All of the ANA Code of Ethics provisions seem exemplary and essential, but the third one is nearest to my values. It emphasizes the critical role of the nurse in promoting and protecting the rights and health of the patient (Gurney et al., 2017). The patient entrusts his life to the other person, and therefore nurse must be responsible for his comfort and provide the necessary care, regardless of his nationality, faith, age, or belief. The fundamental responsibility of the nurse includes four components: to promote health, to prevent disease, to restore soundness, and to alleviate suffering. She must maintain the highest level of care possible in a particular situation and ensure that no one is harmed.
I am guided by the duty to provide care at the most professional level and never, under any pretext, participate in actions against peoples physical and mental health. Furthermore, I follow the purpose of continuous professional and cultural competence improvement. Every nurse must be qualified for the moral and legal rights of the patient (Gurney et al., 2017). Therefore, learning to comprehend the most reasonable and practical treatment practices and legal principles is crucial.
My mission statement is not to leave a person in trouble under any circumstances and respect each patients particular values and choices. It is vital to consider their wishes and carry out those measures that will be most comfortable and effective simultaneously. The joint efforts of the patient and the doctor will contribute to quality treatment and a quick recovery. Furthermore, regardless of where the nurse is, she is obligated to help the person in need, irrespective of the nature of the injury or other external occurrences.
Peace and equality are my most significant hopes for the community, country, and world. If everyone begins to respect the other now, it will cause better living conditions, leading to the absence of conflicts in the long term. I have several fears regarding the healthcare system and taxes. The high cost of services and insurance is the reason for the hardship of accessing care. In the future, the number of people who cannot get treatment may increase, which is a severe cause for concern. All people should be equal, and then the world and care system will change for the better.
Reference
Gurney, D., Gillespie, G. L., McMahon, M. P., & Kolbuk, M. E. (2017). Nursing code of ethics: provisions and interpretative statements for emergency nurses. Journal of Emergency Nursing, 43(6), 497-503.
To provide information and directives for nurses operating the electronic system, prevent the occurrence of cyber security threats, and protect patients private information.
Policy
Internet-connected devices, such as medical or personal mobile devices, present a significant vulnerability source in electronic systems (Stockwell, 2018). Nurses interact with many medical consumer-oriented devices and, therefore, should acknowledge their importance in protecting patients data (Nahm et al., 2019). The connection of personal mobile devices to the hospital network exposes electronic systems to cyber threats. In terms of importance, the security of portable devices takes second place after physical threats, such as leaving the workplace and electronic systems unprotected (Kamerer & McDermott, 2022). Nurses often prioritize patients outcomes and do not acknowledge the risks of cyber security threats (Zaman et al., 2021). Thus, nurses often connect their personal and wearable devices to the hospital network for both work-related and personal purposes (Argaw et al., 2020). Maintaining a regular inventory of all devices in the hospital network presents one of the prominent measures for mitigating the vulnerability of electronic systems. Thus, nurses who use their mobile devices for work-related activities following BYOD (bring your device) policy are required to submit the devices for monthly security checks to the IT department. In cases where nurses do not access the hospital network with their mobile devices, a monthly security check is not required.
Definitions
The personal mobile device is a portable electronic device capable of processing electronic data and accessing the Internet, such as smartphones, tablets, and smart wearable devices.
Conclusion
Before connecting their mobile device to the hospital network, nurses should refer to the IT department for the devices security check. After the initial inspection, nurses must submit their devices to a monthly security check to continue using the hospital network. Alternatively, in cases where nurses do not use their devices to access the hospital network, a security check is not needed.
References
Argaw, S.T., Troncoso-Pastoriza, J.R., Lacey, D., Florin, M., Calcavecchia, F., Anderson, D., Burleson, W., Vogel, J. M., OLeary, C., Eshaya-Chauvin, B., & Flahault, A. (2020). Cybersecurity of hospitals: Discussing the challenges and working towards mitigating the risks. BMC Medical Informatics and Decision Making, 20, 1-10.
Kamerer, J. L, & McDermott, D. (2020). Cybersecurity: Nurses on the front line of prevention and education. Journal of Nursing Regulation, 10(4), 4853.
Nahm, E. S., Poe, S., Lacey, D., Lardner, M., Van De Castle, B., & Powell, K. (2019). Cybersecurity essentials for nursing informaticists. CIN: Computers, Informatics, Nursing, 37(8), 389-393.
Stockwell, S. (2018). What nurses need to know about cybersecurity. AJN, American Journal of Nursing, 118(12), 1718.
Zaman, N., Goldberg, D. M., Kelly, S., Russell, R. S., & Drye, S. L. (2021). The relationship between nurses training and perceptions of electronic documentation systems. Nursing Reports, 11(1), 1227.
Despite being neglected and underestimated in the overall process of medical care provision, nursing is currently recognized to play the key role in the healing process. Nurses are the first people to be near the patient when the doctors mission has already been fulfilled and the patient is placed in his room for recovery. It is the nurse who monitors the current state of health of the patient, who interacts with the patients family more often and more intensely, and can provide them all with reassurance, help and support. For this reason nursing has acquired a more significant role in medicine and hospital operation.
There is a plenty of theories stating the role and responsibilities of a nurse, admitting the extent to which the nurse should participate in the healing process and what qualities he/she should possess to satisfy the needs of the patient. All researchers recognize the vital necessity of active participation of the nurse in the life of the patient, nurturing his or her spirituality and providing the multi-level assistance, not only direct medical one. However, the theory of human caring worked out by Jean Watson is a real breakthrough in nursing in general it is innovative because of the equal role of the caregiver and the one cared for:
Jean Watson views caring as the most valuable attribute nursing has to offer to humanity, yet caring has received less emphasis than other aspects of the practice of nursing over time. In Watsons view, the disease might be cured but illness would still remain because without caring, health is not fully attained (Quizon et al., 2008).
Traditionally, the attention of researchers was focused on concepts of the patients needs, thus neglecting the emotions, the personal feelings and perception of the caregiver. Jean Watson focuses her main attention on three main concepts: carative factors, transpersonal caring moment and caring moment/caring occasion (Jean Watsons Theory of Human Caring, 2009). Carative factors provided by this researcher include both participants united by a caring moment and investigate the possible range of relations and actions that may be taken by both in order to establish a successful relationship and to facilitate the process of recovery.
The situation that is to be analyzed from the point of view of Jean Watsons theory is the following. Once when I was working in post partum we had a young girl who was pregnant and in the hospital with dehydration and a urinary tract infection. She also had a 2 year old child and no one to take care of the child while she was in the hospital. I took the time to talk with her, her mom and dad had both died and her husband was in Iraq.
We had put a baby bed in the room for her but she was in a lot of pain and was having a very hard time taking care of the 2 year old. I would stay after my shift and take care of the 2 year old for her until he fell asleep, and I came in on my days off to help her. She was a very sweet girl and I felt very bad for her. After she was discharged from the hospital she sent me a card with a letter in it telling me how thankful she was and what a difference I had made in her life and her heeling. I have never forgotten that .
Analyzing the described situation from the point of view of Watsons theory of human caring, it is important to outline the main carative factors that are present in the story. With this purpose one needs to estimate the overall set of carative factors Watson pays attention to. They are:
humanistic-altruistic system of value;
faith-hope;
sensitivity to self and others;
helping-trusting, human care relationship;
expressing positive and negative feelings;
creative problem solving caring process;
transpersonal teaching-learning;
supportive, protective, and/or corrective mental, physical, societal and spiritual environment;
human needs assistance;
existential-phenomenological-spiritual forces (Jean Watsons Theory of Human Caring, 2009).
Looking at the defined carative factors, it is possible to say that in the present situation the nurse was of course an active participant in the destiny of the woman who got into such a horribly complicated life situation. She was in a desperate position and had nobody to help her; for this reason the transpersonal caring moment established between her and the nurse was a true example of what Jean Watson is calling everyone for.
The first carative factor in this situation is the humanistic-altruistic system of value. The nurse understood the problem of the your girl very well, and went further than that she offered her not only compassion and sympathy, support in her position, but became an active participant of the events being not only next to her to reassure and comfort her, but to so something that was of real value, of real help.
This is how it is possible to characterize the help with the second child who was 2 years old and could not take care of himself. Arranging a place for the child to stay, taking care of him because of his mothers being in pain and being unable to do this independently this was the humanistic attention from the side of the nurse. Altruistic attitude may be seen in the way the nurse treated the family of the young girl and her child she ignored her own necessities and remained after her shift, took the child to bed, came during her weekends while normally she would have a rest on that days. She neglected her own needs and fully dedicated herself to the patients she had because she knew they had nobody else but her. So this factor was absolutely fully present in the described situation.
Helping-trusting, human care relationship can also be traced in the situation being discussed. The girl trusted the woman who remained near her in her hard moments, and appreciated her help highly. The nurse at that moment was not only a medical worker who fulfilled her direct responsibilities laid on her by her position she exercised not only medical care but first of all human care. She was interested in the destiny of that girl; she asked her about her life and sympathized with her through spiritual help and practical assistance. This is why one can see that the relations of helping-trusting were successfully established and did not remain unilateral. The girl appreciated the nurses help and trusted her, which she later indicated in her card, and the nurse in her turn provided the girl and her child with the maximum of help, understanding, support and inspiration she could.
The third carative factor to be assessed is the creative problem solving caring process. It goes without saying that the decision to take the child to the hospital room of his mother and to let him stay there was a creative decision, since it was possible to give the child to the special caring establishment for the period of his mothers illness this service is surely provided by law in such cases. However, it is necessary to remember that the girl, even being in pain and suffering much, was still a mother, so the absence of her child would be a real stress for her: she would constantly be worried about him, which would slow down the process of recovery and would even put it in risk.
Thus, the decision to arrange a separate bed for the child and let them stay together was a really creative approach to the issue, including the hardships the nurse took over only to provide her patient with comfort and calmness.
Human needs assistance is the factor also relevant to the issue, including the essence of what the nurse was doing in the situation with that young girl. First of all, the initial need of the girl was medical assistance because of her health problems and the risk to lose her child.
For the purpose of not letting this happen the girl was hospitalized and was taken care of by the professionals. Another need of hers, which was equally important for the girl, was to take care of her young child, since she was a mother and could not let her child alone. Combining satisfaction of both these needs is a real challenge, and it would be impossible to accomplish the task for one person. For this reason the nurse took the whole responsibility for the needs of the girl on herself, taking care of both the girl and the child. Consequently, it is possible to say that the task of a nurse in this situation was accomplished more than fully.
It is also notable that the carative factor of expressing positive and negative feelings was absent the nurse was surely the least beneficiary in the present situation and was the one who did the most sacrificing her own life and her own needs. There is no chance that she was completely satisfied with having no free time and working at the weekends. However, she never mentioned her inconvenience in the situation, which contradicts the theory of Jean Watson about the equality of roles of the nurse and the patient. Here only the personality and the needs of the patient were considered.
Summing everything that has been said up, it is necessary to admit that the situation fully corresponds to the theory of Jean Watson, which was shown by the analysis according to the key carative factors stipulated by her. However, the personality of the nurse was neglected and underestimated, which comes into a certain contradiction with the premises of the theory. In general, the transpersonal caring moment was created, so it is possible to say that the main objective of Watson to emphasize the humanistic aspects of nursing in combination with scientific knowledge was successfully accomplished in the situation discussed (Overview of Jean Watsons Theory, 2009).
Works Cited
Jean Watsons Theory of Human Caring (2009). Web.
Overview of Jean Watsons Theory (2009). Vanguard Health Systems. Web.
St. Ursula Laboratory is a faith-based medical lab for the St. Ursula Hospital in Texas, U.S. The hospital is one of the leading church-operated medical centers in the state and offers care to people of all backgrounds. St. Ursula Laboratorys vision statement is a place where everybody, no matter the situation, experiences a great time and desires to come back. The vision comes from the mother organizations veneration of superior quality services and the family institution. The phrase purposes of making the facilitys services a cause targeting everybody.
Organizations need a clear direction to focus their efforts and resources. The trend comes mainly from two crucial facets, the mission, and vision statements. An entitys mission describes the organizations current purpose, which aids in meeting its plans (Alshameri & Green, 2020). On the other hand, the vision statement is futuristic and informs an entitys distant desire. The mission and vision statements enable establishments to remain focused all the time, despite the present circumstances (Alshameri & Green, 2020). Unlike mission statements, the vision proclamation should be short, informing, encouraging, and easy to recite (Alshameri & Green, 2020). The ease to remember and recite helps organizational members to effortlessly state the vision and get energized to carry out their roles, even when facing challenges. Customers also need to have an easy time remembering the vision statement and its meaning and relating it quickly to the product. The brevity of St. Ursulas laboratory vision and its concise purpose make it pass the described checks. The account is essential for accelerating performance to inspire an organization towards the anticipated upshot.
The vision statement is a highly encoded phrase that passes a lot of information despite its brevity. Organizations often endeavor to give as much information about what they stand for in the short, memorable expression. Others even pass the message about how they view people and problems in their vision accounts as a marketing tool ( Mind the differences between mission statements, vision statements, 2021). St. Ursula Laboratorys vision account is not an exemption in this matter. The facility belongs to a quality-conscious healthcare organization with outstanding values known to the people. Patients requiring trustworthy laboratory services and reports go to the facility. Other citizens travel long distances to investigate their health condition at the laboratory. The aspect sees St. Ursula Laboratories always remain busy all year round.
Looking at the choice of words utilized in St. Ursula Laboratorys vision statement communicates many things. Almost every word in the account has a deeper meaning, easily detectable by the customers. Terms such as everybody, situation, experience, and desire contain more meaning than they appear. The first word, everybody, connotes the facilitys indiscriminate services that go to all people, regardless of the socio-economic situation. America is a highly disintegrated society where belonging to some ethnic communities implies a lack of healthcare services. The terms everybody and situation in the vision statement seek to set the facility as exceptional where all humans can access quality laboratory services. The term experience implies the combination of empathy and love-filled care that a customer receives to the point of feeling the goodness and beauty of life and serving humanity. Lastly, desire clears the notion that the facility longs for people to become ill to make money but mainly exists to help humanity regain quality health.
The African Americans in Brookland Ward 5 comprise of 15 percent of the total population.
The actual population of the blacks is 62,864 (Whiteshield Center, 2015).
The females are 50.2% while the males are 49.8% of the population. On age distribution, persons below 6 years represent 6.8%, 6-19 years represent 14.5%, 20-64 years represent 69.6%, and those above 64% represent 9.1% of the total population (Whiteshield Center, 2015).
The average family size of this population is 3.5 (Whiteshield Center, 2015).
The average life span of the population stands at 48 years (Whiteshield Center, 2015).
This community is characterized by a constant population growth rate of 4% (Whiteshield Center, 2015).
At present, almost the entire population is literate and this is projected to hit the 100% mark in the near future (Whiteshield Center, 2015).
Actual Housing Conditions
20% of the houses are not of acceptable quality.
Most of the houses are more than three decades old.
Majority of the houses are for multifamily dwelling with a few being single units as attached in these pictures.
Most of the dilapidated houses are in a condition that can be repaired or restored.
Due to high housing demand, it is very difficult to find a vacant house.
The poor housing can be attributed to population explosion against low income and high unemployment rate (Special Collection Center, 2016).
These aspects are discussed in the next sections of the presentation.
Role of the population in the Community
The most common mode of interaction within this community is through informal communication, politics, trade, and cultural events.
These events attract members of this community.
They have voting blocks, family ties, and community programs on chronic diseases, family planning, economic linearization, and freedom when experts are consulted (Special Collection Center, 2016).
The community network comprises of the formally and informally educated persons who fall into different social classes within the population.
Boundaries of the Group
The Black American community within Brookland Ward 5 is spread evenly within Whitefield.
Brookland Ward 5 boasts of extensive settlement with each cultural group occupying different estates (Special Collection Center, 2016).
Specifically, this community occupies Brookland Ward 5 region.
The population density of Brooklyn is 34, 920 per square mile (Whiteshield Center, 2015).
The average house unit density is 13,180 per square mile (Whiteshield Center, 2015).
There are 34,000 households occupied by the African American within this region (Whiteshield Center, 2015).
The average size of each household size is 2.8 (Whiteshield Center, 2015).
The main safety hazards in Brookland Ward 5 community are contamination as a result of poor solid and liquid waste management and limited housing.
Income and economic standing
From the research survey, the community faces challenge of adequate housing.
Due to poverty level of 20%, the average income is at $3000 per month (Whiteshield Center, 2015).
The household income is $32,135 while median income per family is $36,188. Per capita income is $16,775 (Special Collection Center, 2016).
On an average, the community literacy level is 80% (Whiteshield Center, 2015).
Besides, those with collage education account for 35% of the population (Whiteshield Center, 2015).
The employment rate stands at 69 percent (Whiteshield Center, 2015).
Those informal sector accounts for 49 percent while those in private sector accounting for 51% (Whiteshield Center, 2015).
The major employers are the government, local authorities, and private businesses.
Nursing Diagnosis
Objectives
To establish the housing challenges in the Brookland Ward 5 region.
To recommend the healthcare support to the affected population.
To recommend financial and social support to those in need of housing.
Goals
To assess the actual level of housing disparity.
To assess how the disparity affect healthcare concerns.
To offer recommendations to address the concerns.
Health concerns as a result of poor housing
Due to low income, the consumption patterns of this community align with basic needs.
Despite this, the majority of this population is aware of healthy dietary and are at the forefront of promoting healthy eating habits.
The alcoholic consumption rate stands at 12% with drug abuse more prevalent among the young adults who are the majority who cannot afford better housing (Special Collection Center, 2016).
The main health hazards posed by these activities include injury and infection.
The main health education services offered in this community include family planning, health living and eating habits, and preventive care.
However, there is need to assist the vulnerable members of the community through integrating community based case as part of addressing the healthy people 2020 initiative.
Healthy People 2020 Leading Health Indicator (LHI)
Access to health care service is one of the main indicators of the Healthy People 2020.
This indicator shows the standards, reliability, and availability of health services in a community, especially among the vulnerable persons (Healthy People 2020, 2016).
In this case, the vulnerable people are those who cannot afford better housing.
Access to health care service improvement will ensure that families in this category are served with affordable, accessibly, and flexible health care Healthy People 2020, 2016).
This indicator will address the present concerns and create room for modifications to counter any future dynamics in health status of the target community.
References
Healthy People 2020. (2016). Healthy People 2020 standards. Web.
Special Collection Center. (2016). Guide to the Brookland neighborhood. Web.
Whiteshield Center. (2015). Quick Facts from the US Census Bureau. Web.
Currently, different circumstances are overwhelming and causing a scarcity of healthcare resources. For example, the rising numbers of ill people, multimorbidity, comorbidity rates, health literacy, promotion, as well as high prevalence of chronic, acute, and lifestyle diseases are increasing the demand for body organs and medical technologies (Edelman & Kudzma, 2021; Buja et al., 2018). Further, the varying affordability, cost, access, and affordability of healthcare services and equipment also imbalance the demand and supply of healthcare and medical equipment (Vujicic et al., 2016). It creates the necessity of healthcare rationing for organ and equipment transplants that are controversial from stakeholders perspectives. Concerning this, I would recommend the assessment of medical urgency and evaluation of survival chances of patients as the two criteria for determining who qualifies for organ and medical equipment transplants in the current healthcare system.
Criteria 1: Examining Medical Urgency of Patients
Assessing the medical urgency should be the best criterion that guides patients that get organs or new medical equipment. The United Network for Organ Sharing (UNOS) (2022) report indicates that medical emergencies vary among patients needing organ transplants or medical equipment. Patients in acute, chronic, and emergency departments (ED) always have more medical emergencies than those in other care units. Therefore, providers and payers should prioritize donating or allocating medical equipment to patients with more medical emergencies than those with fewer healthcare necessities. This will help reduce hospital length of stay, readmission, and mortality rates among patients with serious medical emergencies. The approach will also enhance patient well-being and safety because of their previously deteriorating health conditions.
Criteria 2: Examining Survival Benefits and Chances of Patients
Examining the survival benefits is also an appropriate method to control patients that access medical technologies or organs. UNOS (2022) confirms that the control of access and transplant of organs and medical equipment vary based on the availability of resources. For instance, the checklist of qualifications and criteria for organ transplants is longer for organs or equipment readily available and highly supplied in the market. For example, UNOS (2022) demonstrates that the availability of lungs and kidneys make providers use few qualifications to allow transplant. On the other hand, the qualifications for scarce organs and equipment are few. These include the heart and lungs, which are among the scarcely supplied and available organs in the market (UNOS, 2022). Thus, the criteria require providers to increase equipment or organ access to patients who need organs to increase their survivorship and reduce their risk of dying. Similarly, the mechanism requires providers to increase organ or equipment access to patients with higher chances of surviving than those with more risks of dying.
Values that Harmonize with Survival Benefits and Medical Emergency Criteria for Controlling Organ and Equipment Access
The human value of justice directly correlates with the criteria of examining patients survival benefits and medical emergencies before permitting organ transplants. The Organ Procurement and Transplantation Network (OPTN), U.S. Department of Health & Human Services (HHS), and Health Resources & Services Administration (HRSA) (2015) report that every organ transplant should deliver justice to qualified patients in healthcare facilities. In this case, transplanting equipment and organ to patients with higher survival chances and more medical emergencies delivers justice to critically ill patients. This means it would be unfair to deny critically ill patients in ED or chronic care and allow the transplant for clients with manageable conditions. Similarly, it would be unfair to deny patients with higher surviving chances of organs and give those with higher risks of dying. Therefore, the two mechanisms allow critically ill patients with more survival chances to equally enjoy the right to healthy living with those with minor health issues.
Examining patients medical necessities and emergencies is ethical and appropriate when deciding who qualifies for organ and equipment transplants. Similarly, assessing the survival chances of patients is also key in determining patients that qualify for transplants. These methods correlate with my human value of justice, which governs providers and payers of healthcare services when regulating the access and demand of medical equipment, technologies, and organs.
References
Buja, A., Claus, M., Perin, L., Rivera, M., Corti, M. C., Avossa, F.,& & Boccuzzo, G. (2018). Multimorbidity patterns in high-need, high-cost elderly patients. PloS one, 13(12), e0208875.
Edelman, C. L., & Kudzma, E. C. (2021). Health Promotion Throughout the Life Span-E-Book. Elsevier Health Sciences.
Vujicic, M., Buchmueller, T., & Klein, R. (2016). Dental care presents the highest level of financial barriers, compared to other types of health care services. Health Affairs, 35(12), 2176-2182.
This papers objective is to discuss the pathophysiology of intraoperative hypotension, or low blood pressure, with a focus on the causes of hypotension occurring at the cellular/receptor level.
Background
Intraoperative hypotension (IOH) is a major factor associated with postoperative complications and high rates of mortality following non-cardiac surgery. The incidence varies according to the definition of IOH used by physicians and the causes of the condition. Even though there is no single definition of what can be considered intraoperative hypotension, physicians commonly use the indication of mean arterial pressure less than 65 mmHg. Despite the variations in defining hypotension and its symptoms, a strong connection has been between IOH and a number of adverse postoperative outcomes. These include myocardial injury after non-cardiac surgery, acute kidney injury, and other organ injuries.
Results
The current research has identified several major causes of intraoperative hypotension. They include intravascular hypovolemia, vasodilation, high intrathoracic pressure, low cardiac output, and compromised baroreflex regulation. These conditions act as causative mechanisms resulting from the use of anesthetic medication and lead to the reduction of blood pressure. Risk factors are associated with included advanced age, the history of hypotensive episodes, emergency surgery, and the vulnerability to tissue ischemia. Although several conditions and processes have been identified as causes of intraoperative hypotension, more research needs to be done on the treatments and perioperative management of IOH. Patients that receive non-cardiac surgery under general anesthesia still face the risks of a decrease in blood pressure to dangerous levels.
Pathophysiology of Intraoperative Hypotension
Introduction
Intraoperative hypotension is among the most common side effects of general anesthesia used during surgery. Most frequently, IOH or intraoperative hypotension is determined as a mean arterial pressure (MAP) lower than the 25% average value of the patient. Even short periods of the decrease in MAP have appeared to be connected to unfavorable outcomes. IOH is considered to be a major factor associated with adverse postoperative complications, such as ischemic myocardial injury after extracardiac surgery, kidney injury, organ injuries, and other dangerous conditions. Annually, over 8 million patients suffer from postoperative myocardial injury, which is also one of the leading causes of patients dying within the first month after surgery. Thus, IOH is a major factor linked to a high postoperative mortality rate, as it increases the risk of adverse postoperative outcomes leading to death.
Incidence
Studies report the different incidence since the definitions of IOH used by researchers vary. Thus, IOH defined as a mean arterial pressure below 65 mmHg occurs in approximately 65 per cent of operations, and IOH defined as a 20 per cent decrease in MAP from baseline occurred in 94 per cent . Fourteen of the studies reviewed by Wesselink et al. have investigated mortality, and showed an outcome incidence between 0.03% (follow-up: <1 day) and 5.6% (during hospital admission) . Twelve studies reviewed showed a connection between IOH and acute kidney injury, with AKI incidence between 2.8% (7 days) and 72% (7 days) . Nine of the studies investigated the cases of myocardial injury preceded by intraoperative hypotension, and the incidence reported varied between 0.09% (in-hospital) and 30% (1 day) . Even though hypotension is believed to be a strong signal and a significant factor involving adverse postoperative outcomes, and duration of its episodes has not been clearly defined yet.
Etiology
To be able to treat intraoperative hypotension and avoid its dangerous postoperative outcomes, health professionals have to identify its causes. The causative mechanisms that lead to IOH vary in different phases, which are defined according to the different stages of surgery under general anesthesia. Post-induction hypotension (PIH) and early intraoperative hypotension (IOH) have been identified as the main phases induced by intravenous anesthetics and other anesthetic medication.
Patients undergoing surgery under general anesthesia can have hypotension caused by various pathophysiologic mechanisms, which means that the etiology of IOH involves a range of factors. Among the most common ones are vasodilation, intravascular hypovolemia, low cardiac output, high intra-thoracic pressure, and impairment of the sympathetic nervous system or compromised baroreflex regulation. During vasodilation, blood vessels widen as a result of the relaxation of their muscular walls. This mechanism leads to a decrease in systemic vascular resistance (SVR) and an increase in blood flow , which causes a decrease in blood pressure. Vasodilation and venodilation, in particular, is considered to be the main cause of hypovolemia induced by anesthetic drugs. It can also be caused by the reduction in circulating blood volume following massive blood loss (absolute hypovolemia) or inadequate increases in the capacitance of the blood vessels as in vasodilatory shock (relative hypovolemia). As a result, when compensatory mechanisms are impaired or function inadequately, relative hypovolemia can reduce arterial blood pressure.
Decreased cardiac output can be caused by a sinus rate that is too slow and leads to conditions like bradycardia or low stroke volume. Abnormally high heart rates, in turn, can lead to a decrease in stroke volume by reducing ventricular filling time . As a result of ventricular fibrillation, cardiac output falls to zero, which, in turn, causes hypotension. Hypotension can also be a consequence of baroreflex failure in patients undergoing and/or following radical neck dissection, neck injury, throat irradiation, and carotid artery surgery. Along with bradycardia, hypotension is common in patients when they are resting or relaxing. This is due to the loss of buffering ability, which occurs during baroreflex failure. It results from the interruption of the afferent limb of the baroreflex at the level of the carotid sinus, baroreceptor afferents, or medulla , and, apart from orthostatic hypotension, can lead to acute or fluctuating hypertension4. Risk factors associated with intraoperative hypotension have appeared to include advanced age, the history of hypotensive episodes, emergency surgery, and the vulnerability to tissue ischemia.
Signs and Symptoms
Patients sedated with anesthetic medication during surgery do not convey most of the common signs of low blood pressure, such as dizziness, nausea, or blurred vision. Therefore, during surgery, physicians have to depend on common definitions of what is considered to be the lowest blood pressure that can be managed without severe health outcomes. That is why the definitions of what constitutes intraoperative hypotension still vary. However, it is commonly accepted that values below a mean arterial pressure threshold of 65 mmHg are dangerous and entail cases of postoperative complications and death5. It can result in permanent organ injury, as it means that blood is not reaching the patients major organs.
Conclusion
It can be concluded that while the causes of intraoperative hypotension have been identified, the ways to prevent them and treat hypotension have not been clearly defined. IOH remains to be a major signal associated with adverse outcomes and high rates of postoperative mortality. Therefore, further research might focus on investigating the ways to manage.
References
Wijnberge, M., Schenk, J., Bulle, E., et al. Association of intraoperative hypotension with postoperative morbidity and mortality: systematic review and meta-analysis. BJS Open. 2021; 5(1), p.2.
Wesselink, E., Kappen, T., Torn, H., Slooter, A. and van Klei, W. Intraoperative hypotension and the risk of postoperative adverse outcomes: a systematic review. British Journal of Anaesthesia. 2018; 121(4), pp.706-721.
Saugel, B., Kouz, K., Hoppe, P. and Briesenick, L. Intraoperative hypotension: Pathophysiology, clinical relevance, and therapeutic approaches. Indian Journal of Anaesthesia. 2020; 64(2), p.90.
Fitzgerald, J., Fedoruk, K., Jadin, S., Carvalho, B. and Halpern, S. Prevention of hypotension after spinal anaesthesia for caesarean section: a systematic review and network metaanalysis of randomised controlled trials. Anaesthesia. 2019; 75(1), pp.109-121.
The analyzed research was dedicated to discussing the essential role of nurses in diagnostic error prevention. The researcher estimated nurses engagement in the diagnosis process based on the empirical literature review. Then, they proposed the conceptual framework of how the medical organization can reduce diagnosis errors. The conceptual framework was oriented toward designing and offering the model to expand the nurses engagement in the diagnostic process. The last step was to present the results of the framework appliance. Based on the theoretical literature review, the research authors provided an extensive model of full nursing engagement called the tripartite framework (Baker et al., 2017). The model included three essential components: interprofessional teamwork, patient empowerment, and the nurses engagement in identifying the diagnostic signs (Baker et al., 2017). According to the practical model appliance, the outcomes showed a decrease in diagnostic errors and misses, increased diagnosis time, and total growth in patient safety rates (Baker et al., 2017). The model also emphasized the role of the patient experience and engagement in the diagnosis process through the nurses.
The structured literature data presented in the form of the framework was applied within the particular organization. The empirical results contributed to the formulation of the four potential barriers to nursing engagement, including culture, education, regulation, and operations (Baker et al., 2017). Scientists also provided the solutions to mentioned challenges as an additional part of the conceptual framework. Concerning the cultural barrier, the psychology of the nurses self-identification was a vital problem. A vast percentage of nurses and clinicians supposed that nurses should not participate in the diagnosis process (Baker et al., 2017). However, the research highlighted that nurses could not be separated from the diagnosis because they have a role in establishing patient-physician relationships.
Including nurses in the diagnosis, the process was implemented by various medical institutions. Researchers provided examples of such implementation and analyzed the results showing an increased patient satisfaction level and a lower rate of medication errors (Baker et al., 2017). In an attempt to overcome this barrier, the researcher suggested implementing the engaging policy by the medical administrative bodies. In order to overcome the education barrier, medical providers should offer nurse education programs focused on specific diagnosis principles (Baker et al., 2017). Moreover, licensed educational organizations should implement interprofessional training classes in the regular students curricula. The operational barrier can be overcome by the proper nurse staffing regulations and by eliminating turnovers (Baker et al., 2017). The regulation barrier is connected with the lack of governmental or administrative acts of nursing practices. Researchers depicted the correlation between the practical examples of the nurse practice acts passed in some states and the increased patient satisfaction level (Baker et al., 2017). Even though some barriers are hard to overcome, the subsequent framework appliance is supposed to reduce diagnosis errors.
Variables and Theory
During their investigation, researchers provided the practical scientific experiments results which were conducted earlier to prove that the solutions are reasonable and relevant to the topic. Such theoretical variables showed that the medical providers managed to reduce the diagnosis risks by applying some of the frameworks concepts. Therefore, the researchers combined the results of the developed framework research and the comparative analysis of other scientific experiments to design and structure the barriers for their model appliance. The conceptual model included specific guidance to increase the nurses engagement in the diagnosis. Due to the extensive literature review, the model was detailed and easy to use in practice. As a result, its implementation within a separate medical organization was a comprehensible task. However, the question of whether it will be working on a broader range of variables arises.
Currently, obesity is considered the most significant problem in medicine since it is a chronic disease common among both adults and children. The World Health Organization has defined obesity and overweight as pathological or excessive fat accumulation that can negatively affect health and has declared this pathology a global epidemic. Thus, until recently, it was believed that the problem of obesity is relevant for countries with a high standard of living, but the number of children suffering from overweight and obesity is growing in low-income countries, especially among those living in urban settings (Luck-Sikorski et al. 3). The main problem is that human health and well-being become exclusively a public health issue, which leads to the lack of responsibility for ones health. Some effects of this problem include human irresponsibility for their lives and health and the lack of motivation.
In Radley Balkos essay What You Eat Is Your Business, the journalist argues that what people put into their bodies is their business and they are fully responsible for making healthy decisions. The widespread obesity epidemic can only be solved if people become more aware of their choices and take control of their health (Balko 360). He stresses the need for personal responsibility when it comes to food choices and insists that government does not interfere with consumer choices. Since human health and well-being becomes a public health issue, Balko says that Americas healthcare system is heading towards socialism (Balko 362). Politicians spend millions trying to ban snacks and sodas from public vending machines, raise funds for bike lanes and sidewalks, and sometimes go as far as offering a fat tax (Balko 363). Laws have been passed requiring some people to pay for other peoples health problems.
People are becoming less responsible for their health and more responsible for the health of everyone else. It is ridiculous that someones heart attack adds to the value of someone elses bonuses. If the government pays for cholesterol medications, people lack any motivation for a healthy lifestyle. They lack incentives to put off the cheeseburger or any other unhealthy food (Balko 368). This points to the fact that the prices of all insurance premiums are the same, and the healthy eating initiative is virtually non-existent as there are no higher premiums for obese people. By removing obesity from public health issues and making unhealthy people pay their bills, people will learn to be more responsible and will make a big leap forward in tackling the rampant problem of obesity.
While it becomes nearly impossible for a government to stay away from health care, personal responsibility is paramount. Healthcare is currently a matter of government by law, but the choice of food is nobodys business, except for the person who eats it. This is freedom of choice, in which each citizen must make their decisions. It is a difficult question whether the government should or should not take initiatives such as removing unhealthy food from vending machines in schools and using detailed food labels with calorie counts (Luck-Sikorski et al. 7). However, undoubtedly that such initiatives are a smarter use of the state budget and a more practical solution for the government than trying to preach healthy choices for millions of people in the country. Even if the government should regulate the fast food industry in the same way that it regulates tobacco companies, only the individual is responsible for his or her life.
Obesity is a complex issue and not a problem with one variable. The dramatic rise in the prevalence of obesity in the past 30 years is the result of cultural and environmental influences (Dixon 5). Many researchers associate a clear trend towards a decrease in the level of physical activity of the population with sedentary forms of work, rest, and entertainment, with a change in modes of movement and increasing urbanization. Therefore, every person should read and learn about better food choices and how to develop the best daily routine that includes as much energy as possible. It is important to eat healthy food because it is the way to improve health. At the same time, it is not necessary to refuse and put a taboo on some products (Dixon 8). Every citizen needs to do this only from his or her sincere desire. Informing, providing an accessible environment, and qualified medical care is the task of public health and the state. However, maintaining a healthy lifestyle, actively participating in the process of preventing diseases is an aspect of personal responsibility.
Increasing motivation to maintain a healthy lifestyle, physical education, and sports, as well as increasing a persons responsibility for their health are the main solutions to the problem of obesity. This concept provides the stimulation of the conscious, purposeful work of the person to restore and develop vital resources and take responsibility for his or her health. A healthy lifestyle should not be the governments issue but a natural need of a person. This does not mean that the government should not help people with obesity. Therefore, while what you eat is your business, it is tough to isolate obese people and not offer help. Joint efforts are where the solution to this complex problem lies. Actualization of the goal, behavioral modifications, creation of motivation, and a comfortable psychological environment are necessary conditions for the successful implementation of programs to reduce excess weight.
Works Cited
Balko, Radley. What You Eat Is Your Business. They Say/I Say : The Moves That Matter in Academic Writing: With Readings, vol. 2, 2011, pp. 395-399.
Dixon, Beth. Obesity and Responsibility. The Oxford Handbook of Food Ethics, 2018.
Luck-Sikorski, C., S. G. Riedel-Heller, and J. C. Phelan. Changing Attitudes Towards Obesity Results from a Survey Experiment. BMC Public Health, vol. 17, no. 1, 2017, pp 1-13.
Intravenous fluid treatment incorporates the venous administration of crystalloid solution. The therapy is used in cases where patients are highly dehydrated (Hoorn 485). Patient-specific necessities determine the kind, quantity, and infusion rates of the fluids. Normal Saline (NS or 0.9NaCl) is one of the popularly administered IV liquids for utmost hydration requirements such as bleeding, vomiting, diarrhea, drainage from GI suction, metabolic acidosis, or shock (Hoorn 486). It is an isotonic colloid that encompasses 0.9% sodium chloride (salt) liquefied in sterile water. NaCl has largely been used for resuscitation efforts in many institutions.
While using NS, it is vital to monitor the patient and the liquid levels around the clock. The above-stated ensures that there is no overload or less than required for the bodys functioning. NaCl should be watched through clinical parameters and laboratory tests to establish the beneficial endpoints (Hoorn 487). Having all details is important for everyone engaged in the care because the human body cells are bathed in a watery fluid that contains primary sodium and chloride ions. These molecules are essential in maintaining proper fluid balance and keeping the tissues hydrated. Additionally, sodium is involved in many cell processes such as muscle contraction, the transmission of nerve impulses, and kidney function (Sahithya 31). It is crucial to maintain these ions within a therapeutic range, hence the criticality of checking and rechecking throughout.
The family needs to understand what is happening to their loved one regarding nutrition and IV feeding. Some families might be against various approaches used to sustain life at critical stages. It is vital to make sure the family comprehends everything about venous nutrition to avoid confusion and conflicts. I will have a meeting with the relatives and inform them on the status of the patient in form of a psychoeducation session. I will tell them the exact condition the patient is in, talk about the IV method and the benefits of its application.
Conclusively, intravenous nutrition, particularly normal saline, is necessary for people in critical condition because it sustains the functioning of vital organs. However, the approach requires a round clock observation to guarantee the levels are not high or low, for it can be fatal. All individuals involved in the care of such a patient should always be informed on quantity, rate, and days the patient has been on this treatment for a better outcome.
Works Cited
Hoorn, Ewout J. Intravenous Fluids: Balancing Solutions. Journal of Nephrology, vol. 30, no. 4, 2017, pp. 485-492.
Sahithya, Sriman. Fluid ResuscitationPlasma-Lyte a Vs 0.9% Normal Saline for Laparotomy in Acute Gastrointestinal Perforation: A Randomised Double-Blinded Controlled Study. Chennai, Madras Medical College, dissertation, 2017, pp.1-145.
