Anaphylactic shock refers to an extreme and life-threatening allergic reaction. It mainly involves a response to allergens such as food, latex, medications, and insect stings. Patients exhibit symptoms in various body systems, which occur within 5 to 30 minutes after exposure to an allergen (LoVerde et al., 2018). Generally, there is light-headedness, dizziness, and fainting. Respiratory signs include rapid respiration, difficulties in breathing, and shortness of breath.
There are itchy swellings under the skin, and poor blood circulation leads to blue skin color. The patient has a swollen throat, hoarse voice, and coughs severally. There is vasodilation, increased vascular permeability, and dysfunction of the myocardium leading to decreased blood pressure and cardiovascular collapse (LoVerde et al., 2018). In the gastrointestinal system, the patient experiences abdominal cramps, vomiting, and diarrhea.
Some conditions such as severe asthma demonstrate similar symptoms as anaphylaxis. Diagnosis and differentiation of the condition from others are critical because it is a life-threatening reaction. Anaphylaxis is highly likely to be the issue if there are sudden onset and rapid progression of the symptoms and conditions, for example, difficulties in breathing or hypotension, detrimental to life. Moreover, changes on the skin such as urticaria, flushing, or angioedema are important too. Cardiac troponins can also be measured for a timely diagnosis in the emergency departments (Kounis et al., 2018). However, the diagnostic tests should never delay the management of the condition.
If a nurse suspects anaphylactic shock, the first step is to give the patient an adrenaline auto-injector in the middle of the other thigh. The causative agent is carefully removed and the patient is put to lie down flat unless they are having difficulties breathing or are pregnant. A second injection is given in 5 to 15 minutes if there is no improvement. Mechanical ventilators and vasopressors are required in patients with compromised vascularity and respiratory issues. Secondary treatment includes administering glucocorticoids, fluids, and bronchodilators.
References
Kounis, N. G., Cervellin, G., Koniari, I., Bonfanti, L., Dousdampanis, P., Charokopos, N&. & Tsolakis, I. (2018). Anaphylactic cardiovascular collapse and Kounis syndrome: Systemic vasodilation or coronary vasoconstriction? Annals of Translational Medicine, 6(17), 332. Web.
LoVerde, D., Iweala, O. I., Eginli, A., & Krishnaswamy, G. (2018). Anaphylaxis. Chest Journal, 153(2), 528-543. Web.
Patients who receive high dose cytarabine (doses of 1 g/m2 or greater) have significant incidence of:
Neurotoxicity (7% to 28% incidence of neurotoxicity);
Keratitis;
Possible dose-limiting myelosuppression (Szoch & Kaiser, 2015; Alsdorf et al., 2016).
High dose cytarabine means assessment and documentation practices differed among nurses and physicians.
Practicum purpose:
Formulating an evidence-based nursing assessment of neurological side effects of high doses of Cytarabine.
High doses of cytarabine (doses of 1 g/m2 or greater) are usually associated with keratitis, possible dose-limiting myelosuppression and irreversible 7% to 28% incidence of neurotoxicity (Szoch & Kaiser, 2015), as well as ascending, irreversible paraplegia (Alsdorf et al., 2016). High dose errors could emanate from different assessment and documentation practices among nurses and physicians. The purpose of this practicum is to formulate an evidence-based nursing assessment of neurological side effects of high doses of Cytarabine. Prior to the practicum, the focus on is on needs assessment.
The role of the nurse educator in conducting a needs assessment
Gap identification between current practices and best evidence-based practices (Anthony J. Jannetti, Inc, 2012);
A content expert;
Improving educational activities;
Assessment of educational activities on outcomes (American Nurses Credentialing Center, 2014).
The main purpose of a needs assessment is a gap identification (Anthony J. Jannetti, Inc, 2012). A nurse educator plays a critical role in identifying these gaps, specifically between current practices and best evidence-based practices. Moreover, a nurse educator is considered as a content expert who can identify the need for needs assessments to improve educational activities to meet the learning needs of registered nurses and plan interprofessional education programs for improving team performance and patient outcomes (American Nurses Credentialing Center, 2014).
The use of a needs assessment when developing curriculum related to an evidence-based nursing assessment of neurological side effects of high doses of Cytarabine
Needs assessment for evaluating more successful practices and areas for replication.
Evaluating less successful areas: Inexplicit and inconsistent practices.
Identifying practices to advance change (American Nurses Credentialing Center, 2014).
Stakeholder identification:
Nurse;
Pharmacists;
Physicians;
Patients (American Nurses Credentialing Center, 2014).
Assess the need for change and change management plan.
Stakeholders are critical data points and sources.
The role of a needs assessment is to identify evidence-based practices that are more successful in nursing assessment of neurological side effects of high doses of Cytarabine. These practices can be used to improve current less inexplicit and inconsistent practices that lead to high doses of Cytarabine and toxicity.
A needs assessment would help to advance change through evidence-based practices, research, literature, and clinical guidelines for care.
Obviously, a needs assessment is aimed at improving processes, practices, and eventually clinical outcomes. As such, patients, nurses, and pharmacists, and physicians are most likely to be affected by new efforts to reduce neurological side effects associated with high doses of Cytarabine. Change management is therefore an imperative component of a needs assessment. Besides, this process helps in identifying relevant sources of information for assessment (American Nurses Credentialing Center, 2014).
The types of data to be collected and how it relates to student characteristics and the learning environment
Assessment and documentation practices:
Risk factors associated with neurotoxicity and use of high dose cytarabine (Szoch & Kaiser, 2015).
Recognizing neurological symptoms:
How to perform assessments of cerebral status.
Timely intervention to reduce complication:
Document adverse assessment findings.
Data on nurse documenting adverse assessment findings.
Documentation practices.
Knowledge on assessment to perform.
Variation in practices.
Inconsistent information regarding neurologic assessment to perform: The use of a standardized neurologic assessment guide and form (American Nurses Credentialing Center, 2014).
Data collection tool designed for nurses, physicians, pharmacists, and administrators will be used to collect data on an evidence-based nursing assessment of neurological side effects of high doses of Cytarabine (McCawley, n.d).
The type of data for collection will generally target high doses of Cytarabine and possible risk factors and interventions (Szoch & Kaiser, 2015). Data should focus on assessment and documentation practices among nurses, physicians, and pharmacists because risk factors associated with the neurotoxicity and use of high dose cytarabine emanate from assessment and documentation practices that differed among nurses and physicians.
In addition, data will be collected on nurses abilities to recognize neurological symptoms and to perform assessments of cerebral status, as well as timely interventions to reduce cases of long-term side effects.
These data are aimed at presenting evidence-based practices for students to ensure that they understand consequences of poor assessment and documentation, relate knowledge to assessment performance, and observe variations in assessment and documentation practices among nurses and physicians. In addition, data would assist students to identify possible inconsistency and inexplicit documentation. Finally, data should allow students to understand the relevance of standardized neurologic assessment guide and documentation while looking for perceived solutions.
Data will be collected using written surveys. The survey would allow the assessor to reach many respondents as the hospital (McCawley, n.d).
The process of developing a needs assessment
Needs assessment concentrates on:
Target audience identification;
Data resources and the relevant data points for collection;
Data quality and relevance;
Data collection, review and analysis;
Review needs assessment findings (gaps);
Presenting the report (Anthony J. Jannetti, Inc, 2012);
Identify the gap between current practices and best practices;
Determine gap in knowledge, skills, and/or practice;
Identify purpose of the needs assessment;
Develop a course;
Implement the activity;
Assess the activity (Anthony J. Jannetti, Inc, 2012).
A needs assessment development process needs a methodical approach that focuses on data resources and the relevant data points for collection. It ensures that collected data are useful to assessors. The collected data should be reviewed and analyzed to get important insights for the study. The findings represent gaps in knowledge, skills, and/or practice, which the assessor should strive to find the best solutions to mitigate negative outcomes on patients and nursing practices (Anthony J. Jannetti, Inc, 2012).
Once the gap has been identified, the subsequent processes generally aim at closing the gap by finding the best solutions. The most important aspects of solutions should focus on improving the current practices using the best evidence-based options (Anthony J. Jannetti, Inc, 2012).
How open-ended and close-ended questions will elicit the information needed for needs assessment
Open-Ended Questions
Qualitative data for gaining insight on all the opinions on Formulating an evidence-based nursing assessment of neurological side effects of high doses of Cytarabine.
Closed-Ended Questions
Generate easily quantifiable data;
Data will prove the statistical significance;
Assist in categorizing respondents into groups based on responses (McCawley, n.d).
In this practicum needs assessment, both open-ended and closed-ended questions are formulated to gather qualitative and quantitative data respectively. Overall, these questions are designed to assess different data sources and points to collect relevant information for needs assessment. They include important themes; nurse, physicians, and pharmacist involvement; resources; standard guides; and perceived solutions among others (McCawley, n.d).
Any issues anticipated with collecting data, and a plan for mitigating these issues
Outcome measure may fail in:
Reliability: A score or other measure remains unchanged upon test and retest;
Validity: Measure assesses what it was intended to measure.
Mitigation:
Understand principles of reliability and validity as they are used to ultimately evaluate the impact of a needs assessments on the professional practice of nursing, interprofessional team performance, and patient care;
The instruments must be tested for reliability and validity (American Nurses Credentialing Center, 2014).
Irrespective of the outcome measure used, the assessor may encounter reliability and validity issues. The preferred outcome measurements should incorporate aspects of reliability and validity. In this case, validity and reliability will be established by conducting prior tests on data collection instruments (American Nurses Credentialing Center, 2014). This would ensure that data collected are reliable and valid, and they can therefore be used to assess professional nursing practices, multidisciplinary team performance, patient care, and perceived solutions to reduce neurological side effects of high doses of Cytarabine.
References
Alsdorf, W. H., Schmitz, M., Schieferdecker, A., Dierlamm, J., Bokemeyer, C., & Binder, M. (2016). Severe and irreversible myelopathy after concurrent systemic and intrathecal nucleoside analogue treatment for refractory diffuse large B-cell lymphoma: A case report and review of the literature. Journal of Oncology Pharmacy Practice, 22(3), 523-527.
American Nurses Credentialing Center. (2014). The Importance of Evaluating the Impact of Continuing Nursing Education on Outcomes: Professional Nursing Practice and Patient Care. Web.
Anthony J. Jannetti, Inc. (2012). A Representation: Incorporating a Needs Assessment and Gap Analysis into the Educational Design. Pitman, NJ: Anthony J. Jannetti, Inc.
Szoch, S., & Kaiser, K. S. (2015). Implementation and Evaluation of a High-Dose Cytarabine Neurologic Assessment Tool. Clinical Journal of Oncology Nursing, 19(3), 270-2.
Fats are found between internal organs, under the skin, and in the inner bone cavities. They are known to provide insulation and are responsible for the flexibility and structure of cell membranes. Moreover, fats aid in substance movement regulation in the cell membranes and maintain cholesterol and blood pressure levels in the body. Their primary role in the body is to primarily store and release energy. They are able to hold a lot of energy compared to carbohydrates for the bodys future use, which make them suitable for the role of reserving it. However, excessive fat storage is unhealthy for the human body, such as increasing the risk of heart disease. The surplus fat can be reduced by burning fat which can be initiated by activities such as exercise that require energy.
Process of Fat Burning
When the body is deprived of calories to provide energy or is kept under an exercise regimen, it starts to burn fat by using the stored energy for activities. Fat is held in the fat cell in triacylglycerol form. The physiological process of burning fats requires them to be liberated from the adipocytes using complex enzymatic or hormonal pathways, as it does not happen in the fat cell (Prologo, 2022). The brain stimulates the fat cell to release fat into circulation or the bloodstream in the form of fatty acids and deliver it to the tissues where energy is needed through the blood.
More energy packages are transported to muscles that require energy as blood flow increases. The fatty acids are deposited in the mitochondria by lipoprotein lipase via the carnitine shuttle system, where they are burned. The fat cell shrinks after the fatty acids are released, which accounts for the leaner look when the body gets rid of excess fat (El-Zayat et al., 2019). Following this, the fat cells remain drained, leaving them useless. Therefore, the body does not necessarily lose fat cells as the process only involves emptying these storage tanks to be used for the provision of energy when needed. The body absorbs emptied fat cells due to their short lifespan and does not replace them.
Enzymes that Help in Fat Burning
Fat burning is stimulated by various hormones, including hormone-sensitive lipase (HSL). Activities such as exercise, change in the concentration of hormones glucagon and epinephrine, adenosine triphosphate (ATP), as well as other molecules in muscle cells, initiates the activation of HSL, referred to as a fat-burning enzyme. The primary role of HSL is to mobilize stored fats, which helps release fatty acids from the fat cells for them to be transported to the bloodstream (El-Zayat et al., 2019). The HSL enzyme hydrolyzes triacylglycerol or diacylglycerol molecules which releases fatty acids to be used to supplement energy needs in various tissues in the human body.
The thyroid hormone (TH) is significant in controlling metabolism in the body. It is secreted following the release of thyroid-stimulating hormone (TSH) from the pituitary gland. TSH promotes the production of triiodothyronine and thyroxine in the thyroid gland, which is used to improve metabolism in various body tissues. Therefore, the main effect of TH is to enhance the metabolic rate of the body, which requires energy supplementation. The secretion of thyroid hormone is increased in cold weather to compensate for the increased loss of heat during this process (Litwack, 2018). For this reason, TH initiates the breaking down of brown fat to help produce the heat required to maintain the body temperature, especially in cold climates.
Role Growth Hormone
The human growth hormone (GH), also referred to as somatotropin, is secreted by the somatotropes in the pituitary gland anterior globe. It is significant in helping the human body build muscle which aids in fat burning (Wang et al., 2021). The sufficient release of good GH levels depends on getting enough sleep. This is because inadequate sleep lowers the secretion of growth hormones, inhibiting the bodys ability to recover from exercise, thereby limiting energy uptake, which then interferes with the fat-burning process. Enough sleep allows the body to produce the right amount of GH to enable the body to take up energy and help in fat loss in the process.
Additionally, GH helps promote lipid metabolism in the human body. Tissues require a lot of energy to promote effective growth. GH activates adipocytes to break down fat and free glycerol and fatty acids into the bloodstream, thereby enhancing fat loss. This makes it necessary for cells to consume proteins for their growth. Furthermore, GH can initiate accelerated lipolysis, which helps with fat loss (Lewitt, 2017). Lipolysis is a metabolic process that enhances the breaking down of fatty acids to help fat cells shrink and enable weight loss. Moreover, the growth hormone blocks the reentry of fatty acids into the adipose tissue by inhibiting lipoprotein lipase.
Role of Stress in Inhibiting Fat Loss
Stress stimulates the continuous secretion of cortisol hormone in large amounts. Due to stress, the human body tends to hold onto fats which inhibits the release of fatty acids following the massive secretion of cortisol into the blood (Chao et al., 2017). In addition, the distribution of the cortisol hormone in the body raises hunger levels forcing a person to consume more food which interferes with the fat-loss process, particularly in the abdominal region (Xenaki et al., 2018). Excessive accumulation of visceral fats contains severe health consequences considering it surrounds vital organs in the body and enhances the release of fatty acids into the bloodstream, which raises insulin as well as cholesterol levels.
Severe stress stimulates more blood glucose which results in increased insulin levels. The boost in insulin secretion allows the hormone cortisol to promote insulin resistance in the human body, enhancing visceral fat accumulation in the human body (Kumar et al., 2022). High insulin levels push the human body to absorb more sugar from the blood and force the adipose tissue and muscles to store more fat and glycogen. During stress, the body tends to ensure that a sufficient supply of energy is available and that the levels of blood sugar do not drop. For this reason, an individual is forced to increase carbohydrate consumption since cells cannot use the circulating sugar, which blocks the utilization of stored fat for energy.
Importance of Protein
Protein enhances the secretion of glucagon from the pancreas, which is considered as an insulin antagonist hormone. Maintaining low insulin levels enables the body to effectively utilize and have access as a fuel source. Glucagon helps promote the breakdown of glycogen and enhance glucogenesis in the liver, thereby promoting fat use. Additionally, glucagon activates the enzyme adenylate cyclase, which stimulates cyclic adenosine monophosphate (AMP), which triggers HSL, thereby promoting fat burning. Moreover, proteins help spur the release of growth hormone from the pituitary gland (El-Zayat et al., 2019). The growth hormone released works on the fat cells to enable them to secrete glycerol and fatty acids into the bloodstream to be transported where energy is needed.
Moreover, proteins help provide the building material needed for tissue growth. For this reason, increased consumption of protein enables the body to remain in a positive nitrogen balance which promotes metabolic rate elevating greater expenditure of energy. Additionally, protein enhances body metabolism as it needs more energy to be digested as compared to fats, carbohydrates, and macronutrients. For this reason, the thermic effect of food (TEF) rises, which in turn increases the number of calories burnt by the body during the day, which promotes fat loss (El-Zayat et al., 2019). Furthermore, proteins contain strong appetite-suppressing effects by stimulating the secretion of cholecystokinin (CCK) in the stomach cells that signal the brain of the stomachs fullness.
Role of Enzyme Creatine
Creatine is essential in enhancing the metabolism of nitrogen and amino acids, particularly methionine and arginine. The metabolism of amino acids enables the increased use of energy, which can be obtained from stored fat, thereby enhancing fat loss. Additionally, the enzyme creatine helps deliver energy to cells, especially muscle cells, all over the body. The enzyme is transported through the bloodstream to be used by the skeletal muscle and the brain to provide the energy needed to perform their activities (Bonilla et al., 2021). Moreover, the enzyme creatine aids in increasing lean muscle mass and enhances faster muscle recovery after a strenuous exercise which necessitates the breakdown of fats to provide the needed energy.
Importance of Water
Water is an essential component in enhancing the overall body metabolism, which in turn helps burn more fat to support the process. Increased consumption of water stimulates lipolysis, which then burns stored fat to produce energy (El-Zayat et al., 2019). Additionally, water intake promotes body hydration which expands the cell volume, which enhances fat burning and eventually helps with fat loss. Moreover, more water intake increases insulin sensitivity promoting fat breakdown, which enhances weight loss. This reduces food intake to enhance the mobilization of the release of fatty acid to be used for energy provision, which helps the body burn stored fat.
The Triangle Rule of Water, Carbohydrates, and Sodium
Low carbon intake causes a drop in insulin levels in the body which could promote the loss of water and sodium. Sodium is essential in regulating the levels of water in the body (Bankir et al., 2017). Therefore, the amount of sodium consumed directly affects the bodys ability to eliminate or hold water. Moreover, increased carbohydrate intake stimulates water retention contained in glycogen molecules, increasing weight gain. Individuals are required to lower sodium intake to 1500 milligrams per day and limit carbon consumption to 45% of daily calorie intake (Busch, 2020). This will help reduce water retention in the body, which will promote weight loss.
Difference Between Insulin Resistance and sensitivity
Insulin resistance is associated with high carbohydrate and processed diets which force the body to perform the digestion process quickly. For this reason, pressure is put on the pancreas to secrete more insulin than needed, leading to insulin resistance. Additionally, a body that is insulin resistant tends to contain high amounts of fatty acids in the blood (Petersen & Shulman, 2018). Insulin resistance can be reduced by eating low-carbohydrate and soluble fiber foods. On the other hand, insulin sensitivity enables cells to effectively use the blood sugar for energy and allows the body to easily drop excess weight.
Conclusion
In conclusion, fat burning is stimulated by strenuous activities such as exercise. For fats to be burned, they will have to be released from adipocytes and then transported to tissues with energy demand. The process is catalyzed by the thyroid hormone and hormone-sensitive lipase. The GH promotes amino acid transportation to cells and lipid metabolism. Stress enhances the release of cortisol and increases insulin levels, promoting resistance to the hormone. Proteins foster the release of GH and glucagon, increase metabolism, and inhibit appetite. Creatine helps elevate nitrogen and amino acids metabolism, which boosts energy use. High water consumption stimulates lipolysis, while low carbohydrate and sodium consumption lead to a drop in insulin levels. Insulin resistance is associated with high amounts of fatty acids in the blood, while sensitivity to the hormone promotes the effective use of blood sugar, thereby promoting weight loss.
Bankir, L., Perucca, J., Norsk, P., Bouby, N., & Damgaard, M. (2017). Relationship between sodium intake and water intake: The false and the true. Annals of Nutrition and Metabolism, 70(1), 5161.
Beard, J., Yates, D., & Mulliniks, T. (2019). Function and dysfunction of fatty acid mobilization: A review. Diabesity, 5(1), 16.
Bonilla, D., Kreider, R., Stout, J., Forero, D., Kerksick, C., Roberts, M., & Rawson, E. (2021). Metabolic basis of creatine in Health and Disease: A Bioinformatics-Assisted Review. Nutrients, 13(4), 132.
Chao, A., Jastreboff, A., White, M., Grilo, C., & Sinha, R. (2017). Stress, cortisol, and other appetite-related hormones: Prospective prediction of 6-month changes in food cravings and weight. Obesity, 25(4), 713720.
El-Zayat, S., Sibaii, H., & El-Shamy, K. (2019). Physiological process of fat loss. Bulletin of the National Research Centre, 43(1), 115.
The model introduces opportunities for motivating people to change their behaviors toward healthier ones. Additionally, the framework allows the integration of all available resources to facilitate better patient services and enhance patient education. Nola Penders model also offers a chance to tailor specific interventions to the unique needs of patients, which creates an opportunity to improve health outcomes substantially (Khodaveisi et al., 2017).
Attributes
Penders Model consists of eight key attributes. First, the perceived benefits of action allow for forecasting the positive outcomes of an intervention. In turn, the perceived barriers to action help to evaluate the challenges to overcome. Perceived self-efficacy allows for gauging the extent of a nurses competence. The activity-related effect is linked to the effects that behavior produces. Interpersonal influences incorporate social factors, whereas situational influences are linked to patient-specific factors. Finally, commitment to a plan of action defines its success, and immediate competing demands and preferences show the need to embrace every factor in the analysis.
Flaws
At the same time, Penders model has several notable flaws. For example, the model provides only a nebulous description of each of the four meta paradigms (person, environment, nursing, and health). Moreover, the model is oversaturated with extra components and concepts, which makes it difficult to apply.
Criticism
Overall, Penders model has been criticized for its vagueness quite a lot. Additionally, Penders Model of Nursing may be challenging to apply to a specific disease at a particular stage (Bahabadi et al., 2020). Nevertheless, the model has been praised for its focus on patient-specific characteristics and the needs of target populations, which is why applying it to address public health issues should be an important step in promoting health literacy and improved outcomes in patients.
Metaparadigms
The model defines health as a positive dynamic state, the person as a learner, the environment as a combination of extraneous factors, and nursing as the process of guiding patients toward a healthy change.
The patient, a 90-year-old Caucasian male with a PMH of AF, PVD, vision loss, HLD, obesity type I, SOB, and CHF was admitted to hospice on 05/21/21 for systolic congestive failure. Clinically, according to the SAF scale: class 4 (CHF due to AF). According to the CHA2DS2-VASc score, the patient has 2 points (age >75 years), arterial hypertension 1 point (BP 143/72 mmHg), congestive heart failure 1 point, and vascular disease 1 point. Sum: 5 points (>2 for men) which means the constant intake of anticoagulants is strongly recommended (moderate-high risk of stroke). HAS-BLED score: 1 point (age>65), low risk for major bleeding. The combo calculator assessed the 5-year risk of stroke to be 13%, and the 5-year risk of stroke or death to be 93%.
The anamnesis lacks the number of episodes of atrial fibrillation. The essential instrumental tests should be done before prescriptions: ECG (P is absent, F-waves instead), heart ultrasound, and Holter monitoring (Craig et al., 2019). Before prescribing anticoagulants, the patient needs to take a clinical blood analysis (excluding anemia), check the gastrointestinal tract, liver enzymes, kidney functions (creatinine, ALT, ACT, bilirubin), clinical urine analysis (excluding erythrocyturia and albuminuria).
According to the risk scores, the patient needs anticoagulant medications. The patient does not have a mechanical valve or hemodynamically significant mitral stenosis, so no limitations for NOACs, which might be more practical compared to warfarin (no dietary limitation and INR monitoring). Also, warfarin in meta-analyses did not show a reduction in death rates, ischemic events, or strokes but increased the rate of major bleeding (Craig et al., 2019). Moreover, NOACs compared to warfarin, represented an advance in therapeutic safety according to the latest AF guidelines (Craig et al., 2019). The level of the patients CrCl is unknown from anamnesis; however, one of the following NOACs can be prescribed in the relevant doses: Tabl. Dabigatran 150 mg 2 per day (renally excreted, if CrCl < 30 ml/min, cannot be taken) or tabl. Rivaroxaban 15 mg once daily (CrCl should be > 30 ml/min) or tabl. Apixaban 5 mg twice daily (predominantly eliminated hepatically, a drug of choice).
NOACs should be recommended to the patient in terms of fewer drug-drug interrelations, and fewer risks of intracranial bleeding than warfarin. However, if the patient is concerned financially and accepts dietary limitations and repeated INR testing, it is not necessary to start with NOACs. Still, it is important to discuss with a patient all the possible options and implement tailored education for the patient in oral anticoagulation intake (Hawes, 2018). Warfarin is prescribed from a small dosage (lower than 10 mg) with a gradual increase to the final aim of INR 2,0-3,0.
The duration and form of atrial fibrillation play a role in the further tactics. On this occasion, the length of atrial fibrillation is unknown. Then, the peroral intake of anticoagulants for 3 weeks is recommended (warfarin with INR control or NOACs) (Bosch et al., 2018). Afterward: if no clots are found in the left atrium on echoCG, implement cardioversion with monitoring of the heart rate deviations and prolonged intake of anticoagulants. Controlling ventricular rate is also important in AF with HR < 80 bpm (patient has 72 bpm): beta-blocker or nondihydropyridine calcium channel antagonist is recommended (Craig et al., 2019). Currently, the patient has pleural effusion, so the latter is not the primary therapeutic choice also due to the negative inotropic effect. A selective beta-blocker, such as metoprolol tartrate 50 mg twice per day, can be the choice therapy if the patient has no AV blockade II-III, bradycardia, SSS.
Cardizem or other calcium-blockers are not recommended for patients with peripheral vessel diseases as this group of drugs decreases the peripheral restriction of the vessels and worsens the symptoms of CHF, such as edema and pleural effusion (Pariaut, 2017). The patient already had an episode of pleural effusion, so deterioration of the current condition might not be rational on this occasion. While solving the case study, no personal patient documentation was used according to HIPPA guidelines (HIPPA guidelines materials, 2021).
References
Bosch, N. A., Cimini, J., & Walkey, A. J. (2018). Atrial fibrillation in the ICU. Chest, 154(6), 1424-1434.
Craig, T. J., Wann, L. S., Calkins, H., Chen, L. Y., Cigarroa, J. E., Cleveland, J. C., Ellinor, P. T., Ezekowitz, M. D., Field, M. E., Furie, K. L., & Heidenreich, P. A. (2019). 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation. Journal of the American College of Cardiology, 74(1), 105-132.
Hawes, E. M. (2018). Patient education on oral anticoagulation. Pharmacy, 6(2), 1-10.
There is a high degree of general competence to represent a huge population via the use of surveys. Due to the generally large number of individuals that respond to surveys, the collected data provide a more accurate depiction of the relative features of the studys general population. Compared to other techniques of data collection, surveys may extract data that are almost identical to the characteristics of the wider population (Sincero, 2012). One has to pay for the manufacturing of survey questions while conducting surveys. If researchers require a bigger sample of the general public, they may provide monetary or non-monetary incentives of as little as $2 per participant (Sincero, 2012). Other data collection techniques, such as focus groups and personal interviews, are more expensive for researchers. There are several methods by which surveys may be conducted to respondents. The surveys may be conducted through email, fax, or the Internet. Currently, internet surveys are the most common technique to collect data from target participants (Sincero, 2012). In addition to the ease of data collection, researchers may collect information from individuals all over the world.
The survey employed by the researcher from the outset and its administration technique must be kept the same during the whole data collection procedure. Although this rigidity might be considered a shortcoming of the survey approach, it can also be viewed as a virtue, given that both precision and fairness can be applied to the research (Sincero, 2012). Controversial questions may elicit vague responses from participants due to the probable difficulties in retaining pertinent facts. These concerns may need to be resolved precisely as when employing alternate data collection techniques, such as in-person interviews and focus groups. Consequently, a mix of methodologies may be a more robust strategy that accounts for drawbacks and reduces the likelihood of bias.
Validity refers to the degree to which a claim, conclusion, or choice is rational, correct, and justified. The reliability of a survey instrument is measured by the degree to which its questions consistently elicit the same responses when asked again in the same context (Wu et al., 2022). Reliability is a statistical measure of the reproducibility of the data collected by a survey instrument. Both reliability and validity are essential in assessing the quality of research. Researchers may utilize these notions to create research techniques that provide reliable and valuable data. A survey instrument is said to have high reliability if it produces similar results under consistent conditions (Wu et al., 2022). Any change would be due to a true change in the attitude, as opposed to changing interpretation. The concerns with no reliability and validity are the generation of defective data that would be inaccurate, unreproducible, or invalid, resulting in incorrect conclusions and actions.
The reliability stems from the qualifications of the University of Virginia Health System, the name of which is printed on the cover page. The survey questions of UVA Health System are provided in the form of items for discussion, which ensures that the deviation of data is minimal and that all results are replicable. Thus, making the survey targeted and concise ideal for research purposes. They are directly related to the evaluation of the workplace as they convey in short sentences the employee job satisfaction with various organizational parts. It is possible to think that everyone taking the survey would be able to have a similar level of comprehension as, despite vagueness, the survey focuses on distinct feelings about certain situations. Questions are unbiased because they could be applicable in any work environment. This universality of application confirms noninvasiveness. Since the nature of the items discussed focuses on the feelings of respondents, there could be several answers for positive and negative interpretations, which demonstrates overlapping categories.
Wu, M.-J., Zhao, K., & Fils-Aime, F. (2022). Response rates of online surveys in published research: A Meta-analysis. Computers in Human Behavior Reports, 7, 100206.
Surgical incision and drainage + debridement and irrigation is a highly complex surgical procedure associated with various complications. If performed incorrectly, the procedure may cause negative consequences for the patient and the clinical outcome. A definitive diagnosis that may imply the application of surgical incision & drainage + debridement & irrigation is necrotizing soft tissue infection. In this case, the procedure might cause harmful complications, such as sepsis. This paper aims to discuss sepsis while addressing the incidence, pathophysiology, risk factors, signs and symptoms, diagnostic evaluation, and management of the complication. Sepsis is a severe medical issue that can lead to dangerous consequences if not treated properly.
As it is known, sepsis is related to the spread of infection by the bloodstream. The annual incidence of the illness in the United States is estimated to be up to 300 clinical cases per 100,000 people, and it is associated with high rates of mortality and morbidity2. The pathophysiology of sepsis was described in 1914, stating that sepsis occurs when a focus has developed from which pathogenic bacteria, constantly or periodically, invade the bloodstream in such a way that this causes subjective and objective symptoms. 2 Furthermore, the risk factors of sepsis are associated with diabetes and the previous history of various infections2. Invoking the illness as a result of the surgical procedure may cause severe dangers for the patient.
There is a wide range of different symptoms that sepsis can cause. These include increased heart rate, rapid breathing, severe pain or feeling of discomfort, breath issues, confused or disoriented state, fever, shivering, and cold1. The first indicator for the diagnosis of the illness is systolic blood pressure, but the evidence from recent studies suggests that a practical biomarker that can be used for early diagnosis is procalcitonin1. However, the researchers believe that the nature of the infection may vary, provoking different levels of the inflammatory response, which can directly impact the severity of the illness2. To manage sepsis, clinicians use various immunomodulatory agents, primarily glucocorticoids. They help contain inflammatory and coagulatory adverse effects while also preserving their benefits.
Overall, surgical incision and drainage + debridement and irrigation is a highly complex procedure, especially when treating a patient with necrotizing soft tissue infection. The procedure under discussion has several complications, such as sepsis. Sepsis is a severe illness associated with many dangerous symptoms, meaning that, if left unattended or untreated, it can cause significant negative consequences for the patient. However, sepsis is a well-explored disease, and there are effective methods of managing that complication if it appears after the surgical procedure of incision, drainage, debridement, and irrigation.
References
Calsavara A J, Nobre V, Barichello T, Teixeira A L. Post-sepsis cognitive impairment and associated risk factors: A systematic review. Australian Critical Care, 2018;31(4):242-253.
Gyawali B, Ramakrishna K, Dhamoon A S. Sepsis: The evolution in definition, pathophysiology, and management. SAGE open medicine, 2019;7:1-13.
In the context of contemporary health care, the growth of nurse practitioners (NPs) can be observed across the United States. However, numerous barriers limiting nurse practitioner practice exist at various levels. In particular, federal regulations contribute to the problem, impacting the overall health care system. According to Torrens et al. (2020), gaps in primary care provision were reported, aggravated by restrictive federal laws on the scope of practice of NPs. Therefore, eliminating federal barriers to NP practice is essential to expand the nurse practitioner workforce to meet the growing demand for medical services.
Main body
In this regard, research findings support the need for expanding the nurse practitioner practice in todays world. According to Poghosyan et al. (2017), removing restrictions on NP practices that do not match the NP expertise and competencies as well as needs of primary care practices is important; new policies should encourage such effective NP practices to promote teamwork (p.86). As health care evolves, NPs continue to play a pivotal role in improving diverse populations health outcomes. Nonetheless, as reported by the American Association of Nurse Practitioners (n.d.), federal laws prevent the NP and their patients from becoming full program participants. The physician visit requirement suggests that an individual is to receive a primary care service from a primary care physician.
Conclusion
To conclude, barriers for nurse practitioners continue to be an acute problem. In particular, family nurse practitioners face the challenge of federal regulations restricting their practice. Furthermore, NPs must compete with physician assistants due to the federal laws. As a result, a significant barrier arises with regards to meeting the increased demand for health care. American Association of Nurse Practitioners requires that NPs must be authorized to provide care, particularly in todays tough conditions.
References
American Association of Nurse Practitioners (n.d.). AANP federal policy priorities. Web.
Poghosyan, L., Norful, A. A., & Martsolf, G. R. (2017). Primary care nurse practitioner practice characteristics: Barriers and opportunities for interprofessional teamwork. The Journal of ambulatory care management, 40(1), 77-86. Web.
Multiple searches across several databases may be required when searching for relevant articles to support research with evidence to address the PICOT question criteria. Randomized controlled trials have the highest level of evidence, and they remain the focus of the search. The goal of this weeks task is to select five relevant journal articles to search for evidence on the PICOT topic. The MEDLINE database was used to search for relevant articles.
Search Tracker
PICOT Question Organizer
PICOT
For adults >65 years of age in the retirement community (P) does an exercise program (l) compared to no exercise program (C) decrease fall rates (O) within one year.
P
Population
adults >65 years of age in the retirement community
I
Intervention
an exercise program
C
Comparison
no exercise program
O
Outcome
decrease fall rates
T
Time frame
within one year
Search Tracker
Search #
Initial Search Terms
Database
AND/OR
Added Search Terms
Title (Ti) Anywhere, etc.
Number of Articles Found
1
Elderly
MEDLINE
AND
Fall Rates
81
2
Elderly
MEDLINE
AND
Exercise Program
2331
3
65 years of age
MEDLINE
AND
Fall Rates
35
Databases Utilized
The MEDLINE database was used to search for relevant literature on the PICOT topic. OVID/MEDLINE is a database containing literature on nursing, medicine, dentistry, allied health, and the biological and physical sciences (Rutgers University, 2019). The output of articles was relevant because strong terms were used; no other database was searched. To personalize the search, a search filter was set to only available full-text articles. In order for the articles in the search results to be up-to-date, the interval of the last five years was chosen.
APA-Formatted References, Abstract, and Level of Evidence
Bates et al. (2018) are investigating specific exercise programs that will help reduce the risk and frequency of falls among older people. Home exercise programs are liked by some older adults because of their convenience (Bates et al. 2018). This study aimed to determine the effectiveness and cost-effectiveness of a home exercise program for the lower limbs compared to an exercise program for the upper limbs at home. The study is randomized and controlled, which ensures its reliability. The study included 576 community residents from the Illawarra and Shoalhaven regions of New South Wales and Australia (Bates et al. 2018). Participants are randomized to do home exercises for the lower limbs or home exercises for the upper limbs. Participants will take part in three group sessions to learn and improve the exercises and will be instructed to do the exercises at home three times a week for 12 months (Bates et al. 2018). If successful, the trial will provide a model of upper and lower-limb exercise programs that can be done at home and scaled up for the elderly.
Level of Evidence
Since the study provides only a literature review and a description of the proposed intervention, the level of confidence can be no higher than VI. The study provides an analysis of the previous literature and explains the need for intervention. The above data follows the validity of the study. Since the participants were carefully selected and the sample is sufficient, it can be assumed that the conclusions of the study will be relevant.
Liu-Ambrose et al. (2019) highlight the lack of studies on the effect of exercise on subsequent falls in high-risk older adults who have already experienced a fall. A single-blind, randomized clinical trial was conducted on adults aged at least 70 who had fallen within the past 12 months (Liu-Ambrose et al., 2019). Participants were randomized to receive conventional care and a home-based strength and balance exercise program administered by a physiotherapist and a conventional care group consisting of fall prevention care provided by a geriatrician (Liu-Ambrose et al., 2019). The groups were 173 and 172 people, respectively (Liu-Ambrose et al. 2019). Among 345 randomized patients, a total of 236 falls occurred among participants in the exercise group versus 366 falls among participants in the usual care group (Liu-Ambrose et al., 2019). Thus, the study proves that participants who exercised significantly reduced the frequency of falls. This study provides strong evidence for the effectiveness of exercise in older patients.
Level of Evidence
This study achieves II level of evidence because it is randomized and controlled. The data obtained during the study can be considered relevant and practically negligible since the study was long and the control group was significant. Both groups were extensively monitored throughout the study, which increased the validity of the findings. The research can be broadly applied to develop a set of exercises to reduce the number of falls among the elderly population.
Moreland et al. (2020) emphasize the importance of studying falls as it is the leading cause of injury in people over 65 years of age in the US. Data from the Behavioral Risk Factors Surveillance System was analyzed to describe the percentage and frequency of non-fatal falls by age group, as well as demographics and trends in falls and fall-related injuries over time (Moreland et al., 2020). In 2018, 27.5% of older people reported a fall at least once in the past year. The percentage of older people reporting falls increased between 2012 and 2016 and decreased slightly between 2016 and 2018 (Moreland et al., 2020). Screening older patients for risk of falling, assessing modifiable risk factors, and recommending interventions to reduce this risk can prevent older people from falling (Moreland et al., 2020). The data obtained from this study can be used to identify risk factors for falls and design a relevant exercise program to address these risks.
Level of Evidence
This study is a systematic descriptive review and therefore achieves level V of evidence. Researchers are seeking to categorize the information obtained from the database to identify factors that increase the incidence of falls and to analyze at-risk groups in the population. The study is well applicable as it allows the development of a risk-addressing strategy to reduce the frequency of falls. The study could be strengthened by identifying specific fall reduction strategies for each of the risk groups.
The aim of the systematic review and meta-analysis by Papalia et al. (2020) was to evaluate the effect of exercise on static and dynamic balance in the elderly and analyze the number of falls. A systematic literature search was performed using PubMed-Medline, Cochrane Central, and Google Scholar to select randomized clinical trials (Papalia et al., 2020). Meta-analysis showed improvements in dynamic balance (p = 0.008), static balance (p = 0.01), participants fear of falling (p = 0.10), balance confidence (p = 0.04), quality of life (p = 0.08) and physical performance (p = 0.30) in patients who performed physical exercises (Papalia et al., 2020). An analysis of the total number of falls showed a decrease in the likelihood of falls in patients who participated in physical activity programs (p = 0.0008) (Papalia et al., 2020). There was a significant decrease in the number of patients who fell at least once in the intervention group (p = 0.02) (Papalia et al., 2020). Exercise is an effective means to improve balance and reduce falls in the elderly. This study provides a strong evidence base for the effectiveness of exercise as a therapy for helping the elderly.
Level of Evidence
This study is a systematic review and meta-analysis of relevant randomized controlled trials and therefore achieves I level of evidence. The study provides strong evidence to justify the use of exercise as an effective measure to reduce falls in the elderly population. The study used robust tools to select peer-reviewed articles and search multiple databases. Articles have been carefully reviewed for relevance, so the findings of the study can be considered valid and applicable.
The aim of the study by Seymour et al. (2019) was to evaluate the effect of a physical therapy program for people with Parkinsons disease. The study was randomized, and controlled, with a predetermined subgroup analysis. 474 people with Parkinsons disease were enrolled in the study, 238 were enrolled in the physical therapy program, and 236 were in the control group (Seymour et al., 2019). The intervention group had an individually tailored, progressive home-based fall prevention strategy training program with balance and strengthening exercises. By 6 months, 116 (55%) in the control group and 125 (61.5%) in the intervention group reported recurrent falls (controlled OR 1.21, 95% CI 0.74 to 1.98, p = 0.447) (Seymour et al., 2019). Secondary subgroup analysis showed different responses to the intervention between the moderate and severe disease groups (Seymour et al., 2019). The results of the study can be used in further work to prove the need for medical personnel to intervene in the control of exercise.
Level of Evidence
This study presents data from a well-designed, randomized, controlled trial, reaching the II level of evidence. The results of the study were inconsistent due to insufficient control over the intervention group of subjects. The higher number of subjects who reported a sustained number of falls in the controlled group may be associated with greater reflexivity over their health compared to the uninstructed group. Research results may have been more relevant if the number of subjects is increased to minimize randomness.
The provision of quality care and adequate patient safety, especially regarding medication administration, is the primary and nationwide initiative that assumes implementing evidence-based strategies and practices. In this regard, staff training is an integral component of maintaining, improving, and upgrading nurses competency in all areas of their activity and increasing their commitment to the best medication administration principles. Therefore, this paper aims at enhancing nurses awareness of medication administration errors (MAEs), providing an improvement plan, and describing their role in realizing it. The session will also deliver resources or activities promoting necessary skill development and process understanding and methods of fostering the audiences feedback and integrating it for future improvements.
Problem Overview
Despite the recent significant technology implementation in the healthcare sector, adverse drug events (ADEs) still remain one of the most prevalent medical safety issues. According to the Agency for Healthcare Research and Quality (AHRQ), ADEs amount to about 700,000 visits to the emergency department and 100,000 hospitalizations every year ( Medication errors, 2019). Moreover, 7,000 to 9,000 patients die because of MAEs, and the total cost of medication-associated errors is over $40 billion every year (Tariq et al., 2021). Herewith, it is worth noting that thousands of patients and even medical providers do not report complications and different adverse reactions induced by medications.
Issues of Concern
Generally, MAEs can result from various sources connected with prescription, clinicians, nurses, medical organizations, and patients as well. The causes of medication errors include incorrect dose, expired drugs, improper medication preparation, a mix of several drugs with contradictions, disregarded allergies, pharmacists or nurses wrong actions, frequent distractions, and distortions. In particular, distractions are guilty of nearly 75 percent of all MAEs and are mainly related to nurses and physicians overload and multitasking (Tariq et al., 2021). Additionally, Hammoudi et al. (2017) indicate inadequate communication between nurses, doctors, and patients. Wondmieneh et al. (2020) also state nurses who had low work experience and training and do not follow guidelines for medication administration and are more inclined to MAEs. Finally, patient age and related diseases are among the widespread factors.
Safety Improvement Plan
A safety improvement plan (SIP) pursues five objectives: enhancing patients and nurses education and collaboration, improving environmental conditions, cultural strategies, clinical interventions, and technological interventions. Specifically, the first goal includes close face-to-face discussions between various professionals, strict adherence to medication administration guidelines, ongoing training, and visual tools. Communication can be strengthened by conferences, active listening, proper writing, and specific technologies such as clinical decision support systems. The second goal assumes streamlining nurses workflow and alleviating workload. Cultural strategies imply highlighting a multidisciplinary responsibility for error prevention, whereas clinical interventions mean minimizing opioid and sedative medications. Finally, technological interventions involve using barcode scanning of medication (BSM) or smart infusion pumps.
Staffs Role
The staff plays an essential role in realizing the SIPs goals since their main responsibility is to promote care quality and safety. In particular, nurse executives arrange measures and ensure the resources availability for the SIP, while nurse managers supervise and encourage nurses commitment to the structure of the plans implementation. Quality assurance coordinators gather relevant data on the progress of the plans implementation and collect regular forums to accord productive quality improvement work. Nurse practitioners (NPs) and registered nurses (RNs) deliver appropriate day-to-day care, diagnosing and treating patients and conducting minor medical procedures. Besides, these persons are directly responsible for identifying problematic areas in medication administration in their organizations.
Staffs Importance
The personnel motivation, attitudes, commitment to the structure and core objectives of the improvement plan will reflect on the ultimate outcomes. Nurses are accountable for delivering robust communication, necessary emotional or physical support for patients, and the continuity of care and involving patients in their self-management and education. Furthermore, since nurses are at the forefront of care delivery, the relevancy and quality of provided information for developing and adopting the SIP considerably depend on them. The study by Rahimi et al. (2020) exhibits that due to understaffing, nurses error reporting is relatively low. This unfavorably impacts data collection, which eventually results in the ignorance of critical issues linked to medication administration.
Benefit for Staff
First of all, the successful realization of the plan will contribute to the formation of a thriving corporate culture with a healthy working atmosphere and sound communication. In turn, this will improve nurses motivation and devotion to their obligations, which should boost safety culture. Moreover, participants can receive valuable experience during the implementation process and acquire or develop useful skills and knowledge needed for daily tasks and procedures. Finally, the SIP can streamline personnels workaday workflow, which alleviates nurses workload and reduce the number of distractions, the predominant cause of MAEs.
Skills and Processes
First, the training session will aim at enhancing the staffs communication skills such as active listening, emotional control, speech clarity, body language, empathy, and respect. Communication also assumes knowing both verbal and non-verbal means of conveying information. Besides, participants will be familiar with multitasking skills which implies concentration on medication administration as the primary task while tracking others. Furthermore, personnel will gain profound knowledge about federal and WHO guidelines, nursing textbooks, and other relevant literature related to medication administration. Finally, nurses will be acquainted with advanced technologies, including health information systems (HISs), BSM, and smart infusion pumps.
Learning Activities
First, in-service sessions will include diverse classroom activities such as lectures and webinars that will contain PowerPoint papers and videotapes to stimulate group discussion and essential knowledge acquisition. Safaeifard et al. (2020) recommend using diagrams, self-learning, and papers with enjoyable materials in lectures. Besides, sessions can have case studies that examine the most prevalent and adverse incidents and issues connected with MAEs. Job rotation is another practical learning method, which will require participants engagement in different interdisciplinary activities, including an NP, RN, pharmacist, coordinator, or nurse manager. It is also relevant to conduct on-the-job training for trainers, assuming reading the manuals and combining explanation, observation, and practice.
Learning Activities (cont.)
Moreover, the fourth learning activity is coaching which means individual mentoring under experienced professionals. In this case, learners can always ask various questions and receive comprehensive answers. Finally, the innovative method of teaching is technology-based learning that comprises e-learning training programs, simulators, and interactive videos with interesting and useful information. During training programs, nurses can receive fundamental knowledge and care skills by simulating interactions with patients. Additionally, coordinators can record and track the progress of participants and address challenging points.
Possible questions
During sessions, students can have numerous questions concerning medication errors and prevention procedures and strategies. For example:
What are the most prevalent causes of MAEs:
Distractions, incorrect dose, and wrong prescription;
Contributing factors:
Poor communication, staffs negligence and ignorance, and patients age and diseases.
How to prevent MAEs:
Double-check the dosing and medications, write legibly and without abbreviations, check drugs contradictions and patients age, weight, allergies, existing comorbidities, and conditions of the kidneys and liver, be aware of high-risk medications, and monitor patients states.
Feedback Encouragement
Feedback from the audience helps determine both enjoyable and struggling activities and assesses the outcomes of the sessions. In this respect, to encourage feedback, the educator can ask questions during the sessions, which are related to the courses material and learners interests. Furthermore, the educator can perform a post-training evaluation survey that contains various questions regarding the courses goals, structure, activities, and content, the quality of delivery, a trainer, and technical issues. It is also helpful to utilize one-to-one feedback with participants of different occupations, including a pharmacist, RN, or nurse manager. Finally, the coordinator can use other channels such as emails, social media platforms, or telephones. It is also worth noting that it is vital to be open and demonstrate the desire to feedback and encourage honest answers.
Future Improvements
The obtained feedback can be employed while designing future training sessions and selecting respective activities. In particular, it can help tailor the structure and duration of the course to learners needs and preferences, and improve the content and ways of its delivery. In addition, feedback aid in averting the most frequent technical issues, including bugs, dead links, problems with video and material loading, and the courses overall functionality. Due to feedback, educators have an excellent opportunity to explore drawbacks in their communication and areas needing immediate consideration. Finally, educators can make relevant adjustments to the learning environment to make it more conducive for learning.
Conclusion
In summary, the paper has provided an overview of MAEs and the SIP and examined the staffs role in implementing the plan. In particular, MAEs still remain one of the most prevalent medical safety issues, comprising thousands of hospitalizations and deaths each year. The SIP primarily targets improving patients and nurses education and environmental conditions and providing technological interventions. The staff encompasses many roles while implementing the SIP, including coordinating, delivering quality data, and diagnosing and treating patients. The direct benefit for personnel is an improved working atmosphere, sound communication, and motivation, and the acquisition of new skills and knowledge. Learning activities can consist of lectures and webinars, case studies, job rotation, on-the-job training, coaching, and e-learning training programs. The feedback can be derived through a post-training evaluation survey and digital channels and be applied to refine the courses structure, design, and content.
References
Hammoudi, B. M., Ismaile, S., & Abu Yahya, O. (2018). Factors associated with medication administration errors and why nurses fail to report them. Scandinavian Journal of Caring Sciences, 32(3), 1038-1046. Web.
Medication errors and adverse drug events. (2019). Patient Safety Network. Web.
Rahimi, E., Alizadeh, S. H., Safaeian, A. R., & Abbasgholizadeh, N. (2020). An investigation of patient safety culture: The beginning for quality and safety improvement plans inpatient care services. Journal of Health, 11(2), 235-247. Web.
Safaeifard, N., Roshangar, F., Ebrahim, H., Moonaghi, H. K., & Janani, R. (2019). Preferred learning styles of nurses in in-service training courses at Tabriz University of Medical Sciences. Acta Facultatis Medicae Naissensis, 36(1), 69-78. Web.
Tariq, R. A., Vashisht, R., Sinha, A., & Scherbak, Y. (2021). Medication dispensing errors and prevention. StatPearls Publishing.
Wondmieneh, A., Alemu, W., Tadele, N., & Demis, A. (2020). Medication administration errors and contributing factors among nurses: A cross-sectional study in tertiary hospitals, Addis Ababa, Ethiopia. BMC Nursing, 19(1), 1-9. Web.
