CAUTI Prevention Research Critique

Research Critique Essay
Moses Williams
NURS 450
Professor Peggy Melloh
Introduction
Catheter–associated urinary tract infection (CAUTI) is a fairly common complication in hospitalized
patients. Nosocomial infection prevention and patient safety promotion has been issued and many
researches have been conducted to improve patient's quality of life. In this article, Saint et al. (2005)
hypothesize that using a paper–based urinary catheter reminder can reduce the incidence of urinary
catheterization, and consequently this will enhance the patients' safety.
Critique Part 1 Research Questions or Hypotheses The background and significance of this study are
properly presented in the introduction. The research question is presented at the end of the ... Show
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Review of the Literature This article does not provide the search strategy including a number of
databases and other resources which identify key published and unpublished research. In this article,
both the primary sources and the theoretical literatures are collected and appraised in order to
generate the research question and to conduct knowledge–based research. In the section of the
literature review, nineteen professional articles are appraised in order to provide the significance and
background of the study. Saint develops the research question based on these analyses. "Catheter–
associated urinary tract infections in surgical patients: A controlled study on the excess morbidity
and costs" is one of the primary sources written by Givens and Wenzel who conduct and analyze this
study. In addition, "Clinical and economic consequences of nosocomial catheter–related bacteriuria"
is a review of a literature article which is the secondary source. Although many studies state that
patient safety is a top priority and CAUTI can be controlled by the caution of health care providers,
the infection rate is relatively high among other nosocomial infections. One of the reasons Saint and
colleagues uncovered is unawareness and negligence by health care
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National Patient Safety Goals ( Npsgs )
National Patient Safety Goals (NPSGs) were established in 2002 by the Joint Commission to help
accredited organizations address specific areas of concern in regard to patient safety ("Catheter–
Associated," 2015). NPSG.07.06.01 Implement evidence–based practices to prevent indwelling
catheter–associated urinary tract infections (CAUTI) is a 2015 NPSG ("The Joint Commission,"
2015). Our facility has 1.32 CAUTIs per 1000 device days (Carson, 2015). Decreasing our CAUTIs
can be achieved with a strict goal, addressing the financial implications, interdisciplinary
collaboration, nursing leadership, a measurement tool, and discussing the future healthcare delivery
methods.
Goal
Urinary tract infections are the most common type of healthcare ... Show more content on
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Your morbidity and mortality rate increase 2.8–fold when acquiring a CAUTI, and can add up to
$1000 direct cost to your bill in the acute care setting. Medicare beneficiaries with CAUTI have a
higher median Medicare reimbursement of $1500 in the acute care setting, and up to $8500 in the
ICU setting, not to mention increasing your length of stay in the ICU an extra 8 days ("Catheter
Associated Urinary Tract," 2011).
Healthcare–associated infections account for nearly $45 billion yearly in the United States, because
CAUTI is one of the most common, CMS stopped reimbursing hospitals for additional costs
associated with CAUTIs in 2008 (Kennedy, Greene, & Saint, 2013). Costs incurred with CAUTIs
when symptomatic urinary tract infections are involved can average up to $911 per patient, and up
to $3824 per patient when bloodstream infections are involved (Kennedy et al., 2013). This includes
costs associated with oral medications, intravenous medications, and laboratory testing.
Interdisciplinary Collaboration
Fakih and Jones (2013) really bring home the fact that once you communicate to your colleagues
that infection reduction is an organizational priority, the first step to reduce CAUTIs is to implement
a Comprehensive Unit–based Safety Program (CUSP) developed by Johns Hopkins Medicine
Armstrong Institute for Patient Safety and Quality. This starts with senior leadership commitment,
then involves physicians, nurse leaders,

The Change Theory Of Nursing Model
Framework The Change Theory of Nursing Model will be used to facilitate change in the unit
because it will drive the patient in a desired direction (Nursing Theory, 2016). The model, developed
by Kurt Lewin, uses three stages of change. Before change can be implemented the agent goes
through unfreezing, experiencing the change, and refreezing (Nursing Theory, 2016). Unfreezing
This phase involves focusing on the staff's mindfulness for the necessity of change based on the
evidence collected by an infection control committee. This phase is necessary to overcome the
tensions of individual resistance and group compliance (Nursing Theory, 2016). Using three
methods is how this phase is achieved. First, redirecting the behavior away from the existing
situation. Second, reducing the restricting forces that have a negative affect on the movement.
Lastly, using a combination of the two methods mentioned above. Experiencing the Change This
stage is where the staff will be required to view the education power point on the new CAUTI
prevention tool. The staff will then take a post education competency test to demonstrate proficiency
of the risks and complications of CAUTIs as well as the prevention tool. Nurses are encouraged to
assess the need to continue the Foley each shift and offer patients an urinal, commode, or bedpan
when needed. When indications are no longer met, the RN is to call the doctor for Foley removal.
Refreezing This is where establishing the change

Time Management And Prioritization Is Important Aspects Of...
Time Management and Prioritization Time management and prioritization are important aspects of
nursing care. The Pareto Principle states that 20% of focused effort results in 80% of outcome
results and is an important principle for all nurses to practice in order to provide high quality care
(Maloney, 2011). The majority of a nurses' time is spent on documentation, followed by care
coordination, patient care activities, unit related activities, med administration, non–clinical
activities, and personal time (Maloney, 2011, p. 425). Judie and I prioritize our nursing care based
on each patient 's diagnosis and need. Patients with severe diagnoses are seen first and patients who
are the least severe are seen last. If a patient is in pain or needs immediate attention we see those
patients first. Nurses prioritize their care activities into seven levels; imminent concern, high
uncertainty, pain management, relationship management, documenting and patient support, cleaning
and/or prepping supplies, personal breaks and social interactions (Patterson, Ebright, & Saleem,
2011, p. 389). Flexibility to deviate from this framework at any time is important in providing high
quality, personalized care. I reprioritize patient care based on a number of factors. Throughout our
shift I care for the highest priority patients first then I see patients who do not require much attention
so I can designate the majority of my time to patients who do. High priority patients are categorized
by

Cauti
Urinary tract infections (UTIs) are the most common nosocomial infection; accounting for up to
40% of infections reported by acute care hospitals. Up to 80% of UTIs are associated with the
presence of an indwelling urinary catheter. Catheter associated urinary tract infections (CAUTIs)
represent the largest proportion of healthcare associated infections (HAI). Catheter–associated
urinary tract infection (CAUTI) increases hospital cost and is associated with increased morbidity
and mortality .CAUTIs are considered by the Centers for Medicare and Medicaid Services to
represent a reasonably preventable complication of hospitalization. As such, no additional payment
is provided to hospitals for CAUTI treatment–related costs.CAUTIs can lead to ... Show more
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Not maintaining a sterile technique during insertion and closed drainage system after insertion.
4. The drainage bag of the bacteriuric patient is a reservoir for organisms that may contaminate the
environment and be transmitted to other patients. 5.Outbreaks of infection with resistant gram–
negative organisms attributable to bacteriuria in catheterized patients have also been reported.
PREVENTION
1. Limiting catheter use and, when a catheter is indicated, minimizing the duration the catheter
remains in situ are primary strategies for CAUTI prevention.
2. Ensure that only trained, dedicated personnel insert urinary catheters.
3. Implement a system for documenting the following information in the patient record: indications
for catheter insertion, date and time of catheter insertion, individual who inserted catheter, and date
and time of catheter removal
a. Include documentation in nursing flow sheet, nursing notes, or physician orders. Documentation
should be accessible in the patient record and recorded in a standard format for data collection and
quality improvement purposes.
4. Ensure that there are sufficient trained personnel and technology resources to support surveillance
of catheter use and outcomes.
5. Educate healthcare personnel involved in the insertion, care and maintenance of urinary catheters
about CAUTI prevention, including alternatives to indwelling catheters and procedures for catheter
insertion, management, and removal.
6. Maintain

Personal Narrative-Sever's Story
After the night when Maeve stood up for herself at dinner, she was a much more confident girl.
Hurling helped her do that. She was having a lot more fun with hurling than she ever did with
soccer. The day after she was accepted to the team, her practices began. "Aren't you excited for
practice?" asked Maeve to Patrick. "I guess a little, but you know that I've been doing this for a long
time, right? But I'm very excited for you, little sis." Patrick replied. They left the house for practice
and got there soon after. They began their basic warm–ups and Maeve followed along to the best of
her ability. Her brother had told her what they did earlier, but at that moment it was just a big jumble
like a messed up puzzle in her mind. The whistle blew and they all ... Show more content on
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"Hi," Maeve said quietly. "Maeve, hi! It's such a pleasure to see you," he replied. She laughed, then
replied, "I understand if your answer is no, but is there anyway I would join the hurling team? I
know I quit about a month ago, but I miss it a lot. I promise to be devoted and try my hardest during
practices and games." "Maeve, I remember you being in here a month ago asking the complete
opposite," coach laughed, "You can join the team again, but you must be completely determined to
become better. You aren't just going to wake up one day and be better at hurling. Remember practice
makes progress, not perfect." "Yes, I completely understand. Thank you so much, see you later!"
Maeve replied. Later when Maeve got home from school she ran into the house and yelled, "I'm
back on the team! I decided that I would play hurling!" "Really? Nice Maeve," her dad replied. After
multiple weeks of determination, Maeve was starting to get the hang of it. She was getting better
each day, and eventually she was a major part of the team, starting almost every game. Maeve then
knew that determination and practice would make you better at whatever one was

Animal Care And Experimental Procedures
Animals: 8–12 week old male C57Bl/J6 mice (Jackson Laboratories) were housed in groups of four
on a 12 hour light/dark cycle with ad libitum access to food and water. All experiments were
performed during the light part of the diurnal cycle. Housing, animal care and experimental
procedures were consistent with the Guide for the Care and Use of Laboratory Animals and
approved by the Institutional Animal Care and Use Committee of the Scripps Research Institute.
Fear Conditioning: Contextual fear conditioning experiments were performed using a set of four
modified Noldus Phenotyper (Model 3000) chambers (Leesburg, VA) with shock floors (Lattal et
al., 2007). The Phenotyper Model 3000 chamber has a 30 × 30 cm floor and is 40 cm in height. The
... Show more content on Helpwriting.net ...
During this period of time, the mice were also acclimated to the injection procedure performing
dummy cannula removal and infusers placement using infusion needles (Plastics One) shorter than
the guide cannula, and to the sound of the infusion pump that would be used for intracranial
injections. For those animals that received siRNA injection, after recovery from surgery and three
days before the contextual fear conditioning, animals received 3 days of acclimation to transport
from their home cages to the procedure rooms. Mice were injected during the first day (72 hours
before training) and then handled during the following 2 days. Behavioral data were analyzed using
ANOVA and Student's T test (GraphPad Prism).
Polyribosome isolation and RNAseq analysis: Polyribosomes were prepared as described in Stefani
et al., 2004. 20–50% w/w linear sucrose gradients were prepared in 10 mm HEPES–KOH, pH 7.4,
150 mm KCl 5 mm MgCl2, 1 mM DTT and 0.1 mg/ml cycloheximide using a Hoeffer SG 50
Gradient Maker (Amersham Biosciences) and MINIPULS® 3 peristaltic pump (Gilson Inc.). 5.6 ml
of a 20% sucrose solution was pipetted into the outlet side of the gradient maker, tiled to fill the
connecting passage between the chambers and tapped to remove any bubbles. The valve between
two chambers was closed with the 20% solution filling the passage. 5 ml of a 50%

An Evidence Based Quality Improvement Project Using A...
I am writing to obtain permission to conduct an evidence–based quality improvement project using a
pretest/posttest design in your facility with the purpose of evaluating the effectiveness of an
educational intervention regarding the importance and use of the nurse driven protocol on nurses '
knowledge and CAUTI rates.
This study will be done to fullfill requirements for completion of the Doctor of Nursing Practice
degree at Regis University, Denver, CO. The following information is an overview of the project:
Can Empowered Nurses Decrease CAUTI rates?
This project will employ a Population–Intervention–Comparative–Outcome (PICO) fromat for
development of the research question to be investigated:
Population: Nurses on the ... Show more content on Helpwriting.net ...
O A nurse–driven protocol is the recommended tool to be used by the nurse to remove catheters
without orders following set CDC guidelines and prevent CAUTI
O Nurses are best positioned to make the decision to remove catheters as they are in direct and
constant contact with the patient.
O According to Hospital Compare Cape Fear Valley Hospital is labeled as as "Worse than national
bench mark" for CAUTI rates (Medicare.Gov, 2015)
O Potential for reduction in reimbursement by 1– % if it falls with other hospitals that rank among
the lowest– performing 25 percent with regards to Hospital Acquired conditions (HAC): CAUTI
being of them.
O The hospital already has protocols in place, but the need for education regarding these protocl is
great.The need on these protocols are great Type of Study: Pretest, education, posttest quality
improvement
Participant Requirement: Full and part time nurses
Risks, Cost, and Benefits:
There no risk to the patients. Nurses may have to work longer hours to care for patients with
CAUTIs. The hospital will have to pay for the cost of re–education of staff and shoulder the
intangible cost that may

Nurse Reimbursement
All staff involved in catheter insertion and care must be educated on proper care. Nurses must be
educated on the importance of decreasing catheter use and their right to question Foley catheter
insertion and maintenance. Choosing a "champion" among staff, or a certain peer to help influence
behavior will also help overcome resistance to change among nurses who are unwilling to change
for the sake of convenience or habit. Creating a peer–to–peer educational plan is also shown to
encourage and empower nurses to decrease catheter use (Meddings et al., 2014). Finally, behavior
must be analyzed to see if new protocols and policies are being followed. If they are not, a
discussion should occur to see if any new resistors to change have been ... Show more content on
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The team will oversee the evidence–based practice aspects of CAUTI prevention and will be set up
using aspects of the guidelines established by Andreessen et al. (2012). Several different types of
nurses will be recruited to assist including infection control (for evidence–based practice guidance),
nurse educators (to help set up the education program), and staff nurses (to advise from staff's point
of view) (Andreessen et al., 2012). Leadership including, nurse managers, clinical nurse leaders, and
the medical director, will assist with implementation. The team consisting of resource type
individuals such as urologists, will guide evidence–based practices and information technology will
assist to set up flow chart and tracking processes (Andreessen et al., 2012). The next step will focus
on educating the unit's staff. Employees that place an indwelling catheter will be required to go
through a refresher course on proper insertion technique, indications for catheterization, and catheter
care. Additionally, there will be a class on the new flow sheet created to track indwelling catheters
(Andreessen et al., 2012). Posters with information pertaining to catheter care, CAUTI prevention,
the new charting system, and alternative bladder management systems will be placed in highly
visible areas such as break

Evidence-Based Nursing Practice
Running head: EVIDENCE–BASED NURSING PRACTICE
Evidence–Based Nursing Practice
Karen Medley
Walden University
NURS 4000 Section 05, Research and Scholarship for Evidence–Based Practice)
July 22, 2012
Abstract
For patients that have indwelling catheters, with the evidence–based practice and standards of care,
UTI's does still continue to be an ongoing problem today. In one of the large hospitals in my area
had recently developed a poster and video approach with special focus on alternatives to urinary
catheterization, removing catheters early, and the reinforcement of sterile technique prior insertion
and foley catheter care were used to educate nursing staff and improve outcomes. The purpose of
this paper is to educate nursing on ... Show more content on Helpwriting.net ...
The lower income communities are probably more affected. The cost of a single episode to treat
UTI's ranges from $980–$2900, depending on the presence of the bacteremia (Saint, 2000).
Differences in care based on evidence Sterile technique is required for insertion of an indwelling
urinary catheter in the hospital setting, but clean technique can be used for intermittent
catheterization in non–acute settings. By itself, sterile technique on insertion doesn't prevent UTI's.
Prevention of UTI's depends on knowledge of causes, proper care techniques, and early catheter
removal. Nurses are taught early on in school that sterile technique helps to reduce infections. It was
drilled in our heads the entire time and now to have the evidence tell us that early catheter removal,
along with proper technique good hand hygiene is the key to reduce UTI's.
Summary
UTI's is an all too common problem that causes unnecessary distress to patients and delays their
recovery during their hospital stay. All healthcare professionals should adhere to these good practice
points that could reduce the risk of UTI's and assure staff that they are demonstrating best practice in
their care.
References
Burke J.P. (2003). Infection control– a problem for patient safety. New England Journal Medicine,
348(7):651–656.
Hobbs F.B. (2001).The elderly population. US Census Bureau, Population

Summary Of Heroism In Updike
A: Author's and Speaker's Purpose:
Updike is degrading, de–romanticizing heroism, the actions of Sammy when he quit his job by
setting the story during the 1960's which is when people started abandoning the conservative
approach to life and started expressing themselves more openly. An example of open expression is
when Sammy quit his job or how the three girls walked into the A&P in nothing but bathing suits.
Queenie and her entourage are being heroes by breaking the social norms regarding women at the
time which makes them heroines in the eyes of many females. They break the social norm by going
into an A&P dressed only in bathing suits and by the way they behaved.
He intends to show the differences in the lifestyles of each member of the triangular conflict and
how each lifestyle conflicts with each other forcing Sammy to choose between to live his life like
Lengel or Queenie. Lengel being a conservative ancient man or Queenie being an open–minded
young person.
Updike satirizes American society's fondness for heroism by having one of their own. Lengel, shot
down a female heroine, Queenie, for standing against the common stereotype of women having to
be extremely conservative.
B: Drawing Inferences:
One would assume that under normal circumstances Sammy and Lengel would be acquaintances
since Lengel is a friend of the family, not Sammy. However, since Sammy is a teen he must likely
despise the idea of growing up to be like Lengel which leads me to believe that he

Preceptor Experience Essay
The second half of my preceptorship went well and I learned a lot. I felt comfortable giving
medications, performing assessments, and caring for the patients. I was able to complete all of my
objectives. We were in the ER for one day, and the rest of the time my preceptor was the Charge
Nurse on the med–surg floor. I gave medications every day that I was precepting. When giving
medications I am very cautious. I verify the patient, and we scan the patient and medications. But
sometimes medications are split in half and I needed to make sure to set them aside during scanning.
One day I scanned an aspirin and the computer said it was for the wrong patient. I verified the
medication on the MAR, and it was the correct medication. My preceptor said that happens
sometimes, and we manually entered the medication. I feel comfortable giving medications, but will
continue to be cautious. I performed assessments every day of preceptorship. Lung sounds can be
difficult for me to identify, so I liked being able to listen and ask my preceptor if she heard the same
thing. I heard a whooshing sound over the heart of one of my patients and spent extra time listening
to it. I guess he noticed that I was confused because he told me that he has a Pig Valve. Some of the
other sounds I could verify were crackles and wheezes. ... Show more content on Helpwriting.net ...
This was awkward for me since I have never been around it. I did not help with post–mortem care
because they were not our patients and we were busy doing other things. My preceptor had to call
Lifeshare for organ and tissue donation, even though the patient was not an organ donor. This is
standard for all patients that pass away. The spouse of the patients insisted that the patient wasn't an
organ donor, but Lifeshare insists on talking to a family member. After telling Lifeshare that the
patient's religion was a Seventh Day Adventist, they didn't need to talk to the family because that
religion does not donate

The Audio Of The Movie Beauty And The Beast
I listen to the audio of the movie "Beauty and The Beast." Having the topic being about sound, this
type of movie would be an example, for there are more technical obligations to take care of than
those of realistic movies. The movie is about a prince who was curse and turns into a beast, in which
a woman has to fall in love with him in order for the curse to be lifted. Throughout this movie, there
were many sounds effects including fairy dust sound that represent magic. Additional sound effects
include swooshes and roars represent the sound of the beast. Other sound effects would be the
thunder and rain, in which represent the darkness. In the beginning scene, the movie introduces
Belle, and the village she lived in that's filled with the sound effect of rooster crowing and birds
flapping their wings, in which represents peacefulness accompany by happy singing. From watching
Foley video, it shows how the Foley artist used a bundle of plants rubbing against each other to
create thunder sound. Another example from the movie includes using a pair of boots to make the
sound horses jogging.
Since this is the cartoon version of the movie, it definitely will sound cartoony. For each character in
the movie, there are uses of high and low pitch, to which it doesn't sound realistic. This is through
the used of ADR, which is also called Additional Dialogue Recording. This is a process in which the
recording of the dialogue by the original actor after the filming process is used to

Long Hand Charting for Iv Insertion and Removal, Trach...
Pt requires 20 gauge IV for _______. 20 gauge catheter inserted to the right anterior forearm, first
attempt. Flushed with 10 cc normal saline. Stat lock in place, covered with transparent dressing. Pt
tolerated well with no complaints of pain or irritation upon flushing, no visible swelling or bruising.
Sharps placed in approved container, patient's bed lowered as far as possible and assisted to
comfortable position. Reassessed in 5 minutes for bleeding , none noted.
Pt requires IV discontinuation d/t: pain / infiltration / expiration of indwelling time frame.
Discontinue 22 gauge IV catheter from L hand. Cannula intact. Pressure held for 3 minutes, assess
for continue blood loss, none noted. 2 x 2 gauze dressing with paper tape ... Show more content on
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Bed rail returned to upright position and bed lowered to lowest possible position.
Order written by _____ for a 16 F indwelling catheter for _(preop)__. Pt instructed on the need and
gave consent denies iodine allergies. Pt is positioned in the dorsal recumbent position, perineal area
cleaned with warm damp cloth and dried. Labia spread and meatus cleansed with betadine.
Lubricated catheter inserted immediate return of 500 ml of cloudy

Personal Statement Of Utmb Nursing
Personal statement My name is Robin Parisher and I am applying to be a part of the UTMB Nursing
Program with Spring 2017 admission. It is within this personal statement, I wish to successfully
explore my drive for this career choice, past experiences, and future endeavors with you. Nursing, in
my opinion, takes full commitment from someone. One must be knowledgeable, dedicated, and
willing to help others at all cost. My mother is the greatest nurse I have ever encountered and has
been my inspiration since I can remember. She has been a nurse for over 20 years and I have been
captivated ever since. I was born to do this, to advocate and help others that are in need. Being able
to apply the knowledge and skills learned in a real hands–on situation has given me the utmost
motivation to fulfill my dreams of one day becoming a nurse. I was able to successfully complete
my rounds of clinical hours as part of my nursing program at various locations and departments. I
was assigned to MD Anderson, Harris County Psychiatric Center, and Silverado Memory Care
Community, where I was able to work with many different types of patients and become acclimated
to the environment. The duties in which I was able to preform varied location to location but
included, head to toe assessments, insertion/removal of Foley catheters, medication administration,
tube feedings, trachea suctioning, and numerous care plans just to name a few. I was able to interact
with patients one on one as a student which has instilled confidence and reassurance in my future. ...
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I wish passionately that the turn of events that occurred this year were different but that is not
possible and I feel the need to explain myself and the reasoning behind my unsatisfactory

The Importance Of A Nurse Driven Protocol On Nurses '...
Identify the need or problem you intend to solve through your capstone project
Nurses lacked knowledge in the use and was unaware of the importance of the underlying evidence–
base recommended criteria's indicated on the nurse driven protocol to remove inappropriate UC's. A
nurse driven indwelling catheter removal protocol is an evidence base tool recommended by
infection control organization and experts for the early removal of unnecessary or inappropriately
placed urinary catheters (UC). Evidence shows that urinary catheters are the source of catheter
associated urinary tract infection (CAUTI). CAUTI, is the leading cause of hospital acquired
infections in the United States. The purpose of this evidence–based quality project is to evaluate the
effectiveness of an educational intervention on the importance and use of the nurse driven protocol
on nurses ' knowledge and CAUTI rates.
Identity your PICO
PICO QUESTION
For nurses, (P) on 2 South caring for patients with urinary catheters, will education, on the
importance and proper use of a nurse –driven indwelling catheter removal protocol (I), change
knowledge on the use of the nurse driven protocol, as compared to knowledge before receiving an
education, (C), as evidenced by (O), change in knowledge in the use of the nurse –driven indwelling
catheter removal protocol, and CAUTI rates as evidenced by, pre and posttest scores and CAUTI
audits after three months? The project will utilize a

Catheter Associated Urinary Tract Infection
Catheter Associated Urinary Tract Infection (CAUTI) is defined as the occurrence of a urinary tract
infection (UTI) in patients with a urinary catheter in the past 48 hours. Published guidelines by the
Infectious Diseases Society of America (IDSA) further defines CAUTI by the presence of
significant bacteriuria of ≥ 103 CFU/ml found in the urinalysis and signs and symptoms of a UTI
without the presence of another cause for these findings. Signs and symptoms of CAUTI could
include: altered mental status, fever, chills, flank pain, costovertebral angle tenderness, and
hematuria. If the catheter has been removed in the past 48 hours the symptoms could also include
urgency and frequency (Fakih et al., 2016).
A2. Significance of the problem
The most common health care associated infection (HAI) is CAUTI. Forty percent of all hospital–
acquired infections are UTIs and 80% of these are directly linked to having an indwelling urinary
catheter in place (Underwood, 2015). Urinary catheters are required in up to 25% of hospitalized
patients and bacteriuria results in about 25% of patients with a catheter for greater than 5 days and
this number increases by 1 to 5% for each day the catheter is in place after that. The harmful
consequences of CAUTI include increased length of stay, higher health care cost, and increased
mortality. CAUTI is known to cost health care in the U.S. $400–$500 million annually (Leuck et al.,
2015).
A3. Current Practice
The growing concerns over

Urinary Tractinfection
An APIC Guide 2008
Guide to the Elimination of Catheter–Associated Urinary Tract Infections (CAUTIs)
Developing and Applying Facility–Based Prevention Interventions in Acute and Long–Term Care
Settings
About APIC APIC's mission is to improve health and patient safety by reducing risks of infection
and other adverse outcomes. The Association's more than 12,000 members have primary
responsibility for infection prevention, control and hospital epidemiology in healthcare settings
around the globe. APIC's members are nurses, epidemiologists, physicians, microbiologists, clinical
pathologists, laboratory technologists and public health professionals. APIC advances its mission
through education, research, consultation, collaboration, ... Show more content on Helpwriting.net ...
Of these patients, approximately 3% will develop bacteremia. The 1997 APIC/SHEA position paper
on urinary tract infections in long–term care (LTC) identifies CAUTI as the most common infection
in LTC residents, with a bacteriuria prevalence without indwelling catheters of 25% to 50% for
women, and 15% to 40% for men. Therefore, usage of indwelling urinary catheters in residents of
LTC facilities can be expected to
ASSOCIATION FOR PROFESSIONALS IN INFECTION CONTROL AND EPIDEMIOLOGY
5
Guide to the Elimination of Catheter–Associated Urinary Tract Infections (CAUTIs)
result in higher CAUTI rates with an associated risk of CAUTI–related bacteremia, unless
appropriate prevention efforts are implemented. The 2008 SHEA/APIC Guideline "Infection
Prevention and Control in the Long–term Care Facility"3 notes that "guidelines for prevention of
catheter–associated UTIs in hospitalized patients are generally applicable to catheterized residents in
LTCFs." Strategies contained in this resource will be helpful in any healthcare setting, when the
facility's infection risk assessment identifies CAUTI as an infection prevention priority.
Legislative Mandates and CAUTI Risk Assessment
The impact of external factors is germane to facility

The High Incidence Of Catheter Associated Urinary Tract...
The high incidence of catheter–associated urinary tract infections (CAUTI) during the patient's
admission can result in further complication and could potentially increase their hospital days. This
could delay the patient's recovery time, causing emotional and financial distress and possible death
if CAUTI goes unnoticed. There are research studies focusing on the prevalence of CAUTI and all
previous studies show that it is in the best interest of the patient to discontinue the Foley catheters as
soon as possible to decrease the rate of infections. In some health care organizations, different
approaches have been indicated to tackle this problem. CAUTI rounding teams have shown positive
results leading to a number of health care facilities to implement the rounding team into their
practice for the benefit of the patient population.
Keywords: catheter–associated urinary tract infections, CAUTI, urinary tract infection, UTI, Foley
catheter infection, infection control
Indirect Clinical Project
Catheter–associated urinary tract infections (CAUTI) have been studied in clinical situations where
it is in the best interest of the patient to discontinue as soon as possible to decrease the infection
rates. Prompt Foley catheter removal as soon as indicated improves patient outcomes (Magers,
2013). When a Foley catheter remains indwelling, there is chance for bacteria to migrate up the
urethra causing urinary tract infections (UTIs) (Glowicz, 2015). If gone

Informative Speech On Lamar Williams
Hey its Ernesto and I am going to tell you about how Jeffery grew up and how he gained the fame
and also about his current time and how he is doing. Jeffery Lamar Williams professionally known
as young thug was born august 16 back in 1991. He is a rapper from Georgia . Before young thug
quickly got fame from his solo mixtapes, before he been rapping, before he been making music with
other rappers, before he was in rich gang, he was born Jeffery Lamar Williams. He was the second
youngest of 10 kids. Jeffery was growing up in such a bad lifestyle. He also spent 4 years in juvenile
detention for breaking his teachers arm and his older brother was shot and killed when he was a kid
and his younger one in jail for murder charges... so that's how you know he had a bad life in his
early days. ... Show more content on Helpwriting.net ...
Soon after he joined rich gang they made a song called "lifestyle" that had rich homie Quan and
birdman features and also to make a claim that they came from the bottom from being poor to rich.
It quickly boosted up their fame and also of course young thug got criticized for not being
understandable in the song. While he was in cash money aka rich gang he made 2 albums with rich
homie Quan and bird man that got lots and lots of hits and fans. Soon rich homie Quan left to focus
on his solo career and same with young thug soon after rich homie Quan left. Young thug left to
focus on his solo career also but mainly to build up his own fame instead of barrowing fame from
something much bigger than him. And to stop the criticism, he still hangs out with birdman and cash
money but at the moment he says hat he is not signed with cash money aka rich

Essay on Professional Wrestling
Professional Wrestling
Watching a well–built young man take a death–defying fifteen foot leap through a wooden table
onto another man's prone body can be a thrilling experience. The fact is if you are a fan of
professional wrestling today you have grown used to these stunts as if they weren't as spectacular as
they sound.
Professional wrestling's recent boom in popularity began in the late 90's, but unlike it's past success
it is not as safe as once was. While all theatrics the stunts have continued to push the limits to levels
that have never been seen before. The results of this constant risktaking can be seen in the early
retirements of many of pro–wrestling's brightest stars and rookies who ... Show more content on
Helpwriting.net ...
In addition to this they also began to appreciate a new style of wrestling, a wrestling labeled as
"extreme" wrestling.
"Extreme" wrestling was not your typical wrestling match in which the gladiators would exchange
moves and holds as they built the match to it's climax. In this type of wrestling, the competitors had
replaced the generic moves with high–impact moves, steel chairs, barbed wire, wooden tables, and
jumps and falls that resemble movie stunts.
This new type of wrestling has been criticized as being just as dangerous to an athlete's health as
steroids were to them in the past. This type of wrestling has caused many of the upcoming wrestlers
to become myths and legends before they even make it to television.
One great example of this is a wrestler known as Mick Foley. Foley never had physique or looks to
be a professional wrestler. Instead, Mick had a high threshold for pain and a great sense of humor.
For Mick this ended up being a winning combination in the world of wrestling. He went on to
become one of the most beloved stars of all time but not before 17 years in wrestling destroyed both
his body and mind. Mick's list of career injuries is like a lesson in human anatomy. He has incurred
a broken his cheekbone, jaw ,right wrist, nose (twice), left thumb, five ribs, and left toes. Mick has
also seperated his right shoulder, herniated two

How Rock Has Changed The Way I Look At The World
I had been fishing for hours now. The piercing heat radiated off of the sun. My forehead was beaded
with sweat as my eyes came across a rock poking out of the water. I turned back to my line anxious
for a tug, a nibble, anything that showed me there was still life in the water. My eyes made their way
back to the rock. It seemed so out of place, yet it didn't move from its spot. I did not want to end up
like this rock. It was stuck, captured by the pond, waiting for the forces of nature to erode it away. I
eventually reeled in my line and just continued to stare at the pond. The water was calm now and
still the rock sat there. Since then, I have driven by that pond numerous times and the rock still held
its place. Each time I think to myself, that rock has really changed the way I look at the world. Each
time I am thankful, for this has rock taught me what I wanted to do with my life by showing me
what I did not want to happen in my life. I found myself at the pond that day through lack of
anything better to do, and since it had been a beautiful summer day, I figured I do something
outdoorsy. I broke from the norm that day. I hardly ever go fishing, so it was a rather peculiar
thought of me to have. I had then gone out to our garage to try and find the fishing gear. It was so
cluttered and messy. Things had piled up over the years. Everything had turned to chaos. This made
it impossible to find the fishing rods; consequently, I found myself rethinking this whole day. I
would

A & P John Updike Analysis
In John Updike's best known story "A&P", a tale of a young 19 year–old boy name Sammy, who
works in a local supermarket ; A&P, as a cashier. Sammy is attempting to tell the story of why he
impulsively quit his job one day. He narratively gives a very vivid description of everything that
happens. Sammy acts decisively when standing up for what he thinks is right. Standing up for what
you believe in is an essential life skill. Sammy recalls on that day three barefoot teenage girls, in
bathing suits walking into the store. "In walks these three girls in nothing but bathing suits" (Updike
1). He ogles them from his work station throughout the store, and conveys a very clear image of
their actions. He categorizes them based on their looks and what they were wearing. Sammy says
things like, There was this chunky one, with a two piece...", and also "... there was this one, with one
of those chubby berry faces, the lips all bunched together under her nose" (Updike 1). The way he
describes the last of the three girls would cause you to grasp the idea that he was fond of her. He
tells us that she was tall with black hair. He goes on to explain that other girls would think she was
very striking and or attractive. He proclaims her as a queen. Sammy declares, "She was a queen" (
Updike 1) "She kind of led them, the other two peeking around and making their shoulders round.
She didn't look around, not this queen..." (Updike 1). He kids about a girl's mind and how it works.
Sammy

Reflection About My Clinical Experience
Also, the objective is to find patient's document finding and correlate it with chronic disease process
of elderly adults. With this reflection, I will discuss what I've learned, and my strengths and
weakness in my clinical experience.
Day 1
On Thursday the 9th, I worked with a patient who is a 74 years old male, with general weakness.
His admitting diagnosis was caused by the metastasis of prostate cancer to the bone. Talking to the
patient was an amazing experience for me because we liked the same thing such as the NBA. He
told me that he was a lawyer and that all of his children are grown up and successful. He does a
wife, who I did not see during my rotation. But, it was easy to talk to communicate with him. I have
always had social anxiety growing up. Talking to people had always been my weakness because I
was always worried about how people would perceive me when I talked. However, now that I have
grown up, I learned to look past my social anxiety. I learned that from shutting my brain off that
caused me overthink, facilitated me to ... Show more content on Helpwriting.net ...
I was slightly familiar with the foley catheter, however, I need some slight guidance. I knew that I
needed to drain the foley bag because it was slightly full, but I did not know where to unclamp to
drain it. The nurse's aid taught me how to unclamp the bag so I can drain the urine. I also learned
that when moving the patient who has a foley bag, it was important to make sure that the patient is
not going to get a UTI. UTI can be caused by holding the foley bag at a higher positon causing the
urine to backtrack. It is important to keep that in mind as a healthcare worker. I have not been skill
checked on foley catheters, however, I need to practice working around foley catheters to protect the
patient. I could always go on youtube and search videos on foley catheters or I can use the perry and
potter book to learn

Catheter Associated Urinary Tract Infection
Introduction
The purpose of this paper is to implement a policy that will aid in reducing foley catheter induced
infection by providing a guideline for the health care providers on how to care for patients with
foley catheters. Catheter Associated Urinary Tract Infection (CAUTI) are the most commonly
reported hospital acquired condition, and the rates continues to rise. According to American Nurses
Association, greater than 560,000 patients developed CAUTI each year. Registered nurses can play
a vital role in reducing CAUTI rates (ANA, 2015). Hospital acquired conditions are major threat to
patient safety with estimated cost of 33 million annually (ANA, 2015).
A policy is defined as documentation defining the minimal requirements for clinical ... Show more
A universal precaution and a sterile field must be maintained during the procedure. All foley must
have a stat lock retention device placed to patient's inner thigh area to keep the foley stable. The
foley drainage bag and chamber must be placed below the knee at all times to avoid back flow of
urine into the bladder. The order set directs the nurses on how to document for care every eight
hours. The documentation includes checking the potency, including any twisting or kinking of the
catheter, emptying the foley every two hours, and performing foley care every 8 hours. As part of
the policy, every nurse is required to attend bi–annual skills fair

Observation Report On Coaching Observation
Intro
For the coaching observation project I observed the head coach of the Ohio State Buckeyes, Urban
Meyer. I watched him on TV when Ohio State played Penn State. The reason I selected Urban
Meyer to do my coaching observation is because he is the coach I decided to model my coaching
philosophy after. The reason I chose this game specifically is because this is a very important game
and I want to see how he handles his team in high–pressure situations.
Review
1. Coaching style used or observed
A coaching style is the specific way a coach leads his team. The coaching style Urban Meyer used
was a laissez–faire type coach. A laissez–faire type coached is defined as a leader who makes as few
decisions as possible. During the weeks prior ... Show more content on Helpwriting.net ...
His non–verbal communication was just his facial expressions that his players and assistant coaches
can see. His team was losing for most of the game and you could tell he was not happy. Penn State
returned the opening kick off and he looked disappointed, but he kind of kept his composure. Later
in the 2nd quarter during another kick return that was returned pretty far by Penn State his anger was
a little more visible as he was yelling and appeared very angry. Later once Ohio State started to play
better you could see his attitude change and he got happier. I'm not sure if his negative attitude made
his team play worse, it is just something to think about whenever I am a head coach.
3. Reinforcement techniques
Reinforcement techniques are used to increase or decrease a behavior. During a game, especially on
the stage that Urban Meyer is coaching, it is important for his players to play well. Some techniques
that Urban Meyer used to reinforce his players during the game I observed were negative discipline.
His special teams were struggling a lot, especially his kickoff team. They were playing so bad that
he decided to remove multiple players from it and add starters from other positions onto the kick–off
team to try and have better success. This shows that if you want to play, you have to perform.
4. Motivation techniques
Motivation techniques are how a coach

A Short Story : A Story?
It was a perfect day to be outside. No breeze to blow clouds in front of the sun that was making my
brother and I faces bead with sweat as we hopped out of his SUV. The drive through the gravel
backroads was harsh. We were bouncing everywhere because he needed to replace his shocks on his
red 4 runner.
"This is the place?" I looked around at all the dead grass and juniper trees.
"We have to hike a few miles to get to the falls then we will jump off there." Ezra, my almost 18
year old brother said.
I looked down at my flip flops and noticed all the sand around me.
I leaned up against a sigh that was about as tall as me that said "Steel Head Falls"
"Great. Walking in sand with flip flops." I mocked.
After an hour or so of hiking up hill I hopped from one foot to the other so the hot sand wouldn't
burn both of my feet, as I shook my flip flops to get the sand out.
"How far down is that?" I asked more worried than I wanted.
"About 30 feet" A boy about my brothers age said to my right.
"Great huh!" Ezra called as he was laying a Superman towel down in the sun so he could take off his
shoes.
The teenager that told me how high the cliffs were yelped with joy and jumped off the cliff. I could
even bring myself to look over the edge better yet jump off it.
"You want me to jump off here?" I laughed "That's not going to happen, 30 feet is taller than an
overpass!" I stared at Ezra expecting him to call me a wuss.
"It's not that high. It just looks high. I have done this so

Prevention Of Catheter Associated Urinary Tract Infections...
Prevention of Catheter Associated Urinary Tract Infections
In the Healthcare Setting
Dayna Menard
Mount Vernon Nazarene University
Prevention of Catheter Associated Urinary Tract Infections In the Healthcare Setting
A Urinary Tract Infection (UTI) is a serious problem in the clinical setting. "UTIs are mostly
associated with catheterization" (Hooton, 2010, p. 629). The infection can be described as bacteria
invading the urinary tract. More so, the bacteria accounts for nosocomial bacteremia since the
patient obtains the infection in the hospital (Hooton et al., 2010). A Catheter Associated Urinary
Tract Infection (CAUTI) is common because nurses do not find this problem at the top of their to–
do list during their shift. It can be easy for the nurse to become accustomed to a slight deviation
from the correct method. Any break in the chain of infection has opened the opportunity for
microorganisms to reproduce in a susceptible host. Research has proven that when hospitals, long–
term care facilities, and other healthcare settings intervene with making positives changes, less of
the patients developed a UTI with catheterization. Infection control with catheterized patients can be
implemented and resolved with collaboration and education among healthcare staff.
There has been a reoccurring incidence of staff members using urinary indwelling catheters for
unnecessary reasons and convenience. More so, the nurses did not think of the issue as the most

Dwayne Johnson Research Paper
Wouldn't you love to experience how it feels to be a football player, wrestler, actor, and even the
sexiest person in the world? Dwayne "The Rock" Johnson knows these feelings. Today, people
know his name as a celebrity with all of his fame and fortune, but his life was not always so
glamorous. Throughout his life, he went through many challenging situations where he felt that his
options were limited and had to make tough decisions. Dwayne Johnson's choices not only, got him
out of tight spots, but also, began to unlock opportunities that brightened his future and has made
him a memorable man in American history. .
Johnson was born on May 2nd, 1972, in Hayward, California, however, his family moved frequently
making it difficult for him to make friends ("Dwayne 'The Rock' Johnson"). According to Daniel
Roberts, in the article, "The Rock In This Corner, Dwayne Johnson", he had lived, "everywhere
from California to New Zealand to Texas", because of his father's wrestling career. Roberts goes on
to tell about Dwayne and his mother being evicted from their small home when Dwayne was only
fifteen. Also during that time, Roberts reports that Dwayne had been arrested for various things,
such as theft, assault, and vandalism. Obviously, he was heading down the wrong road and needed
to turn the ... Show more content on Helpwriting.net ...
Because of his hardship, he is entitled as the "Sexiest Man" in the world and is still living. Today in
2018, he is now forty–five years old and has plenty of life and experience ahead of him. He
represents the Christian doctrine and the continuation of the millennium as a well–known celebrity
(Leyner 81). He stands out as a person on top of other memorable characteristics (Leyner 81).
Dwayne to this day is still showing competitiveness and "showing his sexy". The Rock has gone
through so many challenges and experiences as a role model for others given the life circumstances
that he has encountered early, middle, and later in his

Coach Stoley-Personal Narrative
I continued to take shots and miss them, advance up the court, fumble the ball, and then turn it over.
What I didn't do was the look at the crowd, the score, the clock, or Coach Foley. The stern look on
his face masked the aggravation, fuming, and unsatisfied mentality he had. His folded, muscular,
arms, that could not be unwrapped, were cemented to his chest. His large, positioned feet were
engraved into the sideline. His perspective had been changed about me. As the time in the third
quarter was wasting away, the energy on the court continued to deteriorate. This couldn't happen, I
thought to myself. Coach Foley will be so disappointed. Jogs transformed into sloppy sprints, the
passes were weakening, and shots that didn't have a single thought on them, went up. I looked over
at my best friend, Sydney, just to see the frustrated, yet timid, look on her ... Show more content on
Helpwriting.net ...
The five girls on the court sprinted over to the bench, knowing we would be taken out of the game if
we walked. "Girls, I want you to run this new play," He demanded, while he got down on one knee
and began to scribble something foreign on his clipboard. My head was spinning, I was exhausted,
irritated, and distracted. We huddled, then sprinted back out to the court. We continued to fumble the
ball around and attempt to block the layups the other team was scoring. The buzzer boomed and
echoed across the lifeless gym. We jogged over to the bench, yet Coach Foley had no words.
Individually we made our way back onto the court. We couldn't pull through as a team and the
discouragement was toxic. I ripped the ball from the opponents hands and began to force my way up
the court to make a layup, or assist Sydney from cross–court. The opponents gathered around me,
and began to ferociously hit and push at me. I fell to the ground and lost the ball. I had failed the
play. I looked back at my enemy, his eyes blackened, and mine widened when he screamed, "You
are just

The Quality Improvement Nursing Process
The Quality Improvement nursing process that I have chosen to research is patient safety. I have
chosen to focus specifically on the topic of catheter associated urinary tract infections (CAUTI's)
during hospitalization and their preventions. It is estimated that 15–25% of hospitalized patients
receive a urinary catheter throughout their stay, whether or not they need it. A large 80% of all
patients diagnosed with a urinary tract infection (UTI) can be attributed to a catheter (Bernard,
Hunter, and Moore, 2012). The bacteria may gain entry into the bladder during insertion of the
catheter, during manipulation of the catheter or drainage system, around the catheter, and after
removal. The difference between men and women regarding UTI's related back to the human
anatomy. A man's urethra is 8 inches in length, while a woman's urethra is 1.5 inches in length.
Bacteria can quickly and easily make its way into a woman's bladder. This is why there is a large
percent of women UTI's when used in comparison to men (Mayo Clinic Staff, 2012). Catheter–
related urinary tract infection (UTI) occurs because urethral catheters inoculate organisms into the
bladder and promote colonization by providing a surface for bacterial growth. Brusch says, "Once a
indwelling catheter is placed, the daily incidence of bacteriuria can be between 3–10%." Another
large problem that results CAUTI's is that at times, catheters are left in a patient longer than
necessary. Prolonged use of

Indwelling Catheter
This study focuses on whether the use of reminders assists in decreasing the use of urinary
cathethers and the occuruence of catheter associated urinary infections. UTI risk increases by 5
percent with the use of indwelling catheters. The Center for Disease Control and Prevention (CDC)
has recommended that patients receive catheters if indicated but over 41% of physicians have
ignored this and nursing staff have ignored evaluating when the catheter should be removed. Besides
noncompliance with the CDC, this study shows for patients who have catheters, the reminder system
will help to decrease the length of indwelling cathethers are potential UTI infection associated with
it. In previous studies, their has been different views as to whether ... Show more content on
Helpwriting.net ...
A stoma is an artificially creted hole in the abdomen that allows for the passage of stool and urine to
exit the body. Self–care is vital when one has a stoma. Perisotomal self–care is very important and
has been one of the main issues ostomates have experienced. The main characterisits seen with
peristomal site complications are discoloration, erosian, and tissue overgrowth. Previous studies, to
determine skin problems, with the use of SPSC have not been done. The hypothesis of this
randomized controlled study is that those who use SPSC will have a lower percentage of periostmal
skin problems (discolartion, erosion, and tissue overgrowth) than the CT group. To test out this
study, 81 elgible patients were chosen. Some of the Elibiity requirements included those who were
undergoing a colostomy or ilostomy, were 20–18 years of age, and understood why the study was
being done. These particpants were chosen from a single tertiary hospital. The 81 participants were
split into two groups, the SPSC (45 patients) and CT group (36 patients). Wound Ostomy Care
Nurses educated the each group on how they would care for their ostomies. Those with Standarised
Peristomal Skin Care (SPSC) use direct pouching on skin with powder if needed. Those with the
crusting technique use an artificial skin memberane over

Summary: Hospital Acquired Infections
Research Problem Hospital acquired infections (HAIs) are infections a person get while in the
hospital, however the infection must occur forty–eight hours after admission because of the
incubation period of infections (Shang, Stone, & Larson, 2015). HAIs provide an unnecessary risk
to patient safety (Center for Disease Control and Prevention [CDC], 2016). Every day at least one
out of twenty–five patients in hospitals across the United States (U.S.) acquires an HAI (CDC,
2016). HAIs leads to many problems in hospitals across the U.S. One problem is HAIs can lead to
patients' deaths. In 2011 722,000 people developed at least one HAI, over half happened outside of
the intensive care unit, and around 75,000 of the 722,000 died while in the hospital ... Show more
The study will take place at one hospital, South Georgia Medical Center, over three–months. The
independent variable will be the nurse to patient ratio on the medical surgical floors and the
dependent variable will be the percent of HAIs acquired on each floor, specifically foley catheter
associated urinary tract infections, central line associated blood stream infections, hospital acquired
pneumonia, and surgical wound infections. There will be four medical surgical floors in the study
and adult patients admitted or transferred to medical surgical floors will be randomly assigned to
one of the floors. On the first medical surgical floor the day shift (0700 to 1900) nurse to patient
ratio will be 1:4 and the night shift (1900–0700) ratio will be 1:5, on the second floor the day shift
ratio will be 1:5 and the night shift ratio will be 1:6, and on the third floor the day shift ratio will be
1:6 and the night shift ratio will be 1:7. The fourth floor will be the control group and nurse to
patient ratio will depend on how many nurses are scheduled to work on each shift, as previously
done at this hospital. Data will be collected on the percent of patients on each floor who gets one of
the four HAIs forty–eight hours after getting admitted or transferred to the medical surgical floor to
determine if nurse staffing has an impact on the percent of patients who gets an

Orem 's Self Care Deficit Theory
Orem's Self–Care Theory Orem's Self–Care Deficit Theory (SCDNT) is complex and contains
various parts that help to explain how self–care can influence the overall health status of an
individual. The basics of SCDNT can be broken down into four interconnected parts: theory of self–
care, theory of dependent care, theory of self–care deficit, and theory of nursing systems (Berbiglia
& Banfield, 2014). Each theory can be integrated into how the nurse will interact and plan care for
patients. The nurse meets the patient's self–care needs by teaching, demonstrating, and supporting
the patient in performing basic self–care practices. Self–care can be defined as the practice of
activities that maturing and mature persons initiate and perform, ... Show more content on
Helpwriting.net ...
All of the nursing actions are developed around self–care and produce a therapeutic effect on that
patient. These relationships between the nurse and the patient guide care and help to develop an
understanding of what actions must be taken for each patient. Along with the four theories, Orem
also developed goals to be met with self–care using eight requisites. When nurses are assessing
patient's these eight areas should be included in the assessment: maintance of sufficient intake of air,
food, and water, provision of care associated with elimination processes and excrements,
maintenance of balance between activity and rest, and solitude and social interaction, prevention of
hazards to human life, human functioning, and human well–being, and promotion of human
functioning and development within social groups in accordance with human potential, known
human limitations, and human desire to be normal (Berbiglia & Banfield, 2014). Patient Assessment
The patient to be assessed is a 63–year–old male admitted to the hospital for a planned admission
for a transurethral resection of prostate (TURP) due to benign prostatic hyperplasia (BPH) with
obstruction. The patient's past medical history includes: infantile cerebral palsy affecting the right
side, sliding hernia that was repaired, tonsillectomy, and skin cancer at age 2.

athletes Essay
Different Types of Athletes
Between the indifferent and the protestor, we find a marvelous creature called an athlete whose
species is varied into many different types; the marshmallow, the jelly bean, and the rock. Athletes
can be found everywhere– in the classroom, locker room, the gym, the thick of the game, and in
church. Places people will not find athletes are up late, in bars, missing church, in trouble, or being
disrespectful to his elders. An athlete is made of wondrous stuff. Athletes have the eyes and the
steadiness of an architect, the muscles of a body builder, the speed of a bullet, the reflexes of a cat,
the heart of a lion, and the faith of a saint. To his coach an athlete is a modeled ... Show more
Usually these types are the easiest to find not only by the players, but the coaches. These are the
types who do not try hard or give a 100 percent. They do not work hard in the weight room, on the
field, or in the class room. When a marshmallow comes to mind think about this type of athlete
because they are soft on the inside and soft on the outside.
The jelly bean athletes are the ones that will hurt a team the most. These are the kinds that work hard
in front of the coach, but lack the effort behind his back. These are the types who go out at night and
are not a good role model for younger players. Once one player sees him careless about what he
does then they think they can do the same and then it starts a trend. These types are the hardest to
spot. The players can spot this type quicker than a coach because players will know this type on a
personal level. Coaches only know players on the field, but will eventually separate these athletes
from others. Being hard on the outside in front of coach but being soft in the middle when coach is
not around is just like a jelly bean
A rock athlete is the type of athlete that all coaches wish they have on their team. This type works
hard in front or behind closed doors. They give a 100 percent on and off the field. These types go to
class, keep their grades up, and stay out of trouble. These types are a good roll model for younger
players. If something does not

Safdar, Purvis And Knobloch: Qualitative Study
Qualitative Study
Safdar, Codispoti, Purvis, and Knobloch (2015) conducted a qualitative study using interviews with
twenty patients with urinary catheters who were hospitalized within a two–month period. The
interview used a semi–structured guide to ensure that the same questions were discussed with each
participant. Themes found in this study included that "75% of patients perceived that they had not
received adequate education about [their] indwelling urinary catheter consequences... and 65% of
patients felt that they had not received adequate information on the risks of [the catheter] ..."
(Safdar, Codispota, Purvis, & Knobloch, 2015, p. 3). From this research, it is apparent that the
potential consequences and risks associated with the insertion of a catheter are not fully discussed
with patients. Initially, after K.T. stated that she did not feel that she was adequately educated
regarding her intermittent catheter it was wrongly assumed that K.T. may not have ... Show more
She reports self–consciousness when out in a public setting out of fear that she will "wet herself."
This self–consciousness, fear, and anxiety all fall under the category of physiological factors or
unpleasant symptoms. To provide relief of these unpleasant symptoms, the patient was then
provided with information (both pamphlet and internet resources) regarding how to perform pelvic
floor muscle exercises. She was also provided with information regarding the potential risks and
benefits to the pelvic floor muscle training. By providing the patient with this information, the
nursing staff is using a noninvasive patient centered intervention to alleviate the that patient's
unpleasant symptoms. she was provided with information on how to perform pelvic floor muscle
exercises to help strengthen her pelvic floor and reduce the occurrence of urinary

Goldust Personality
5 weirdest moments of Goldust's career
Every time a list of bizarre characters who have stepped inside a wrestling ring for any promotion is
made Goldust will feature on top of each and every one of those lists. In September 1995, Goldust
debuted as a heel character that played mind games with his adversaries using his sexually
suggestive antics. He used to make coquette and indecent advances towards his opponents during
the matches. Goldust portrayed a character that was a drag queen. He always wore a golden jump
suit and face paint with little splashes of other colours on the jumpsuit and a golden wig. In those
days WWF was pushing the envelope with a risqué product and the Goldust gimmick was a
successful attempt towards it. Over the years ... Show more content on Helpwriting.net ...
1. Goldust's bondage gimmicks
Goldust was a character that was known for his quirky attires throughout his career. In the late 1997,
Goldust was paired with an equally crazy valet, Luna Vachon. Though this pairing did not last for a
very long time, it will be known for a lascivious gimmick.
During this short period, Luna brought Goldust to the ring with a chain around his neck and gag ball
in his mouth. Goldust had ditched his golden outfit for a green one. The new outfit even had silver
spikes covering his nipples.
This was a ludicrous act and was not even entertaining. Thank God that the angle was not continued
and is not mentioned on TV as it was the freakiest moment of the Bizarre One's career.
Goldust is one of those characters who had thrived in the Pre–PG era. You can still trust him with
sneaking up on people at the most unsuspecting places. He will surely be a WWE Hall–of–Famer
when he retires, but, will continue to entertain the fans with his spooky character till

John M Barry On Politics Analysis
John M. Barry examines the nuances of power in America by comparting and connecting and the
concepts behind politics, sports, and the media in Power Plays. As a means of maintaining the
audience's attention, Barry uses an informative narrative tone through different specific examples
along with anecdotal experiences to prevent the topic from becoming entirely conceptual. Barry, a
former college football coach, is able to draw parallels between sports and politics displaying how
powerful agendas affect lives. Barry focuses much on the devious tactics that are used to create or
destroy America's most powerful figures.
Barry represents sports as a metaphor for American politics by demonstrating how the powerful will
impose their visions upon the ... Show more content on Helpwriting.net ...
Jim Wright and Newt Gingrich were both House Speakers. Jim Wright was the Speaker beginning in
1987, however he was forced to resign in 1989. Barry explores how Gingrich, who Barry recalls
was "ruthless in the coldest way," exploited and manipulated the media to unfairly and unjustly
bring down Wright through a scandal. While it was Gingrich who orchestrated the attacks on
Wright, Barry focuses mainly on the media as being "a player" in the game. Gingrich understood the
influential power of the media. While most politicians dislike the media as most of what is written
exists as lies or exaggerations, powerful politicians are able to manipulate the media to further their
own needs. Inside "the game," the politician with the better tactics, for example the one who knows
what to say, when to say it, and with what tone should it be said, will have a more positive
relationship with the media and a greater chance to abuse the influence the media has. Outside "the
game," similarly to athletes, money has power and can be crucial in establishing relationships.
Therefore the man who has greater money has a greater potential to create positive ties with the
media. Again, while this book, due to the time period, relates this power of influence struggle
between Wright and Gingrich, a more up to date comparison would be between potential
Presidential Candidates Hillary Clinton, who owns the media through inside "the game" tactics and
Donald Trump, who holds influence outside "the game" by using his own non–lobbyist

How To Write A Short Story: Jerry's Mistake
Jerry goes to the same resort every summer vacation and he swims at the same beach full of people.
He discovers a new beach area and new friends as well as almost experiencing death. At the end of
all of this, he accomplishes something great. Jerry was walking with his mom going to the villa that
was near the beach that was full of people. He noticed a little beach that had crystal clear water and
had no one not a single soul on the shore, and so Jerry wanted to go to that beach. He asked his mom
if he could go and swim and she reluctantly said yes and so he went toward the beach, and when he
got closer he finally saw that it would be a treacherous trek to get down to the beach. He had to
climb down some jagged rocks and paths that were very ... Show more content on Helpwriting.net ...
He made it his goal to swim through the tunnel even it killed him to do so and so the second to last
day would be his day. He went over to his private beach and grabbed a rock to take him under the
water quicker so he has as much oxygen as possible. When he was close to the entrance of the
tunnel, he could clearly see the opening and the seaweed that was attached to the top of the hole. He
swam to the entrance and started to go through the tunnel but, he forgot a flashlight to see in the
darkness and avoid dangerous things. He was swimming through the tunnel and he started to float
up to the roof of the tunnel and, when his back would touch the roof he got a sharp pain in his back
from the rocks. He then swam into a rock that was sticking out of the side of the tunnel and hit his
head. He was dazed by the hit but he continued on and he started counting and counted to 115 and
thats the only number he got to. He just didn't count on thats the only number he could think of then
everything turned red. There was blood inside his goggles and then his nose started bleeding and
this made him get light headed and almost pass out but he kept going because there was no turning
back. He eventually made it out of the tunnel and swam to the surface and laid down on the rock and
stared up at the sky. After he got himself composed, he ran back to his house to clean up before his
mom came home

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