Category: Health & Medicine

Introduction

Training of employees is a major requirement for every institution that wants to remain relevant in a fast-changing world. As such, organizations are turning to professional development courses as a useful strategy for equipping employees with key skills. This is, however, not possible without conducting an educational needs assessment. For this assignment, and educational needs assessment is conducted in a general intensive care unit, the GICU unit, which is located in a tertiary hospital. The assessment targets 25 registered nurses and aims at identifying their essential educational needs. This will enable the assessor to develop an educational course based on the nurses educational needs.

Background

The educational needs assessment is aimed at identifying essential educational needs for registered nurses working at the GICU unit. The unit has an 18-bed capacity, and about 70 registered nurses. The assessment focuses on 25 registered nurses, preferably those who have worked in the hospital for less than two years. Thus, while the assessment helps to identify the prevailing educational needs, it also helps the assessor to define the course as well as identify essential instructional needs.

Data Collection Tool

Many healthcare organisations undertake a multi-professional development approach as a useful strategy for equipping healthcare professionals with multiple skills (Harden, 2004). As a result, healthcare professionals can increase participation in daily medical routines (Pirrie, 2003).

The acquisition of multiple skills requires an assessment of the essential educational needs (Gilligan et al. 2005). Needs can be defined as the difference between existing knowledge and the desired skills. Needs assessment, therefore, involves the evaluation of the knowledge gap and what ought to be done to eliminate the gap (Tobey, 2007). Additionally, working with the target group in assessing educational needs is necessary as it helps identify actual educational needs. The needs assessment also enables the assessor to identify potential problems and challenges which are likely to be encountered.

There are many data collection tools useful for the needs assessment plan. However, as Tobey (2007) explains, a questionnaire is the most popular data collection tool. A questionnaire enables the assessor to collect both qualitative and quantitative data, which include the attitudes, opinions and perceptions of the target population. Additionally, questionnaires are quick and easy to develop. A questionnaire is relatively easy to prepare and can be modified to fit the context within which data was being collected (Rubin and Babbie, 2012). Furthermore, the questionnaire can be administered through nonconventional means such as email and social media.

This implies that a questionnaire can be completed at the convenience of the participant. The use of questionnaires enhances the legitimacy of data since confidentiality is maintained. Tobey (2007) adds that in selecting a data collection tool, time is a major determining factor. The needs assessment exercise takes four weeks. Thus, there is sufficient time to administer the questionnaire, data analysis and design of the course unit. Coupled with the assertions made herein, a questionnaire seems to be relevant for this exercise.

In developing a good questionnaire, the assessor ought to follow requirements as described by research experts. This begins by gathering data from the available literature. This is followed by developing a list of probable educational needs. The list enables the assessor to develop a questionnaire, which is to be used for the assessment exercise. According to Tamburini (2004), a questionnaire should be critically reviewed for credibility, reliability and relevance. Considering this, the assessor sought assistance from a senior colleague from the GICU unit. The senior colleague assisted in critical evaluation of the content, format, relevance, wording and usefulness of the questionnaire. Suggestions from the senior colleague were used to improve the quality of the questionnaire. Before pretesting the questionnaire, a final opinion was sought from a second colleague.

His suggestions were further used to improve the quality of the questionnaire. Additionally, as Presser (2004) asserts, the assessor ought to carry out a pilot test, which helps to determine the strengths and shortcomings of the questionnaire. Pretesting also helps in developing a properly worded and well-formatted questionnaire. Pre-testing of a questionnaire is best done with participants from within the target population. Thus, 11 registered nurses were selected from the GICU unit for the pre-testing exercise. The observations made were used to further improve the quality of the questionnaire.

As earlier stated, a questionnaire enables the assessor to collect various forms of data, which include personal feelings, opinions, perceptions, preferences and attitudes. This is only possible through Likert-type questions. As explained by Dawes (2008), Likert-type questions enable participants to select responses that demonstrate their perceptions, feelings and attitudes. Additionally, Likert-type questions are used to simultaneously collect qualitative and quantitative data (Kumar, 2005).

The assessment focuses on three major topics namely tracheotomy care, medication administration and aseptic technique. Participants are requested to rate the three topics in terms of importance. As such, the following Likert-scale seems relevant: 1 = very essential, 2 = essential, 3 = less essential. Additionally, the participants views on additional topics for further study are sought. Participants are also asked to indicate how important the suggested topics are. This helps the assessor to capture the participants feelings and attitudes regarding the suggested topics. Furthermore, it is important to identify the areas of concern within each of the three topics identified. Thus, three questions have been developed for each major topic.

Sample

The assessment is sanctioned by the hospitals nursing department. It is aimed at supporting the institutions mission to sustain high quality and experience based training for its employees. It targets 25 registered nurses working in the GICU unit. The assessment enables the assessor to develop a training program based on the most essential educational needs for nurses at the GICU unit. The nurses are expected to complete no less than ten hours of training per week to meet the requirements of the course successfully. The course covers at least three major topics and focuses on the most essential subtopics within each of the major ones. To incorporate the views and opinions of the nurses, the questionnaire contains open ended questions. Suggestions from the open-ended questions are taken into consideration while developing the course content.

Major course issues and expected challenges

As explained by Wick, Pollock, Jefferson and Flanagan (2006) it is impossible to construct a perfect and error free questionnaire. As such, the questionnaire used for the assessment exercise is likely to contain technical, format, semantic and other types of errors. In regards to this, some errors are expected within the data collected as well as within the process of data collection. For instance, an effective assessment criterion identifies both the learning and instructional needs (Trolley, 2006).

An error prone questionnaire is likely to focus on learning needs and ignore instructional needs. Given this, the assessor will attempt to identify both the learning and instructional needs for each of the major topics mentioned herein (Wick, Pollock, Jefferson and Flanagan 2006; Rothwell and Kazanas, 2011). Additionally, there are numerous disadvantages associated with questionnaires. For instance, Rubin and Babbie (2012) explain that questionnaires usually have a low response rate, especially when participants are required to complete the questionnaire in the absence of the assessor. However, participants have been informed about the importance of completing and returning a completed questionnaire to the assessor. Additionally, the assessor plans to collect completed copies of the questionnaire, in case participants are unable to send back completed copies. While this makes the process laborious and time-consuming, it nevertheless increases the response rate.

Data Analysis

Administration of the questionnaires

As explained by Rubin and Babbie (2012), questionnaires have a low response rate. As such, to increase the response rate, the assessor personally contacted the participants before issuing the questionnaires, to explain the importance of the survey. This was intended to gain the assurance of the participants on their total commitment to completing and returning the questionnaire. An envelope containing a copy of the questionnaire was left with each participant, each having details on how a completed copy of the questionnaire should be returned to the assessor. An offer was made by the assessor to collect the completed copy of the questionnaire. This significantly increased the response rate. Additionally, key terms such as educational needs and instructional needs were explained.

A total of 25 registered nurses were contacted and asked to complete the questionnaires. A total of 20 questionnaires were returned. This implies that the exercise achieved an 80% completion rate. According to Watkins, West-Meiers and Visser (2011), an 80% questionnaire completion rate is considered to be very successful. Analysis of all completed questionnaires indicates equal participation of male and female participants. Detailed statistics are described in Table 1 presented below.

Table 1: questionnaire response rate.

As it has been explained earlier, the assessor preferred a 3-point Likert scale, where 3 is very essential, 2 is essential and 1 is less essential. Using this scale, the most essential educational need scored three points, while the essential need scored two points. Less essential need scored one point. From the results, Medication administration scored highest, at 27 points, followed by Aseptic technique at 12 points while Tracheotomy care scored 5 points. The full results are detailed in Table 2 and Table 3 below.

Table 2: Results.

Table 3: results.

Educational needs

The results above demonstrate the most urgent educational needs for new registered nurses in the GICU unit. Medication administration is the most essential educational need for nurses working at the GICU unit. Most of those polled suggested that Medication Administration Errors (MAEs) are a very essential area that requires further study, and justified this by asserting that there are legal, professional and health implications associated with MAEs, a fact acknowledged by McKenna (2004).To make the teaching/learning process meaningful, most of the participants suggested the incorporation of multimedia in the teaching process.

Aseptic technique is considered an essential topic for further study. Asepsis, which is the process of sterilising the clinical setting, emerged as an essential subtopic. Additionally, Asepsis reduces pathogenic infections, and therefore important elimination of pathogens. Tracheostomy care emerged as a less essential educational need. Nevertheless, those in support of it identified Suctioning as an important subtopic for further study, due to its sensitivity. As explained by Ackerman (2003), misapplication of knowledge is likely to increase the occurrence of other serious health complications. Cooperative learning was identified as the most essential instructional need with regards to Tracheotomy care. A general plan within which the course is to be delivered is described in Table 4 presented below.

Table 4: General program plan.

Conclusion

The most essential educational need for new registered nurses at the GICU unit is Medication administration. As such, it forms a major part of the course. Tracheostomy care and Aseptic technique also form a significant part of the training program. Nevertheless, to make the course meaningful, appropriate instructional methods have been used, based on participants preferences. The assessor hopes that training registered nurses on the three major topics not only enhances their professionalism but also equips them with the necessary knowledge that enables them to increase their participation in a daily nursing routine.

Reference List

Ackerman, M. (2003). The effect of saline lavage prior to suctioning. American Journal of Critical Care, 2(3), 23.

Dawes, J. (2008). Do data characteristics change according to the number of scale points used? An experiment using 3-point, 5-point and 7-point and 10-point scales. International Journal of Market Research, 50(1), 61.

Gilligan, P. et al. (2005). To lead or not to lead? Prospective controlled study of emergency nurses provision of advanced life support team leadership. Emergency Medical Journal, 22(6), 28632. Web.

Harden, R. (2004). Effective multiprofessional education: A three-dimensional perspective. Medical Technologies, 20(40), 28.

Kumar, R. (2005). Research methodology: A step-by-step guide for beginners. London: Sage.

McKenna, H. (2004). Barriers to evidence-based practice in primary care. Journal of Advanced Nursing 45(2),1789.

Pirrie, A. (2003). AMEE Guide No. 12: Multiprofessional education, Part 2 promoting cohesive practice in health care. Medical Technologies, 20(4), 915.

Presser, E. (2004). Methods for testing and evaluating survey questionnaires. New Jersey: John Wiley and Sons.

Rothwell, J. and Kazanas, H. (2011). Mastering the instructional design process: a systematic approach. New Jersey: John Wiley and Sons.

Rubin, A. and Babbie, E. (2012). Brooks/Cole empowerment series: Essential research methods for social work. Ontario: Cengage Learning.

Tamburini, C. (2004), Needs assessment for cancer patients and their families. Biomedical Journal, 8(12),4.

Tobey, D. (2007). Data collection for needs assessment. Baltimore, Maryland: ASTD Press.

Trolley, E. (2006). Lies about learning. Baltimore, Maryland: ASTD.

Watkins, R., West-Meiers, M. and Visser, Y. (2011). A guide to assessing needs: Essential tools for collecting data. London: Sage.

Wick, C., Pollock, R., Jefferson, A., Flanagan, R., (2006). The six disciplines of breakthrough learning: How to turn training and development into business results. San Francisco: Pfeiffe.

Abstract

This paper is going to carry out a critique of the article Women Decline Prenatal Screening and Diagnosis? The methods employed by the researchers will be examined. The paper will also seek to determine if the researchers managed to ground their theory and claims in actual data. The question of whether the researchers provided a proper description of their research will also be addressed. Finally, other issues about research, such as the number of participants, representativeness, and response rate, will also be studied.

Article Summary

The article by Liamputtong, Halliday, GradDipSoc, Watson, and Bell investigates the factors that make women in Australia refuse prenatal diagnosis and screening. The study was conducted by issuing self-administered questionnaires to women who had been pregnant for a period of twenty fours weeks by that time. Three hundred and ninety-five pregnant women were involved in this study. 46 women were picked from this group for further examination.

These females were recruited from different hospitals in Australia based on the number of pregnant women the hospital handled in its antenatal care unit. Research assistants and medical practitioners were used in identifying the participants. The self-administered questionnaires contained fifteen questions that captured data about the type of prenatal testing these women had obtained. The test was aimed at identifying if these women understood the reasons why one should or should not have prenatal testing, and the factors that influenced the decisions of these females (Liamputtong, Halliday, GradDipSoc, Watson, & Bell, 2008).

The research showed that the majority of women declined prenatal testing because of various reasons. The most common factor these women mentioned against prenatal testing was fear of abortion. This is because if the screening detects abnormalities in the fetus, the doctor will suggest an abortion. They also rejected prenatal testing because if some problems were detected, medication would be subscribed to sustain the pregnancy. Pregnant women also cited a certain risk as one of the reasons why they did not want to have prenatal testing. The cited risk was their belief that there was a possibility that the process itself might harm the fetus, or cause a miscarriage (Liamputtong et al., 2008).

This paper is going to carry out a critique of the article by Liamputtong et al. The issues, which are going to be examined here, include how the researchers have dealt with ethics and vigor in their research design and methods. Secondly, the paper will examine whether the techniques and the approaches they used in analyzing data are well described. Thirdly, the study will show the possibility of grounding theory as well as claims in data will also be examined. Other issues that will be considered in the research are the number of females involved, the design of the sample questionnaire, the adequacy of the responses, and the response rate.

How have the researchers addressed rigor and ethics in study design and methods?

Rigorous research can be defined as a study that employs relevant tools to ensure that the objectives of the investigation are achieved. Rigor in research is obtained by making sure that the techniques used to collect data yield accurate data for analysis. The techniques should also capture the variety of phenomena under investigation, and the tools used to analyze data should show the patterns and relationships between variables (Blumer, 1979).

Liamputtong et al. tried to achieve accuracy through sampling methods, and data collection techniques in their research. Concerning sampling methods, rigor was obtained with the help of trained research assistants and medical practitioners. Medical practitioners, such as doctors and trained nurses, were asked to identify pregnant women who, they thought, would be suitable for the research. In addition, criteria, such as education level and other demographic characteristics, were considered and taken into account while conducting a study. This ensured that only pregnant women who had relevant data concerning the prenatal diagnosis and screening were involved to take part in the research.

Multi-stage sampling was also used in the study to ensure that rigorous results were obtained. In the first sampling stage, three hundred and ninety-five women were selected from eighteen hospitals across Australia. After administering the first questionnaire, this figure was narrowed down to forty-six women, who perfectly met the requirements of the research. The data collection was carried out through self-administered questionnaires, which were in turn close-ended, ensuring that the respondents would pick the answers that best describe their opinion. This helps achieve the accuracy of the research by preventing the collection of irrelevant data, or facts that would be difficult to categorize and analyze due to many differences. However, the researchers failed to provide the exact methods they employed in the analysis of data. This can serve to cast doubts on the rigorousness of their results.

Ethics in research normally revolved around safeguarding the privacy of the data supplied by the respondent. Researchers sometimes faced ethical dilemmas when it came to generalizing the findings of research and safeguarding the privacy of the subjects involved in the study. The privacy of the respondents can be protected by observing appropriate ethical standards (Bernstein, 2002). Liamputtong and other authors addressed ethical issues through the method used in collecting data. The researchers used a self-administered questionnaire, which ensured that the respondents had privacy when answering the questions. Self-administered questionnaires also guaranteed that the respondents were not influenced, or coerced to respond in a certain way. Most questions in the questionnaires were close-ended making respondents choose the given answers, which best reflected their position. This made it possible for the respondents not to disclose too much personal information.

Is The Approach To Analysis And The Techniques Used Well Described?

The researchers have not adequately described their approach to data analysis and the techniques they used to analyze data. Instead, they provide their results in a tabular form indicating percentages, which they use in their discussion to support their claims.

Is There Theory Development in the Form Of A Step By Step Account of how theoretical Insights are built up?

There is no theoretical development and step-by-step accounts which indicate how theory is built in the research. The researchers do not come up with any new theory instead they seek to confirm the reasons why Australian women reject prenatal testing.

Are There Novel Claims?

There are no novel claims in the research because it is general knowledge that Australian women are reluctant to take prenatal testing. What the researchers did was to bring out reasons why Australian women declined testing.

Claims/Theory Development Grounded In Actual Data?

If evidence is sufficient in research, it should enable us to determine whether we should accept or discard the theory under investigation. To indicate that theory and claims are grounded by the facts, researchers must show that there are other similar theories, which are supported by the same evidence (Educational Research Service, 1980). In their study, Liamputtong et al. cited similar studies conducted in Australia to determine factors that influence women to reject prenatal testing. They also indicated that these researchers had come to the same conclusion as they did.

The major claim made by the authors is that most women in Australia rejected prenatal testing based on various factors ranging from fear of abortion to the potential risk the procedure has on the fetus. The claim and the theory used by the researchers were in line with the data they collected. The data indicated that seventy-two percent of pregnant women who participated in the study rejected prenatal testing because of the fear of abortion as their main reason. The researchers managed to base their theory and claims on actual data by using constant comparison as the main data analysis method.

The responses obtained from the pregnant women who participated in the research were grouped into categories in a table, and percentages were generated from different categories. These percents were then compared, and the results indicated that they met the theory the researchers were testing, and their prior claims. In their discussion section, the authors of the article backed up their claims with empirical evidence derived from data.

Precisely, the researchers managed to support their theory using data and indicated the relationships between different variables. However, the method of data analysis implemented by them, which was a comparison, may be used just to ensure that their theory was supported by concrete facts. The data that was analyzed in this research was obtained from forty-six pregnant women. This number may be too low to generate correct results that can adequately support the theory being investigated.

Is There Rich Description?

A rich description was required for the researchers adequately to indicate their area of research interest, the phenomena they were going to investigate, research design, and the variables they were to measure (Ogundipe, El-Nadeef, & Hodgson, 2005). Liamputtong et al. described the area of research they were interested in by informing their audience about the issues, and other studies conducted on pregnant women and prenatal testing. The subject of investigation and the variables that were measured in the research were also adequately presented.

The authors normally provide a rich description of the research design and methods used. Liamputtong and his colleagues provided details of the sampling method used in the research as well as how the procedure was conducted. For this study, the researchers obtained their sample through multi-stage sampling and used medical practitioners and trained research assistants in identifying pregnant women who could participate. The description of the sampling method ensured that only the relevant examples were included in the research. The process of data collection and tools used were also effectively described in the research. The initial data was collected from the results obtained from three hundred and ninety-five women. After analysis, forty-six women were identified as suitable for further study.

The questionnaire, which was the main tool used to collect data in the study, was also well described. It was self-administered and contained close-ended questions that were tailored to capture pregnant womens perceptions about prenatal testing and demographic information. The researchers are also supposed to provide a detailed description of the results they obtained. They indicated the popular reasons that make pregnant women reluctant to have prenatal testing. The overview of the research, its justification, and its aims were also richly described in the article. However, the writers failed to present the methods of data analysis.

Are Findings Transferable

The findings of this research are transferable to any population of pregnant women in any region of the globe. This is because the factors these researchers cite as responsible for the rejection of prenatal testing apply to most women.

Is the Analysis Reflexive (I.E. Do the Researchers Take Account of the Potential Impact of Research(er) On Setting/Participants)?

The analysis is reflexive and the researchers take into consideration the potential impacts the researchers have on the subjects. This is why the researchers decide to use self-administered questionnaires as their main tool of data collection so that the subjects do not feel uncomfortable during the research.

Is There Attention Given To Negative Cases?

The researchers do mention that some pregnant women did not adequately respond, leaving certain fields in the questionnaire blank. However, data from such questionnaires were discarded during the analysis.

Other Issues

The initial number of females used by the researchers was 395 pregnant women, and it was further narrowed to 46 women. Being a national study, the sample size of women who participated in the study may limit the possibilities of generalizing the findings of this research. This is because the number may be too small to be compared to the general population, and assuming the general population using this sample may arise erroneous interpretations.

The sample may not also adequately reflect the opinion of pregnant Australian women. This is because the criteria used in obtaining the sample may have excluded the majority of women. The researchers conducted purposive sampling using certain demographic features and attributes such as education level. This might have served to exclude numerous pregnant women from the study, especially females from rural regions in Australia.

The questionnaires used in the research were self-administered and filled privately by the participants. These could lead to a collection of the wrong data because some participants may have requested other people to fill out the questionnaires on their behalf. Most of the questions in their questionnaire were close-ended, therefore limiting the ability of the participants to give their true responses. The researchers reported that some participants left certain fields in the questionnaires blank. All these factors could greatly interfere with the validity and accuracy of data.

References

Blumer, H., & Thomas, W. I. (1979). Critiques of research in the social sciences: An appraisal of Thomas and Znanieckis the polish peasant in Europe and America. New Brunswick, NJ: Transaction Books.

Bernstein, B. B. (2000). Pedagogy, symbolic control, and identity: theory, Research, Critique. Lanham, MD: Rowman & Littlefield Publishers.

Educational Research Service. (1980).Class Size Research: A Critique of recent meta-analyses. Arlington, VA: ERS.

Liamputtong, P., Halliday, J., GradDipSoc, R. W., Watson, L. F., & Bell, R. B. (2008). Why do women decline prenatal screening and diagnosis: Australian womens perspective? Women & Health 37(2): 89-108.

Ogundipe, L., El-Nadeef, M., & Hodgson, R.E. (2005). Lecture notes on paper critique: research methodology and statistic for critical paper reading in psychiatry. Victoria, BC: Trafford.

Molloy, L. B. (2011). Implications of post operative visual loss: Steep trendelenburg and effects on intraocular pressure. AANA Journal, 79(2), 115-120.

This study involves a concrete analysis of the effects of postoperative visual loss. The title covers the whole research paper and is appropriate in the representation of the whole case study. The research was carried out for three years of collecting data. The participants were patients who had a history of eye problems such as disease or had surgery in their eyes. Patients who had diabetes were excluded from other illnesses such as hypertension and vascular problems.

The time of data collection was sufficient to conduct the experiment and make the observation. The participants were important, as they were patients who had the condition and they excluded patients with further illnesses that would affect the outcome, therefore, making the samples reliable. The study sample was 37 patients, with women being 21 and men 16. The mean age was 50 and the participants were from age 31 to 78. The study group is small and there was a need to have a bigger sample of over 100 participants. An assumption had been made that the age range and sample size were sufficient. In addition, the age range did not consider the young who have eye problems, like the teens, children, and young adults.

Another challenge, the study, took place only in one hospital and depended on the experience of a few specialists. The research question was adequately answered as the researchers determined that ophthalmic safety can be improved by measuring the IOP. This finding is crucial to the medical profession and nursing being included. The study, however, should have recommended further studies based on the obvious limitations.

Introduction

According to the Lancet report of 2000, tobacco usages result in millions of deaths worldwide. This has provoked reactions from the WHO in regulating any tobacco-related activity. Consequently, the WHO has created a body mandated to control any tobacco-related activity globally. FCTC approaches tobacco control from new perspectives where Parties share tobacco-related information from monitoring and surveillance globally to combat tobacco-related deaths. This paper seeks to highlight the effectiveness of FCTC activities in a few countries concerning controlling tobacco usage.

Literature review

The WHO Framework Convention on Tobacco Control (WHO FCTC) operates under the World Health Organisations auspices. It tries to reaffirm peoples right to the highest quality of health using evidence. It approaches issues of using addictive drugs from a different perspective as opposed to earlier approaches. It emphasizes the issue of demand reduction and reducing supplies. It came as a result of the global effect of tobacco on humanity. The tobacco epidemic increased due to cross-border trades, direct foreign investments, global marketing, promotion and sponsorship, global advertisement, movements of populations, and the spread of illicit tobacco.

Since its establishment, FCTC has strived to focus on maximizing the global agenda on tobacco control using different means. Such efforts have proved effective in Canada and the US. These are coordinated, collaborative, and cooperative for maximizing efforts and reducing duplication. These cover research centers and policymakers for sharing of information.

The Lancet notes that tobacco consumption results in almost five million deaths every year in the world. It estimates that the figure will rise to 10 million by the year 2020 of which majorities will be from low and middle-income countries. This calls for an alteration of this trend and actions to prevent tobacco-related deaths (Lancet, 2000).

FCTC has some components that guide its operations across the world. The most common is the health warning on packages of cigarettes. This provides useful information about the harmful consequences of tobacco consumption. This strategy is effective as FCTC surveys show that a majority of smokers get information from packages. Health warnings on packages work more than any other form of media reach. It shows that smokers who use 20 sticks per day get at least 7300 warning messages every year. Warnings on packages also reach non-smoking populations such as children and youths. Warning labels are mainly effective in three ways. Labeling offers information and education to both smokers and non-smokers regarding the harmful effects of tobacco use. The information encourages smokers to stop and non-smokers to avoid smoking, and it also offers information that increases efficacy for quitting.

Likewise, the FCTC component of a smoke-free environment is also effective as an approach in controlling the harmful effects of tobacco. Smokers reduce, quit, or reduce initiation depending on the areas they are. These laws are effective due to the support and compliance they receive both from private and public institutions as well as individuals. These laws promote that smoking is socially not suitable for every person.

Progress made so far indicates that there are possibilities of achieving smoke-free environments because of global interest to create smoke-free zones. Both developed and developing countries have adopted the policy and implemented it successfully. These countries include the US, Ireland, Canada, Bermuda, and Kenya among others. This law mainly operates in indoor environments, such as offices, pubs, and public transport systems. Others countries have started borrowing from the successful implementation of smoke-free environment laws.

Overview of the FCTC: its aims, history, outcomes, and monitoring

The FCTC aims to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke by providing a framework for tobacco control measures to be implemented by the Parties at the national, regional and international levels to reduce continually and substantially the prevalence of tobacco use and exposure to tobacco smoke (WHO, 2005).

The WHO FCTC has its adoption in May 2003. Since then, it has strived in the provision of support to countries in signatures, ratification, and implementation of its strategies. The WHO reports show that pilot studies have proved useful in the treaty ratification and implementation. It has provided useful information on the provision of a national tobacco control mechanism. Some of its successful implementations include establishments of Smoking Zones in Kenya, tobacco cells of India, Chinas free cities of tobacco advertisement, and Ukraines national action plan. Countries are also continuing to sign and ratify the treaty. It has also provided the basis for improving the national capacity for controlling tobacco consumption.

The FCTC approach to tobacco control takes a multisectoral approach. Consequently, it has provided a new basis for regulating tobacco consumption. It has both national and international parameters for regulating tobacco usage through setting minimum requirements in its approaches. The transnational approach provides a basis for cooperation among countries in controlling tobacco usage (Gilmore, 2012).

However, the FCTC may not achieve its objectives if there is no rapid and sustained reduction regarding tobacco usage. Many countries require strong legislation that will legally help the implement control tobacco at the national level. Likewise, they also need legislation that will ensure that both manufacturers and consumers of tobacco comply with the laws (Raw, 2011).

The FCTC has monitoring strategies of its objectives in every country. It requires countries to regularly collect national data on the magnitude, patterns, determinants and consequences of tobacco use and exposure (FCTC, 2010). Through monitoring, the FCTC wants to enhance the availability and provision of information related to tobacco activities. Thus, it works with Parties in the adoption of the standard and scientific methods of evidence-based in their surveys. FCTC also seeks to build the capacity of members to improve their survey activities, implementation, and dissemination of findings as well as create, store and use data for tobacco monitoring policies. This also reflects outcomes of tobacco exposure and usage (Warner, 2012).

Global Case study

Describe and evaluate the degree of implementation of the two articles and the evidence of their effectiveness in three countries

Article 13: Tobacco advertising, promotion, and sponsorship

This article calls for a comprehensive ban on advertising, promotion, and sponsorship and requires Parties that do not have legislative obstacles to banning every type of promotion and advertising of tobacco (WHO, 2005). In situations where there are legal impediments, the FCTC requires Parties to control or ban print media, radio, Internet, television, other forms of media. Bans and restrictions also affect the sponsorship of both local and international events. Public officials agree that advertisement and promotional bans directly contribute to a reduction in tobacco usage.

Article 8: Protection from exposure to tobacco smoke

This FCTC article needs countries to the agreement to implement and enforce restrictions and bans on public smoking. There are provisions for parties to implement bans on public smoking. The provisions require complete restrictions and bans in all indoor public places. It does not cater for any exceptions based on the nature and occupancy of any place such as pubs, nightclubs, and casinos. For smokers at homes and other private places, the FCTC article offers guidelines and recommendations on the harmful effects of second-hand smoking.

Implementation in China, Ireland, and Uruguay

In China, the ban has been there since 1996. However, tobacco manufacturers have found other means of promoting their brands such as sponsoring events or using companies logos without making any reference to cigarettes on advertisement media. In 2011, China announced that it will fully implement the FCTC provision on smoking advertisement and promotions (Ma, 2004).

Most Chinese tobacco promotional and advertisement strategies are illegal and attract fines. China also expects to ban Internet promotions of cigarettes. However, legal constraints are affecting the implementation of advertisement and promotion strategies in China. Some Chinese firms argue that they use scientific and technological developments to reduce the harmful contents of cigarettes. However, we all know that there are no known methods of making smoking a healthy habit (Yang, 1999).

Since 2005, Ireland has been one of the most FCTC compliant in the world. On Tobacco Advertising, Promotion and Sponsorship, Ireland law has a comprehensive ban with only limited exceptions on point of sale for tobacco shops only. Ireland has banned all forms of publicity and sponsorship that promote tobacco. The country only allows financial support from tobacco dealers (Fong, 2006).

Uruguay has performed well about the FCTC provisions. However, just like China, the country is grappling with the challenges of illegal advertisement, particularly at the points of sale (POS).

Uruguay law allows for tobacco advertisement at the POS, but the advertisement must be within the POS and contain the same health warning of the same size and visibility. Recent studies show that violation of the law outside the POS is growing.

Ireland gives strong evidence of the positive health outcomes of smoke-free environments. Following the countrys implementation of the smoke-free law in 2004, ambient air nicotine concentrations decreased by 83%, and people exposed to second-hand smoke reduced from 30 hours per week to zero (Hyland, 2008).

In 2006, Uruguay provided 100% smoke-free by enacting a ban on smoking in all public spaces and workplaces, including bars, restaurants, and casinos. The ban won massive public support, including almost two-thirds of smokers.

Majorities of Chinese in large cities support smoking bans in public places, hospitals, workplaces, bars, restaurants, and schools. However, China has not been strict with the implementation and enforcement of the FCTC provision.

Compare and contrast the FCTC in the three countries you have chosen: Uruguay, Ireland, and China

Uruguay achieved a 100 percent smoke-free environment by the year 2006 in the Latin Americas. The ban covers places such as workplaces, public places, public, transport bars, and restaurants. These are some of the public places in Uruguay where the law does not allow smoking. Uruguay has been having a smoking ban in public places since 1996, but it had not fully implemented it. In the year 2004, Uruguay ratified the FCTC. This development paved the way for the complete implementation of the smoke-free law in 2004.

Just like Uruguay, Ireland also has effective smoke-free environment legislation. The country has been able to maintain its smoke-free environment due to strict implementation of the law and associated fines on people found smoking in non-designated zones. Uruguay also has a 100 percent smoke-free environment.

Among these countries, China is the least effective in implementing its FCTC treaty. The country has not been able to achieve any meaningful regulation of smoking in the public due to laxity in the implementation of the law. This happens even though China prohibits smoking in schools, welfare institutions, and indoor areas with more than three occupants. China allows smoking in designated areas outside public institutions and places.

In regulating tobacco advertising, promotion, and sponsorship, the three countries differ considerably. According to the WHO requirements, countries or cigarette manufacturers must display large health warnings on cigarette packages. In addition, countries must actively ban or restriction any form of media campaigns regarding tobacco advertisement and promotion (WHO, 2011). Uruguay and Ireland have successfully been able to achieve maximum implementation and positive results in regulating cigarette promotion and advertisement due to implement of strict laws. On the other hand, China still suffers from the ineffective implementation of the laws despite their existence (WHO, 2011).

A feasible and effective approach to reducing smoking-related harm in Brazil

Article 9: Regulation of the contents of tobacco products

Most countries regulate the contents and ingredients of tobacco products, and Brazil is one of them. Brazil requires tobacco firms to report all ingredients they have used in manufacturing their brands. However, this provision has a drawback because the FCTC has not developed any acceptable scientific method of assessing the contents of tobacco products (Brazilian National Cancer Institute, 2006).

The WHO claims that cigarettes ingredients increase addictiveness and toxicity, but there are no data to prove that all cigarettes have the same harmful effects. However, some of the cigarettes with various ingredients are attractive and palatable to consumers.

In 2010, the European Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR) concluded: there is no evidence that ingredients enhance the addictiveness of tobacco products and found that it is very difficult to identify the significant role of individual additives in promoting the tobacco products attractiveness (DIN, 2004). Thus, a ban on tobacco ingredients will have no impact on effects or in countries where flavored cigarettes are not available.

Surveillance and monitoring of the FCTC

Watching the tobacco industry

WHO FCTC watches new strategies and developments in the tobacco industry to develop new approaches. They know that if smokers use tobacco according to the recommendations of manufacturers, then most of its users will die of tobacco-related deaths. Thus, it monitors the tobacco industry and informs Parties of the developments.

Monitoring consists of surveillance and regulation. Under surveillance, FCTC carries out an ongoing process of monitoring and countering changes in the tobacco industry that may affect public health policies. FCTC also collects reports and keeps a database of activities of the tobacco industry that disregard transnational control of tobacco. Under the regulation, FCTC attempts to control the contents, smoking, advertisement, promotion, and packaging of tobacco products (Jasarevic, 2012).

Conclusion

A global survey across these four countries reveals several challenges in the implementation of the FCTC treaty. The fundamental problem in combating tobacco-related activities in most countries is laxity in the implementation of the law as China demonstrates. At the same time, some countries experience legal challenges concerning the FCTC treaty. Given these scenarios, the FCTC must review its strategies and encourage its Parties to find solutions in enacting the treaty. This is the only way to achieve the results Uruguay and Ireland have achieved, and reduce tobacco-related deaths.

Reference List

Brazilian National Cancer Institute 2006, Health warnings and images on cigarette packages, NCI, vol. 1, pp. 3-4.

DIN 2004, The Toxicological Evaluation of Additives for Tobacco Products, Technical Guide, vol. 133, pp 30-35.

FCTC 2010, Conference of the Parties to the WHO Framework Convention on Tobacco Control, Second Session, Elaboration of guidelines for implementation of the Convention, Product regulation, vol.9, pp. 1-15.

Fong, G 2006, Reductions in tobacco smoke pollution and increases in support for smoke-free public places following the implementation of comprehensive smoke-free workplace legislation in the Republic of Ireland, Tob Control, vol. 13, pp. 3, 3-5.

Gilmore, A 2012, Understanding the vector in order to plan effective tobacco control policies: an analysis of contemporary tobacco industry materials, Tob Control, vol. 21, pp. 119-126.

Hyland, A 2008, A 32-country comparison of tobacco smoke derived particle levels in indoor public places, Tob Control, vol. 1361, pp. 1-19.

Jasarevic, T 2012, New protocol proposed to address illicit trade in tobacco products, Media Centre, vol.1, pp. 5-7.

Lancet 2000, Who has the power over tobacco control?, The Lancet, vol. 360, pp. 267-268.

Ma, G 2004, Tobacco use in China: prevalence, consequences, and control, Californian J Health, vol. 2107, pp. 119-120.

Raw, M 2011, Framework Convention on Tobacco Control (FCTC) Article 14 guidelines: a new era for tobacco dependence treatment, Addiction, vol.106, no. 12, 55-57.

Warner, K 2012, Tobacco control at twenty: reflecting on the past, considering the present and developing the new conversations for the future, BMJ Journal, vol. 21, no.2, pp. 20-21.

WHO 2005, WHO Framework Convention on Tobacco Control, LC/NLM classification, vol. 1, pp. 1-42.

WHO 2011, WHO Report on the Global Tobacco Epidemic, 2011. WHO Report on the Global Tobacco Epidemic, pp. 1-6.

Yang, G 1999, Smoking in China: findings of the 1996 National Prevalence Survey. JAMA, vol. 282, pp. 12471253.

Clostridium difficile is an anaerobic gram-positive bacterium that forms spores. These bacteria produce toxins and cause opportunistic infections. Clostridium difficile bacteria produce A and B toxins. It accounts for 15%-25% of all episodes of antibiotic-associated diarrhea. A new strain of Clostridium difficile that is more virulent was isolated recently. Its high virulence is related to the production of a larger level of toxins (Maja and Nelson 3).

The major reservoirs of clostridium difficile bacteria are individuals infected or colonized by these bacteria. Also, a contaminated environment is perfect for Clostridium difficile bacteria. Clostridium difficile spores can survive on the surfaces for weeks and months. Rectal thermometers and bathing tubs are examples of materials and devices that, when contaminated with infected feces, can act as Clostridium difficile reservoirs (Kyne 129).

Defecation is a portal of exit for Clostridium difficile spores. It is shed in the stool of symptomatic and asymptomatic people. After spores shedding, they contaminate hands, bathroom fixtures, floor surfaces, and incontinent individuals, such as hospital staff.

Clostridium difficile is transmitted through feces. Examples of materials that transmit Clostridium difficile spores include feces, contaminated rectal thermometers, and bathing tubs (Maja and Nelson 3). Health workers should observe aseptic techniques to avoid transmitting Clostridium difficile spores to patients. Ingestion is a portal of entry for Clostridium difficile spores. This happens when an individual picks up spores from environmental surfaces. Patients should wash their hands before meals. Additionally, health personnel should thoroughly clean rooms before new patients come to prevent Clostridium difficile infection. Susceptible hosts include individuals on broad-spectrum antibiotics, immune-compromised individuals, surgical patients, those on treatment, and the elderly (Kelly 78).

Some of the necessary precautions against Clostridium difficile include all staff and visitors washing their hands when entering and leaving patients rooms. Gloves and gowns are effective measures in preventing the spread of Clostridium difficile spores. It is, therefore, recommended that health staff and visitors go to attending patients to put on gloves and gowns to minimize the chances of spreading these spores. Signs should be placed outside the Clostridium difficile patients rooms for precaution purposes. Before sending patients for laboratory tests or treatment, health workers must wash their hands, wear gowns and gloves (CDC: Frequently Asked Questions par. 4).

There are various ways to break the Clostridium difficile chain of infection. To break the chain at the reservoir stage, it is necessary for staff, patients, and visitors to wash their hands. Health institutions should provide disposable hand wash clothes. They should have dedicated staff, necessary equipment, washroom, and commode. Infected patients should be provided with private rooms and cohorts. Also, they should be restricted from bedroom movement to limit spore spreading. Rapid treatment with antibiotics is vital for identified cases. To break the link at the portal of exit level terminal room cleaning is required. In addition, patients movement around the facility should be limited. Health personnel should carefully change bed linen and wash their hands after assisting patients (Maja and Nelson 5).

To break the link at the mode of transmission level carefully remove curtains and change bed linen to avoid spreading spores. The susceptible host should not share a room with a known suspect of Clostridium difficile infection. Beds and rooms should be thoroughly cleaned before placing new patients. Cleaning the room twice a day and hand washing is essential.

To break the link at the portal of entry it is recommended to clean any utensils and thermometers before putting them into the mouth. Avoid storing food from patient trays in the communal fridge. Health institutions should provide disposable hand wash clothes to those with mobility problems before meals. Staff and visitors should wash their hands before entering and after leaving the patients room. Also, patients should wash their hands before meals.

To break the link at susceptible hosts level avoid placing new patients in the room previously occupied by Clostridium difficile, unless proper terminal cleaning has been done. The use of broad-spectrum antibiotics should be controlled. Visitors and staff should wash their hands before or on entry to the patients room. Public education on ways to prevent Clostridium difficile infections is necessary. Additionally, hand washing before meals or snacks is recommended.

Standard precautions are the basis of preventing Clostridium difficile transmission through promoting infection control practices. Consistent use of these precautions offers the greatest potential for preventing transmission of Clostridium difficile infection. One of the keys recommended precautions in preventing the spreading of clostridium spores is observing hand hygiene. The latter preventive measure cuts down chances of passing clostridium spores to other environments or people. Hand washing and not using alcohol based hand rubs is recommended in the presence of Clostridium difficile (Owens 305).

Contact precautions entail use of gloves and gowns when attending to individuals infected with Clostridium difficile. Regular hand washing is a vital step in reducing the risk of transmitting Clostridium difficile spores. After removal and appropriate discarding of gloves and gown, hands should be washed immediately with soap and water in order to physically remove Clostridium difficile spores through friction, lather and rinsing. Some of hand cleaning detergents such as iodophors, alcohol, and chlorhexidine do not completely kill Clostridium difficile spores (Kyne 134).

Works Cited

CDC: Frequently Asked Questions 2005. Web.

Kelly, Canon. Clostridium Difficile: More Difficult than Ever. New England Journal of Medicine 35.1 (2008): 77-96. Print.

Kyne, Lisbon. Clostridium Difficile: Beyond Antibiotics. New England Journal of Medicine14.1 (2010): 129-134. Print.

Maja, Wilcox, and Dale Nelson. Clostridium Difficile Infection: New Developments in Epidemiology and Pathogenesis. Nature Reviews Microbiology 7.2 (2009): 2-15. Print.

Owens, Richard. Clostridium difficile Associated Disease: An emerging Threat to Patient Safety. Pharmacotherapy Journal 26.3 (2006): 299-311. Print.

Introduction

Surgical procedures are quite common in most health centers. This is based on the fact that some health complications are well-corrected through surgical means. Additionally, advancement in knowledge and medical technology has significantly augmented the adoption of operative procedures to correct medical problems among patients. While this is a common and an effective way of handling such problems, it might lead to other infections if preoperative procedures are not performed accordingly (Tanner, Norrie & Melen, 2011). This research paper focuses on the concept of preoperative procedures, which are widely used by medical practitioners around the world.

Preoperative procedure

Surgery is a very important procedure in medicine. Whilst a lot of attention is mainly accorded the actual technical process performed by surgeons, there are several essential stages, which a patient undergoes before the operation is done. These preoperative preparations are quiet important in facilitating the process and preventing infections that arise from improper procedures (Tanner, Norrie & Melen, 2011). Traditionally, preparation of patients for surgical processes mainly included the removal of hair, covering the area to be operated. Although there could be other methods of achieving this, hair removal has dominated the field.

There is always the need for shaving, since the presence of hair may affect the entire process and lead to aftermath infections. For instance, the presence of hair is known to affect the visibility and exposure of the incision. Additionally, its presence may affect the wound created after surgery, stitching and application of chemicals for quick recovery and during dressing. Besides these implications, it is believed that hair is commonly associated with insufficient cleanliness and hair removal is considered to be one of the ways of preventing surgical site infections. Importantly, other schools of thought argue that some preoperative processes like hair removal lead to surgical site infections (Dellinger et al., 2005).

Abbreviated as SSI, surgical site infections generally encompass deep or superficial incisional. The presence of an infection is always characterized by redness, tenderness or pain, among other signs. According to the Center for Disease Control, these can be observed physically or diagnosed through laboratory testing. It further notes that approximately 10% of patients in the United Kingdom suffer from these infections annually (Dellinger et al., 2005). The survey found that SSIs may result into delayed healing of wounds, higher levels of hospital stays and death in extreme cases.

Old practice

One important fact is that there were a variety of infections related to surgical procedures before the end of 19^th century. Some of the infections were highly fatal during any major operation in hospitals around the world. Credit has always been given to Joseph Lister, who contributed to the understanding of major infections, which were as a result of surgical procedures performed by medical experts (Clinical Update, 2008). His input influenced most surgeons and other medical experts to appreciate the need for safe operations to minimize cases of such avoidable health complications.

He carried out a survey in 1865 on surgical infections based on Pasteurs germ theory, which had been published in1857. During the survey, it was hypothesized that tiny bacteria in the environment were responsible of infections in case they gained access to body tissues via broken skin. As a result, it was concluded that measures were needed to prevent entry of these pathogens into the body before and after a surgical process. Additionally, it was necessary to limit the spread of micro-organisms to other parts of the body. These surgical principals have continually been observed to-date. Despite Listers contribution and other medical advances, which followed, surgical site infections remain a major cause of concern (Clinical Update, 2008).

Preoperative hair removal

Although it is not precisely known when doctors and other medical practitioners adopted hair removal on surgical sites, many believe that this was highly appreciated in the 20^th century. Removal of hair was traditionally carried out to allow stitching of wounds, easy access to the site, accurate estimation of edges, and proper bandaging of the wound (Small, 1996). The commonest method of hair removal, which was applied, was traditional shaving. This was carried out at an appropriate time before the patient was allowed into the operating room. Due to advancement in technology, there have been other methods of hair removal, including use of depilatory creams and clipping. Besides this, research has indicated that hair removal is unnecessary especially when wound asepsis is to be carried out, because of possible harm associated with it.

Literature review

As mentioned before, there are three methods of hair removal, which are commonly applied today. These include shaving, chemical depilation and clipping. While shaving is considered as the commonest method applied, it is believed that there are several factors, which contribute to this trend. For example, shaving is quite affordable. It can therefore be used across people from various social classes. It is also simple and lacks the need for technical skills as required by other methods of hair removal. It also uses simple equipment like razor blades, whose cost is highly affordable (Small, 1996).

The head of the razor ensures that the blades are held in good position to allow proper shaving, without harming the skin. On the other hand, hair clipping makes use of clippers, which are fitted with fine teeth, to cut hair close to the surface of the skin. The effect of this method is a stubble, which is approximately one millimeter long. It is worth noting that the heads of the clippers used can be reused by disinfection in between patients or disposed immediately to prevent the risk of cross-infection among patients (Taylor & Tanner, 2005).

Apart from the above mechanical methods, hair can also be removed by use of chemicals referred to as depilatory chemicals. Their mode of action is that they dissolve the hair, leaving the surgical site clean. This method is practically slow compared to clipping and shaving since the cream is allowed to remain at the site for a t least five minutes and a maximum of twenty minutes (Taylor & Tanner, 2005). Besides this, there is the likelihood of some patients being allergic to the chemical used. The chemical also causes the risk of irritation at the place of application. As a result, it is recommended to carry out patch tests for such possibilities, twenty-four hours before the cream is applied.

Unlike shaving chemicals, clipping and shaving can be done at home, in wards or even in surgical theaters by people with relevant skills. On the other hand, application of depilation chemicals is mainly done at home since its action takes long. Even though hair removal can be done from the surgical room, this is highly discouraged because loose hair can contaminate the sterile surgical environment (Tanner, Moncaster & Woodings, 2007). Moreover, preoperative removal of hair needs to be done by a skilled person to prevent skin abrasions, which may lead to infections.

One obvious thing about shaving is the fact that it leads to tiny cuts and abrasions. These are believed to be entry points for bacteria and other disease-causing micro-organisms. This exposes patients to contracting postoperative wound infections. In addition, abrasions may contribute to oozing of exudates, which provide a convenient medium for the multiplication of pathogens (Tanner, Moncaster & Woodings, 2007). Clippers are considered to be safer as compared to depilatory chemicals and shaving, since clippers do not get in contact with the skin.

Recommended practices

Hair can be removed by use of various methods, which are commonly applied around the world. For instance, the Center for Disease Controls discourages the removal of hair on the surgical site, unless the hair affects the efficacy of the operation (Tanner, Moncaster & Woodings, 2007). However, this view is contradicted by the Norwegian Centre for Health Technology Assessment, which strongly supports preoperative removal of hair. According to this organization, there exists no evidence that supports or condemns removal of hair on surgical sites prior to the operation. The Hospital Infection Society Working Party does not support the removal of hair before an operation is done.

If hair removal has to be done before an operation is carried out, the above mentioned organizations recommend that alternative methods be adopted to reduce the exposure of patients to other infections. For example, CDC recommends the immediate removal of hair using clippers, the Norwegian Centre for Health Technology Assessment recommends the use of clippers or creams as close to the surgical areas as possible and the Hospital Infection Society Working Party guidelines recommend the use of chemical creams, twenty-four hours prior to the operation day (Bratzler & Hunt, 2006).

Surgical Site Infections

SIS is a common healthcare problem in the world today. In a survey conducted in 2006 in the United Kingdom, 4.6% of patients who underwent surgical procedures developed SSIs (Stoessel, 2008). This is definitely a major problem since such infections result into delay in the healing of wounds and are expensive to the National Health Society. The survey further indicated that SSIs result into congestion of patients in hospitals since most of them have to spend more days in hospital. This has a direct impact on the countrys economy as more money is used to support such cases. Another important concern about SSI is the extent to which they affect patients.

It has been found that patients who develop SSI are more likely to succumb to their illness and are five times more likely to suffer from a disease that would require admission in hospital. Additionally, these patients are prone to physical suffering (Tanner & Khan, 2008).

While there is evidence showing the effects of SSI, it is believed that existing findings might be underestimating the problem due to the fact that surgical site investigations are given minimum attention compared to other health complications affecting people in most parts of the world. Consequently, it is essential to understand some of the factors, which contribute to unreliable SSI surveillance. The first explanation is lack of organized survey programs. Many leaders and stakeholders have not laid down proper structures to address the issue of SSI through empirical analysis. Additionally, it is believed that most surveyors lean on a wrong definition of SSI.

As a result, the findings upon which conclusions are drawn do not reflect the situation in different parts of the world (Tanner & Khan, 2008). Lastly, follow-up on patients who have recovered from a surgery is never effective. It is recommended for medical practitioners to find out the health status of a patient, thirty days after being discharged from the hospital or a year if the patient underwent organ transplant.

Risk factors

Like in other infections, there are factors which increase the chances of a person developing SSIs. These factors are classified into different groups: those linked to the surgical procedure, aesthetic and those related to the patient. Importantly, they affect the patients exposure to bacteria and his or her ability to fight pathogens (Stoessel, 2008). On the other hand, the CDC classifies surgical operations depending on their infection risk. In general, SSIs are likely to occur in contaminated and dirty surgery environments than in places where surgery is carried out under sterile conditions. This is based on the fact that the body might contain several bacteria in the digestive system, genital and urinary tract.

Clinical implications

Surgical site infections resulting from preoperative removal of hair have several implications in the medical industry. These emanate from exposure of patients, which may lead to other infections. When patients contract new infections, the cost and duration spent in the hospital may widely differ, depending on the impact of the postoperative infection. On average, these patients spent approximately seven more days in the hospital, causing congestion and competition for resources. Due to these conditions, patients are likely to suffer a lot because of limited resources and attention from medical practitioners. It is therefore clear that surgical site infections have an array of implications (Dizer, 2009).

In dealing with SSIs, most hospitals are advised to improve their hair removal techniques, which cause minimal abrasions and do not expose other people to contracting infections. To achieve this, stakeholders need to acquire better equipment, which are recommended by experts in the field. Apart from acquisition of equipment, training of nurses and other medical practitioners is necessary. Lastly, there is need for sterile and healthy conditions during preoperative procedures (Dizer, 2009). Training would ensure that all the processes meet minimum requirements to prevent the occurrence of surgical site infections. Nevertheless, these developments are necessary in ensuring that patients who undergo surgeries do not pass on because of infections, which are caused by contaminated surgical rooms.

How to improve the procedure

According to the CDC, there is need for healthy preoperative strategies in order to prevent the occurrence of SSIs among patients across the world. For example, effective surgical equipment are essential for the purpose of maintaining the bodys homeostasis and removal of unwanted body tissues and foreign materials as far as possible (Dizer, 2009). Moreover use of sterile drapes, gloves, gowns, caps and facemasks are highly recommended to avoid contamination of the wound.

This minimizes the transmission of pathogens like bacteria in the body through the wound. Sterilization of surgical equipment is equally important in improving the entire process of minimizing the survival chances of pathogens. Besides sterilization and cleanliness, it is paramount to note that some pathogens may remain active at the site even after a thorough process of sterilization. As a result, the use of emerging technologies is important to overcome the challenge of stubborn microorganisms. A good example of this technology is the use of microbial sealants, which lower the likelihood of getting infected by such pathogens (Mangram et al., 1999).

Involvement of stakeholders

In order to realize healthy preoperative procedures and safe operative processes in medical facilities, there is need to involve every stakeholder in the entire process. While doctors and other medical practitioners may hold high responsibility in determining the safety of these processes, all organs have to be consulted (Mangram et al., 1999). For example, the use of sterilizers, good shaving chemicals and proper hair clippers require the input of the government and other donors. This would ensure that the equipment, which are bought meet the required standards. Good chemicals and shaving equipment will minimize abrasions on the skin during preoperative procedures.

Additionally, the involvement of all stakeholders would be appropriate for support. In cases where training of medical practitioners and the public require education on perioperative procedures, it would be easy to implement if every stakeholder is involved. Importantly, stakeholders would need to be convinced in order to ratify change of these procedures. To achieve this, it is essential to let everyone understand the negative effects of existing procedures as compared to benefits of adoption of preoperative and postoperative procedures, which limit the exposure of patients to SSIs (Mangram et al., 1999).

Barriers

There are several barriers and challenges, which are likely to be encountered during the implementation of Evidence-Based Practice. One of these factors is insufficient resources. It is worth noting that these resources include assets and human resources. As mentioned before, perioperative procedures need to be done skillfully in a sterilized environment (Thompson et al., 2005). As an important stage before a surgical procedure, effective equipment and chemicals are quite significant. This ensures that the process does not expose patients to being affected by the nature and status of the equipment used.

Besides the facilities, qualified manpower is necessary. Training of medical practitioners is essential in ensuring that they are equipped with professional skills and knowledge, necessary to lower the prevalence of SSI. Lack of knowledge within the public domain may also be an impediment towards the implementation of safe perioperative procedures (Thompson et al., 2005). Many people do not understand the importance of professional removal of hair before an operation is carried out. In order to tame this situation, there is need for massive public education on issues, which have constantly been ignored. Poor survey on SSIs is also a major barrier towards this change. Most research findings are no reliable, thus affecting the entire process of change.

Conclusion

Perioperative procedure is quite essential in the entire field of surgery. This is based on the fact that most surgeries involve breaking of the skin, which is covered by hair. The removal of this hair is sensitive since it may allow pathogens into the body as a result of abrasions caused on the skin, either by depilatory chemicals or shaving blades. Improper removal of hair causes SSIs, which may be fatal or lead to increase in treatment cost. There is need for all stakeholders to be involved in promoting safe and healthy preoperative procedures.

References

Bratzler, D., & Hunt, D. (2006). The Surgical Infection Prevention and Surgical Care Improvement Projects: National Initiatives to Improve Outcomes for Patients Having Surgery. Infectious Diseases Society of America, 43, 322-330.

Clinical Update. (2008). Pre-operative hair removal to reduce surgical site infection. Australian Nursing Journal, 15 (7), 27-29.

Dellinger et al. (2005). Hospitals collaborate to decrease surgical site infections. The American Journal of Surgery, 190, 915.

Dizer, B. (2009). The effect of nurse-performed preoperative skin preparation on postoperative surgical site infections in abdominal surgery. Journal of Clinical Nursing, 18, 33253332.

Mangram et al. (1999). Guideline for prevention of Surgical Site Infection. Infection Control and Hospital Epidemiology, 20 (4), 247-278.

Small, S. (1996). Preoperative hair removal: a case report with implications for nursing. Journal of Clinical Nursing, 5, 79-84.

Stoessel, O. (2008). Surgical site infections: epidemiology, microbiology and prevention. Journal of Hospital Infection, 70 (2), 310.

Tanner, J., & Khan, T. (2008). Surgical Site Infection, Zone preoperative body Washing and hair removal. Journal of Perioperative Practice, 18 (6), 232-241.

Tanner, J., Moncaster, K., & Woodings, D. (2007). Preoperative hair removal: a systematic review. Journal of Perioperative Practice, 17 (3), 118-132.

Tanner, J., Norrie, P., & Melen, K. (2011). Preoperative hair removal to reduce surgical site infection. Cochrane Database System Review, (11), 1-50.

Taylor, T., & Tanner, J. (2005). Razors versus clippers. British Journal of Perioperative Nursing, 15 (12), 518-523.

Thompson et al. (2005). Barriers to evidence-based practice in primary care nursing  why viewing decision-making as context is helpful. Journal of Advanced Nursing, 52 (4), 432444.

Introduction

In todays society, people have changed their mode of dietary intake due to the fact that they are so busy with other demanding life activities. The change in dietary intake has resulted in health issues. Diabetes, heart diseases, obesity and such others are caused by the change in dietary intake (National Health & Medical Research Council, 2006).

Todays society is highly knowledgeable, but in spite of this, people are faced with frequent chronic diseases that hinder them from performing well in society. This is due to the fact that they are not taking into consideration the importance of a healthy diet. People tend to stick to one diet that contributes to the deterioration of health. People are today realising the consequences of this (Zimmet & James 2006, p.21). If the knowledge gathered from health studies is made public, attitudes towards health will change, and people will begin to adhere to a balanced diet (Boyle et al. 1993, p.25).

Core Food Group (1994) model and the national health and medical council have suggested adequate possible models for daily food intake to ensure that people of Australia include the correct food proportions in their diet. The models use several methods to address the issue of dietary intake, which include both the three days as well as the 24 hours model to monitor dietary intake. All these methods aim to help individuals to take a diet that contains the nutrients needed on a daily basis. The 24 hours, as well as the three days model, was meant to make sure that if a certain crucial meal is not taken in the 24 hour period, the three day period will save the situation.

This report is intended to bring into focus the nutritional status of the author based on a 24 hours as well as a three days record. It is also to analyse the excess, deficiency and variance in the recorded results. The report will determine whether the author has consumed the recommended amount of all food categories. The 24 hours and three days records will be the focus of the paper in reporting the results according to the recommended dietary intake (herein referred to as RDI).

Methods

The report is based on an analysis of data recorder from a 24 hours recall and a three-day record from a male aged 26 yrs who has a height of 163cm and weighs 60.00kg. The author is categorised as a low active person and has a BMI of 22.58. The recommended weight is 53 kg-66.4kg based on a BMI range from 20 to 25. The analysis has been done through a comparison of data from the 24-hour record and the 3-day record with Dietary Guidelines (NHMRC, 2003) and the Core Food Groups (1994) (DCSH, 1989-95). Data from the two records have also been compared to identify any similarities or differences. Lastly, the effectiveness of each method is analysed in relation to associated limitations and advantages. The conclusion is drawn from the overall analysis.

Results

Table 1: Comparing the Days Nutrient Intake with the Recommended Dietary Intake (RDIs) in Australia for Each Subject.

Table 2: 3 Days Intake.

Table 3: 24 Hours Record.

Table 4: Comparing the Three Days Record with the Recommendation of the Dietary Guidelines NHMRC (2003) Based on Food Categories.

Table 5: Comparing the 24 Hours Record with the Recommendation of Dietary Guidelines NHMRC (2003) Based on Food Categories.

Table 6: Comparing Three Days Record with Core Food Groups 1994 Based on Nutrients and Food Categories.

Table 7: Comparing 24 Hours Records with Core Food Groups 1994 Based on Nutrients and Food Categories.

Table 8: Comparing Three Days Record with NHMRC Report 1992b on the Role of Polyunsaturated Fats in the Australian Diet.

Table 9: Comparing 24 Hours Record with NHMRC Report 1992b on the Role of Polyunsaturated Fats in the Australian Diet.

Discussion

The dietary intake from the results has various implications ranging from underutilisation of some nutrients and over utilisation of others. In some cases, nutrients have been balanced as required by the National Health and Medical Research Council. The record of food intake comes from the authors dietary intake in the 24 hours and the three-day records. All these have some consequences on the subject which they are going to be analysed.

Comparison the subjects three days intakes with the RDI value

The subject is not taking the right amount or proportions of food when the results are compared with the RDI value. For example, in table 1, the protein, energy and carbohydrates consumption is below the RDI recommendations. Protein is below the RDI value, which is supposed to be 64g as opposed to 54g, which the subject consumed. Protein composition in the body is very important since it allows the body to maintain the correct mechanisms to keep the body fit (Cashel & Jefferson 1994, p. 23).

Water and fibre intake in the subjects record is also below the RDI stipulations. It is too dangerous for any person to take these elements in low quantities. Water is essential for digestion and transport in the body. It helps in the absorption of nutrients by the body (National Heart Foundation of Australia [NHFA] 1990). Fibre also is very important since it allows for efficient digestion and absorption of food in the body.

Low intake of these elements will inhibit the absorption of essential nutrients in the body, which may result in chronic diseases like diabetes (English & Lewis 1991, p.25). Another fact is that the situation encourages lower energy intake with calories below 50%. The Department of Community Services and Health [DCSH] (1989) warns that such an imbalanced diet is the major cause of chronic diseases.

Hypertension is a disease characterised by high blood pressure. Obese individuals have higher chances of suffering from the disease because of the accumulation of fats in the blood vessels creating pressure during the pumping of blood in the entire body (NHMRC 2006). Na is an important element in the body where it performs different functions. However, the RDI value for Na is two times more than the required value, which is 920g. This inhibits the kidneys as well as the heart from ejecting the unwanted liquids from the body. If the fluid is retained in the body for so long, the heart will have problems in pumping blood, thereby causing high blood pressure (NHMRC 2006).

Comparison between the Authors 3 Days and 24 Hours Records and the Dietary Guidelines

People living in Australia have their dietary regulations controlled by NHMRC. This organisation ensures that people embrace healthy eating habits by recommending suitable guidelines that are supposed to be followed. The guidelines also ensure that the prevalence of chronic illnesses is reduced by helping people adhere to healthy eating habits (NHMRC 2006).

Table four illustrates that the three days record (as compared to NHMRCs recommended intake) is not sufficient enough for a balanced diet. For example, the table illustrates food categories and age with the correct food proportion for each category. However, the subjects record for the three days has not achieved any of the recommended guidelines as far as the serving is concerned. All food categories are below the serving that is required. For example, the recommended 4-9 serve has not been met in the subjects three-day intake in the cereal category. Vegetables, fruits and other food categories (except beverages) have not been met according to the NHMRC guidelines (NHMRC 2006).

In table five, the authors food intake is presented on a 24 hours basis, where the intake is compared with the NHMRC recommendations. The trend is the same as the others as the table illustrates the imbalanced food serve amounts, with the beverage being the only food category falling within the stipulated NHMRC recommendations. Although the author has consumed a good amount of cereal, the serves fall below the recommended guidelines. This imbalanced diet is a great contributor to chronic diseases that are caused by insufficient amounts of food. All days activities require that individuals take the right amount of food categories in order to be safe from illnesses as well as to enhance the healthy development of a person (Greenfield 2003, p.7)

Other minerals like Ca, Fe and P plays an important role in the body. For example, Ca enables one to have strong bones, and according to the results above, the mineral is below the RDI value, and this may be problematic for the bones. Fe and K are also below the RDI value, which exposes the author to a myriad of risks. On the other hand, minerals take time before they are excreted from the body. The author had within the 24 hours, and three-day span consumed potassium and zinc, which may make him vomit and experience consistent headaches. Zinc has even been shown to slow down the absorption of the other minerals, and when taken in excess, it may lead to a diminished immune system (Greenfield 2003, p.9).

Vitamins too play a significant role in the body. If they are taken in low quantities or in surpluses, they may put the author at risk. For example, riboflavin, Thiamine and Niacin are above the RDI value. Vitamins tend to take long during absorption, and metabolic reaction is low as well, which lowers other reactions in the body. This poses a threat to the body if they are retained for long. They tend to reduce blood thickness. This effect can lead to health complications if the ratio of vitamins is not taken into consideration (Jellife 1966, p.23).

Comparison between Two Methods of Nutritional Assessment with that of the Core Food Groups 1994

The 1994 guidelines were put in place to ensure that individuals take in the required amount of energy. This is according to the 1994 food groups, which provides specific recommendations based on different age categories. Sex was also an issue of concern where each person (male or female) is supposed to take the correct rations of food to avoid problems arising from nutrients deficiency. Different sexes require different food rations, and the core food group was published in 1994 to address this issue. The aim was to complement the RDI requirements as opposed to deviating from the recommended food values.

Three models have been established to meet the stipulated food requirements. These are models A, B and C. Model B was established on the basis of the other models putting together the information contained in the other two. This is evident when a pattern of food consumption is the same in model A as well as in model B. Table six explains it all. The three days consumption (in comparison with the 1994 food groups) shows that cereals intake is higher, postulating a close relationship with the 24 hours table. Therefore both tables reflect a close relationship between the two food categories.

Other food categories like milk and fruits are below the postulated requirements, and this is inconsistent with the correct food consumption in both the 24 hours and the three days records. But a close observation shows that milk consumption is consistent in both tables (24 hours and three days). These are both table six and table seven. Additionally, a grim observation is made in the same tables as consumption of sodium is very high. This increases the risk of developing conditions such as hypertension. Intake of other valuable minerals in the tables is very low. For example, zinc, which is very important, is below the RDI provisions.

Comparison between the Three Days Record with NHMRC Report 1992b and the Role of Polyunsaturated Fats

When the consumption of fat is higher than the intake of energy, the individual is likely to experience health complications. This means that a high intake of fats is a health hazard (Jellife 1966, p.25). Additionally, when the body uses fats to create energy, this contributes greatly to the emergence of chronic diseases like hypertension, obesity and diabetics. In Australia, this problem was addressed by recommending the reduction of total fat intake by 7% from the initial intake, which was 37 %. Total energy was reduced too by 5%, which led to the reduction in polyunsaturated fat.

The NHMRC has recommended the use of carbohydrates and monounsaturated fats instead of fatty acids (NHMRC 2006). Generally, when people use fatty acids, they may exceed the 30% mark, which is dangerous to them. The results from the table show that the author has consumed high energy fatty acids. This shows that the diet is a risk to health and creates uncertainties as a result of the high percentage of fat consumption (NHMRC 2006).

Table nine, on the other hand, shows the 24-hour record with the polyunsaturated fat at 4.8%, which is below the recommended value of between 6-7%. The saturated fat is above the recommended value, which is 12.1%. This is beyond the recommended 10% mark. All these incorrect intakes of energy and fat can lead to health complications and need to be rectified.

Importance of the Two Assessment Methods

All two criteria are very important in ensuring that the individual takes the correct amount of nutrients. The good thing with the 24 hours record is that it reminds the individual what they ate just a few hours ago. The three days record, on the other hand, helps an individual to keep a record of the quantity, type and kind of food they eat. However, the three-day record does not give an account capable of reminding the individual what they ate a few hours ago, like the 24 hours record (Marr 1971, p.36).

Both categories of nutrients records are important, but the consumption of food varies from one table to the other (Hewlett 2011). This is simply because the consumption of food in the records is determined by the interest of the individuals. The author had to consume different kinds of foods in the three days record. This is especially so when an individual undertakes different kinds of physical activities that need different foods (NHMRC 2006).

The Need to Modify the Diet

The author is a male aged 26 years with a height of 163cm and a weight of 60kg. The recommended weight ranges between 53kg and 66kg with a BMI value of 20 to 25.

The authors weight falls within the required range, but since they are not very active, the diet needs to be modified by strictly adhering to provisions of both assessments to make sure that the author does not omit any of the required nutrients. As the values in the tables illustrate, the author needs to increase the intake of water as well as that of fibre. This seems to affect the author since they are not consuming enough of these important components. The authors anthropometric measurements, which are shown in the table, are important when recommending the correct composition of food intake that best suits them.

Conclusion

It is noted that there are differences in the criteria used in both records. These include the food categories that were not consumed in the 24 hours record but which were later consumed in the three days record. The smaller one day record is limited as it does not give room for consumption of all food categories. However, the three days record provides room for different food categories. The most important thing about the 24 hours record is that it is an effective means of assessing the correct intake of food on a daily basis (Jelliffe 1966).

Both of these methods are very significant as they ensure that the variations in food consumption are well taken care of. The author seems to be within the RDI range, but appropriate dietary measures should be taken to ensure that the person remains healthy. NHMRC provides that there is a need to increase the consumption of elements like zinc, potassium and sodium. Saturated fats, on the other hand, should be taken in small quantities (between 6 and 7 %). Adequate intake of water and fibre is another factor that should be taken into consideration by the author.

References

Boyle, CA, Dobson, AJ, Egger, G & Bennett, SA 1993, Waist-to-hip ratios in Australia: a different picture of obesity, Aust. J. Nutr. Diet, vol. 50 no. 1, p. 57-64.

Cashel, K & Jefferson, S 1994, The core food groups: the scientific basis for developing nutrition education tools, NHMRC, Canberra.

Department of Community Services and Health, 1989, Composition of foods, Australia (COFA), AGPS, Canberra.

English, R & Lewis, J 1991, Nutritional values of Australian foods, AGPS, Canberra.

Greenfield, H 2003, Food composition data.: production, management and use, FAO, New York.

Hewlett, J 2011, The role of polyunsaturated fats in the Australian diet, AGPS, Canberra.

Jelliffe, B 1966, The assessment of the nutritional status of the community, WHO, Geneva.

Marr, J 1971, Individual dietary surveys: purposes and methods, World Rev. Nut. Diet. vol. 13 no. 1, pp. 105-164.

National Health & Medical Research Council, 2006, Nutrient reference values for Australia and New Zealand, including recommended dietary intakes, AGPS, Canberra.

National Heart Foundation of Australia, 1990, Risk factor prevalence study: survey no. 3, 1989, NHF, Canberra.

Zimmet, P & James, W 2006, The unstoppable Australian obesity and diabetes juggernaut. What should politicians do?, The Medical Journal of Australia, vol. 185 no, 2, p. 187-188.

Introduction

Coronary Artery Bypass Graft (CABG) is a type of surgery performed to increase the efficiency of the flow of blood to the muscles of the heart. It is used to decrease the risks of death caused by coronary artery disease. Blood vessels are removed from other areas of the victims body and used to replace the damaged arteries.

These arteries of the heart are referred to as the coronary arteries. This is mainly done to create new routes in areas where the arteries had narrowed or blocked up (Smeltzer, Bare, Hinkle, & Cheever, 2008). This allows enough blood to flow through it and supply blood rich in nutrients and oxygen to the muscles of the heart, which is referred to as the myocardium.

Overview of the disease

The CABG surgery is necessary when a patient is suffering from coronary artery disease (Glenn, 1972). This is mostly done on a heart that is not pumping blood. This calls for the use of a cardiopulmonary bypass. However, there are techniques that can be employed to perform the same surgery on a beating heart. When this is done, it is referred to as an off-pump surgery (Shroyer et al., 2009).

This disease occurs when the arteries harden and build up within the walls of the coronary arteries. This hardening is what is referred to as atherosclerotic plaque. The plaque is mostly made of cholesterol. Some habits or diseases may accelerate the amount of accumulation in the arteries (plaque). For example, habits such as smoking may accelerate the effect. Diseases and conditions such as high blood pressure, diabetes and elevated cholesterol may work in a way as to accelerate the accumulation effect.

Age is a determining factor when it comes to this disease. Men of ages 45 and above and women of ages 55 and above are at higher risk. This disease causes certain changes in the normal functioning of the human body (pathophysiology) but treatment is available. Patient education is also necessary when it comes to those suffering from coronary artery disease (CAD).

Pathophysiology

Since the arteries become narrow, there is a limited amount of blood that flows into the heart. This causes ischemia, which is the starvation of the cell from lack of oxygen. The cells that suffer in this case are the myocardial cells. They may eventually die when they lack oxygen for a substantial amount of time.

When this occurs, this is referred to as myocardial infarction. This is commonly referred to as a heart attack. This leads to the damaging of the heart muscle. Consequently, it leads to the death of the heart muscle. Myocardial scarring occurs and this may cause the heart muscle not to grow again (Glenn, 1972).

In cases where the arteries have constricted to a high degree, this leads to the induction of ventricular arrhythmia. This may cause ventricular fibrillation, which is deadly (may lead to death). The sudden blockage of a blood vessel (coronary artery) leads to myocardial infarction. This usually occurs when a plaque ruptures. This causes the activation of the process of clotting and this causes the blood vessel to close suddenly. The reason why the plaque raptures have not been understood clearly despite the many theories that have been developed.

The plaque that forms within the artery appears like a large pimple. This causes a partial obstruction of the vessel. This plaque is mostly made out of deposits. These deposits may consist of calcium, inflamed cells, and fats. In cases where calcium phosphate is deposited within the muscles of blood vessels, this may cause two things to happen.

First, it causes the stiffening of the arteries. Secondly, it causes the early stages of coronary arteriosclerosis. This is evident in the calcification that occurs in patients suffering from chronic kidney disease. Despite the patients suffering from chronic kidney disease, 50 percent of all deaths are due to CAD.

Treatment of Coronary artery disease

There are medicines that are available to treat angina. This reduces the demand for oxygen by the heart muscle. This is necessary to compensate for the reduced blood supply caused when the coronary arteries constrict. There are three main classes of drugs used to treat coronary artery disease. They include calcium blockers, beta-blockers, and nitrates. An example of nitrate is Nitroglycerin. Propranolol and atenolol are examples of beta-blockers. Nifedipine and nicardipine are examples of medicines in the category of calcium blockers.

Aspirins may also be used in the treatment of angina. Intravenous blood thinner heparin is also useful in this treatment. Since clotting of the blood may be deadly when it comes to coronary artery disease, a medication that prevents the clumping of platelets is necessary. Aspirin plays an important role. In order to prevent blood clots from occurring on the surfaces of the plaques, heparin is used. This prevents the narrowing of the arteries to critical stages.

However, patients with CAD may continue to have angina even when all these forms of medication have been administered. Patients may also show signs of significant ischemia. In such situations, coronary arteriography is used. The data collected gives the doctors enough information to decide whether the patient requires percutaneous transluminal angioplasty (angioplasty). This is whereby a balloon-like structure is inserted to inflate the artery and remove the blockage.

If all forms of medical therapy fail (including angioplasty), CABG surgery is performed. This is especially important when a patient has multiple narrowing in several branches of the artery. This surgery has been determined to improve long-term survival in patients. This is especially when it comes to those who had significant narrowing of the main coronary artery. This also significantly helps those whose heart muscles had decreased in pumping functions.

Nursing interventions

The nurse should constantly monitor the heart rate and the patients blood rate when it comes to angina episodes. Nitroglycerin should be kept close to allow for immediate use when the need arises. During nursing care, the nurse should record the duration of pain. It is also necessary to record the amount of medication necessary to relieve the pain and the symptoms that accompany the medication should be put down. If the patient is scheduled for surgery, it is important for the nurse to explain the procedures to the patient (Hannan, 2008).

Patient educational handout

Medication

The doctor may recommend cardiac rehabilitation through medication. This may apply for both angina and after CABG has been performed. When surgical treatments are combined with medication, the recovery of the patient may be faster (Hannan, 2008). It is important for the patient to understand the importance of the medication and ensure that he or she has finished the dose.

Activity

The patient should be encouraged to make lifestyle changes in order to help prevent or treat CAD. This includes the following of a heart healthy eating plan. This helps prevent or reduce high blood cholesterol high blood pressure. One should also be encouraged to increase the physical activity in order to maintain a healthy weight (Tung et al., 2010).

However, it is important to confirm with the doctor what kind of activity and how much of it is healthy for your condition. One should also quit smoking if one is a smoker. Avoiding secondhand smoke is also vital because the effect is the same. Learning to cope with stress is also vital for such patients.

Post op teaching

Every individual who has undergone a coronary artery bypass graft surgery recovers at a different rate. This may take between 6 to 8 weeks. During this time, it is important for the patient to maintain contact with the doctor. The instructions that would be provided would include general postoperative instructions. Others include information of how to get the family involved and information about sex after surgery.

Discharge teaching

As the patient is discharged, he or she is made to understand that the recovery is still a long way to go. This would mean that the patient keeps in touch with the doctor and continue with the medication provided. The patient will also be advice to maintain a healthy lifestyle.

Conclusion

Coronary artery bypass graft is a procedure that is done on patients suffering from CAD. It involves taking portions of arteries from other parts of the body to the coronary artery. This helps to replace the areas of the coronary artery that had blocked. This improves the flow of blood to the heart muscle. Several types of medication exist but surgery (CABG) is necessary for chronic conditions. After surgery, the patient is provided with vital information (education) that helps the person lead a healthier life in order to eliminate risks of coronary artery disease.

References

Hannan, E. (2008). Drug-eluting stents vs. coronary artery bypass grafting in multivessel coronary disease. N. Engl. J. Med., 358(4), 331-341.

Shroyer, A., Grover, L., Hattler, M., Collins, D., McDonald, O., Kozora, E., &Novitzky, D. (2009). On-pump versus off-pump coronary artery bypass surgery. N. Engl. J. Med., 361, 1827-1837.

Smeltzer, S., Bare, B., Hinkle, J., & Cheever, K. (2008). Brunner & Suddarths Textbook of medical surgical nursing (12^th ed.). Philadelphia: Lippincott Williams & Wilkins.

Tung, H., Chen, Y., Wei, J., Liu, C., Chang, C., & Wang, T. (2010). Leisure physical activity and quality of life after coronary artery bypass graft surgery for patients with metabolic syndrome in Taiwan. The Journal of acute and critical care, 39(5), 410-420.

Introduction

Nursing is a form of vocation that needs specialized knowledge, skills, and adequate preparation. From my past personal experiences in life, I learned vital lessons that I believe will assist me to interact appropriately with patients/clients. This paper discusses my life experiences and how I developed them prior to nursing/healthcare as the chosen profession. Additionally, it illuminates how those issues may help (positive) or hinder (negative) my future relationships with patients.

The discussion presents personal reflections in life and their importance to my future career as a nurse, my future relationship with clients, and the merits as well as the inconveniences that are bound to occur to me through this interaction. Moreover, it presents the different ways (plan for overcoming negative effects) through which I will be able to handle the situation or enhance my relationships with clients.

Personality Traits (courteousness and humility)

Personally, I previously developed several personality traits prior to my profession as a healthcare practitioner. It is crucial to note that these traits will influence my future relationships with clients in a positive manner. When I was still young, I developed the aspects of courteousness and humility.

I had been interacting with sick people at home. Additionally, my personal interactions with people suffering from different illnesses helped me to develop the mentioned personality traits. I realized that sick people need some exemplary courtesy and humility for their psychological well-being. Having realized this provision at a personal level, I vowed to remain polite and humble to patients regardless of the nature of their illnesses.

Evidently, these will assume prominent roles in shaping my ambitions for the nursing profession in the future. For example, most of the sick persons I previously met were terminally ill and always viewed life pessimistically. I indulged positively in their lives and gave them hope as well as encouragement.

These helped me to develop some aspects of courteousness and humility as indicated earlier. Such initiatives have inculcated in me the senses of empathy and sympathy, counseling as well as guidance. I believe that in the future as a practicing nurse, I will be able to enhance these skills through training and real-time experiences.

These traits will also enhance my key competencies as a future professional nurse. Agreeably, handling anxieties from patients as well as from his familys side had been the most tasking event. In this context, I believe my personal nature as a polite and humble person will enhance my effective performance and client relationship. Additionally, my religious values have enhanced my humility and politeness. From the struggles I underwent during my growth, I shall come to relate well and professionally with all my clients.

I shall also appreciate the role of counseling in nursing care to all my clients. Based on these traits, my interactions with clients will be focused more on finding and analysis of their route problems, respect for their decisions as well as consultations with their family members.

Having developed such personal traits previously, I shall be able to enhance and integrate courtesy, humility, and counseling skills into my relationship with the clients. This initiative shall also assist clients to note and cope with distressful psychological and social challenges. Moreover, it shall help to develop and enhance their interpersonal associations.

Additionally, I will be able to focus on assisting clients to adopt novel attitudes, positive feelings as well as constructive behaviors. It is apparent that the ability of a client to consider alternative behaviors and identify options helps them to develop their sense of logic or control (Kim, 2010). I have noticed the urge to transform the systems within healthcare-providing institutions to be able to accommodate the clients needs in the future.

Empathy and Fearlessness

There are core attributes and traits that all nurses must have to professionally practice. Previously, there are some conditions that forced me to develop courage and empathy towards sick people. Luckily, I formerly interacted with several patients as well as their family members, an instance that enabled me to adopt critical lesions within the nursing process. For example, I come across a critical road accident, which left several casualties grieving in agony, pain, and despair.

Several passengers had died instantly while others were to be ferried to the hospital to save their lives. Since there were no specialized people to help, the few witnesses who were present (including myself) had to participate and save the lives of the casualties despite the condition. Having developed some empathy and ethics, I had to be courageous to help in the situation. This indicates how I had developed and realized the importance of empathy, ethics, and boldness in the clinical context.

In essence, these form some of the basic elements within nursing care. Compliance and practice of the basic professional code of ethics, empathy, and courage within nursing is an important recipe for the effective nurse-client association. For example, a typical instance of the relationship between a nurse and a terminally ill patient is critical.

Another instance that made me develop empathy, morals, and courage in the clinical context is my personal interaction with a terminally ill cancer patient. Respect and courtesy that I developed over time formed important attributes towards effective relationships with patients. From these virtues (previously developed), I shall be able to respect the existence and rights of patients.

For example, upholding the health standard of patients, respecting their humanity and existence are critical. The interchanging nursing roles require more flexibility and open mindedness. This is because one is not meant to entirely deal with a particular type of client with a specific illness or health deformity.

Consequently, I believe my noble experiences will play a critical role in enhancing my relationships with clients as a nurse. Since I will be working in a hospital environment, I will be meeting with clients who are tensed and anxious regarding the status of their health. Moreover, I am also aware that I will not just be interacting with the patients but also family members or caretakers to the sick person. Empathy, courage, humility, patience, close contact as well as courtesy and love are vital ingredients for effective relationships between a nurse and the client.

These virtues will enhance my relationships with clients. For example, these are vital attributes that I have come to learn, adopt, and practice due to my daily life interactions at school, home, and other social places. In this respect, it is important to note that nursing involves sacrifice and commitment to healthy living. It forms the main spring board of the nursing practice. Personally, there had been many occasions that these vital nursing attributes were put to test by meeting diverse people in life. I believe that these past experiences will immensely enhance my future interactions with my clients when I become a qualified nurse.

Fear

Previously, I was fearful in various aspects. It was impossible for me to visit, touch, or talk to the sick regardless of the condition. I used to think that by doing so, I would contract similar ailments. This was a prejudicial reasoning. Its continuity could ruin the affectivity of my participation as a professional nurse. I could not take time to counsel and listen to the patients grievances.

Additionally, due to fear, I could not comprehend that the hospital or healthcare providers have capitalized mostly on clinical conditions, treatments, and also recognizing the psychological and social implications of clients. Fear has proved to be a potential barrier towards effective interactions with sick patients. Most health practitioners might not be able to practice their mandates due to fear and other negative provisions. As a result, they will not address the problems or concerns of their clients.

For example, it is observable that fear among nurses has led to several implications on the nurse-client relationship. As a result, the interactions become compromised due to apprehension. This is applicable from my past experience. The situation interferes grossly with the client-nurse interaction. Approach, active listening, counseling, empathy, and giving pieces of informed advice do not adequately occur in such scenarios.

The health status of the client is a vital consideration in effective interactions between the client and the nurse. For example, it is obvious that not much of interactions can occur between a harshly ill client and the nurse due to fear. This is basically due to physical incapability and the need for prompt medical attention.

My Plan for Overcoming Negative Effects

The negative effects of fear and other provisions mentioned earlier can be alleviated through various means. As a future professional nurse, my interactions with diverse clients and personalities will enable me learn critical lessons that will assist me in dealing professionally with diverse patients within different contexts (Chism, 2013).

For that matter, undertaking relevant studies on the matter will help considerably. The lessons will be critical since I will be able to brainstorm on more rationale ways of handling the observed negative effects. Foremost, I will learn to ultimately observe the notable nursing roles as well as professional ethics. Assuming the roles of a teacher can equally help (Kim, 2010). This attribute will offer information that might assist clients to learn and obtain novel coping skills.

Adequate education will assist in compliance to the prescribed medication, enhance healthy lifestyles, instill ethics, thwart fear, and provide fundamental information to the health practitioners.

Another plan helpful in overcoming the mentioned negative effects is to pay attention to clients grievances in order to articulate and communicate their feelings. Being a change agent as a future nurse is critical in enhancing such roles (Freshwater, 2002). The ability to evaluate care as well as personnel enables the nurse to set up appropriate systems for effective client nurse relationship or interaction.

Conclusion

My previous experiences allowed me to develop personal traits including empathy, humility, courage, politeness, courteousness, and other positive virtues that will enhance my future interaction with clients in the clinical realms. Negative factors like fear are devastating to the nursing career; nonetheless, it is possible to develop a plan that will help in overcoming their off-putting effects. The daily life experiences will enhance my skills, develop my problem resolution competencies, and also transform my career ambitions.

References

Chism, L. (2013). The doctor of nursing practice: A guidebook for role development and professional issues. Burlington, MA: Jones & Bartlett Learning.

Freshwater, D. (2002). Therapeutic nursing: Improving patient care through self awareness and reflection. London: SAGE.

Kim, H. (2010). The nature of theoretical thinking in nursing. New York: Springer Pub.Co.

Abstract

The purpose of this project was to compare the dental practices that are carried out in Taiwan, Cambodia, and Australia. My major focus as I carried out this project was based on; the level of infection, the type of control and treatment provided, and the quantity of workload per dentist. To be able to collect all the data required, I had to travel to Cambodia, Taiwan and Australia. This was necessary in order to collect primary data from my target population.

Most developing countries governments have challenges meeting the health needs of the common citizens, especially the majority of the common population which makes up most of the population. In this research work, we examine the state of dental health in Taiwan, Cambodia, and Australia and compare the state of dental health in these countries.

I used several methods of collecting data. They included; note-taking, observing their dental clinics, interviewing local dental officers, video recording, inspecting their medical records and using questionnaire forms that were filled by the dental officers. Through these methods, I was able to collect and store sufficient data for analysis and sequentially make relevant assumptions on my research findings. I was able to collect appropriate data that can be used to make relevant comparisons.

On completion of my research work, I was able to conclude that, both Cambodia and Taiwan compromise their level of infection control. However, there were various factors that dictated their decision. For example, lack of dental medical supplies and extremely high numbers of patients as compared to the number of medical staff. Apart from that, there were major differences in the type of dental treatment methods used in these countries.

In Taiwan and Australia, they practiced preventative and conservative dentistry. However, Cambodia clinics mainly provided services such as extractions and simple fillings. I noted that, dental staff worked for long hours in Taiwan and Cambodia and saw more patients per day than in Australia.

Description of Elective Project Placement

I spent my first elective placement in Cambodia under the supervision of Dr Li. During the first one week we practiced in the local dental clinic, when we could get some free time we would go to nearby schools to promote oral health among students. At this time I noticed the lack of equipments, dental resources and oral health education to Cambodian children. Most of the children have caries in their front tooth and practice very poor oral hygiene. I offered a helping hand to Dr Li as she performed dental treatment on many of these children.

While Dr Li performed treatment such as extraction of carious deciduous tooth, fillings of first permanent molars, scaling and cleaning of teeth, I assumed the role of dental assistant. I would perform duties such as; suctioning of saliva and water, handling of medical material and explaining tooth brushing instructions to students. I discovered that, there were only a few dentists in the province, and very scarce clean fluoridated water and dental resources. All these factors contributed to very poor oral hygienic conditions of Cambodian children.

There was an argent need for the oral health condition of Cambodian children to be improved by the government. The government can also fund to train more dentists, purchase dental equipment and resources. In case there are insufficient funds to support the project, the government can call on the international community for support. This can be achieved by making donations and sending volunteers to the local non-profit organizations in Cambodia.

In December 2011, I spent another six weeks in the Taiwan National University Hospital in Taipei. In the first four weeks I was in the oral surgery department in the dental faculty. During these four weeks, I enjoyed a great time building relationships with the dental staff in the hospital and observing their dental practices. At the same time, I had an opportunity to witness their surgical procedures in their operating theatres. For instance, I had a rare opportunity to observe the removal of oral cancer and neck lymph node clearance in some patients.

The dental staff worked long hours each day however, they demonstrated great surgical skills and excellent communication skills to patients. Among the different procedures that I encountered include; wisdom tooth extractions, implants, squamous cell carcinoma diagnosis and resection, cryotherapy, incision biopsies and impacted supernumerary tooth removal. Furthermore, I spent another two weeks as a volunteer in hospital wards.

Under the guidance of the head nurse, I helped the hospital staffs with surveys, data entry, and filing power point presentations. Overall, I gained valuable experience in my placement at this hospital and noticed various variations in the way they practice dentistry from Australia, Cambodia to Taiwan. More importantly, I have been able to established strong relationships with my supervisors and colleagues.

Analysis and Evaluation of Learning Agreement

Initially before I started my elective placement, I hoped I could experience overseas dental practice by travelling and being involved in their dental care. I set out the goal of broadening my knowledge with a wide range of experiences in different countries and to compare the differences in practices amongst Taiwan, Cambodia and Australia. I wanted to focus specially on variances in the level of infection control, type of treatment provided, dentists workload and fatigue, and levels of dental training in each country.

Infection Control

During my placements in both Taiwan and Cambodia, I spent a significant amount of time observing the level of infection control in these countries. I noticed that while both Cambodian clinics and the Taiwan National hospital attempted to achieve high levels of infection control, there were significant flaws in the protection of both dentists and patients in both countries. In the Cambodian clinics I visited, both dentists and patients used basic protective equipment such as goggles; masks, gloves, and gowns during treatment.

Furthermore, they sterilize all their equipment and do their best in wiping down working area after each patient has been attended to. However, there were still areas of concern in the effectiveness of infection control in the clinics. For instance, due to the lack of resources, the sterilizing machine was never checked for its effectiveness.

As a result, it was not clear whether equipment were sterilized properly or not. Also due to the inadequate level of dental supplies, dentists rarely change their masks in Cambodian clinics. This may lead to major cross contamination across patients. Similarly, there were serious concerns in the level of infection control in the Taiwan National Hospital. I noticed that the dental staff was routinely under a very high workload.

They often had very short breaks and looked after more than thirty patients a day. In order to work faster and be more efficient, they significantly compromised their standard of infection control. For example, dental staffs often failed to use gloves during routine examinations to save time but used gloves while doing other procedures.

Perhaps this was because they believed the risk of disease transmission was low under routine examinations. In addition, staffs rarely changed masks and did not offer patients eye protections during procedures. Another important aspect is that, wiping of working area is almost non-existent in the dental hospital.

These practices raised my concerns and I believed staff has become accustomed to these habits in order to save time and to see more patients. Each day there was a long list of patients booked in for every staff. Consequently, they had to work faster at the expense of proper infection control to treat every patient in the same day.

All dental staff aware of infection control protocol yet they failed to practice safely. At times staff ignored infection control procedures only for their own convenience. For instance, a dental staff ignored to wear eye protection, while performing neck lymph node clearance during an operation for an oral cancer patient and risk transferring body fluid into his eye. At other times, they fail to report and perform blood tests after being pricked with a needle. It is obvious that significant retraining is required in order improve their awareness in infection control.

Main Treatments Provided and Workload of Dental Staff

In Cambodia, there is a tremendous lack of dental material, equipment, and staff, which limits the type of treatment accessible to patients. On the other hand, patients are often faced with a significant level of pain and grossly carious teeth. In most cases, the priority is to relieve pain with limited resources. As a result, most treatments offered are either simple tooth extractions or filling. This is relatively simple and achievable given the limited time allocated to each patient.

Ironically, staff in the Taiwan National Hospital has resources and training to support a wide variety of treatment options that are similar to Australia. During my short stay, I observed a few implant cases, endodontic, restorative, wisdom tooth extractions and oral cancer cases. I will point out that there is a relatively high incidence of oral cancer and oral submucous fibrosis cases in Taiwan due to betel nut chewing. In addition to that, prophylactic removal of wisdom tooth without any associated symptoms or pathologies is a common practice in Taiwan.

The Taiwanese government supports National Health Insurance cover for many health care treatments for citizens. Some of them include numerous dental treatments such as restorative, endodontic, and wisdom tooth extractions. This has made preventative and restorative dental treatments much more accessible and increases the number of prophylactic wisdom tooth extractions. Dental staffs were trained in professional dental schools for six years after high school entry.

Each day, staffs are usually overbooked with an overwhelming number of patients that result to very late working hours and short breaks. As a result of a very high level of workload the breaks given to them is rendered insignificant. What is required is for the government to look for ways to hire more doctors and improve on disease control measures. This may reduce the level of work load. At the moment the situation is very unpleasant as the doctors keep on treating more than they can handle.