefore, the lack of improvements in regards to sepsis and related issues serves as a basis and rationale for findings and developing measures to lower the overall mortality rates for sepsis.

Background On the Problem and Population of Interest

The incidence of sepsis in the world is growing every year (Neri, 2020). The increase is facilitated by increasing resistance to antimicrobial drugs, the widespread introduction of new medical technologies, the expansion of indications for cytostatic and immunosuppressive therapy, the development of transplantology and prosthetics. It is important to note that significant progress has been achieved in understanding the general biological mechanisms of the bodys response to bacterial aggression and the alteration associated with the responses. Sepsis is based on the formation of a generalized inflammation reaction initiated by an infectious agent, in response to which there is an uncontrolled release of endogenous inflammatory mediators, a lack of mechanisms limiting their damaging effect is formed, which ultimately are the causes of organ-systemic disorders. Although the current understanding of biological mechanisms behind sepsis and inflammatory responses is significant, the knowledge is not entirely improving the practical aspect of healthcare in regards to timely treatment and diagnosis (Luhr et al., 2019). In addition, the world continues to discuss the definition, diagnosis, and treatment of sepsis, severe sepsis, and septic shock.

The problem of sepsis mortality due to sepsis has existed for a long time and still remains among the top causes of death both worldwide and in the United States. The main emphasis of the research project will be based on recent interventions in regards to sepsis outcome improvements. Evidence suggests that prompt treatment is critical, which can be implemented through early goal-directed therapy or EGDT, which is highly effective in 3 and 6-hour bundles (Lehman, 2019). Another important element of a protocol-based intervention is vasopressor therapy, where angiotensin II is administered through an intravenous infusion with a desired concentration being between 5000 to 10000 nanograms per milliliter (Lehman, 2019). In addition, the utilization of sequential organ failure assessment or SOFA can be highly useful in assessing and identifying the general disease progression in real-time with possible alternatives, such as qSOFA or eSOFA (Rhee et al., 2019). These intervention frameworks can also be used for biomarker monitoring and tracking since these factors serve as strong predictive indicators of sepsis, which also promotes prompt treatment (Lehman, 2019). Therefore, the evidence-based intervention protocol for sepsis EGDT, vasopressin therapy, SOFA and its variations, and biomarker analysis.

In addition, one should also be aware that there are a number of risk factors, which can be targeted throughout the project in order to derive the potential solutions to the sepsis mortality rates, including the lower sepsis. Therefore, the focus of the project will be specifically directed at assessing and implementing evidence-based protocols to reduce sepsis mortality in order to promote better methods of prevention, prediction, and reduction of the problem.

Significance of The Problem to Nursing and Healthcare

It is important to note nursing professionals play a major role in the process of sepsis treatment, which means that integrating novel nursing protocols of care after these patients might inevitably lead to reductions in mortality rates. The new data on the implementation of protocols centered around the use of EGDT, vasopressin therapy, SOFA, and its variations, and biomarker analysis as key interventions for sepsis intervention reduction can be highly effective for reducing the overall mortality rate (Lehman, 2019). The impact of sepsis should not be underestimated since the healthcare costs can be substantial on both healthcare facilities and patients.

Benefits of The Project to Nursing Practice

The key benefit of the project to nursing practice is rooted in the fact that there will be improved outcomes among patients with sepsis in terms of mortality rates, and key risk factors will be identified in order to achieve the overall objective of reduction. Nursing professionals will be able to provide better and more effective care on the basis of evidence in order to promote evidence-based practice, which is an essential framework in the field of nursing.

PICOT and Scope of the Project

Among older individuals aged 60 and older, how does the use of novel intervention protocols, such as EGDT, vasopressin therapy, SOFA with its variations, and biomarker analysis, compared to traditional approaches influence the sepsis mortality rates over the course of the disease over 30 days? The general scope of the project will attempt to assess the issue on the national level by accessing the official databases relevant to the aims of the project. The objective is to conduct a comprehensive data acquisition from reliable sources and analyze the data for potential risk factors, such as socioeconomic and possible nursing protocol improvements, such as supplementations, which will require resources for these tasks.

Conclusion

In conclusion, the purpose of the project is to assess and analyze the sepsis mortality rates in order to develop and design improved nursing care protocols, such as EGDT, vasopressin therapy, SOFA with its variations, and biomarker analysis, for the patients of interest with the goal of lowering the mortality rates from the condition. The presented evidence is strongly indicative of the fact that supplementation and risk factor identification can effectively improve the occurrence of the issues through improved prevention, prediction, and reduction of sepsis mortality rates.

References

Byerly, S., Parreco, J. P., Soe-Lin, H., Parks, J. J., Lee, E. E., Shnaydman, I., Mantero, A., Yeh, D. D., Namias, N., & Rattan, R. (2020). Vitamin C and thiamine are associated with lower mortality in sepsis. Journal of Trauma and Acute Care Surgery, 89(1), 111117.

Lehman, K. D. (2019). Evidence-based updates to the 2016 Surviving Sepsis Guidelines and clinical implications. The Nurse Practitioner, 44(2), 2633.

Luhr, R., Cao, Y., Söderquist, B., & Cajander, S. (2019). Trends in sepsis mortality over time in randomised sepsis trials: A systematic literature review and meta-analysis of mortality in the control arm, 20022016. Critical Care, 23(1), 1-9.

Rhee, C., Zhang, Z., Kadri, S. S., Murphy, D. J., Martin, G. S., Overton, E., Seymour, C. W., Angus, D. C., Dantes, R., Epstein, L., Fram, D., Schaaf, R., Wang, R., Klompas, M., & CDC Prevention Epicenters Program (2019). Sepsis surveillance using adult sepsis events simplified eSOFA criteria versus sepsis-3 sequential organ failure assessment criteria. Critical Care Medicine, 47(3), 307314.

The article Priorities and challenges for health leadership and workforce management globally: a rapid review begins by noting the complex and dynamic nature of health systems. According to the article, such challenges arise from the divergence of healthcare contexts and service levels. In this regard, the researchers argue that the capabilities required of health leaders and managers to address these emerging challenges are not well understood. To support this assumption, the researchers refer to the limitation of past studies that, in their opinions, have only provided country-specific data while ignoring the importance of diverse settings and health systems. The researchers determined several challenges emerging in modern health care settings and grouped them into system context, organizational context, and in the context of an individual healthcare manager (Figueroa et al., 2017). These findings are consistent with existing literature on global challenges facing health management, often associated with political, technological, societal, and economic changes. Thus, I find the ideas presented in the article relevant in modern healthcare environments.

The article was published in BMC Health Services Research, a journal website that publishes research in health services. The information provided in the paper is a review of previous studies. I find the information provided in the article to be valid and reliable. Essentially, all articles published in BMC Health Services Research are peer-reviewed, which means that they have undergone rigorous scrutiny by several scholars to ascertain their quality. Additionally, the studies utilized in the article were obtained from three major public health and health care databases, including Pubmed, MEDLINE®, and Scopus. According to the researchers, these databases were chosen for their relevance to the reviews subject matter and breadth of content. Furthermore, the researchers used PRISMA associated with enhanced systematic review reporting accuracy and provide significant clarity about the choice of articles for systematic reviews (Figueroa et al., 2019). Based on these three reasons, it can be concluded that the information provided in the article is valid and reliable.

The information provided in the article may not be relevant in other contexts, for example, health systems in regions such as Africa or Asia. Notably, the article focused on studies based on the Anglo-American context and health systems (Figueroa et al., 2017). These regions have different health systems whereby underdeveloped and understaffed health systems characterize the former regions while the latter regions have more advanced health systems. As such, the articles claim that its focus was on international context may be a source of confusion.

The information from the article can be applied in business contexts. In consideration is the articles claim that under the productivity framework, health system and service administrators are confronted with instances of inefficient human and technological resource distribution, resulting in a disparity between demand and supply. This finding calls for business leaders to be creative and adaptive in their HRM practices. For example, businesses can be successful and effective by utilizing centralization working processes, where individuals are educated to become specialists at one specific aspect of a job to achieve efficiency.

In conclusion, I agree with the articles findings regarding the challenges facing modern health systems. In my opinion, healthcare leaders should anticipate dozens of new challenges in the following decades, including legislative and policy shifts, medical and technical advances, financing, education, and ethical concerns. As such, healthcare leaders must understand that the convergence of these challenges will rapidly consume resources for clinical research (time and money), facility maintenance, infrastructure redesign, and organizational training. Solving these problems will require adaptive leaders who can influence policy change, as suggested by the article

Reference

Figueroa, C. A., Harrison, R., Chauhan, A., & Meyer, L. (2019). Priorities and challenges for health leadership and workforce management globally: A rapid review. BMC Health Services Research, 19(1), 1-11. Web.

Falls among older patients is a common and severe healthcare practice challenge with complex consequences for the population. The challenge is a crucial practice issue in the context of elderly individuals because the increased incidence of falls is often combined with the increased susceptibility to injury after falls (Abraham & Cimino-Fiallos, 2021). Therefore, the increased likelihood of the elderly to experience falls results in the increased occurrence of accompanying conditions.

More than 30% of individuals over the age of 65 years fall each ear, and in half of the cases, the falls are repeated (Sharif et al., 2018). As a result, one in ten falls leads to severe consequences such as hip and other fractures, traumatic brain injury, and subdural hematoma (Abraham & Cimino-Fiallos, 2021). Importantly, regardless of older individuals overall health status, falls are linked to lower mobility, limited capability to perform various everyday activities, as well as increased risks of being admitted to a nursing home. Thus, it is imperative to develop an evidence-based solution to address the practice problem of risks among older patients and facilitate an improved quality of life for the defined target population. The current quality improvement project will focus on fall reduction among elderly patients within a Medical-Surgical (MS) unit.

Analysis of Evidence

Scholars have extensively studied the issue of falls among older adults because they represent one of the main causes of the elderlys disability and morbidity. Falls constitute the second-leading cause of unintentional deaths after road-traffic incidents (Alshammari et al., 2018). Individuals are more likely to experience falls if they suffer from gait impairment. The more severe the impairment is, the higher is the likelihood of an older person suffering a fall (Talarska et al., 2017).

For instance, in osteoporosis patients, the management and prevention of falls should include not only bone-strengthening but also an increased focus on individuals muscle function and balance, which are closely related to the disease (Dionyssiotis et al., 2014). In addition, it is notable that the higher rates of fall occurrence are among individuals with walkers than those with other walking aids as 72.5% of the elderly who use them had a history of falls (Dionyssiotis et al., 2014).

It should be noted that the history of falls among the target group has shown to be strongly related to issues associated with movement, medication side effects, poor vision, mental impairment, consistent pain, as well as environmental dangers that impact the functioning of different joints (Talarska et al., 2017). It was also found that chronic conditions that reduce older adults health outcomes contribute to the increased risks of falls (Dionyssiotis et al., 2014). Polypharmacy, which is characterized as taking more than five different medications daily (Masnoon et al., 20176), also increases the risks of falls among elderly individuals.

When a healthcare team in a medical-surgical unit is tasked with treating older patients, they must assess the risks of falls using evidence-based measurement tools to prevent the events from occurring. According to Park (2018), using a combination of several tools, such as the Berg Balance Scale and Mobility Interaction Fall chart. Different tools are needed for measurement because falls among elderly patients occur due to different risk factors, which maximize the benefits of each measurement for predicting fall occurrence. Therefore, fall prevention in elderly adults is a complex and multi-faceted healthcare practice problem that requires quality improvement steps to be implemented consistently and effectively in order to alleviate the burden on patients and their health providers.

Quality Improvement Process

A comprehensive and multi-dimensional evidence-based quality improvement program is necessary to implement within the primary care healthcare setting to prevent falls and fall-related injuries in the elderly. The quality improvement plan entails the special responsibility of a Clinical Nurse Leader (CNL) to establish a diverse team to work together to reduce the rates of falls in an MS unit. The plans purpose is increasing the days lasting between the instances of patient falls by improving the effectiveness of the intentional processes of rounding and catering to patients needs.

The suggested plan of intervention is concerned with testing the success of the intentional rounding process through patient interviews and direct staff observations. It is expected to facilitate an environment of safety within the MS setting and prevent injuries from the occurrence of fall events. The role of the CNL is essential because they will complete a comprehensive microsystem assessment to identify the quality gap in the care processes that results in patient fall events. The rationale for the recommended quality improvement program is concerned with the possibility to integrate the entire team, ranging from shift nurses to hospital leadership, to collaborate and facilitate change implementation.

Using the Institute for Healthcare Improvement (IHI) Model of Improvement, it is possible for the diverse team involved in the care processes to point out main fall causes. A plan-do-study-act cycle (PDSA) will be used for testing changes in the unit to improve fall rates (Park, 2018).

Relevant steps include measuring the current rates of falls, evaluating causes and risk factors, implementing problem-specific solutions, as well as maintaining improvements. Specifically, the MS unit team will develop informative posters that will remind patients to ask for assistance before going out of their wards to use facilities. A daily monitoring tool will aid in capturing the usefulness of the informative poster in raising elderly patients awareness of falls and considering calling for help if they are not confident about their capacity to avoid falling on their own.

To monitor the effectiveness of the proposed quality improvement measures, several measures should be monitored. The data to be collected during the quality improvement program includes baseline and current falls data obtained from facility quality databases and patient chart reviews. Pre- and post-intervention outcome measures will be compared to determine whether the rates of falls have lowered. In addition, the number of days between the cases of fall occurrence in elderly patients will be measured.

Summary

To conclude, falls among the elderly is a healthcare practice issue that reduces the target populations quality of life while also increasing the burden of care for healthcare providers. The research on falls among elderly individuals showed that the presence of accompanying conditions and co-morbidities increase the risk of falls. In addition, age-related factors such as reduced bone strength or poor vision contribute to falls occurrence. In an MS setting, it is recommended to implement a quality improvement initiative to combine standardized rounding, interprofessional team collaboration, and patient education. It is expected to enhance patients experience in the care setting while also allowing the team to carry out their duties effectively.

References

Abraham, M., & Cimino-Fiallos, N. (2021). Falls in the elderly: Causes, injuries, and management. Web.

Alshammari, S. A., Alhassan, A. M., Aldawsari, M. A., Bazuhair, F. O., Alotaibi, F. K., Aldakhil, A. A., & Abdulfattah, F. W. (2018). Falls among elderly and its relation with their health problems and surrounding environmental factors in Riyadh. Journal of Family & Community Medicine, 25(1), 29-34. Web.

Dionyssiotis, Y., Skarantavos, G., & Papagelopoulos, P. (2014). Modern rehabilitation in osteoporosis, falls, and fractures. Clinical medicine insights. Arthritis and Musculoskeletal Disorders, 7, 33-40. 

Masnoon, N., Shakib, S., Kalisch-Ellett, L., & Caughey, G. E. (2017). What is polypharmacy? A systematic review of definitions. BMC Geriatrics, 17(1), 230. Web.

Park S. H. (2018). Tools for assessing fall risk in the elderly: A systematic review and meta-analysis. Aging Clinical and Experimental Research, 30(1), 1-16. Web.

Sharif, S., Al-Habri, A., Al-Shihabi, A., Al-Daour, S., & Sharif, R. (2018). Falls in the elderly: assessment of prevalence and risk factors. Pharmacy Practice, 16(3). Web.

Talarska, D., Strugala, M., Szewczyczak, M., Tobis, S., Michalak, M., Wroblewska, I., & Wieczorowska-Tobis, K. (2017). Is independence of older adults safe considering the risk of falls? BMC Geriatrics, 66. Web.

The United States is a country where multiple cultures coexist and interact while retaining their cultural identities. However, in some cases, cultural differences can lead to worse outcomes in health care. Chinese Americans are a significant ethnic group with unique health beliefs, which can impact their interactions with the health care system. The Chinese culture has a strong emphasis on traditional medicine, which can impact a persons perception of clinical, evidence-based medicine.

Chinese traditional medicine places a significant amount of trust in herbal medicines. Thus, a stronger belief in such medicines, combined with a lower belief in the benefits of Western medications, can lead to issues with medication preparation, administration, and adherence to the regimen. Moreover, cultural health and health care beliefs can assign different values to different conditions, potentially viewing some as less critical or needing treatment than do Western medical views.

The study by Eh, et al. (2016) found that belief in the superiority of traditional Chinese medicine was indirectly associated with reduced adherence to type II diabetes self-management and medication. The same study notes that this impact is less likely in more educated patients, suggesting that patient education can help improve adherence. Thus, programs aimed at educating patients, and instructing and empowering health care providers to instruct patients not only in the administration of medication but its effects and the reasoning behind its prescription can be beneficial.

The herbal preparations used in traditional Chinese medicine have been found to be contaminated with potentially harmful compounds. Specifically, instances of contamination with heavy metals, such as lead or arsenic, which are known to cause serious poisoning, were reported (National Center for Complementary and Integrative Medicine [NCCIM], 2019). Similarly, undeclared components or incorrect herbs, which can cause asthma, severe allergic reactions, or organ damage, have been found in some traditional Chinese herbal medicines (NCCIM, 2019). Thus, using herbal remedies alongside or instead of Western medicine can cause significant adverse reactions.

The same health and healthcare beliefs can lead to issues with medicine preparation and administration. Specifically, increased medication complexity and precision are required to prepare and administer medicines, especially with multimorbid or older patients (Schenk, 2019). Such patients who are less familiar with Western medications and more used to traditional herbal ones can find it difficult to prepare and administer their medications.

This issue can be further exacerbated by the language barrier, particularly for drugs with difficulty to read or pronounce names (Schenk, 2019). In these situations, patients can have difficulty identifying their different medications. Thus, there is a risk of the patient taking an incorrect drug, or an incorrect dose of the correct one. Both of these situations can be dangerous or limit the effectiveness of treatment.

Another issue with medication administration by patients relates to the timing of taking medication. In traditional Chinese medicine, certain times of the day are associated with different organs and systems in the body; therefore, medicines targeting these organs should be taken during these specific time frames. Conversely, patients may distrust medications that should be taken at times that conflict with this traditional schedule, potentially leading to reduced adherence to the prescribed regimen or refusal to take the medicine.

Cultural factors, particularly health and healthcare beliefs have a significant impact on various aspects of ones interaction with the healthcare system and medication. For Chinese American patients, this can mean a general distrust of, or unfamiliarity with, Western medication and medical practices. Furthermore, a reliance on traditional Chinese medicines can lead to significant adverse reactions from undeclared components in them. Therefore, like with any other group, cultural awareness and competency are critical skills for a practitioner to ensure the best standard of care.

References

Eh, K., McGill, M., Wong, J., & Krass, I. (2016). Cultural issues and other factors that affect self-management of Type 2 Diabetes Mellitus (T2D) by Chinese immigrants in Australia. Diabetes Research and Clinical Practice, 119, 97-105. Web.

National Center for Complementary and Integrative Health (2019). Traditional Chinese medicine: What you need to know. Web.

Schenk, A., EckardtFelmberg, R., SteinhagenThiessen, E., & Stegemann, S. (2019). Patient behavior in medication management  Findings from a patient usability study that may impact clinical outcomes. British Journal of Clinical Pharmacology. Web.

The articles Are Organ Donors Really Dead: The Near-Irrelevance of Autoresuscitation by Robert M. Veatch and DCDD Donors Are Not Dead by Ari Joffe raises the problem of resuscitation and brain donation. These two topics are thoroughly related to the previously conducted research on giving new life to a dead brain. The mentioned articles determine the notion of death as well as ethical aspects of brain donation and resuscitation.

Ari Joffe opens his article by providing a clear definition of the term death. According to the researcher, death is permanent loss of the capacity for consciousness and all brainstem functions (Joffe). In this definition, the loss of the capacity for consciousness means that the body will no longer provide the person with conditions to perceive, think, and be conscious; and these functions cannot be restored (Joffe). He also mentions the primary reason for this condition, which is either permanent cessation of circulation or brain injury (Joffe). Therefore, death is considered to be irrevocable: mortals cannot be resurrected from being dead, while resuscitation by human actions just interrupts the process of dying.

The second article points out that some DCD protocols should be reconsidered since the patient might be dead according to brain criteria even if the autoresuscitation can take place. When the patient is dead because of brain injuries or other brain-based problems, autoresuscitation is irrelevant because the brain is already dead (Veatch). Furthermore, the more time is needed to rule out the autoresuscitation, the more brain tissues might get damaged.

The findings described in the articles can be later used by those scientists who are occupied with the question of bringing the brain back to life. As can be seen, death might be pronounced either because of the impossibility of circulatory functions or severe brain damages. In some cases, autoresuscitation is impossible since the damage to the brain function cannot be irrevocable. Therefore, the patient should be announced dead whenever the brain function is impossible to be restored.

Works Cited

Joffe, Ari. DCDD Donors Are Not Dead. Hastings Center Report, vol 48, 2018, pp. S29-S32. Wiley.

Veatch, Robert M. Are Organ Donors Really Dead: The Near-Irrelevance of Autoresuscitation. The American Journal of Bioethics, vol 18, no. 8, 2018, pp. 1-2. Informa UK Limited.

Theories are essential for introducing and advancing various professional practices, hence the need for their evaluation to determine their relevance, as well as potential applications. In clinical practice, multiple models, theories, and frameworks associated with the evidence-based practice are advocated (Lynch et al., 2018). These ideas and concepts form the bases for execution of new and advanced practices, thus minimizing the overwhelming circumstances caused by professional unfamiliarity. However, basing the new change on theories and models improves conceptual understanding, making the execution process easier. Likewise, experts become more confident in their knowledge and practice through the application. Theory and learning are central to improving professional experiences and efficiency as they inform conduct, corporate culture, and duties. These concepts are relevant to community health practices, including in advancing family care models, leading to a safe and healthy lifestyle.

The Outcome of Practice in Nursing That Can Be Improved

For the aged individuals, who are above 65 years, avoidance of stair climbing is among the functional activities that are encouraged in a community setup. According to Goes et al. (2020), the level of functionality in individuals reduces with age. This physiological aspect is related to either the bodys pathological or physiological response in relation to normal aging, as well as the disease process. The inability of the geriatrics to use multi-story buildings may be a disadvantage to this group of people.

Accidents related to falls are among the leading causes of mortalities and morbidities for community members aged 65 and above. Age-related accidents are increasingly contributing to a high percentage of old adults visiting emergency departments (Jacobs, 2016). According to a report produced by the Center for Disease Prevention and Control in 2016, an estimated 30.000 individuals aged 65 years old and more succumb to falls (Burns & Kakara, 2018).Approximately, one out of four elderly individuals in the US report of fall incident each year (Burns & Kakara, 2018). Of the 30.000 deaths, approximately 9% occur while using steps or stairs (Burns & Kakara, 2018). Among the common injuries resulting from falls are fractures, contusions, lacerations, sprains, and internal injuries. Most deaths are caused by trauma associated with the neck and head.

Since a significant number of seniors live or prefer story buildings, they are subject to scenarios that put their health and safety at risk. Musculoskeletal conditions that occur due to degeneration of body systems with age also limit the usage of stairs with time. In events of emergency, the elderly may find it difficult to use stairs leading to further complications. Hence, the use of stairs poses a considerable safety risk to populations, especially the elderly.

The Concept in Watsons Theory of Caring That Could Represent or Include the Outcome

One of the ways of explaining the nursing practice is through the caring theory. In support of this concept, Jean Watson explained the caring attitude through the Caritas process (Clark, 2016). According to the theory, care for authentic patients has a therapeutic effect and results in good health outcomes. Nursing entails curative factors that lead to human satisfaction, given the various needs. The practical aspect assists in enhancing the health of individuals, families, or communities at large. This concepts attitude is perceived as a virtue from which nursing exists in society, hence transmitting it to other generations.

Watsons theory describes the values and scope for nursing practice, as well as the guiding principles. In Watsons theory, caring is perceived as inclusive, expansive, and circular (Norman et al., 2016). This concept expounds on the helpful aspects, such as doing good for self and others, including individual clients, families, or communities at large, and surroundings. Through thoughtful practices based on self, others, or the environment, individuals learn to change destructive cultures. The outcome in the picture involves reducing the use of stairs/steps amongst the elderly in the community. This intervention will contribute mainly to a reduction of fall cases, related injuries, hospital visits, and associated deaths.

A Practice That Can Be Changed or Implemented That May Influence the Outcome

As the elderly population increases, health care providers are tasked with addressing the rising number of morbidities and mortalities resulting from falls. Health care practitioners should be guided by the fact that some of these deaths are preventable despite the significant number of the affected individuals (Jacobs, 2016). Therefore, related prevention measures should be given priority when discussing the risks facing the seniors.

Various practices can be implemented towards minimizing staircase related accidents, especially for the elderly. Modification of the environment, including structure, floor surface texture, visual cues, such as lighting, placement of handrails, and the removal of distractors, play a significant role in reducing elderly hurts (Jacobs, 2016). Programs that promote education by eliminating risky behavior while at stairs create awareness for the need for proper structuring of buildings, especially when the elderly are involved. Placing rails on both sides of stairways increases stability. The elderly can also be educated on the importance of simple precautions, such as ensuring that lights are on when walking around, especially at night. Enlightening the aged regarding the use of stair rails will also improve the outcomes.

The Concept in Watsons Theory of Caring That Includes the Practice

Caring involves changing self, others, and the culture of groups or environments. In the efforts to bringing change, engaging in actual teaching-learning experience contributes to wholeness. The concept of teaching-learning includes providing education on the ways to prevent stairs falls among the seniors. It is the care providers work to enlighten society members on the risks involved among the elderly while using the stairs. They should also ensure the public understands the recommended structure of stairs that decreases the aged risks of falling. The buildings with inappropriate structures will have to be renovated for the good of the aging. By applying the teaching-learning concept, a trustable and authentic caring relationship will be created and sustained between care providers and community members.

How the Two Concepts Will Be Measured with Their Operational Definitions

Caring entails actions taken by an individual or a nurse that lead to therapeutic effects and good health outcomes. It revolves around helping those who are considered vulnerable, ill, and unhealthy to better their conditions (Clark, 2016). Consequently, it leads to the satisfaction of the needs of specific individuals or society. In reducing falls amongst the elderly, this concept is measured through the actual number of individuals in society who avoid the associated injuries. By reducing falls, as well as associated morbidities and mortalities, the level of care and efficiency will be established. On the other hand, programs associated with self-awareness and learning are likely to shape the activities and efficiency of operational, as well as community-based interventions. Behavioral change in relation to safety, functional capacity, and best health practices is deemed essential for better care outcomes.

A Proposition between the Two Concepts

The teaching-learning concept involves the impaction of knowledge to others to promote anticipated change. The concept is measured through how much individuals execute the change (Norman et al., 2016). In structuring stairs, the percentage of the subjects who would yield to education and implement proper stair structures will help achieve positive outcomes. Teaching-learning is the best way to care for the elderly as it effectively reduces staircases-related accidents.

The establishment of an appropriate teaching-learning model is instrumental in achieving positive results, given the demographic variance. On the same note, due to heterogeneity and complexity associated with aging, it is imperative to ensure that the seniors, as well as family nurses or other caregivers, collaborate in monitoring and managing not only health conditions but also lifestyle. The aim is to improve the safety of the aging members of society by helping them to identify their functional capacities and learn appropriate behavior for self-care (Goes et al., 2020). The seniors are likely to achieve better health and prevent unnecessary nursing needs by implementing intervention strategies, given their functional states.

Conclusion

The use of theory has proved to be the best way to introduce, implement, and sustain practices. Stairway fall among the elderly is rated prevalent and injurious health-related accidents. It is a severe global public health concern with economic implications. Stairway falls are rated amongst the leading cause of injuries and related morbidities and mortalities amongst the elderly. Such concepts as caring and teaching-learning in Watsons theory can be applied in planning, implementing, and evaluating practices geared towards minimizing these injuries.

References

Burns, E., & Kakara, R. (2018). Deaths from falls among persons aged e65 Years  the United States, 20072016. Morbidity and Mortality Weekly Report, 67(18), 509514.

Clark, C. S. (2016). Watsons human caring theory: Pertinent transpersonal and humanities concepts for educators. Humanities, 5(2), 21.

Goes, M., Lopes, M. J., Oliveira, H., Fonseca, C., & Marôco, J. (2020). A nursing care intervention model for elderly people to ascertain general profiles of functionality and self-care needs. Scientific Reports, 10(1), 1770.

Jacobs, J. V. (2016). A review of stairway falls and stair negotiation: Lessons learned and future needs to reduce injury. Gait & Posture, 49, 159167.

Lynch, E. A., Mudge, A., Knowles, S., Kitson, A. L., Hunter, S. C., & Harvey, G. (2018). There is nothing as practical as a good theory: A pragmatic guide for selecting theoretical approaches for implementation projects. BMC Health Services Research, 18(1), 857.

Norman, V., Rossillo, K., & Skelton, K. (2016). Creating healing environments through the theory of caring. AORN Journal, 104(5), 401409.

Significance to Nursing Practice and Nursing Research

Considering the necessity of helping people addicted to drugs to either fight this addiction or live with it healthier, it is likely to suggest that the qualitative proposed research findings on the phenomenon under study will contribute meaningful evidence in clinical settings and advance research. Since the main focus of this qualitative paper is to explore whether having harm reduction programs in treatment centers may increase the likelihood of actively using addicts going into treatment, the findings will provide a concrete answer to this question. This, in turn, will significantly help researchers and medics as they will know whether their efforts should be put into creating such clinical settings and programs or aimed at finding other options.

Any findings and results of this research will be helpful. First, participant observation and focus group interviews may show that harm reduction initiatives and nurses indeed increase the likelihood of drug addicts start their treatment. In that case, further research will be aimed at several important issues. First, exploring the best strategies and programs to introduce into substance abuse treatment centers will be necessary in order not to reduce their effectiveness. Second, it will be required to study additional factors influencing active drug users and the ways medics can benefit from them.

However, in case the answer to the research question appears to be negative, it will also be beneficial for advancing research. This result will allow medics to look for other methods of increasing the likelihood of drug addicts going into treatment and avoid putting much effort into creating a clinical environment that is not really effective. Therefore, the specific findings will allow gaining a clear understanding of the needs and preferences of such patients, and medics and researchers will most likely find it easier to communicate with active addicts and help them be safer.

Dissemination of Information

Apart from conducting this qualitative study and getting specific results, it is also vital to make sure that the valuable information is received by other researchers so that it may have an outstanding contribution to the current and future clinical setting. Therefore, before communicating the research proposal for the proposed qualitative study at the place of employment or for an educational conference, it is necessary to have a certain plan.

First, it is essential to begin with providing accurate statistics and stating the importance of the problem under study, as well as the research question. Thus, according to American Addiction Centers (2021), 19.7 million American adults (aged 12 and older) battled a substance use disorder in 2017 (para. 2). These numbers are increasing every year, and it is crucial to help these people fight their addiction and recover. What is more, American Addiction Centers (2021) states that drug abuse and addiction cost American society more than $740 billion annually in lost workplace productivity, healthcare expenses, and crime-related costs (para. 2). Thus, solving this issue will contribute to the health of society, so it is essential to find out whether harm reduction initiatives are actually effective.

Further, it is efficient to provide some ideas and facts from the literature review part. For example, Dubois (2017) mentions that harm reduction approaches allow persons with a substance abuse disorder to either safely change their habits when being under medical supervision or alter their practices to reduce the chances of being infected. These programs and interventions may become not a replacement but a vital complement to other prevention and treatment strategies. Finally, it would be helpful to note that this research adds to the study of this phenomenon and provides essential information related to its seriousness.

References

American Addiction Centers. (2021). Alcohol and drug abuse statistics. AAC. Web.

Dubois, T. M. (Ed.). (2017). Harm reduction. Journal of Addictions Nursing, 28(1), 42. Web.

Policy Issues of Public Healthcare

The state health policy is aimed at creating conditions for the health system that allows for health education of the population, prevention of diseases, provision of medical care to citizens, the conduct of scientific research in the field of health, and training of medical and pharmaceutical workers, maintain and develop the material and technical base of the health system. The main policy issues of public healthcare are: support for measures to preserve and promote public health; Respect for human and civil rights in the field of public health protection and the provision of state guarantees related to these rights; Ensuring guarantees for the provision of medical care to citizens that meet the established standards of quality of medical care; Priorities for financing the health care system; Participation of the population in addressing issues of health preservation and promotion, as well as health management; Development of international cooperation in the field of health. Currently, state medical institutions are trying to comply with these policy issues.

Policy Issues of Private Healthcare

Previously, people visited mainly public health facilities, but in recent years, the number of private multidisciplinary medical centers has increased significantly, which indicates that people are making a choice in their favor. People often choose private clinics because their policies address important issues such as high-quality service, a comprehensive approach to treatment, professionalism of doctors, high quality of services provided, the security.

Managed Medical Care

Managed health care is a system of health care delivery organized to manage cost, use, and quality. People are granted benefits based on contracts with government agencies and managed care organizations, which are paid monthly at a fixed cost.

Managed care gives people with higher needs access to all their services through a single body. It also allows the Government to improve monitoring of the quality of medical care. An increase in the salaries of the doctors will encourage them to perform their work quickly and efficiently.

Local Policy Regulations

In order to submit a letter with a proposal for a new law to local governments, you must perform the following actions: there is an idea for the introduction of a nursing home, this idea is correctly formulated in the proposal and sent to the City Hall. This proposal is amended by civil servants and is presented at a public hearing. Then a vote is taken, if the voting results are positive, the document is signed by the mayor and becomes law.

Federal Policy Regulations

A bill at the Federal level can be initiated by any member of the House of Congress  the House of Representatives or the Senate. Before the draft gets to the President, it must be discussed in both chambers. A bill initiated by a member of the House of Representatives is submitted to the entire House for consideration, there is a debate, and then a vote. The same actions occur when the draft is submitted to the relevant committee of the Senate. Both chambers make their proposals for correcting the document and, if they agree on the final version of the document, send it to the President. If the chambers do not agree, the document is sent to the conciliation committee (which consists of members of both chambers). After the adoption of all edits and agreements, the document is sent to the President. The President can sign the document and then the law is published and enters into force or vetoes the document. Congress can override the presidents veto by a 2/3 vote in both houses.