An explanation of the Concept of My Plate My Plate for Diabetic Patient
It is estimated that there are currently millions of people worldwide living with diabetes. Diabetes is a chronic condition that can have severe complications if not managed properly (Perry et al., n.d.). Three main concepts are involved in providing care to patients with diabetes: the diabetes health eating plan, the insulin pump, and the blood sugar meter (Cooper & Gosnell, n.d.). Developing and implementing a heathy eating plan grants individuals identified to have with diabetes an opportunity to ration their food intake. The insulin pump is a device that allows insulin delivery to the body while blood sugar meter measures patients levels of blood sugar.
The diabetec plate is divided into three sections: the carbohydrate section, the protein section, and the fat section. The patient should eat the appropriate amount of food from each section based on their blood sugar levels (Cooper & Gosnell, n.d.). The carbohydrate section contains foods including bread, rice, and pasta that will raise blood sugar levels, hence, it is essentital to eat the right amount of carbohydrates based on the current patients diagnosis. The protein section is composed of a meal that adheres to the right amount of protein to maintain the levels of blood sugar. Foods in the fat section lower blood sugar levels, which promote eating the right amount of fat. Overall, proper patient care is essential to prevent complications and improve the quality of life of people with diabetes.
Nursing assessment for My Plate for Diabetic Patient
Assessment is an essential first step in the nursing process. Fundamentally, it allows nurses to gather information about patients to develop individualized care plans. When assessing a patient with diabetes, nurses must consider the various aspects of the disease, including its symptoms, treatments, and complications (Perry et al., n.d.). By doing so, nurses can identify any problems the patient may be experiencing and develop a plan of care to address those issues (Cooper & Gosnell, n.d.). In this scenario, signs of diabetes can vary depending on the individual, but some common ones include increased thirst, frequent urination, fatigue, and blurred vision. These symptoms can be caused by high blood sugar levels, which can damage the body over time. In essence, various challenges have been associated with diabetes including heart disease, stroke, kidney disease, nerve damage, and vision problems. These threats can be severe and even life-threatening. For this reason, the patient needs to make lifestyle changes to improve her long-term health.
For effective responses to the above mentioned diabetes triggered problems, the patient is recommended to have a treatment regimen that will incorporate a new diet plan. The patient must avoid sugary foods, drinks, and fried foods (Perry et al., n.d.). Notably, the patients diet plan should include eating three meals per day and limiting intake of carbohydrates. For every meal, half of the plate should be filled with non-starchy vegetables, such as broccoli, carrots, or salad. One-quarter of the plate should be filled with lean protein, such as grilled chicken or fish. The final quarter of the plate should be filled with a whole grain, such as brown rice or quinoa. The patient should include a small amount of fat, such as olive oil or avocado, and a small amount of fruit with each meal. The patient must stick to the diet plan and take insulin injections on time.
Patient Problems
The section explores the nursing judgement related to the patients long-standing history of diabetes and its associated complications. The first nursing examination of the patients condition should prioritize on ineffective tissue perfusion, since diabetes can cause damage to the blood vessels and nerves, the disease can lead to poor circulation and reduced oxygenation of the tissues (Perry et al., n.d.). Consequently, this can lead to various problems, such as wound healing and an increased risk of infection. In addition, the second nursing diagnosis that health care services providers would consider is the risk for disease. The recognition is significant since diabetes can lower the bodys ability to fight infection considering that wounds and ulcers are more common in people with diabetes. Infections can cause severe problems in people with diabetes, thus, it is essential to develop effective approaches to prevent them.
The third interpreatation related to the patients condition is impaired wound healing. This is because diabetes can cause damage to the blood vessels and nerves, leading to poor circulation and reduced oxygenation of the tissues (Cooper & Gosnell, n.d.). As a result, patient may have difficulties when healing the wounds. Moreover, nurses can scrutinize the patients pain since diabetes can cause damage to the nerves, which can lead to pain in the extremities (Cooper & Gosnell, n.d.). Pain can be caused by problems such as ulcers and infections. These nursing judgement should be based on the patients needs and individualized to the patients condition. The patients condition should be well managed and related to diabetes care. This will allow nurses to focus on the medical and psychological needs of the patient. Overall, the nursing diagnosis advocates the development of a plan that supports measures to prevent or manage diabetes complications.
Specific, Realistic and Measurable Goals for My Plate for Diabetic Patient
When it comes to diabetes, diet is essential in the recovery process of the patients. A healthy-eating plan can trgger a great difference between managing the disease and letting it take over patients life (Perry et al., n.d.). There are various specific goals to prioritize while recommending a healthy-eating plan to a diabetic patient. The primary purpose of any diabetic diet is to keep blood sugar levels in check. That means monitoring carbohydrate intake since carbs raise blood sugar levels more than any other nutrient. In addition, affected people should limit salt and focus on potassium-rich foods like fruits, vegetables, and low-fat dairy. Eating healthy is crucial for people with diabetes, but it can be hard to make changes. A registered dietitian can help patients create a healthy-eating plan that fits their individual needs and lifestyle.
A healthy-eating plan is a critical component of diabetes management, and there are several ways to approach it. A few general principles should be followed when developing a realistic healthy-eating plan for a diabetic patient. First, the diet should be high in fiber and complex carbohydrates and low in simple sugars, including plenty of fresh fruits and vegetables. Third, the diet should be moderate in protein and fat. In addition to following these general principles, paying attention to portion sizes and ensuring patient get enough calories to meet their energy needs is essential. Measurable goals of a healthy-eating plan for a diabetic patient should be individualized and consider the patients preferences, lifestyle, and health status (Perry et al., n.d.). The program should help the patient make gradual changes in eating habits that can be maintained over the long term.
Nursing Intervention for My Plate for Diabetic Patient
As a registered nurse, one of the best interventions for a diabetic patient is to help them develop and stick to a healthy eating plan. This means educating them on which foods to eat and avoid, portion sizes, and the timing of meals (Cooper & Gosnell, n.d.). Moreover, it is vital to aid them fathom the relevance of regular physical activity. There are a few things that must be adhered to when developing a healthy diet plan for a diabetic patient. As mentioned previously, diabetic patients should focus on eating fruits, vegetables, whole grains, and enough protein (Perry et al., n.d.). They should limit their intake of saturated and trans fats, sugary drinks, and foods and get enough protein. A healthy eating plan should be individualized for each patient, as different people have different dietary needs. However, some general guidelines can be followed. Of all, the paramount action is to help the patient develop a plan that they can stick to, which will help them control their blood sugar levels.
Registered nurses plays a vital role in the care of a diabetic patient that cannot be understated. Apart from a dietary plan, there are other interventions that a nurse can perform to help a diabetic patient manage their condition and improve patients overall health (Perry et al., n.d.). One of the most important interventions nurses can serve is to help the patient maintain a strict blood sugar control regimen. Nurses may need to instill patients with knowledge on monitoring their blood sugar levels properly and administering insulin injections.
References
Cooper, K., & Gosnell, K (n.d.). Foundations of Nursing, 9th edition. Elsevier Health Sciences.
Perry, A. G., Potter, P. A., & Ostendorf, W. (n.d). Nursing Interventions & Clinical Skills. Elsevier Health Sciences.
Tommy Bennett is a 40-year-old man who has been living in a Northeastern inner city.
When the police found him, he was living in a cardboard house below a bridge in a homeless area.
Bennett has been living in dilapidated conditions.
As a result, his health has been failing.
When he was brought to the emergency room, it was suspected that he was suffering from bilateral frostbites on his toes.
Upon diagnosis, it was discovered that Bennett would need to have a peripheral inserted central catheter (PICC) line fixed inside his body.
Bennetts failing health could have been contributed by the housing conditions of the homeless area. For instance, the frostbites and chills he was experiencing must have been occasioned by cold conditions due to poor housing and probably, the lack of warm clothes and proper beddings.
How the Clients Economic Implications/Issues Affect Care
The health of individuals depends on many factors, among them, access to quality care and the surrounding environment.
The surrounding environment relates to factors such as the quality of air, water, and the condition of the housing where the individual lives.
The socioeconomic status (SES) of an individual affects the above conditions.
Hence, it directly influences the state of his or her health.
Bennett has been living in a homeless area.
The possible lack of healthcare facilities near Bennetts residence implies that he has no immediate access to regular health checkups.
Recent developments in the healthcare sector have resulted in high cost of care.
Healthcare has become expensive, especially after the adoption of fee-for-service.
The result has been that people with a low SES have limited access to quality healthcare.
Living in a homeless area implies that Bennett is a person with a low SES.
Besides the problem of poor diet, this status could have contributed greatly to his poor healthcare.
At the same time, the cost of insurance for private care has increased considerably, causing many Americans to live without healthcare insurance.
The situation encourages diseases among people such as Bennett who cannot afford quality care.
According to Chambers et al. (2014), inner cities have been found to have poorer healthcare infrastructure compared to suburban areas. Additionally, the healthcare facilities in these areas have limited equipment and poorly qualified staff (Acri et al., 2016). The net effect of these conditions is that people in inner cities have poorer health compared to their counterparts from the suburbs.
Miewald and McCann (2014) assert that poor diet among people of low SES contributes to a high disease incidence. Additionally, people living in inner cities have limited access to pure drinking water, a situation, which could contribute to a high disease incidence.
Steps that the Client should take to Manage His Health
Patient activation involves several components among them, individual knowledge, skills, and confidence.
Such components enable patients to be actively involved in matters regarding their health and healthcare (Greene & Hibbard, 2012).
According to Greene and Hibbard (2012), patients with high activation levels appreciate their role in the health care process.
They are motivated to take the necessary steps to fulfill this role.
First, Bennett will need to take antibiotics as prescribed by the healthcare provider.
Adherence to treatment is examined in terms of dose, the intervals between taking medication, the duration of the treatment, and other special instructions that the healthcare expert may issue.
In the first step, Bennett may be instructed to take medication without food.
He will need to alert the physician if he stops or alters the drug treatment regimen.
This strategy will ensure that the physician can examine possible effects of this obstruction of the treatment.
In the second step, Bennett will need to manage the frostbite condition by covering himself with warm clothes during cold times.
If possible, he should leave the cardboard house.
The goal will be to seek housing in a place with proper structures that can arrest excessive environmental cold.
Another important step to proactive care is for Bennett to examine his lifestyle.
This step may call for a change in diet habits while avoiding sedentary living.
For instance, Bennett will need to increase the intake of healthy foods such as fruits and vegetables.
At the same time, he will need to reduce the intake of unhealthy foods such as refined substances, including those that are high in sugar.
Bennett will also need to adopt an exercise program to eliminate sedentary living.
Exercise can facilitate blood flow in the limbs, hence reducing the effect of frostbite (Woo et al., 2013).
Patients can take various steps to manage their health with assistance from healthcare providers. The concept of involving patients to manage their own health is known as patient activation.
Leaving the cardboard house will prevent the frost-bitten area from refreezing, hence preserving the affected tissue (Woo et al., 2013).
The fitness program should be designed to begin with minimum impact exercises at first, followed by higher impact exercises. Importantly, Bennett will need to avoid unhealthy habits such as excessive drinking and smoking, as well as any other drugs that are categorized as harmful for human consumption. Drug abuse and alcoholism are associated with frostbite (Woo et al., 2013).
Rationale for Following the Plan
Often, patients fail to follow instructions on how to take the medications provided to them by healthcare givers.
This situation causes the disease to fail to heal.
It also makes disease-causing pathogens immune to the drugs administered.
Therefore, Bennett must ensure that he takes all the antibiotics given to him and during the specified times.
This plan will ensure that recovery is attained.
Immunity to the drugs may be detrimental to the patient to the extent that he or she will need to incur extra costs to obtain stronger medication (Haddad, Brain, & Scott, 2014).
Many diseases today are either caused or contributed to by poor lifestyles.
Therefore, Bennett should begin his journey of proactive care.
He should adopt a lifestyle that can support healthy living.
Failure to adopt a healthy living style may worsen his condition.
As a result, he will incur extra costs managing the same condition.
In addition, failing to leave the cold environment of his current residence may lead to refreezing of the affected tissue, thus necessitating the amputation of his toes (Maness, & Khan, 2014).
For chronic diseases such as diabetes and asthma, failure to stick to the treatment regimen can result in further complications, even causing death. In the US, non-adherence has been found to cause nearly 125, 000 deaths every year. It also leads to high cases of readmission among patients.
According to Woo et al. (2013), frostbite patients should avoid re-exposure to cold conditions since this case may worsen the tissue condition and/or lead to tissue loss.
A Description of how Giving Client Education is Doing Gods Work
The Bible encourages Christians to help others whenever they are able without expecting to be refunded.
The rationale of this Bible teaching can be adopted in healthcare, especially relating to the treatment of patients with a low SES.
Healthcare in the US is expensive, as situation that prevents many low-income people such as Bennett from accessing quality care.
The fee-for-service approach to healthcare favors only patients who can afford to pay for care.
Christian nurses can make efforts to minimize the disparity in healthcare that is caused by ensuring that the poorer patients also have access to comprehensive care (White, 2013).
One way that caregivers can help low-income patients is through client education.
Nurses interact with patients from different economic and ethnic backgrounds.
Nurses who adopt Christian values in their profession are likely to be sensitive to these differences, hence rendering objective care to the patients (White, 2013).
Christian nurses view their patients as brothers and sisters, as well as people who deserve quality care, regardless of their SES status.
This belief is based on the Christian understanding that all people are equal before God.
Christianity and organized healthcare can be traced back to the collapse of the Roman Empire.
At the time, only patients who had money could access healthcare.
Client education helps patients to manage their condition with minimum assistance from healthcare attendants. As a result, their health is improved without having to incur unnecessarily high costs.
Christians who are trained in healthcare would step in and assist patients with low income based on the Christian teaching of helping those in need. These early values should be reflected in modern care among Christian nurses. The Nurses Christian Fellowship International (NCFI) calls for nurses to adopt the virtues of love, unity, respect, equity, and integrity in dealing with their patients (White, 2013).
References
Acri, M. C., Bornheimer, L. A., OBrien, K., Sezer, S., Little, V., Cleek, A. F., & McKay, M. M. (2016). A model of integrated health care in a poverty-impacted community in New York City: Importance of early detection and addressing potential barriers to intervention implementation. Social Work in Health Care, 55(4), 314-327.
Chambers, C., Chiu, S., Scott, A. N., Tolomiczenko, G., Redelmeier, D. A., Levinson, W., & Hwang, S. W. (2014). Factors associated with poor mental health status among homeless women with and without dependent children. Community Mental Health Journal, 50(5), 553-559.
Greene, J., & Hibbard, J. H. (2012). Why does patient activation matter? An examination of the relationships between patient activation and health-related outcomes. Journal of General Internal Medicine, 27(5), 520-526.
Haddad, P. M., Brain, C., & Scott, J. (2014). Nonadherence with antipsychotic medication in schizophrenia: challenges and management strategies. Patient Related Outcome Measures, 5(1), 43-62.
Maness, D. L., & Khan, M. (2014). Care of the homeless: an overview. American Family Physician, 89(8), 634-640.
Miewald, C., & McCann, E. (2014). Foodscapes and the geographies of poverty: Sustenance, strategy, and politics in an urban neighborhood. Antipode, 46(2), 537-556.
White, B. (2013). Nurses Christian fellowship international: Partners in care. Journal of Christian Nursing, 30(2), 97-99.
Woo, E. K., Lee, J. W., Hur, G. Y., Koh, J. H., Seo, D. K., Choi, J. K., & Jang, Y. C. (2013). Proposed treatment protocol for frostbite: a retrospective analysis of 17 cases based on a 3-year single-institution experience. Archives of Plastic Surgery, 40(5), 510-516.
While trying to help a patient, a doctor should pay attention to their unique features and difficulties that may arise in the wake of them.
With regard to the case described in the article, the main objective of the surgery was to help Virgil. Nevertheless, he was blind since early childhood, which resulted in a tragedy (Sacks 1). Given that he had a purely visual experience and a world of perceivable objects was hard to understand for Virgil, it was inevitably complex for him to make sense of them. An operation that should have led to a miracle turned out to be a disaster due to neurological and psychological challenges he had to face. Regarding reading, Virgil identified letters easily due to the fact that he studied the alphabet during the period when he was blind. In other terms, the reading process did not require a profound reorientation as the alphabet signs were a part of the world in nonvisual terms.
However, the concepts of distance and shape are understandable for other people, who were learning how to form a complex perception at first sight in their childhood. As for Virgil, his brain was not able to perceive sense based on optic nerve impulses as he has not achieved perceptual constancy like others (Sacks 6). Such a situation might lead to the collapse of perceptual systems, which happened in this case and caused final blindness (Sacks 8). Thus, not having a flexible childs brain that allows learning essential skills, such as a language or walking, he experienced great difficulties in the learning process.
To conclude, although any operation is aimed at the patients well-being, it is of great importance to take into consideration the individual patient characteristics, especially considering perceptual-cognitive processes, in order to avoid harm.
Works Cited
Sacks, Oliver. To See and Not See. New Yorker, 1993, Web.
All the possible diagnostics for the patient include bronchoscopy, chest tube procedure, bronchial ultrasound, endobronchial valve therapy, and lung function test.
Lung function tests
Lung function tests would be used to examine how the lungs function. The process will entail spirometry, which measures the air volume the lungs hold and how forcefully a patient can empty air from the lungs. The test is recommended since the patient was coughing and had a fever which indicated the likelihood of a lung disorder (Thomas & Bomar, 2018). The presence of phlegm when coughing confirms the presence of pulmonary disease, making the test unsuitable since the symptom is linked to various pulmonary conditions like tuberculosis, COPD, bronchitis, and pneumonia. The main risk of this test is that the equipment may spread germs. The gold standard for accurate and repeatable measurement of lung function is the use of spirometry.
Bronchoscopy
Bronchoscopy utilizes a camera attached at the end of a flexible tube to take photos of the air passages. The test was requested since the patient was coughing and producing phlegm, a sign of bronchitis (Thomas & Bomar, 2018). Similar signs in other conditions like tuberculosis, COPD, and pneumonia make it challenging to rule out, leading to the need for advanced tests to specify the condition. National recommendations for managing pulmonary diseases provide that bronchoscopy should be undertaken in all patients with chronic coughs where the patient is suspected of inhaling foreign objects. The procedure is highly beneficial, although it may lead to low blood oxygen.
A chest tube procedure
A chest tube procedure was requested since the patient experienced pain between the lungs and the ribs. The diagnosis is used to drain fluid between the lungs and the chest. The test was required since the patient complained of lung and chest pain when coughing and produced phlegm. The test will be used to affirm or roll out the existence of pleurisy, which will be decided after analyses (Thomas & Bomar, 2018). The procedure is highly effective, although the procedure is painful and may lead to infection. National recommendations for using a chest tube call for interprofessional teams to always identify the indications of the placement of a chest tube.
Endobronchial valve therapy
Endobronchial valve therapy this test was requested to confirm the presence of advanced emphysema and COPD since the patient has a history of the condition. The lack of swelling on the feet and ankles of the patient and the lack of signs of Weight loss and blood in the cough ruled out the presence of COPD and tuberculosis (Thomas & Bomar, 2018). The main risks of the test entail bleeding, infections, and pain. The national recommendations for this test call for care and efficiency should be maintained during the insertion of the endobronchial valve to reduce the pain and prevent bleeding.
Conclusion
In conclusion, a chest X-raytest was requested to differentiate if the patient suffered from pneumonia bronchitis. The test enables the differentiation between pneumonia and bronchitis. The main distinguishing factor to be observed through the test observation is the presence of consolidation signs or infiltration on the chest radiograph. Such evidence will rule out bronchitis and confirm the condition as pneumonia. The tests effectively diagnose lung infections, inflammation, and cancer (Thomas & Bomar, 2018). The procedure is safe, although linked to cases of complications, collapsing, bleeding, and pain. National recommendations for undertaking risk tests provide that doctors should use the lowest radiation dose possible while undertaking the test.
This presentation will review a quality improvement project. Its focus was on catheter-associated urinary tract infections (CAUTIs), and it was aimed at improving the ability of a particular long-term care unit to control them. This presentation will cover the projects problem statement, explain its significance, and present the PICOT question, as well as the stated purpose. A very brief literature review will be provided as well, and the methodology will be discussed in great detail. Finally, the findings will be summarized and then discussed to include a reflection on implications, recommendations, and contributions of the project.
Problem Statement and Significance
CAUTIs as a problem:
12.9% of hospital-acquired infections are UTIs;
67.7% of UTIs are CAUTIs (Nicolle, 2014);
common in older adults (Jump et al., 2018);
have negative outcomes (including disability and death).
The role of nurses: prevention and management to ensure the quality of care/patient safety.
In order to explain the significance of the problem of CAUTI, it is necessary to mention that this issue is very prevalent. Indeed, urinary tract infections (UTIs) constitute almost 13% of all infections that are acquired by patients in hospitals, and almost 68% of those are associated with catheters (Nicolle, 2014). Moreover, CAUTIs are especially common among particular populations and settings, which includes the older residents of long-term facilities (Jump et al., 2018). Finally, these infections are also dangerous; they can result in multiple negative outcomes, including lethal ones. As a hospital-acquired condition, CAUTIs are especially important to prevent and manage appropriately, and nurses play a crucial part in this endeavor. Thus, the introduction of a quality improvement project that would target such a problem is fully justified by its significance.
Literature Review
Chlorhexidine: an antiseptic, common for decolonization strategies (Noto & Wheeler, 2015).
Bathing with 2% chlorhexidine gluconate washcloths can prevent CAUTIs (Huang, Chen, Wang, & He, 2016; Mitchell et al., 2019; Swan et al., 2016).
Nurse knowledge of CAUTI may be insufficient (Jain, Thakur, Dogra, Mishra, & Loomba, 2015).
A review of the literature related to CAUTI prevention can help to gain insights into the project and its intervention. The fact that chlorhexidine has antiseptic properties has been employed in nursing to reduce colonization, which is connected to CAUTIs (Noto & Wheeler, 2015). There exist different specific approaches (Mitchell et al., 2019), but chlorhexidine bathing, specifically with the help of 2% chlorhexidine gluconate washcloths, is a method that is evidenced to be effective when compared to non-chlorhexidine bathing. This conclusion is based on randomized trials and their meta-analyses (Huang et al., 2016; Swan et al., 2016). In addition, this project encountered some evidence which showed that nurses might experience difficulties with CAUTI prevention and lack the knowledge related to it. This problem was demonstrated in a study by Jain et al. (2015) with a sample of over 100 nurses. To summarize, the literature supported the idea that the chosen problem was significant, supplied an evidence-based solution, and provided evidence on the challenges that the presented project might encounter.
PICOT and Purpose
Purpose: preventing/reducing CAUTIs in long-term care.
PICOT: For senior residents ages 65 years and above of long-term care facilities (P), how does the use of a disposable washcloth with 2% chlorhexidine gluconate (I) compared to standard catheter care (C) affect the rate and prevalence of catheter-associated urinary tract infections (O) within a two-week period (T)?
This slide demonstrates the PICOT question, as well as the purpose of the project. Its goal was mostly to prevent or reduce CAUTI incidence in a long-term care facility; in particular, residents older than 65 were the population. The evidence-based intervention was the washcloths, and the comparison was care-as-usual, that is, bathing without the washcloths. The measured outcome was concerned with CAUTIs, and the timeframe was limited to two weeks.
Framework
Unfreezing: training (explaining the value of the intervention).
Change: the project (applying and testing the intervention).
Refreezing: post-project stage; the project prepares for it.
Has been used in nursing; simple but provides the necessary structure (Cummings, Bridgman, & Brown, 2016).
The project utilized a framework that would enable the integration of the new bathing method into the sites routine. Specifically, Lewins (1947) model was chosen because it is a very common framework that provides the necessary structure while being simple to use. The fact that it has been employed in healthcare means that it is applicable to the described project (Cummings et al., 2016). The model incorporates three stages; first, it is necessary to enable change by unfreezing the existing status quo. To ensure the completion of this stage, the described project incorporated training aimed at advancing the understanding and knowledge of CAUTIs, the intervention, and its correct application in the nursing staff of the site. Following this stage, the change itself took place, which mostly consisted of the rest of the project. Due to its short timeframe, the refreezing stage would mostly occur after the project depending on the findings; however, the two prior stages prepared the ground for it. This way, the framework was employed to enable the compliance of the nursing staff and the correct application of and adherence to the intervention.
Design
Methodology: pre-test post-test.
Intervention: routine bathing with a disposable washcloth (2% chlorhexidine gluconate) for 2 weeks.
Site: 100-bed unit; a long-term care facility (high CAUTI rates).
Final sample: 26 nurses/nursing assistants; 4 residents (65-90 years old, indwelling/suprapubic Foley catheter).
The design of the project can be characterized as a pre-test post-test study, in which routine bathing with disposable 2% chlorhexidine gluconate washcloths was tested against care-as-usual for two weeks. The site was a 100-bed unit of a long-term care facility, which has been exhibiting rather high CAUTI rates; from this perspective, the purpose of the project was directly associated with quality improvement. The final sample of the project consisted of 26 nurses and nursing assistants who were a part of the training activity; they were then engaged in caring for the residents, including the four residents who were involved in the project and its bathing procedures for 2 weeks. The primary eligibility criterion for the nurses was the fact of their work in the unit; for the residents, the criteria included their age and the presence of an indwelling or suprapubic Foley catheter, which put them at risk of CAUTIs.
Procedures and Ethics
Staff:
Recruitment; minimal risks.
Pre-training assessment.
Training (30-minutes session with handouts and hands-on demonstration).
Post-training assessment.
Residents:
Recruitment (informed resident/guardian consent).
Pre-test data collection.
Bathing with the washcloths.
Post-test data collection.
The ethical considerations were taken into account while planning the project; it was fully approved by the universitys review board. The risks associated with participation were minimal, especially for the staff, but everybody involved was provided with all the necessary information, and all the recruited people signed informed consent forms. It should also be noted that for the participants who needed guardian consent, that consent was also granted.
The project proceeded with the following actions. With the staff, the intervention consisted of training, which took 30 minutes and involved a theoretical section and a demonstration. Before and after that event, their CAUTI knowledge was assessed, after which the nurses proceeded with their usual duties and the implementation of the intervention. Regarding the residents, their pre-test urine samples, as well as the information about CAUTI symptoms, were collected and checked. After the assertion of their eligibility, they were bathed with the washcloths for the following two weeks, after which their samples were collected once again.
Data Collection and Analysis
Staff:
Tool: a survey based on Jain et al. (2015).
Analysis: Wilcoxon signed ranks test (non-normal distribution) (Polit & Beck, 2017).
Residents:
Tool: dipstick urinalysis (leukocytes and nitrite).
Analysis: descriptive statistics.
The data collection, which took place before and after interventions, was carried out with the help of special tools. Thus, the staffs CAUTI knowledge was measured with a survey, which was based on the study of CAUTI knowledge by Jain et al. (2015). The tool also incorporated some questions about the demographics of the sample. For residents, the dipstick urinalysis was used, and leukocytes and nitrite in their urine were employed as the measures of their health.
Regarding the analysis, the features of the final datasets allowed determining the suitable approach. Thus, the distribution of CAUTI knowledge scores was not normal, which ruled out the application of the t-test to the staffs data (Polit & Beck, 2017). However, the Wilcoxon signed ranks test remained applicable, which is why it was employed. Also, descriptive analysis was applied to demographics. With residents, the small sample and lack of changes prevented the application of statistical tests, but the data were summarized, and descriptive statistics were helpful in completing this task.
Findings: Demographics (Staff)
Upon analyzing the data, the following findings can be reported. The staffs questionnaire included questions about their demographics, and it turned out that the nurses and nursing assistants who had been enrolled were all women. You can see the detailed information describing the samples experience and age in these two charts. Almost two-thirds of them (66%) had more than five years of experience in nursing, and 74% were older than 30 but younger than 60.
Findings: Nurse Survey Results
The results of their CAUTI knowledge survey are displayed here. These graphs show the prevalence of scores earned by the participants; higher scores indicate better knowledge. Before training, no participant earned a score that would be higher than 13; after the training, one participant earned 14 points, and one had the maximum number of points, which was 16. Therefore, some changes in the score prevalence took place after the training.
Average Pre-Test
Average Post-Test
P-Value (Wilcoxon Signed Ranks Test)
8
10
0.004
Indeed, the average pre-test score was 8, but the post-test one was 10. The Wilcoxon signed ranks test allows concluding that this increase was statistically significant; with p=0.004, the differences in the scores before and after the training cannot be explained as accidental fluctuations. Most likely, they are attributable to the independent variable, which was training.
Discussion and Interpretation
Relatively experienced staff.
P<0.05; the training was effective (with this sample).
The staff was well-equipped to perform the intervention.
Staff with gaps in CAUTI prevention knowledge pre-training:
Consistent with Jain et al. (2015): CAUTI knowledge may be lacking.
The staff data allows making the following statements. First, the majority of the staff that was engaged in the project was fairly experienced, which increases the likelihood of them being able to apply the intervention correctly. Second, due to the difference between the scores being statistically significant, the training is likely to be responsible for the increase, which implies that it has successfully improved the participants CAUTI knowledge. In other words, the training was proven to be effective. In turn, that means that the participants should have applied the intervention knowingly. However, the fact that some of the participants scored rather poorly implies that the literature review findings are supported by this project (Jain et al., 2015); nurses can indeed lack crucial information about CAUTIs, which highlights the importance of training them before tasking them with the bathing procedures.
Pre and Post Urinalysis Results (Residents)
Resident Code
Leukocyte Pretest
Nitrite Pretest
Date
Leukocyte Posttest
Nitrite Posttest
Date
Star 9090
+
8/22/19
+
8/30/19
Star 9091
+
+
8/22/19
+
+
9/07/19
Star 9092
+
+
8/22/19
+
+
9/07/19
Star 9093
+
8/22/19
N/A
N/A
N/A
Star 9094
+
8/23/19
+
9/06/19
Regarding the residents, the final sample consisted of four people. A fifth person was recruited, and his urinalysis was performed, but before the implementation of the washcloths was started, he was transferred, which prevented the project from using his data. As can be seen from the table, 100% of the participants had leukocytes in their urine based on the dipstick analysis, and two of them (50% when the final sample is considered) also had nitrite. None of the residents exhibited any symptoms of CAUTIs, which allowed their enrollment. Their state remained completely unchanged for the duration of the two weeks that they were bathed with the washcloths; their post-test urinalysis results were identical to the pre-test ones.
No new CAUTIs: intervention may be effective in preventing CAUTIs (similar to the literature).
But:
Very small sample (5 pre-intervention; 4 post-intervention).
Having leukocytes/nitrite in pre-test samples (no CAUTI symptoms).
Therefore, the evidence is limited.
Based on this information, the washcloths may have prevented the development of CAUTIs and negative changes in the residents health. However, with a sample that small and a time period that short, this evidence is not very strong. In addition, while the residents showed no symptoms of CAUTIs, they did have leukocytes in their urine. With few people available at the site, they were deemed eligible for the project, but it is still a limitation to be considered.
Limitations
Sample size (both cases; especially residents).
Sample features.
Staff: one facility and only nurses; insufficient representation of subgroups (e.g., age, experience; no male nurses).
Residents: presence of leukocytes/nitrite pre-test.
Timeframe: 2 weeks of intervention; no follow-ups.
Indeed, the projects limitations need to be discussed. First, the samples can be considered a limitation; the residents sample is especially small, but 26 nursing specialists from one unit do not constitute a large sample either, which limits inferences about nursing populations at large. Similarly, the fact that the nurses sample was not very diverse means that the application of findings to different or more specific subgroups should be done very carefully. The residents pre-test urinalysis results are a limitation, and so are the short timeframe and the absence of follow-ups. The project cannot make inferences about the long-term effects of the training or intervention.
Implications, Contribution, and Recommendations
Implications/knowledge contributions:
There may be CAUTI prevention knowledge gaps.
Training appears to be effective with nurses.
Some evidence of the effectiveness of washcloths.
Future research recommendations:
greater/more diverse samples and duration;
consideration of CAUTI knowledge gaps/training.
Some inferences, implications, and recommendations can still be made. First, it is an important finding that even the nurses working in environments where CAUTIs are a major risk might not be sufficiently equipped to address the issue. Therefore, the assessment of the knowledge of nurses and nursing assistants is very important. Second, the project does suggest that training is a suitable solution. Third, the effectiveness of the 2% chlorhexidine washcloth bathing in limiting urinary tract infections in residents with catheters is supported by some evidence, but it is not very strong. As a result, it is recommended to further investigate the intervention and training before making the quality improvement intervention permanent. New research should reflect on and attempt to avoid and prevent the limitations of the current one. Still, the presented project has contributed some information that can be of use to nurses, especially the projects site and staff, as well as nursing students. From this perspective, the project has been advancing the universitys mission, especially as related to some of the pillars of nursing, including caring and professionalism.
Conclusions
A pre-test post-test quality improvement project (training + an evidence-based CAUTI prevention intervention).
Outcomes:
training was successful (p<0.05);
no new CAUTIs in residents;
evidence on CAUTI training and prevention (limited).
Recommendations: eliminating limitations in future research.
To summarize, the presented project consisted of quality improvement, which incorporated the elements of training and the implementation of an evidence-based intervention. Both activities aimed to reduce CAUTI rates in a unit where they were rather high. The nursing staff was successfully trained, and the residents who were enrolled did not develop CAUTIs. Therefore, the aim was achieved; the project resulted in the staff improving their knowledge and residents remaining without new CAUTIs. The project does contribute some data to CAUTI prevention, but it is not very extensive because of the limited duration and relatively small samples, which is especially relevant and important for the resident sample. Based on the findings, it is a good idea to proceed to explore the intervention and training in long-term settings while attempting to increase the sample size and timeframe of a project.
References
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Huang, H., Chen, B., Wang, H., & He, M. (2016). The efficacy of daily chlorhexidine bathing for preventing healthcare-associated infections in adult intensive care units. The Korean Journal of Internal Medicine, 31(6), 1159-1170. Web.
Jain, M., Thakur, A., Dogra, V., Mishra, B., & Loomba, P. (2015). Knowledge and attitude of doctors and nurses regarding indication for catheterization and prevention of catheter-associated urinary tract infection in a tertiary care hospital. Indian Journal of Critical Care Medicine, 19(2), 76-81. Web.
Nicolle, L. E. (2014). Catheter associated urinary tract infections. Antimicrobial Resistance and Infection Control, 3(23), 1-8. Web.
Jump, R., Crnich, C., Mody, L., Bradley, S., Nicolle, L., & Yoshikawa, T. (2018). Infectious diseases in older adults of long-term care facilities: Update on approach to diagnosis and management. Journal of the American Geriatrics Society, 66(4), 789-803. Web.
Lewin, K. (1947). Group decision and social change. Readings in Social Psychology, 3(1), 197-211.
Mitchell, B. G., Fasugba, O., Cheng, A. C., Gregory, V., Koerner, J., Collignon, P., & Graves, N. (2019). Chlorhexidine versus saline in reducing the risk of catheter associated urinary tract infection: A cost-effectiveness analysis. International Journal of Nursing Studies, 97, 1-6. Web.
Noto, M., & Wheeler, A. (2015). Understanding chlorhexidine decolonization strategies. Intensive Care Medicine, 41(7), 1351-1354. Web.
Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
Swan, J. T., Ashton, C. M., Bui, L. N., Pham, V. P., Shirkey, B. A., Blackshear, J. E., & Butler, M. O. (2016). Effect of chlorhexidine bathing every other day on prevention of hospital-acquired infections in the surgical ICU. Critical Care Medicine, 44(10), 1822-1832. Web.
Delivering quality services is a direct obligation of each medical organization. Quality in medicine is measured by the capacity of clinical workers to provide appropriate patient services for a maximally short time. Any medical agencys clinical and business development is crucial because it influences patient outcomes. This paper will analyze the possibilities of development for clinical organizations and assess the role of nurses in developing improvement policies.
There are many possibilities for medical organizations to offer to improve the quality of services. For instance, the Institute of Medicine proposed six quality dimensions that help measure, define, and match the correspondence of medical services delivered within the organization to a higher standard (Plebani, 2017). This approach also helps decrease medical agencies costs, simplify the organizations work, adjust payments, and guide how to make the process safe and effective.
Positive patient outcome and experiences are essential when considering the development of medical services. Another way to assess and improve the quality of clinical services is a patient survey. This is a popular way to measure medical service quality and effectiveness and estimate the customers experience. Patient surveys enable medical organizations to examine conceding points and allow performing the services in a better way.
The role of the nurse is crucial in generating various improvement policies. Nurses often participate in different activities and can impact the positive development of the policy. They seek development opportunities, assess patient needs and help advance the healthcare policy (Duquesne University, 2020). Moreover, nurses can volunteer at the policy meeting and share the knowledge of effective standing against patient harm. For example, if I attend a policy meeting, I would like to know how nurses organize their work during the current situation with the pandemic. Nurses may provide an important insight that can be beneficial for other clinical organizations and their workers. I think it can contribute to the development of medical agencies and explain how to deal with patients during this severe period.
Overall, medical organizations have many possibilities to improve the quality of clinical services, including business and medical solutions. These approaches facilitate agencies to simplify the work inside the organization and improve patient outcomes. It is also hard to overestimate the input of nurses in the process of developing clinical policies. Nurses stand on the first line of defense against harm to patients, and they have crucial information to offer and share.
The healthcare sector is guided by ethical and legal conduct. One of the key requirements is the rule of informed consent. In many cases, there are several options available to handle a given patient condition. Informed consent requires that the patient be allowed to make an informed decision based on the information provided and the situation at hand. The legal and moral principle of patient autonomy is the basis for informed consent. Voluntary informed consent is required for all medical tests and procedures. Failure to obtain informed consent leads to the battery, a legal and moral violation. There are several factors that determine the application of informed consent:
The patient should be in capacity to make decisions.
The medical practitioner should provide all the necessary information to facilitate informed consent.
The patient must fully comprehend the information given, and lastly, they must give their voluntary consent.
The given case presents a situation where an elderly man requires urgent medical intervention but cannot provide informed consent. In this case, the elderly mans condition has deteriorated, and the option available is putting him on a respirator. The elderly man does not satisfy any of the four principles of informed consent. He can barely communicate or understand the options before him. The decision belongs to his daughter, who has been frequent at the hospital. In cases where a patient cannot give informed consent, the next of kin is usually contacted (Scholten et al., 2021). In this scenario, the elderly man is a widower, further complicating the situation. In this case, the elderly mans daughter has the legal right to decide her fathers clinical options.
The fiduciary relationship defines the patient-physician relationship in following three basic rules. To begin with, the patients interest should be given priority. This implies that the physician should consider the options that bring out patients wellbeing instead of the physicians choices (Scholten et al., 2021). The second principle follows that the physician must exercise loyalty, and lastly, there must be an element of obedience. The physician must respect and obey the patients decision at all times. In this case, the nurses have given the necessary information to the daughter to facilitate decision-making. Therefore, they are required to listen to her decision and adhere to it. Besides, the daughter has been the closest family member to the elderly man. She knows what her father would want, and therefore her decision represents her fathers will.
In conclusion, although the eldest son claims that the doctors should do anything possible to save his father, the nurse should not take his opinion. This is because the eldest son is not named the legal next of kin to his father. Also, he has not been following his fathers medical condition closely. Any decision made by the son is based on his personal feelings rather than his fathers will. On the other hand, the daughter has been present in most of his fathers medical examinations. The closeness between the father and daughter implies that she has a better understanding of her fathers wish. Therefore, the nurses should follow the fiduciary relationship principles and informed consent by considering the daughters opinion and adhering to it. Since there is no law prohibiting the daughter from deciding on behalf of her father or recommending the eldest sons opinion, the daughter stands to be the preferred decision-maker.
Primary wound healing can be observed in wounds with a slight loss of tissue having smooth edges. The edges of the injury are close to each other; the wound is clean, not contaminated with microbes or foreign bodies, and does not contain necrotic (dead) tissue (Kordestani, 2019). An example of such healing may be small postoperative scars, the edges tightly connected by suturing. They heal quickly with the formation of a minimal scar. Secondary wound healing is characteristic of injuries with extensive tissue damage, such as bitten ones (Kordestani, 2019). With severe burns and bedsores, this healing type also occurs since the wound must heal from the bottom to the edges, and it is impossible to perform surgical suturing. Tertiary healing presumes delayed closure of the injury, implying that the wound should be left open until it is free of germs (Kordestani, 2019). This type is observed in post-surgery cuts, especially in the abdominal or pelvic areas.
Reticular tissue is a type of connective tissue that forms the basis of hematopoietic organs (bone marrow, spleen, lymph nodes, and others.). It is part of the tonsils, dental pulp, the basis of the intestinal mucosa, and some other body parts. It consists of reticular cells; reticulin fibers are attached to the body and processes of cells, having a mesh arrangement and composed of thin reticulin fibrils, the basis of which is collagen. Their structure allows for providing support to the mentioned organs. Goblet cells can be found in all parts of the intestinal tract, but their maximum number is in the rectum, especially in the crypts of the colon. The major function of these cells is the production of mucins high-molecular glycoproteins capable of forming a gel. Intestinal mucins form a surface layer of mucus, which facilitates the movement of the contents into the intestinal lumen and serves to protect its mucous membrane.
Reference
Kordestani, S. S. (2019). Atlas of wound healing: A tissue engineering approach. Elsevier Health Sciences.
The creation of any health promotion organization should start from gaining information about the community in which the primary activities will be focused. The first step is researching the issue of antismoking activities in the chosen community, its history, and earlier actions that were taken in a particular area to address the issue. It also includes the analysis of the possible institutions which can host the creation of such a coalition. Creating such a project independently is irrational because it will be challenging to build the community around the health promotion program from scratch. It would be more rational to find a supporting, well-known community organization. The second step is to search for the possible stakeholders ready to support such a program. The search area can also be centered on analyzing the institutions which can provide material support. The third step is to analyze the target audience, its ethnicity, race, and socioeconomic status to define the reliability of the concepts to the chosen community. The last step is considering the limitations related to the geographic boundaries and legal aspects of coalition creation.
Building Trust
Entrancing the new community is realized through establishing the four steps of trust: contractual, communication, competency, and caring. The first one is related to ensuring the awareness of the community about the project through, for example, local social media. The second addresses the implementation of a clear communicational strategy to improve the communitys comprehension of the projects aims and goals. It also includes the establishment of the ideas exchange with the members of the community, improving participation. The competence trust is related to providing the training for the recruited personnel performing the activities of the project. The last step, ensuring care trust, includes the creation of a physical place where volunteers can be welcomed and gain necessary information regarding the coalition.
Cultural Competences Characteristics
The primary aim of cultural competence is to ensure that racial, economic, ethnic, and social differences do not interfere with the implementation of the project within the community. Its importance is defined by the primary aim of the public healthcare worker to provide community-oriented services. The antismoking coalition is centered on improving the quality of life and increasing awareness of the people disregarding their cultural differences. The characteristics of cultural diversity as it is implemented and interacted with the community include three aspects (Henderson et al., 2018). The first one is hiring culturally diverse staff helping to serve the community. The second principle is fairness in retention, promotion, and support provision for all workers and members of the community. The last direction includes the training for the personnel focused on the development of cross-cultural skills.
Christs Teachings and Cultural Competency
The total acceptance of Christ can be interpreted in the scope of cultural competence. Christ sacrificed himself for the sake of all people disregarding culture, race, social status, or ethnicity. He advanced the ultimate love, which is the central principle that can be adapted to interact with diverse groups without judgments. The ultimate acceptance and love of the people is the aspect that can be brought from Christs teaching. The cultural integration and competency can be seen from the perspective of total acceptance of difference due to the concept of ultimate Gods love.
Communitys Awareness and Buy-In
As was mentioned earlier, informing the community can be proposed through social media or allocating the advertisement. It would be especially relevant to share the information through the topic-related institutions. In the case of the antismoking coalition, the healthcare institutions resources should be used to increase the awareness of the community. Considering getting buy-in, the three aspects should be mentioned. Buy-in is used to gain the support of the target audience or congregation. To do so, any project should formulate a clear vision and objectives. The integration of the improvement ideas offered by others can also be mentioned as an efficient strategy. Such an approach will help to establish trustful and supporting relationships with the community. The last factor is gaining feedback to improve the quality of the initial idea. It can be done by communicating the progress of the projects particular activities.
Conflict Management Strategies
There are two types of conflicts that can occur with the stakeholders: cognitive and interest. The first one is related to the inconsistencies of beliefs of the project creators and stakeholders. In order to solve such a conflict, both sides should focus on the opposite position to find common ground through discussion. The collaborating strategy can be used to solve cognitive conflicts. (Basogul, 2020). The second one is related to the difficulties in organizational issues which do not correspond with the stakeholders expectations. The negotiations should be implemented to find a compromise. The compromising conflict management strategy can be used in such a case (Basogul, 2020). The fostering of collaboration within the scope of such a project can be achieved through the strategy of reducing conflict. The conflicts are the primary problem disturbing the collaboration.
Nurse shortage is one of the most burning issues the healthcare systems of the USA and other countries are facing. According to the report of the World Health Organization (WHO), there is a shortage of over 7 million nurses in the healthcare setting on a global scale (Mar et al., 2018). It has been estimated that the deficit of nurses will almost double by 2035 and will reach up to 12,5 million (Mar et al., 2018). In the United States, approximately 11 million more nurses are needed to address the issue (Haddad et al., 2020). The U. S. government has already acknowledged the problem, and diverse strategies have been implemented to address the issue, but these efforts have had rather limited success so far. This paper includes a brief analysis of nurse shortage in the United States and a particular healthcare organization, with certain recommendations regarding possible policies to be launched.
Multiple factors contribute to the enhancing pressure on the system related to nursing staffing. One of the principal issues is demographic, as the number of patients is growing exponentially due to the aging population (Haddad et al., 2020). In addition, aging nurses retire while the number of new nurses is insufficient to satisfy modern communities needs (Jones-Berry, 2017; Haddad et al., 2020). Social aspects are also relevant and have a negative influence on the development of the system. Jones-Berry (2017) states that nurses leave the profession, with the field losing over 30,000 professionals, and this number is growing rapidly. In addition, the profession is still unpopular among people, and a decreasing number of people enter the corresponding courses.
The reasons for such trends are associated with the characteristic features of nursing practice. Workload and comparatively low salaries keep people away from the profession. Moreover, job dissatisfaction caused by ineffective organizational culture, inappropriate working conditions and atmosphere, as well as insufficient reimbursement leads to significant turnover (Haddad et al., 2020). The local healthcare facility I work for can be seen as an illustration of the influence of the factors mentioned above on the quality of provided care. Turnover at this hospital is high due to the increasing workload, low reimbursement, poor equipment, and inappropriate relationships between healthcare practitioners. Thus, the nurse shortage is a challenge to be addressed on local, national, and global levels.
A brief literature review shows that the existing policies are often criticized, while some of them are seen as potentially beneficial. For instance, the increase in reimbursement for nurses is a positive policy as low salaries remain one of the central issues leading to nurses job dissatisfaction and high turnover (Mar et al., 2018). The provision of grants to working nurses and graduates to gain education or receive on-the-job training is also regarded as beneficial (Mar et al., 2018). Jones-Berry (2017) claims that the government implements certain policies that can have a positive impact, but these efforts are often inadequate or untimely. An example of such an ineffective measure is the announcement of additional nursing student placements only weeks before the nursing courses start (Jones-Berry, 2017). Jones-Berry (2017) argues that well-thought and coherent programs are necessary to facilitate the development of the healthcare system and address the most burning issues.
Another strategy is improving the working environment and developing an effective organizational culture in healthcare facilities. Governments can contribute to advancing this area by providing grants to effective facilities and introducing guidelines based on the experience of diverse units. Gray et al. (2018) claim that the development of the program encompassing nurse empowerment, the use of a collaborative approach, and on-the-job training increased nurses satisfaction. Henry (2017) emphasizes that professional education is critical for all health workers, which is specifically apparent in the environment of the pressing shortage of nurses. Clearly, numerous programs and policies have been introduced, but a more focused effort is needed at the national and local levels.
It is possible to analyze the policy encompassing the provision of grants to students to start nursing courses for ethical considerations. It is undoubtfully good and ethical to promote learning and motivate young people to enter nursing practice, which is one of the most humane professions. Implementing this policy is likely to contribute considerably to the communitys sustainable development. The strength of this policy is the focus on expertise and qualifications. The government understands the benefits of creating a pool of high-profile nursing practitioners (Jones-Berry, 2017). However, this policy is also characterized by multiple challenges that need to be addressed. Clearly, such policies need proper implementation as the corresponding promotional campaign has to be launched at the beginning of each study year. Such initiatives should be introduced on the national, state, and community levels on a regular basis. In addition, it is critical to make sure that the profession can be attractive to nurses, so salaries should be higher, and working conditions should be improved through the allocation of more funds.
A complex of measures can be helpful at the facility mentioned above. The facility should apply for a grant to increase the reimbursement of high-achieving nurses, as well as educational opportunities for the staff. The hospital administration (or a nurse leader) should initiate the changes related to the organizational culture to promote collaboration. Nurses should feel empowered, and they should have the necessary skills and knowledge to cater to their patients needs. It is necessary to note that the implementation of such policies will comply with the nurses ethical standards and virtue ethics. Nursing practitioners will be able to provide high-quality care when they have the necessary resources (knowledge, skills, and equipment) and find themselves in a favorable working environment to realize their potential to the fullest.
In conclusion, nurse shortage is an urgent issue the U. S. government is trying to address through the implementation of various policies. Some of the major aspects to consider include nurses salaries, working conditions, and organizational culture. The focus on formal and on-the-job education can help in reducing understaffing, but the provision of some grants is insufficient. Nurse practitioners should receive higher salaries and diverse benefits (health insurance and retirement packages, wellness and education opportunities, and so on). Every healthcare facility should have a sound organizational culture based on collaboration, caring for others, and self-development principles. It is important to develop a comprehensive initiative to promote the profession. The use of multiple communicational channels, including the K-12 system, conventional media, and social media, is the necessary premise for the development of the system. Clearly, each facility should also strive to create an appropriate working environment for nurses, which can be attained with the help of wise fund allocation and the development of proper organizational culture.
