Nurses play a key role in detecting delirium in hospitalized patients, but often have insufficient knowledge about delirium and its risk factors. This study assessed nurses' knowledge of delirium using a questionnaire and evaluated their perception of their own competency. The results showed that nurses had moderate knowledge of general delirium facts but lacked knowledge of specific risk factors. Experience with delirium education was correlated with higher scores. Most nurses perceived their delirium knowledge as inadequate, highlighting the need for further education to improve early detection and management of this common condition.
1) A study by Hare et al. (2008) assessed nurses' knowledge of delirium using a questionnaire
sent to 1,097 nurses. While 64% scored over 50% on general delirium knowledge questions,
only 36.3% scored over 50% on risk factor questions.
2) Fick et al. (2007) used case vignettes to evaluate nurses' ability to recognize delirium and
dementia. Nurses had difficulty distinguishing delirium from dementia and hypoactive delirium.
3) Dahlke and Phinney (2008) interviewed nurses and identified challenges in assessing delirium
due to time constraints and a lack of formal delirium education
Why Are Nurses Confused from Baker Summary DQ.pdfsdfghj21
Nurses play a key role in detecting delirium in patients, yet it often goes unrecognized. A literature review found that nurses have a knowledge deficit regarding delirium, including its definition, assessment tools, and risk factors. Several studies showed that educational interventions for nurses improved outcomes like shorter hospital stays. One study assessed nurses' knowledge of delirium using a questionnaire and found that while most understood general knowledge, fewer understood specific risk factors. Educating nurses is important for improving early detection and management of delirium.
Delirium Why Are Nurses Confused Analysis HW.pdfsdfghj21
Nurses play a key role in detecting delirium in patients, yet it often goes unrecognized. A literature review found that nurses have a knowledge deficit regarding delirium, including its definition, assessment tools, and risk factors. Several studies showed that educational interventions for nurses improved early detection of delirium and led to better patient outcomes like shorter hospital stays. One study assessed nurses' knowledge of delirium using a questionnaire and found that while many scored over 50%, their understanding could still be improved.
Medication errors are a serious issue that compromise patient safety and result in harm. Some contributing factors include high patient acuity, heavy nursing workload, distractions during medication administration, and failure to follow safety policies. Proper staffing ratios and limiting workload are needed to decrease errors by reducing nurse fatigue and allowing them to focus on medication administration. Involving patients can also help catch errors and improve safety.
This document discusses a nursing case study that assesses a patient using the Roper-Logan-Tierney model of nursing. The model covers 12 activities of daily living and how they can be influenced by biological, psychological, socio-cultural, environmental, and political-economic factors. The document focuses on assessing one patient admitted to a cardiac ward named Ann and identifies one problem during the assessment and the corresponding nursing care provided.
Nursesí practices and perception of delirium in the intensive care units of ...Alexander Decker
This document summarizes a study that assessed critical care nurses' practices and perceptions of delirium among critically ill patients in Egyptian intensive care units. The study found that nurses ranked delirium assessment as their fourth priority and that more than half of nurses never assessed for delirium in patients. All nurses reported never receiving training on assessing or managing delirium. While delirium is common in ICU patients and associated with poor outcomes, the study results indicate that it remains under-recognized and under-assessed among ICU patients in Egypt due to lack of protocols, tools, and education for nurses. The study highlights the need to incorporate delirium assessment and management into nursing education and daily ICU care to improve outcomes for critically ill patients.
The document discusses improving patient communication standards through evidence-based practice. It outlines the problem of communication vulnerabilities for certain patient populations and the complications that can arise. An evidence-based solution is proposed using standardized communication boards to improve outcomes. Research studies are cited that show communication boards reduce patient frustration and increase satisfaction.
Patient Medical History Assessment Tool By Confusion Assessment Method.pdfbkbk37
The document provides background information on three patient scenarios for a simulation experience, including details of their medical histories. It also discusses several assessment tools that could be applicable for the scenarios, such as the SPICES tool for assessing common geriatric syndromes, the PAIN AD scale for pain assessment, and the Confusion Assessment Method (CAM) for detecting delirium. The CAM is summarized as a standardized tool for identifying delirium in patients based on features of acute onset, inattention, and disorganized thinking. Guidelines are provided for its use and scoring.
1) A study by Hare et al. (2008) assessed nurses' knowledge of delirium using a questionnaire
sent to 1,097 nurses. While 64% scored over 50% on general delirium knowledge questions,
only 36.3% scored over 50% on risk factor questions.
2) Fick et al. (2007) used case vignettes to evaluate nurses' ability to recognize delirium and
dementia. Nurses had difficulty distinguishing delirium from dementia and hypoactive delirium.
3) Dahlke and Phinney (2008) interviewed nurses and identified challenges in assessing delirium
due to time constraints and a lack of formal delirium education
Why Are Nurses Confused from Baker Summary DQ.pdfsdfghj21
Nurses play a key role in detecting delirium in patients, yet it often goes unrecognized. A literature review found that nurses have a knowledge deficit regarding delirium, including its definition, assessment tools, and risk factors. Several studies showed that educational interventions for nurses improved outcomes like shorter hospital stays. One study assessed nurses' knowledge of delirium using a questionnaire and found that while most understood general knowledge, fewer understood specific risk factors. Educating nurses is important for improving early detection and management of delirium.
Delirium Why Are Nurses Confused Analysis HW.pdfsdfghj21
Nurses play a key role in detecting delirium in patients, yet it often goes unrecognized. A literature review found that nurses have a knowledge deficit regarding delirium, including its definition, assessment tools, and risk factors. Several studies showed that educational interventions for nurses improved early detection of delirium and led to better patient outcomes like shorter hospital stays. One study assessed nurses' knowledge of delirium using a questionnaire and found that while many scored over 50%, their understanding could still be improved.
Medication errors are a serious issue that compromise patient safety and result in harm. Some contributing factors include high patient acuity, heavy nursing workload, distractions during medication administration, and failure to follow safety policies. Proper staffing ratios and limiting workload are needed to decrease errors by reducing nurse fatigue and allowing them to focus on medication administration. Involving patients can also help catch errors and improve safety.
This document discusses a nursing case study that assesses a patient using the Roper-Logan-Tierney model of nursing. The model covers 12 activities of daily living and how they can be influenced by biological, psychological, socio-cultural, environmental, and political-economic factors. The document focuses on assessing one patient admitted to a cardiac ward named Ann and identifies one problem during the assessment and the corresponding nursing care provided.
Nursesí practices and perception of delirium in the intensive care units of ...Alexander Decker
This document summarizes a study that assessed critical care nurses' practices and perceptions of delirium among critically ill patients in Egyptian intensive care units. The study found that nurses ranked delirium assessment as their fourth priority and that more than half of nurses never assessed for delirium in patients. All nurses reported never receiving training on assessing or managing delirium. While delirium is common in ICU patients and associated with poor outcomes, the study results indicate that it remains under-recognized and under-assessed among ICU patients in Egypt due to lack of protocols, tools, and education for nurses. The study highlights the need to incorporate delirium assessment and management into nursing education and daily ICU care to improve outcomes for critically ill patients.
The document discusses improving patient communication standards through evidence-based practice. It outlines the problem of communication vulnerabilities for certain patient populations and the complications that can arise. An evidence-based solution is proposed using standardized communication boards to improve outcomes. Research studies are cited that show communication boards reduce patient frustration and increase satisfaction.
Patient Medical History Assessment Tool By Confusion Assessment Method.pdfbkbk37
The document provides background information on three patient scenarios for a simulation experience, including details of their medical histories. It also discusses several assessment tools that could be applicable for the scenarios, such as the SPICES tool for assessing common geriatric syndromes, the PAIN AD scale for pain assessment, and the Confusion Assessment Method (CAM) for detecting delirium. The CAM is summarized as a standardized tool for identifying delirium in patients based on features of acute onset, inattention, and disorganized thinking. Guidelines are provided for its use and scoring.
NURS 438 Trends And Issues In Nursing And Health Systems.docxstirlingvwriters
This document discusses trends and issues related to medical errors in nursing and health systems. It outlines several common causes of medical errors, including communication problems, inadequate information flow, and technical errors. Communication issues between nurses and patients can lead to medication errors, while inadequate discharge instructions and a lack of information for patients post-hospitalization can also result in errors. Technical failures of medical equipment during procedures have caused patient injuries and deaths. Reducing these types of errors will help improve safety and outcomes in healthcare.
Learning outcome 1The chronicity of COPD allows for self manage.docxaryan532920
Learning outcome 1
The chronicity of COPD allows for self management by sufferers. (Spencer & Barcomb 2014). The self management goal is reduced hospital admissions and improved life quality (Bedra et al 2013). Sufferers should have access to a wide range of skills available from the multidisciplinary team. Those include exacerbation limitation, respiratory failure, chronic productive cough and anxiety and depression.
Symptom Recognition.
Patients discharged from hospital are susceptible to readmission (Bedra et al 2013). Understanding the condition and knowing when they are having an exacerbation is imperative for self management, and what to do in the given circumstances, and when and what medication to take, or realise they need hospital treatment.
Treatment.
The main form of treatments comes from inhaled therapies and explained below would be when they would be administered and their understandings are a major factor in self management.
For breathlessness and exercise limitations: A short acting Beta2 agonist (as required) or short acting muscarinic antagonist (as required).
For exacerbations or persistent breathlessness: A long acting beta2 agonist, long acting muscarinic antagonist, to – long acting beta2 agonist + inhaled corticosteroid (Combination Inhaler) OR a long acting muscarinic antagonist (must discontinue short acting antagonist once this is commenced).
(Remember if using Corticosteroids, this has no evidence of long terms benefits).
If experiencing persistent exacerbations or breathlessness. Long acting Muscarinic antagonist + long acting beta2 agonist and inhaled corticosteroid (combined inhaler).
Niesters et al, (2012) describe how oxygen therapy can also be used, but awareness of inappropriate oxygen therapy with COPD patients is imperative as this can cause respiratory depression.
Self Monitoring.
The British Thoracic Society (BTS) have identified five high impact actions that can improve outcomes for people being discharged after an acute exacerbation of COPD. The form is a quick way of identifying patients need for those interventions, ensuring their needs are met. The aim is for lessened hospital readmission rates with self monitoring patients. The five actions are;
Review of medication and demonstration of inhalers they will be using.
Provide a written Self Management plan and Emergency drug pack.
Asses and offer referral for smoking sensation.
Assess for suitability for pulmonary rehab.
Arrange a follow up call within 72 hours of discharge.
Educational Interventions.
Reardon et al, (2005) explain pulmonary rehabilitation as programs which work with patients to help manage their condition, muscle strength, ability to cope with their disease, help with social requirements as people can become quite isolated.
Test includes incremental shuttle walk a 10 metre course, consecutive runs, each time getting faster, measured how far they got, will give idea of what they can endure on the exercise programme th ...
Running Head PICOT STATEMENT1PICOT STATEMENT4.docxglendar3
Running Head: PICOT STATEMENT 1
PICOT STATEMENT 4
PICOT statement
Name of the student:
Good start on your PICO question this week. However, I am not clear on what the PICOT question is. What is the specific intervention, comparison, and outcomes you are evaluating? I noted a few corrections and comments in your paper. Be sure to make corrections before including this in the final capstone paper in week 9. Thanks. – Mrs. Guzman
PICOT Sstatement
Patient/Ppopulation
The population that is mostly affected with hypertension are male adults between the ages of 40 and 70 with hypertension, and with different diseases, that shows alteration in lifestyle (attracting routinely in practice and taking in more advantageous and sufficient dinners), appeared differently in relation to patients who use solution to treat/manage their high blood pressure, assist to manage their heartbeat and lessen the threat of making cardiovascular sicknesses in their recovery time inside a half year. The period will be adequately long to make a sick be able not to encounter the evil impacts of high blood pressure and to in like manner diminish the threats that the general population will customarily experience (Dua, et.al, 2014). Comment by Melanie Guzman: Meaning is not clear Comment by Melanie Guzman: This is vague Comment by Melanie Guzman: 5 authors: Put all last names inn first citation, then et al. in subsequent citations
Intervention Comment by Melanie Guzman: Headings bolded
The essential strategy for mediation for sick with high blood pressure it is with no vulnerability to place them under medicine so that they can be restored. That is the most secure way as it will impact the patient to have the ability to manage themselves to the extent how they to think, what they eat and even the activities that they endeavor to take an interest in. The age of the patients will in like manner suggest that the sick are given arrangement that can oversee them in the most useful means and which they can recognize with everything taken into account. The medicine that can be provided for this circumstance is one that can diminish the brutality of a prescription. The nursing intercession for sick with high blood pressure is evaluating the migraine torments that sick is encountering and checking the obscured vision in like clockwork until the point when it leaves. Another nursing mediation is for an attendant to teach a sick on how they counsel with their specialist before the medicine is ceased (Dua, et.al, 2014). Comment by Melanie Guzman: This is not clear. What is the identified problem? PICOT statement? What evidenced-based interventions related to that problem are you proposing? Comment by Melanie Guzman: What interventions are being doing to prevent high blood pressure? Is evaluation of migraine a major issue with HTN? Comment by Melanie Guzman:
Comparison Comment by Melanie Guzman: What are you specifically comparing in your PICOT statement?
The first c.
Running Head PICOT STATEMENT1PICOT STATEMENT4.docxtodd581
Running Head: PICOT STATEMENT 1
PICOT STATEMENT 4
PICOT statement
Name of the student:
Good start on your PICO question this week. However, I am not clear on what the PICOT question is. What is the specific intervention, comparison, and outcomes you are evaluating? I noted a few corrections and comments in your paper. Be sure to make corrections before including this in the final capstone paper in week 9. Thanks. – Mrs. Guzman
PICOT Sstatement
Patient/Ppopulation
The population that is mostly affected with hypertension are male adults between the ages of 40 and 70 with hypertension, and with different diseases, that shows alteration in lifestyle (attracting routinely in practice and taking in more advantageous and sufficient dinners), appeared differently in relation to patients who use solution to treat/manage their high blood pressure, assist to manage their heartbeat and lessen the threat of making cardiovascular sicknesses in their recovery time inside a half year. The period will be adequately long to make a sick be able not to encounter the evil impacts of high blood pressure and to in like manner diminish the threats that the general population will customarily experience (Dua, et.al, 2014). Comment by Melanie Guzman: Meaning is not clear Comment by Melanie Guzman: This is vague Comment by Melanie Guzman: 5 authors: Put all last names inn first citation, then et al. in subsequent citations
Intervention Comment by Melanie Guzman: Headings bolded
The essential strategy for mediation for sick with high blood pressure it is with no vulnerability to place them under medicine so that they can be restored. That is the most secure way as it will impact the patient to have the ability to manage themselves to the extent how they to think, what they eat and even the activities that they endeavor to take an interest in. The age of the patients will in like manner suggest that the sick are given arrangement that can oversee them in the most useful means and which they can recognize with everything taken into account. The medicine that can be provided for this circumstance is one that can diminish the brutality of a prescription. The nursing intercession for sick with high blood pressure is evaluating the migraine torments that sick is encountering and checking the obscured vision in like clockwork until the point when it leaves. Another nursing mediation is for an attendant to teach a sick on how they counsel with their specialist before the medicine is ceased (Dua, et.al, 2014). Comment by Melanie Guzman: This is not clear. What is the identified problem? PICOT statement? What evidenced-based interventions related to that problem are you proposing? Comment by Melanie Guzman: What interventions are being doing to prevent high blood pressure? Is evaluation of migraine a major issue with HTN? Comment by Melanie Guzman:
Comparison Comment by Melanie Guzman: What are you specifically comparing in your PICOT statement?
The first c.
Hospice care and palliative care: Is there a difference between the two, and if so, what?
Many people still think that palliative care means hospice care. But today, hospice is only a small part of palliative care.
The goal of palliative care is to prevent or treat the symptoms and side effects of a disease; and it should be part of the picture from the first day a serious illness is diagnosed.
Dr. Jim Meadows, Director of Hospice and Palliative Care at Tennessee Oncology, will discuss this important topic. How does a family and a health care team best work together to guide a patient through a terminal illness? How does everyone continue to support quality, patient-centered, end-of-life care?
I didn't know this option of Palliative care existed prior to my mother's passing earlier this year of colorectal cancer. However, I do now know about it and want to share it with all of you
This document summarizes factors that contribute to hospital readmissions and strategies to reduce readmission rates. It identifies that patients are at higher risk of readmission if they have multiple chronic conditions, lack social support, or have issues with following discharge plans. High nursing workload is also linked to higher readmission rates for certain conditions. Successful interventions discussed include implementing transition plans, increasing education for patients using "teach back" methods, designating nurse discharge advocates, enhancing post-discharge follow-up including remote monitoring, and improving communication between inpatient and outpatient providers.
This document discusses delirium in the intensive care unit (ICU) and different assessment tools for diagnosing delirium. It provides background on delirium, risk factors, and the need for accurate assessment. Several studies are summarized that evaluated various delirium assessment tools used by nurses in the ICU, with most finding the Confusion Assessment Method for the ICU (CAM-ICU) to be the most effective. The document argues for implementing routine delirium screening of high-risk patients and monitoring using the CAM-ICU to improve outcomes like length of stay and mortality.
Utilizing Care Management Nurses to Improve Transitions in Care in the Oupati...Tanisha Davis
This document discusses a proposal to utilize care management nurses to improve care transitions for high-risk congestive heart failure (CHF) patients in the outpatient setting. It identifies opportunities to improve medication reconciliation and CHF education using teach-back methods. A literature review supports interventions like medication reconciliation, care coordination, CHF education and post-discharge follow up to reduce readmissions. The proposal is to pilot this approach for CHF patients through a microsystem project using a PDSA framework to study workflows and standardized processes for assessments, education and medication reconciliation across care transitions.
Utilizing Care Management Nurses to Improve Transitions in Care in the Oupati...Tanisha Davis
This document discusses a proposal to utilize care management nurses to improve care transitions for high-risk congestive heart failure (CHF) patients in the outpatient setting. It identifies opportunities to improve medication reconciliation and CHF education using teach-back methods. A literature review supports interventions like medication reconciliation, care coordination, CHF education and post-discharge follow up to reduce readmissions. The proposal is to pilot this approach for CHF patients through a microsystem project using a PDSA framework to study workflows and standardized processes for assessments, education and medication reconciliation across care transitions.
Here are a few suggestions to help make Bob more comfortable in his double room during his palliative care experience:
- Speak to the care team about relocating Albert to a private room, if available, to reduce disruptions and allow for a peaceful environment for Bob and his family.
- Ensure Bob's bed is positioned in a way that maximizes his comfort and view (e.g. by the window).
- Set up a quiet, private family space in the room where loved ones can visit without disturbing Albert.
- Provide the family information on palliative care, dementia, and managing disruptive behaviors to help them care for Bob and understand Albert.
- Ask the family about Bob's preferences and
Dr. Harold Freeman founded the first patient navigation program in 1990 to help reduce barriers to care for low-income cancer patients. A study he conducted between 1995-2000 found that the five-year cancer survival rate increased to 70% for low-income patients who received help from patient navigators, compared to only 39% in an earlier study without navigators. Research has shown that patient navigators increase patient compliance, decrease delays in care, and can increase patient satisfaction scores by explaining treatment plans and helping patients overcome barriers to care. While start-up costs may be high initially, patient navigators ultimately save health systems money by reducing unnecessary emergency room visits and improving health outcomes.
Objective: To evaluate the utility of a targeted lecture in improving FP awareness amongst clinicians.
Design: This is a dual institution, prospective survey-based study assessing if an educational lecture can increase the likelihood of FP consideration, discussion, and referral.
This document provides an overview of palliative care, including:
1) Palliative care aims to relieve suffering and improve quality of life for patients facing serious illnesses, and involves addressing physical, emotional, and spiritual needs.
2) As the population ages and chronic diseases increase, more patients will benefit from palliative care services to improve end-of-life experiences and outcomes.
3) Prognostication, or predicting a patient's life expectancy, is an important but challenging skill for physicians, and palliative care aims to improve care based on patient preferences near the end of life.
Breast Cancer and Palliative Care Issues Essay Paper.docx4934bk
A 54-year-old female with breast cancer was admitted to the hospital with a large fungating wound on her breast and mouth ulcers. She had delayed treatment for 1.5 years due to financial issues and lack of awareness about cancer treatment. Her condition continued to deteriorate and she eventually died after 2 weeks in the hospital from metastatic cancer. Multiple factors contributed to her delayed diagnosis and treatment, including lack of awareness, socio-cultural barriers, financial burden, and preference for homeopathic treatment instead of conventional care. Educating patients and the public can help address issues related to breast cancer diagnosis and treatment.
This document discusses several studies on the effects of oral care and dysphagia screenings for patients post-stroke. It finds that early identification of dysphagia through screenings can greatly reduce the risk of aspiration pneumonia. Nurse-led dysphagia screenings using a standardized tool were found to correctly identify swallowing difficulties. However, more research is needed on the effects of screenings on length of hospital stay and time to speech therapy assessment. The document also discusses the need for staff training and protocols for proper oral care post-stroke to maintain oral health and reduce pneumonia risk. A study in Japan found that while most hospitals implement oral care, only 30% of nurses receive training, indicating a need
NURS 4435 TUTA Critically Read and Critique Nursing Research Articles.docxstirlingvwriters
This study examined differences in illness perceptions between injured patients and their caregivers 3-6 months after hospital discharge. A total of 127 patient-caregiver pairs completed questionnaires assessing their perceptions of the patient's injury. The study found that both patients and caregivers held negative views of the injury. Patients perceived more physical symptoms than caregivers. Caregivers of more severely injured patients or those admitted to the ICU had more negative perceptions than other caregivers. Caregivers who did not share care responsibilities also had more negative views than those who did share responsibilities. The results suggest clinicians should explore perceptions to better meet the individual needs of patients and caregivers after injury.
Medication Administration Errors at Children's University Hospitals: Nurses P...iosrjce
Medication administration errors(MAE) can threaten patient outcomes and are a dimension of
patient safety directly linked to nursing care. Children are particularly vulnerable to medication errors because
of their unique physiology and developmental needs.
Aims: The present study aims to examine types, stages and causes of medication errors. Barriers of medication
administration errors reporting and its facilitator at pediatric University hospitals from nurses point of view.
Methods: A descriptive study was conducted in Pediatric intensive care units, medical, surgical and urology
ward of children's university hospital at Mansoura University, intensive care units, kidney dialysis at
Abouelrash pediatric hospital and general wards of Elmonaira at Cairo University Hospitals. 80 nurses were
included in the study after fulfilling the criteria of selection. A structured interview questionnaire that consists
of four sections was used.
Results: The highest types of medication errors as reported by studied nurses occurred when the medication is
delivered by the wrong route, the highest stage of medication errors done by nurses was missing of medication
then patient monitoring and administration and the highest cause of medication errors was due to heavy
workload. The results of this study indicated that the strongest perceived barriers to medication administration
errors reporting were fear from consequences of reporting, then managerial factor and then the process of
reporting from the nurse's viewpoint. The nurses agree that identifying benefits of reporting followed agree that
feeling safe about working environment, and agree that good professional relationship with physicians was the
most facilitating factors of reporting medication errors.
Conclusions: It was concluded that medication errors result from interrelated factors, the strongest perceived
barriers to medication administration errors reporting were fear from consequences of reporting, and good
relationship with nurse managers and physicians were the most facilitators of reporting medication errors.
Recommendation: The study recommended that the assessment of medication errors should be done
periodically and in- service training program about medication administrations should be applied
An Intervention To Improve Respiratory Therapists Comfort With End-Of-Life CareBrooke Heidt
This study evaluated a one-day educational program aimed at improving respiratory therapists' (RTs) comfort and skills in dealing with end-of-life care. RTs frequently care for critically ill patients but receive little training in palliative care. A survey assessed RTs' comfort, perceived role, and knowledge regarding end-of-life care, before and after participating in the program. The program, consisting of presentations, discussions, and role-playing, significantly increased RTs' comfort with end-of-life care, perception of their role, and knowledge based on pre- and post-surveys. However, longer-term impacts require further evaluation.
Database reports provide us with the ability to further analyze ou.docxwhittemorelucilla
Database reports provide us with the ability to further analyze our data, and provide it in a format that can be used to make business decisions. Discuss the steps that you would take to ensure that we create an effective report. What questions would you ask of the users?
Data presentation should be designed to display correct conclusions. What issues should we think about as we prepare data for presentation? Discuss the different methods that we can use to present data in a report. What role does the audience play in selecting how we present the data?
1 PAGE AND A HALF
.
DataInformationKnowledge1. Discuss the relationship between.docxwhittemorelucilla
Data/Information/Knowledge
1. Discuss the relationship between data, information, and knowledge. Support your discussion with at least 3 academically reviewed articles.
2. Why do organization have information deficiency problem? Suggest ways on how to overcome information deficiency problem.
.
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NURS 438 Trends And Issues In Nursing And Health Systems.docxstirlingvwriters
This document discusses trends and issues related to medical errors in nursing and health systems. It outlines several common causes of medical errors, including communication problems, inadequate information flow, and technical errors. Communication issues between nurses and patients can lead to medication errors, while inadequate discharge instructions and a lack of information for patients post-hospitalization can also result in errors. Technical failures of medical equipment during procedures have caused patient injuries and deaths. Reducing these types of errors will help improve safety and outcomes in healthcare.
Learning outcome 1The chronicity of COPD allows for self manage.docxaryan532920
Learning outcome 1
The chronicity of COPD allows for self management by sufferers. (Spencer & Barcomb 2014). The self management goal is reduced hospital admissions and improved life quality (Bedra et al 2013). Sufferers should have access to a wide range of skills available from the multidisciplinary team. Those include exacerbation limitation, respiratory failure, chronic productive cough and anxiety and depression.
Symptom Recognition.
Patients discharged from hospital are susceptible to readmission (Bedra et al 2013). Understanding the condition and knowing when they are having an exacerbation is imperative for self management, and what to do in the given circumstances, and when and what medication to take, or realise they need hospital treatment.
Treatment.
The main form of treatments comes from inhaled therapies and explained below would be when they would be administered and their understandings are a major factor in self management.
For breathlessness and exercise limitations: A short acting Beta2 agonist (as required) or short acting muscarinic antagonist (as required).
For exacerbations or persistent breathlessness: A long acting beta2 agonist, long acting muscarinic antagonist, to – long acting beta2 agonist + inhaled corticosteroid (Combination Inhaler) OR a long acting muscarinic antagonist (must discontinue short acting antagonist once this is commenced).
(Remember if using Corticosteroids, this has no evidence of long terms benefits).
If experiencing persistent exacerbations or breathlessness. Long acting Muscarinic antagonist + long acting beta2 agonist and inhaled corticosteroid (combined inhaler).
Niesters et al, (2012) describe how oxygen therapy can also be used, but awareness of inappropriate oxygen therapy with COPD patients is imperative as this can cause respiratory depression.
Self Monitoring.
The British Thoracic Society (BTS) have identified five high impact actions that can improve outcomes for people being discharged after an acute exacerbation of COPD. The form is a quick way of identifying patients need for those interventions, ensuring their needs are met. The aim is for lessened hospital readmission rates with self monitoring patients. The five actions are;
Review of medication and demonstration of inhalers they will be using.
Provide a written Self Management plan and Emergency drug pack.
Asses and offer referral for smoking sensation.
Assess for suitability for pulmonary rehab.
Arrange a follow up call within 72 hours of discharge.
Educational Interventions.
Reardon et al, (2005) explain pulmonary rehabilitation as programs which work with patients to help manage their condition, muscle strength, ability to cope with their disease, help with social requirements as people can become quite isolated.
Test includes incremental shuttle walk a 10 metre course, consecutive runs, each time getting faster, measured how far they got, will give idea of what they can endure on the exercise programme th ...
Running Head PICOT STATEMENT1PICOT STATEMENT4.docxglendar3
Running Head: PICOT STATEMENT 1
PICOT STATEMENT 4
PICOT statement
Name of the student:
Good start on your PICO question this week. However, I am not clear on what the PICOT question is. What is the specific intervention, comparison, and outcomes you are evaluating? I noted a few corrections and comments in your paper. Be sure to make corrections before including this in the final capstone paper in week 9. Thanks. – Mrs. Guzman
PICOT Sstatement
Patient/Ppopulation
The population that is mostly affected with hypertension are male adults between the ages of 40 and 70 with hypertension, and with different diseases, that shows alteration in lifestyle (attracting routinely in practice and taking in more advantageous and sufficient dinners), appeared differently in relation to patients who use solution to treat/manage their high blood pressure, assist to manage their heartbeat and lessen the threat of making cardiovascular sicknesses in their recovery time inside a half year. The period will be adequately long to make a sick be able not to encounter the evil impacts of high blood pressure and to in like manner diminish the threats that the general population will customarily experience (Dua, et.al, 2014). Comment by Melanie Guzman: Meaning is not clear Comment by Melanie Guzman: This is vague Comment by Melanie Guzman: 5 authors: Put all last names inn first citation, then et al. in subsequent citations
Intervention Comment by Melanie Guzman: Headings bolded
The essential strategy for mediation for sick with high blood pressure it is with no vulnerability to place them under medicine so that they can be restored. That is the most secure way as it will impact the patient to have the ability to manage themselves to the extent how they to think, what they eat and even the activities that they endeavor to take an interest in. The age of the patients will in like manner suggest that the sick are given arrangement that can oversee them in the most useful means and which they can recognize with everything taken into account. The medicine that can be provided for this circumstance is one that can diminish the brutality of a prescription. The nursing intercession for sick with high blood pressure is evaluating the migraine torments that sick is encountering and checking the obscured vision in like clockwork until the point when it leaves. Another nursing mediation is for an attendant to teach a sick on how they counsel with their specialist before the medicine is ceased (Dua, et.al, 2014). Comment by Melanie Guzman: This is not clear. What is the identified problem? PICOT statement? What evidenced-based interventions related to that problem are you proposing? Comment by Melanie Guzman: What interventions are being doing to prevent high blood pressure? Is evaluation of migraine a major issue with HTN? Comment by Melanie Guzman:
Comparison Comment by Melanie Guzman: What are you specifically comparing in your PICOT statement?
The first c.
Running Head PICOT STATEMENT1PICOT STATEMENT4.docxtodd581
Running Head: PICOT STATEMENT 1
PICOT STATEMENT 4
PICOT statement
Name of the student:
Good start on your PICO question this week. However, I am not clear on what the PICOT question is. What is the specific intervention, comparison, and outcomes you are evaluating? I noted a few corrections and comments in your paper. Be sure to make corrections before including this in the final capstone paper in week 9. Thanks. – Mrs. Guzman
PICOT Sstatement
Patient/Ppopulation
The population that is mostly affected with hypertension are male adults between the ages of 40 and 70 with hypertension, and with different diseases, that shows alteration in lifestyle (attracting routinely in practice and taking in more advantageous and sufficient dinners), appeared differently in relation to patients who use solution to treat/manage their high blood pressure, assist to manage their heartbeat and lessen the threat of making cardiovascular sicknesses in their recovery time inside a half year. The period will be adequately long to make a sick be able not to encounter the evil impacts of high blood pressure and to in like manner diminish the threats that the general population will customarily experience (Dua, et.al, 2014). Comment by Melanie Guzman: Meaning is not clear Comment by Melanie Guzman: This is vague Comment by Melanie Guzman: 5 authors: Put all last names inn first citation, then et al. in subsequent citations
Intervention Comment by Melanie Guzman: Headings bolded
The essential strategy for mediation for sick with high blood pressure it is with no vulnerability to place them under medicine so that they can be restored. That is the most secure way as it will impact the patient to have the ability to manage themselves to the extent how they to think, what they eat and even the activities that they endeavor to take an interest in. The age of the patients will in like manner suggest that the sick are given arrangement that can oversee them in the most useful means and which they can recognize with everything taken into account. The medicine that can be provided for this circumstance is one that can diminish the brutality of a prescription. The nursing intercession for sick with high blood pressure is evaluating the migraine torments that sick is encountering and checking the obscured vision in like clockwork until the point when it leaves. Another nursing mediation is for an attendant to teach a sick on how they counsel with their specialist before the medicine is ceased (Dua, et.al, 2014). Comment by Melanie Guzman: This is not clear. What is the identified problem? PICOT statement? What evidenced-based interventions related to that problem are you proposing? Comment by Melanie Guzman: What interventions are being doing to prevent high blood pressure? Is evaluation of migraine a major issue with HTN? Comment by Melanie Guzman:
Comparison Comment by Melanie Guzman: What are you specifically comparing in your PICOT statement?
The first c.
Hospice care and palliative care: Is there a difference between the two, and if so, what?
Many people still think that palliative care means hospice care. But today, hospice is only a small part of palliative care.
The goal of palliative care is to prevent or treat the symptoms and side effects of a disease; and it should be part of the picture from the first day a serious illness is diagnosed.
Dr. Jim Meadows, Director of Hospice and Palliative Care at Tennessee Oncology, will discuss this important topic. How does a family and a health care team best work together to guide a patient through a terminal illness? How does everyone continue to support quality, patient-centered, end-of-life care?
I didn't know this option of Palliative care existed prior to my mother's passing earlier this year of colorectal cancer. However, I do now know about it and want to share it with all of you
This document summarizes factors that contribute to hospital readmissions and strategies to reduce readmission rates. It identifies that patients are at higher risk of readmission if they have multiple chronic conditions, lack social support, or have issues with following discharge plans. High nursing workload is also linked to higher readmission rates for certain conditions. Successful interventions discussed include implementing transition plans, increasing education for patients using "teach back" methods, designating nurse discharge advocates, enhancing post-discharge follow-up including remote monitoring, and improving communication between inpatient and outpatient providers.
This document discusses delirium in the intensive care unit (ICU) and different assessment tools for diagnosing delirium. It provides background on delirium, risk factors, and the need for accurate assessment. Several studies are summarized that evaluated various delirium assessment tools used by nurses in the ICU, with most finding the Confusion Assessment Method for the ICU (CAM-ICU) to be the most effective. The document argues for implementing routine delirium screening of high-risk patients and monitoring using the CAM-ICU to improve outcomes like length of stay and mortality.
Utilizing Care Management Nurses to Improve Transitions in Care in the Oupati...Tanisha Davis
This document discusses a proposal to utilize care management nurses to improve care transitions for high-risk congestive heart failure (CHF) patients in the outpatient setting. It identifies opportunities to improve medication reconciliation and CHF education using teach-back methods. A literature review supports interventions like medication reconciliation, care coordination, CHF education and post-discharge follow up to reduce readmissions. The proposal is to pilot this approach for CHF patients through a microsystem project using a PDSA framework to study workflows and standardized processes for assessments, education and medication reconciliation across care transitions.
Utilizing Care Management Nurses to Improve Transitions in Care in the Oupati...Tanisha Davis
This document discusses a proposal to utilize care management nurses to improve care transitions for high-risk congestive heart failure (CHF) patients in the outpatient setting. It identifies opportunities to improve medication reconciliation and CHF education using teach-back methods. A literature review supports interventions like medication reconciliation, care coordination, CHF education and post-discharge follow up to reduce readmissions. The proposal is to pilot this approach for CHF patients through a microsystem project using a PDSA framework to study workflows and standardized processes for assessments, education and medication reconciliation across care transitions.
Here are a few suggestions to help make Bob more comfortable in his double room during his palliative care experience:
- Speak to the care team about relocating Albert to a private room, if available, to reduce disruptions and allow for a peaceful environment for Bob and his family.
- Ensure Bob's bed is positioned in a way that maximizes his comfort and view (e.g. by the window).
- Set up a quiet, private family space in the room where loved ones can visit without disturbing Albert.
- Provide the family information on palliative care, dementia, and managing disruptive behaviors to help them care for Bob and understand Albert.
- Ask the family about Bob's preferences and
Dr. Harold Freeman founded the first patient navigation program in 1990 to help reduce barriers to care for low-income cancer patients. A study he conducted between 1995-2000 found that the five-year cancer survival rate increased to 70% for low-income patients who received help from patient navigators, compared to only 39% in an earlier study without navigators. Research has shown that patient navigators increase patient compliance, decrease delays in care, and can increase patient satisfaction scores by explaining treatment plans and helping patients overcome barriers to care. While start-up costs may be high initially, patient navigators ultimately save health systems money by reducing unnecessary emergency room visits and improving health outcomes.
Objective: To evaluate the utility of a targeted lecture in improving FP awareness amongst clinicians.
Design: This is a dual institution, prospective survey-based study assessing if an educational lecture can increase the likelihood of FP consideration, discussion, and referral.
This document provides an overview of palliative care, including:
1) Palliative care aims to relieve suffering and improve quality of life for patients facing serious illnesses, and involves addressing physical, emotional, and spiritual needs.
2) As the population ages and chronic diseases increase, more patients will benefit from palliative care services to improve end-of-life experiences and outcomes.
3) Prognostication, or predicting a patient's life expectancy, is an important but challenging skill for physicians, and palliative care aims to improve care based on patient preferences near the end of life.
Breast Cancer and Palliative Care Issues Essay Paper.docx4934bk
A 54-year-old female with breast cancer was admitted to the hospital with a large fungating wound on her breast and mouth ulcers. She had delayed treatment for 1.5 years due to financial issues and lack of awareness about cancer treatment. Her condition continued to deteriorate and she eventually died after 2 weeks in the hospital from metastatic cancer. Multiple factors contributed to her delayed diagnosis and treatment, including lack of awareness, socio-cultural barriers, financial burden, and preference for homeopathic treatment instead of conventional care. Educating patients and the public can help address issues related to breast cancer diagnosis and treatment.
This document discusses several studies on the effects of oral care and dysphagia screenings for patients post-stroke. It finds that early identification of dysphagia through screenings can greatly reduce the risk of aspiration pneumonia. Nurse-led dysphagia screenings using a standardized tool were found to correctly identify swallowing difficulties. However, more research is needed on the effects of screenings on length of hospital stay and time to speech therapy assessment. The document also discusses the need for staff training and protocols for proper oral care post-stroke to maintain oral health and reduce pneumonia risk. A study in Japan found that while most hospitals implement oral care, only 30% of nurses receive training, indicating a need
NURS 4435 TUTA Critically Read and Critique Nursing Research Articles.docxstirlingvwriters
This study examined differences in illness perceptions between injured patients and their caregivers 3-6 months after hospital discharge. A total of 127 patient-caregiver pairs completed questionnaires assessing their perceptions of the patient's injury. The study found that both patients and caregivers held negative views of the injury. Patients perceived more physical symptoms than caregivers. Caregivers of more severely injured patients or those admitted to the ICU had more negative perceptions than other caregivers. Caregivers who did not share care responsibilities also had more negative views than those who did share responsibilities. The results suggest clinicians should explore perceptions to better meet the individual needs of patients and caregivers after injury.
Medication Administration Errors at Children's University Hospitals: Nurses P...iosrjce
Medication administration errors(MAE) can threaten patient outcomes and are a dimension of
patient safety directly linked to nursing care. Children are particularly vulnerable to medication errors because
of their unique physiology and developmental needs.
Aims: The present study aims to examine types, stages and causes of medication errors. Barriers of medication
administration errors reporting and its facilitator at pediatric University hospitals from nurses point of view.
Methods: A descriptive study was conducted in Pediatric intensive care units, medical, surgical and urology
ward of children's university hospital at Mansoura University, intensive care units, kidney dialysis at
Abouelrash pediatric hospital and general wards of Elmonaira at Cairo University Hospitals. 80 nurses were
included in the study after fulfilling the criteria of selection. A structured interview questionnaire that consists
of four sections was used.
Results: The highest types of medication errors as reported by studied nurses occurred when the medication is
delivered by the wrong route, the highest stage of medication errors done by nurses was missing of medication
then patient monitoring and administration and the highest cause of medication errors was due to heavy
workload. The results of this study indicated that the strongest perceived barriers to medication administration
errors reporting were fear from consequences of reporting, then managerial factor and then the process of
reporting from the nurse's viewpoint. The nurses agree that identifying benefits of reporting followed agree that
feeling safe about working environment, and agree that good professional relationship with physicians was the
most facilitating factors of reporting medication errors.
Conclusions: It was concluded that medication errors result from interrelated factors, the strongest perceived
barriers to medication administration errors reporting were fear from consequences of reporting, and good
relationship with nurse managers and physicians were the most facilitators of reporting medication errors.
Recommendation: The study recommended that the assessment of medication errors should be done
periodically and in- service training program about medication administrations should be applied
An Intervention To Improve Respiratory Therapists Comfort With End-Of-Life CareBrooke Heidt
This study evaluated a one-day educational program aimed at improving respiratory therapists' (RTs) comfort and skills in dealing with end-of-life care. RTs frequently care for critically ill patients but receive little training in palliative care. A survey assessed RTs' comfort, perceived role, and knowledge regarding end-of-life care, before and after participating in the program. The program, consisting of presentations, discussions, and role-playing, significantly increased RTs' comfort with end-of-life care, perception of their role, and knowledge based on pre- and post-surveys. However, longer-term impacts require further evaluation.
Similar to D elirium W hy Are Nurses ConfusedNidsa D. Baker Hele.docx (20)
Database reports provide us with the ability to further analyze ou.docxwhittemorelucilla
Database reports provide us with the ability to further analyze our data, and provide it in a format that can be used to make business decisions. Discuss the steps that you would take to ensure that we create an effective report. What questions would you ask of the users?
Data presentation should be designed to display correct conclusions. What issues should we think about as we prepare data for presentation? Discuss the different methods that we can use to present data in a report. What role does the audience play in selecting how we present the data?
1 PAGE AND A HALF
.
DataInformationKnowledge1. Discuss the relationship between.docxwhittemorelucilla
Data/Information/Knowledge
1. Discuss the relationship between data, information, and knowledge. Support your discussion with at least 3 academically reviewed articles.
2. Why do organization have information deficiency problem? Suggest ways on how to overcome information deficiency problem.
.
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State Legislatures
(Part I)
POLS 2212
Legislatures, Policy-Making, and Political Science
• Legislative process is only one part of policy-making
• States are better venue for understanding policy-making
process overall
• Interactions between components are more transparent
• Less ‘political theater’ than national level
• More cases, more variation, more data
• What role do legislatures play in the overall policy-making
process??
• How do legislative-executive relations affect policy outcomes??
Agenda Setting
Formulation /
Negotiation
Adoption /
Enactment
Implementation
Evaluation
Revision /
Termination
• Public attention is focused on an issue
• Collective recognition of problem
Agenda Setting
• Potential solutions are offered
• Some public discourse over options
Formulation / Negotiation
•
Solution
is agreed upon and made into official policy /
law
Adoption / Enactment
• Policy is converted into actionable rules
Implementation
• Fairness, effectiveness, efficiency of policy and rules are
evaluated
Evaluation
• Improvements or changes to policy are made
Revision / Termination
Agenda Setting
• Parties
• Public opinion
• Advocacy groups /
entrepreneurs
Formulation /
Negotiation
• Party leadership
• Interest groups
• Legislature type
• Legislative-executive
relations
Adoption / Enactment
• Legislative-executive
relations
Implementation
• Type of executive
• Bureaucracy
Evaluation
• Social scientists
• Advocacy groups
• Legislative
committees
• State courts
Revision / Termination
• State courts
• Federal courts
‘Professional’
Model
‘Citizen-
Legislator’
Model
Work Load
Nearly full-
time
Part-time
Session
Year-round,
annual
Short-term,
possibly
biannual
Compensation
Medium-high
(over median
for state
employees)
Fairly low
Staff
Large, semi-
permanent
Small, likely
shared
Conceptualizing State Legislatures
Professional Hybrid / Mixture Citizen
State Legislatures
• GA Legislature
• $17k base +per
diem
• $22k – $24k total
Discussion Question
• What are some of the potential benefits /
drawbacks of each of these two models??
State Legislatures and Political Careers (Peverill Squire)
• ‘Career’ Legislatures (Congress)
• Sufficiently high pay
• Minimal incentive to ‘move up’
• Expectation of long tenure
• Heavy time commitment
• ‘Springboard’ Legislatures
• Other positions have higher pay, more prestige
• Expectation of limited tenure
• May be term lim.
DataIDSalaryCompa-ratioMidpoint AgePerformance RatingServiceGenderRaiseDegreeGender1GradeDo not manipuilate Data set on this page, copy to another page to make changes154.50.956573485805.70METhe ongoing question that the weekly assignments will focus on is: Are males and females paid the same for equal work (under the Equal Pay Act)? 228.30.913315280703.90MBNote: to simplfy the analysis, we will assume that jobs within each grade comprise equal work.334.11.100313075513.61FB460.91.06857421001605.51METhe column labels in the table mean:549.21.0254836901605.71MDID – Employee sample number Salary – Salary in thousands 674.11.1066736701204.51MFAge – Age in yearsPerformance Rating - Appraisal rating (employee evaluation score)741.41.0344032100815.71FCService – Years of service (rounded)Gender – 0 = male, 1 = female 822.80.992233290915.81FAMidpoint – salary grade midpoint Raise – percent of last raise9731.089674910010041MFGrade – job/pay gradeDegree (0= BS\BA 1 = MS)1023.31.014233080714.71FAGender1 (Male or Female)Compa-ratio - salary divided by midpoint1124.31.05723411001914.81FA1259.71.0475752952204.50ME1341.81.0444030100214.70FC14251.08523329012161FA1522.60.983233280814.91FA1648.51.213404490405.70MC1763.11.1075727553131FE1836.21.1673131801115.60FB1923.91.039233285104.61MA2035.51.1443144701614.80FB2178.91.1786743951306.31MF2257.61.199484865613.81FD2322.20.964233665613.30FA2453.41.112483075913.80FD2523.61.0282341704040MA2622.30.971232295216.20FA2746.21.156403580703.91MC2874.41.111674495914.40FF2975.61.129675295505.40MF3047.50.9894845901804.30MD3122.90.995232960413.91FA3228.10.906312595405.60MB3363.71.117573590905.51ME3426.90.869312680204.91MB3522.70.987232390415.30FA3624.41.059232775314.30FA3723.81.034232295216.20FA3864.61.1335745951104.50ME3937.31.202312790615.50FB4023.71.031232490206.30MA4140.31.008402580504.30MC4224.41.0592332100815.71FA4372.31.0796742952015.50FF4465.91.1565745901605.21ME4549.91.040483695815.21FD4657.41.0075739752003.91ME47560.982573795505.51ME4868.11.1955734901115.31FE4966.21.1615741952106.60ME5061.71.0835738801204.60ME
Week 1Week 1: Descriptive Statistics, including ProbabilityWhile the lectures will examine our equal pay question from the compa-ratio viewpoint, our weekly assignments will focus onexamining the issue using the salary measure.The purpose of this assignmnent is two fold:1. Demonstrate mastery with Excel tools.2. Develop descriptive statistics to help examine the question.3. Interpret descriptive outcomesThe first issue in examining salary data to determine if we - as a company - are paying males and females equally for doing equal work is to develop somedescriptive statistics to give us something to make a preliminary decision on whether we have an issue or not.1Descriptive Statistics: Develop basic descriptive statistics for SalaryThe first step in analyzing data sets is to find some summary descriptive statistics for key variables. Suggestion: Copy the gender1 and salary columns from the Data tab t.
DataCity1997 Median Price1997 Change1998 Forecast1993-98 Annualize.docxwhittemorelucilla
This document provides a course syllabus for History 2030: Tennessee History at an unnamed university. The syllabus outlines key details about the course including the instructor's contact information, course description and purpose, learning outcomes, instructional methodology, evaluation procedures, course schedule, attendance policy, and accommodations for students with disabilities. The course surveys the geographical background, peoples, political life, economic and social development of Tennessee from its earliest beginnings to the present. Students will be evaluated based on exams, research assignments, and presentations to demonstrate their mastery of Tennessee history and ability to think critically about historical interpretations.
The document summarizes research on the harms of corporal punishment of children and argues that legal reform prohibiting it can be an effective strategy for changing social norms and practices. It describes experiences in Sweden and New Zealand, where legal bans on corporal punishment were accompanied by significant declines in support for the practice and reports of it occurring. While public opinion often lags legal changes initially, studies found dramatic shifts in attitudes and self-reported experiences of corporal punishment over time in both countries following prohibition.
Database Project Charter/Business Case
Khalia Hart
University of Maryland Global Campus
February 21, 2020
Introduction
A database is an electronic collection of data that is built by a user so that they can access, update particular information in the database coherently or rapidly. Today firms employ integrated technology to increase their capacity to serve more clients, keep information well or effectively, organize activities according to the urgency or priorities, accounting records (Tüttelmann F, 2015). Most of the integrated technology depends on multiple databases that supply information relevant in making the decision. Since the business started using databases, their performance increase because the business decisions they make are sound and practical.
Business Problem
The supply chain management is one of the most complicated processes in the business and often at times due to need of detail it gets hard for the supply chain manager to keep the record of the work covered effectively, have enough data to make the decision and also have enough data to monitor the chain of operation (William, 2019). The supply chain has been so crucial for the business because it determines the performance of the company in the industry by assessing the quality of the product produced in the organization, cost of production, the time and effectiveness of distribution network, and overall production operation of the organization.
Operation management has been named as the leading cause of business failure caused by a lack of a system, which the manager or the supervisor can use to monitor the whole system. This is the problem to solve using the database (William, 2019). Using a database, the manager can observe or watch the entire chain from their office, make better decisions by fore- planning approach of the database also make changes within the system when there is the need to cut costs or making the process effective.
Project Scope
Most business organizations are spread in operation, and this is the challenge that makes the supply chain management complex (Tüttelmann F, 2015). This is because the chain is in different localities, and therefore, coordination of operation among the user or the workers becomes a challenge. Through the database system, the business will enjoy proper coordination using the wide Area Network (LAN). Through the LAN network, the company can link computers and cost-effectively share data and communication. Through this system, the company will have a connection and coordination of the processes within the organization. The number of connected devices will range from 10 to 1000, depending on the type of tools and system that is set to facilitate this connection.
Goals and objectives of the system
The purpose of the system that I want to install in the supply chain management is to;
· Monitoring of the supply chain- the system will enable the manager to monitor the system and every process in the order (Gattor.
Databases selected Multiple databases...Full Text (1223 .docxwhittemorelucilla
Kraft reformed Oreo cookies to make them more successful in China. They made the cookies less sweet to suit Chinese tastes, sold them in smaller, cheaper packages, and marketed them with a "dunking" theme. This involved training student brand ambassadors to educate consumers about dipping cookies in milk. Kraft also introduced a Chinese-style Oreo wafer stick that surpassed regular Oreos in sales. These reforms helped Oreo become the best-selling biscuit in China.
DATABASE SYSTEMS DEVELOPMENT & IMPLEMENTATION PLAN1DATABASE SYS.docxwhittemorelucilla
DATABASE SYSTEMS DEVELOPMENT & IMPLEMENTATION PLAN 1
DATABASE SYSTEMS DEVELOPMENT & IMPLEMENTATION PLAN 19
Table of Contents
1. Database System Overview 3
1.1 Business Environment 3
1.2 Database system goals and objective 4
2. Entity Relationship Model 7
2.1 Proposed entities 7
2.2 Business rules 8
2.3 Entity–Relationship Model 9
2.3.1 Relationship Types 9
2.3.2 Normalization form 12
2.3.3 Benefit of using database design 14
3. Structured Query Language (SQL) Scripts 15
3.1 Data definition language (DDL) 15
3.2 Data manipulation language (DML) 16
3.3 SQL report 17
3.4 Benefit of using database queries 19
4. Database Administration Plan 20
5. Future Database System Implementation Plan 21
6. References 22
1.
Database System Overview
1.1 Business Environment
Office Depot, Inc is an American retail store company founded in 1986 and headquartered in Florida, United States. The company provides office and school supplies with 1400 retail stores and e-commerce sites. The supply includes everything to their customer like latest technology, core school and office supplies, printing and documenting service, furniture and other services like cell phone repair, tech and marketing service etc.
Recently there were too many complaints from existing and new customer that the online site is super glitch and lagging. Another customer posted that the delivery did not come on the scheduled day. And they cannot track down the order because the website does not have tracking information. Also when the website is down, customer service cannot help to see the order details either and therefore, they feel it’s frustrating to order online and therefore want to cancel the order. One other customer posted in the website grievance section that the “label maker” showed available in the stock even though it was out of stock when verified with the customer service representative. With every product not in stock, we lose opportunity of sale which costs the store. This not only affect customer but also affect company. We are so dependent on the data, most of the time staff has to correct accounting report, sales estimates and invoice customer manually which is very time-consuming in an excel sheet.
In order to solve above issues and avoid sales loss, Office Depot must have a database to store and maintain correct count of the products. This database will help inventory management i.e. tracking products, update inventory, find popular or less popular item, loss prevention, track inventory status and perform data mining. The staff can access this database via a computerized database. (Gerald H., Importance of inventory database retail)1.2 Database system goals and objective
The mission of the company is to become number one retail company by creating inclusive environment and great shopping experience where both customer and employees are respected and valued. To achieve the retail store mission, we are committed to provide secure and robust data base system for ou.
Database Security Assessment Transcript You are a contracting office.docxwhittemorelucilla
Database Security Assessment Transcript You are a contracting officer's technical representative, a Security System Engineer, at a military hospital. Your department's leaders are adopting a new medical health care database management system. And they've tasked you to create a request for proposal for which different vendors will compete to build and provide to the hospital. A Request For Proposal, or RFP, is when an organization sends out a request for estimates on performing a function, delivering a technology, or providing a service or augmenting staff. RFPs are tailored to each endeavor but have common components and are important in the world of IT contracting and for procurement and acquisitions. To complete the RFP, you must determine the technical and security specifications for the system. You'll write the requirements for the overall system and also provide evaluation standards that will be used in rating the vendor's performance. Your learning will help you determine your system's requirements. As you discover methods of attack, you'll write prevention and remediation requirements for the vendor to perform. You must identify the different vulnerabilities the database should be hardened against.
Modern healthcare systems incorporate databases for effective and efficient management of patient healthcare. Databases are vulnerable to cyberattacks and must be designed and built with security controls from the beginning of the life cycle. Although hardening the database early in the life cycle is better, security is often incorporated after deployment, forcing hospital and healthcare IT professionals to play catch-up. Database security requirements should be defined at the requirements stage of acquisition and procurement.
System security engineers and other acquisition personnel can effectively assist vendors in building better healthcare database systems by specifying security requirements up front within the request for proposal (RFP). In this project, you will be developing an RFP for a new medical healthcare database management system.
Parts of your deliverables will be developed through your learning lab. You will submit the following deliverables for this project:
Deliverables
• An RFP, about 10 to 12 pages, in the form of a double-spaced Word document with citations in APA format. The page count does not include figures, diagrams, tables, or citations. There is no penalty for using additional pages. Include a minimum of six references. Include a reference list with the report.
• An MS-Excel spreadsheet with lab results.
There are 11 steps in this project. You will begin with the workplace scenario and continue with Step 1: "Provide an Overview for Vendors."
Step 1: Provide an Overview for Vendors
As the contracting officer's technical representative (COTR), you are the liaison between your hospital and potential vendors. It is your duty to provide vendors with an overview of your organization. To do so, identify infor.
Database Design Mid Term ExamSpring 2020Name ________________.docxwhittemorelucilla
Database Design Mid Term Exam
Spring 2020
Name: ____________________________
1. What is a data model?
A. method of storing files on a disk drive
B. simple representation of complex real-world data structures
C. name of system for designing software
D. method of designing invoices for customers
2. A Relationship Database system consists of 3 parts: a client front end for sending information to a command processor, a middle tier that interprets user commands, and a management frame work for storing, organizing and securing data.
a. True
b. False
3. What are the 3 components of a table:
A. Row, column, value
B. Row, top, bottom
C. Column, row, top
D. Top, middle, end
4. What does the column represent in a table?
a. Attribute of the table records
b. A complete record in the table
c. The system log from the database
d. A list of database tables
5. What does a row in the table represent?
a. A complete data record
b. List of system logs
c. A list of file systems on database server
d. The primary keys from all the tables.
6. Which of the following is an example of data definition language (DDL)?
a. UPDATE
b. V$SYSLOG
c. CREATE
d. DETAIN
7 . Which of the following is an example of data manipulation language (DML)?
A. SELECT
B. ABORT
C. GRANT
D. REVOKE
8. A _______ key is an attribute that uniquely identifies a record in a table.
9. A _______ key is an attribute that is a primary key in one table and is used as a reference in a second table to establish a relationship between the two tables.
10. When running a ‘SELECT’ join, what is returned from the table:
A. ROW
B. Column
C. single attribute
D. all tables in the database
11. When running a ‘PROJECT’ join, what is returned from the table:
A. COLUMN
B. ROW
C. Single Attribute
D. a list of tables in the database
12. What are the 3 types of relationships commonly shown on an entity relationship diagram?
A. 1 to 1
B. 1 to Many
C. Many to Many
D. All the above
E. None of the above
13. What is an entity relationship diagram (ERD)?
A. graphical representation of all entities in a database and how the entities are related
b. list of the log files in the database.
C. list of all the tablespace names in a database
D. A diagram that shows how data is written to a physical disk drive.
14. The definition of an attribute in a table that has no value is:
A. ZERO
b. NULL
c. ZILTCH
D. NONE
15. A ____________ attribute can either be stored on retrieve on an ad hoc basis.
16. Briefly describe the advantages and disadvantages of storing a derived attribute?
17. A database can process many types of data classifications. Which of the following is not a data classification or architecture that databases can process:
A. Structured
B. Semi-structured
C. undelimited
D. Unstructured
18. The process by which functional/partial dependency and transitive dependency is removed from a database table is called:
a. sharding
b. normalization
c. defragmentation
d. reallocation
.
Database Justification MemoCreate a 1-page memo for the .docxwhittemorelucilla
This document contains two proposed memos. The first recommends migrating from a static website to a database driven application system, noting the benefits of databases in managing dynamic content and data while also acknowledging potential drawbacks. The second memo advocates for using web services and highlights considerations around security, scalability to large volumes of traffic, and compatibility across different devices and platforms.
Database Dump Script(Details of project in file)Mac1) O.docxwhittemorelucilla
Database Dump Script
(Details of project in file)
Mac:
1) Open up the terminal, or if already in MySQL, get out by typing "exit" and pressing enter.
2) Type:
/usr/local/mysql/bin/mysqldump -u root -p [database name] > /tmp/filename.txt
...where [database name] is the name of the database you want to export. When prompted, type the password. Check the /tmp file for your output.
.
Database Design 1. What is a data model A. method of sto.docxwhittemorelucilla
Database Design
1. What is a data model?
A. method of storing files on a disk drive
B. simple representation of complex real-world data structures
C. name of system for designing software
D. method of designing invoices for customers
2. Which of the following are the most important elements of a security program for databases:
a. Integrity, referential index, user rights
b. Confidentiality. Integrity and Availability
c. Availability, multi-master replication, high-bandwidth
d. DBA, System Admin, and PMO
3. Suppose that you have a table with a number of product sales. The product code may repeat in the table as it is likely the same product could be sold multiple times. If you want to produce a list of the unique products that are sold, you could use which of the following keywords in the SELECT statement:
A. LIKE
B. ORDERED BY
C. DISTINCT
D. DIFFERENT
4. What does the column represent in a table?
a. Attribute of the table records
b. A complete record in the table
c. The system log from the database
d. A list of database tables
5. What does a row in the table represent?
a. A complete data record
b. List of system logs
c. A list of file systems on database server
d. The primary keys from all the tables.
6. Which of the following is an example of data definition language (DDL)?
a. UPDATE
b. V$SYSLOG
c. CREATE
d. DETAIN
7 . Which of the following is an example of data manipulation language (DML)?
A. SELECT
B. ABORT
C. GRANT
D. REVOKE
8. A _____________ key is an attribute that uniquely identifies a record in a table.
9. A _____________ key is an attribute that is a primary key in one table and is used as a reference in a second table to establish a relationship between the two tables.
10. When running a ‘SELECT’ join, what is returned from the table:
A. ROW
B. Column
C. single attribute
D. all tables in the database
11. When running a ‘PROJECT’ join, what is returned from the table:
A. COLUMN
B. ROW
C. Single Attribute
D. a list of tables in the database
12. What are the 3 types of relationships commonly shown on an entity relationship diagram?
A. 1 to 1
B. 1 to Many
C. Many to Many
D. All the above
E. None of the above
13. What is an entity relationship diagram (ERD)?
A. graphical representation of all entities in a database and how the entities are related
b. list of the log files in the database.
C. list of all the tablespace names in a database
D. A diagram that shows how data is written to a physical disk drive.
14. The definition of an attribute in a table that has no value is:
A. ZERO
b. NULL
c. ZILTCH
D. NONE
15. A __________ attribute can either be stored on retrieve on an ad hoc basis.
16. Which of the following is not considered a characteristic of distributed management systems:
a. Concurrency Control
b. Business intelligence
c. Transaction management
d. query optimization
17. A database can process many types of data classifications. Which of the following is not a data class.
How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
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How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
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The simplified electron and muon model, Oscillating Spacetime: The Foundation...RitikBhardwaj56
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Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
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D elirium W hy Are Nurses ConfusedNidsa D. Baker Hele.docx
1. D elirium : W hy Are Nurses Confused?
Nidsa D. Baker
Helen M. Taggart
Anita Nivens
Paula Tillman
Nurses have a key role in detection of delirium, yet this
condition
remains under recognized and poorly managed. The aim of this
study was to explore nurses' knowledge of delirium-related
infor-
mation as well as their perception of their level o f knowledge.
D elirium is a serious, costly, potentially preventable
com-plication for hospitalized
patients age 65 and older (Wofford &
Vacchiano, 2011). This acute, short-
term disturbance of consciousness
may last from a few hours to as long
as a few months. It is characterized
by an acute onset of inattention, dis-
organized thinking, and/or altered
level of consciousness.
Delirium can be categorized as
hyperactive, hypoactive, or mixed
based on symptoms that can fluctu-
ate and change during the course of
the disorder. Hyperactive or excited
delirium involves agitation and hal-
2. lucinations (American Psychiatric
Association, 2011; Holly, Cantwell,
& Jadotte, 2012). Patients with
hyperactive delirium are more likely
to receive earlier treatment than
patients who exhibit the less easily
recognized signs of hypoactive deliri-
um: lethargy, drowsiness, and inat-
tention. In addition, patients may
show signs of both hyperactive and
hypoactive delirium in a condition
described as mixed variant delirium
(Holly et al., 2012). Health care
providers often confuse delirium
with depression and/or dementia
(Fick, Hodo, & Lawrence, 2007;
Holly et al., 2012; Voyer, Richard,
Doucet, Danjou, & Carmichael,
2008). Unlike delirium, which hap-
pens suddenly over a few hours or
days, dementia usually develops
gradually over months or years,
while depression generally develops
over weeks or months, or, less often,
after a sudden event (Holly et al.,
2012; Young & Inouye, 2007) (see
Table 1).
Delirium is a common multifac-
torial disorder that involves a vul-
nerable patient with predisposing
factors and exposure to precipitat-
ing factors (Sendelbach & Guthrie,
2009). It can occur at various ages.
However, older adults are particu-
3. larly vulnerable to delirium, espec-
ially when they are ill (Featherstone
& Hopton, 2010) (see Table 2).
Underlying risk factors are often
contributory to delirium in older
adults. Common triggers are infec-
tion, medications, general pain,
constipation, dehydration, and
environmental factors (Dahlke &
Phinney, 2008; Quinlan et al.,
2011). Although delirium occurs
commonly in acute care settings,
older adult residents of long-term
care and assisted living homes are
vulnerable as well. Rates of delirium
in long-term care settings range
from 1% to 60% (Lee, Ha, Lee,
Kang, & Koo, 2011; Siddiqi, Young,
& Cheater, 2008). Delirium is asso-
ciated with poor patient outcomes
that include longer hospital stays,
increased costs, increased need for
post-acute care, and significant
stress for patients and families
(O'Mahony, Murthy, Akunne, &
Young, 2011). At least 20% of the
12.5 million patients age 65 or older
hospitalized each year have deliri-
um as a complication, causing a
$9,000 to $15,000 increase depend-
ing on the severity in hospital costs
per patient. Delirium attributes to
annual estimated cost of $38 - $152
billion (Kalish, Gillham, & Unwin,
2014; Young & Inouye, 2007).
4. The prevalence of delirium varies
from 1% to 80% depending on pop-
ulation, the time of delirium assess-
ment, and the assessment method.
In addition, the documented inci-
dence of delirium extended from
3% to 61% (Kalish et al., 2014;
Young & Inouye, 2007). Addition-
ally, the prevalence of this condi-
tion reported in medical and surgi-
cal intensive care unit cohort stud-
ies varied from 20% to 80% (Girard,
Panharipande, & Ely, 2008; Kalish
Nidsa D. Baker, MSN, RN, ANP-BC, is Adult Nurse
Practitioner, St. Joseph’s/Candler Health
System St. Mary’s Health Center, Savannah, GA.
Helen M. Taggart, PhD, RN, ACNS-BC, is Professor,
Department of Nursing, College of Health
Professions, Armstrong Atlantic State University, Savannah,
GA.
Anita Nivens, PhD, RN, FNP-BC, is Graduate Nursing Program
Coordinator and Professor,
Department of Nursing, College of Health Professions,
Armstrong Atlantic State University,
Savannah, GA.
Paula Tillman, DNP RN, ACNS-BC, is Assistant Professor,
Armstrong Atlantic State University,
Savannah, GA, and Informatics Specialist, Memorial Health
University Medical Center,
Savannah, GA.
5. Acknowledgments: The authors thank Malcolm Hare, Fremantle
Hospital and Health Service
and Curtin University School of Nursing in Australia, for
granting permission to utilize the ques-
tionnaire.
MEDSURG n u r s i n g . January-February 2015 • Vol. 24/No.
1 15
Research for Practice
TABLE 1.
C o m p a ris o n o f D e liriu m , D e m e n tia , a n d D
epression
Delirium Dementia Depression
Onset Sudden: Hours or days Gradual over months or years
'
Gradual over weeks or months,
or after an event
Alertness/
Attention
Fluctuates: Sleepy or agitated,
unable to concentrate
Generally stable Generally stable, some difficulty
concentrating
Sleep Sudden changes in sleeping
pattern, unusual confusion at night
6. Can be disturbed, with habitual
night-time wandering
Early morning waking
Thinking Disorganized, rambling Specific, difficulty with short-
term
memory
Preoccupied with negative
thoughts, hopelessness, help-
lessness, self-depreciation
Perception Delusions, hallucinations common Generally normal
Generally normal
Source: Holly et al., 2012
TABLE 2.
P redisposing a n d P re c ip ita tin g Factors fo r D e liriu m
Predisposing Factors Precipitating Factors
Age a 65 Use of sedative hypnotics, opioids, or
Male sex anticholinergic drugs
Co-existing dementia/cognitive Stroke
impairment Infections
History of delirium Hypoxia
Depression Shock
Functional dependence Fever or hypothermia
Immobility Anemia
Low level of activity Poor nutritional status
History of falls Recent surgery (major/minor)
Visual impairment Admission to an intensive care unit
Hearing impairment Use of physical restraints
7. Dehydration Use of indwelling urinary catheter
Malnutrition Multiple procedures
Polypharmacy Pain
Alcohol/drug abuse Emotional stress
Prolonged sleep deprivation
Source: Sendelbach & Guthrie, 2009
et al., 2014). Delirium is com m on
am ong elders in long-term care
(LTC) facilities, with its prevalence
ranging from 9.6% to 89% (Voyer et
al., 2008).
Although com m on, delirium
often is under-recognized and
under-diagnosed (O'Mahony et al.,
2011). Because of the high incidence
and costs associated with delirium,
prevention should be a high priority
for health care professionals, espe-
cially nurses (Harris, Chodosh,
Vassar, Vickrey, & Shapiro, 2009).
Nurses spend more time with
patients, allowing them to observe
any changes in patients' attention,
level of consciousness, and cognitive
function (Brixey & Mahon, 2010). As
a result, frequent assessments by
nurses are crucial for early detection
of delirium (Girard et al., 2008).
Literature Review
A comprehensive review of the
8. literature was conducted of all orig-
inal research published 2001-2014
using MEDLINE, CINAHL, and
ProQuest Psychology Journals.
Search terms included delirium or
acute confusion and nurses, nurses'
recognition, nurses' identification, or
nurses' knowledge. Exclusion criteria
were studies not reporting primary
data and studies th a t did n o t
include m easurem ent of nurse
recognition or knowledge of deliri-
um. A lthough now dated, the
selected research specifically evalu-
ated nurses' knowledge deficit for
delirium in studies of various
designs. In addition, fewer studies
actually assessed th e levels of
knowledge about delirium factors,
such as definition, available and
appropriate assessment scales/tools,
and risks (Hare, Dianne, Sunita, Ian,
& Gaye, 2008).
Many studies of delirium focused
on th e advantages of educated
intervention, such as prevention
practices, increased early detection,
and proper medical management
(Bergmann, Murphy, Kiely, Jones, &
Marcantonio, 2005; Featherstone &
Hopton, 2010; Rapp, Mentes, &
Titler, 2001). Researchers also found
a positive correlation between use
9. of an educational intervention for
nursing and medical professionals
and positive patient outcomes such
as decreased length of hospital stay
(Meako, Thompson, & Cochrane,
2011; Tabet et al., 2005). Fick and
co-authors (2007) found using case
vignettes could evaluate nurses'
16 la n u a ry -F e b ru a ry 2015 • Vol. 2 4 /N o . 1
MEDSURG N U R S IISTO
Delirium: Why Are Nurses Confused?
knowledge of delirium in patients
with dementia.
Hare and colleagues (2008) tar-
geted 1,097 clinical nurses in a hos-
pital setting with a questionnaire to
assess their knowledge of delirium
and its associated risk factors. Of the
338 (30.8%) returned responses,
64% (n=217) scored 50% or better
on the questionnaire. In addition,
36.3% (n=123) scored 50% or better
for the risk factor questions while
81.9% («=227) scored 50% or better
for the knowledge questions. Find-
ings indicated orthopedic nurses
who had participated in a delirium
education forum prior to the
research scored better on the gener-
al facts portion of the questionnaire
10. when compared to nurses having
no pre-survey educational interven-
tion. However, the orthopedic nurs-
es did not score higher compared to
other surveyed nurses on the risk
factor questions. The researchers
thus found nurses were n o t as
knowledgeable about delirium risk
factors as they were about general
facts concerning delirium.
Fick and co-authors (2007) also
assessed nurses' knowledge of deliri-
um but more narrowly focused on
delirium superimposed on dementia
(DSD), with the goal of determining
if nurses were able to recognize these
conditions using case vignettes. The
case vignettes were designed to eval-
uate knowledge of delirium, its risk
factors, and management. The study
also assessed nurses' geropsychiatric
knowledge using the Mary Starke
Harper Aging Knowledge Exam
(MSHAKE), a tool that measures gen-
eral geropsychiatric knowledge. Of
29 participating nurses, 41% (n=12)
were able to identify dementia cor-
rectly in the dementia vignette but
had difficulty differentiating deliri-
um factors from DSD factors and
specifically identifying hypoactive
delirium. While this study had a
small sample size, its findings sug-
gested nurses are more likely to dis-
tinguish dementia and hyperactive
11. delirium than DSD and hypoactive
delirium alone.
Dahlke and Phinney (2008) eval-
uated how nurses assess, prevent,
and treat delirium in older hospital-
ized patients, and identified deliri-
um-related challenges and barriers
faced by nurses when caring for
patients with delirium. This descrip-
tive qualitative study comprised
interviews with nurses who worked
in a hospital. A convenience sam-
pling included 12 registered nurses
in a mid-sized regional hospital in
western Canada who had manageri-
al, educational, and bedside roles
and worked in various areas such as
medical and surgical units. The nurs-
es in the study had 6-43 years of
nursing experience. Level of profes-
sional education included diploma
(«=7), baccalaureate (n=4), and mas-
ter's degree {n= 1). Each respondent
was interviewed for approximately
1.5 hours with open-ended ques-
tions about his or her clinical and
personal experience with delirium
assessment, recognition, and inter-
vention. Analysis of the recorded
interviews yielded three main deliri-
um-related strategies: Taking a Quick
Look, Keeping an Eye on Them, and
Controlling the Situation.
12. Taking a Quick Look suggested
nurses quickly assess patients
because of the limited time general-
ly available in a fast-paced acute
care setting (Dahlke & Phinney,
2008). Keeping an Eye on Them rec-
om m ended frequent rounding and
m onitoring of patients assessed to
be at risk for delirium. Controlling
the Situation focused on intervening
as needed to prevent injury and
provide appropriate therapy. Au-
thors found nurses repeatedly
reported having little to no formal
education about older adults and
had sparse formal knowledge of
delirium; they concluded nurses
would benefit from increased deliri-
um-related educational support.
Additional research assessing
nurses' knowledge of delirium has
been completed in LTC settings.
Voyer and co-authors (2008)
assessed nurse detection of delirium
in older adults. This prospective
study identified th e signs and
symptoms m ost challenging to dis-
tinguish, as well as delirium factors
most likely to go unnoticed. At
three LTC facilities and a large
regional hospital LTC unit over two
7-day periods, trained research
assistants (nurses who had complet-
ed 15 hours of instruction on delir-
13. ium and dementia detection) inter-
viewed 160 consenting patients age
65 and over with no history of psy-
chiatric illness. Investigators collect-
ed relevant dem ographic and
health inform ation and assessed
patients for delirium as part of their
interviews. Nurses were questioned
about their ability and experience
in assessing delirium in patients.
The incidence of delirium among
patient participants was 71.5%
(n=108); of those, nurses identified
delirium in just 13% (n=14).
Authors concluded nurses under-
recognize delirium in older adults
in the LTC setting.
Purpose
Nurses' failure to differentiate and
recognize delirium early may be due
to lack of knowledge about delirium,
risk factors, preventive measures,
and treatment. Therefore, the pur-
pose of this study was to assess nurs-
es' knowledge of delirium and its risk
factors, and correlate findings to
demographic variables, such as nurs-
es' years of experience, level of edu-
cation, and area of practice. The
study also was designed to evaluate
nurses' perception of their own level
of competency related to delirium
recognition and management.
14. Research Questions
Research questions addressed in
this study included the following:
1. W hat was nurses' level of
knowledge of delirium?
2. What was nurses' level of know-
ledge of delirium risk factors?
3. Was there a correlation be-
tween nurses' years of experi-
ence, education, and practice
area, and their knowledge of
delirium and its risk factors?
4. How did nurses perceive their
own knowledge com petency
related to delirium?
Hypotheses
1. Nurses have insufficient knowl-
edge of delirium and its risk fac-
tor as evidenced by scoring less
th an 75% on the questionnaire.
2. A high correlation exists be-
tween a nurse's level of experi-
ence, education, and area of
MEDSURG n uhs img. J a n u a r y - F e b r u a r y 2015 • V
ol. 2 4 / N o . 1 17
15. Research for Practice
practice, and his or her knowl-
edge of delirium and its risk fac-
tors.
M e t h o d s
After receiving institutional re-
view board approval from the affili-
ated hospital and university in the
Southeast region of th e U nited
States, researchers sent an a n -
nouncem ent about the study by
mass email to potential respondents
who were nurses employed at this
hospital. This nonexperim ental,
descriptive study was conducted
over a 2-week period. Researchers
manually distributed 150 question-
naires to every hospital unit (med-
ical-surgical, orthopedic, oncology,
progressive care, neuro-intensive
care, m edical-surgical intensive
care, cardiac care) to nurses who
volunteered to participate in the
study.
In str u m e n ta tio n
The research instrum ent used in
this study was used previously in a
similar study (Hare et al., 2008).
Permission to use the questionnaire
was obtained from its original
16. developers (M. Hare, personal com -
m unication, March 15, 2011). The
questionnaire, which was untitled
in the previous study, was labeled
for the current study as Nurses'
Knowledge of Delirium (NKD)
(Hare et al., 2008). The NKD ques-
tionnaire has neither been validated
nor had its reliability established
(M. Hare, personal com m unication,
September 22, 2011). However, the
developer explained m any other
researchers and organizations world-
wide, such as N ational Health
Service in the Great Britain, have
utilized all or part of the question-
naires subsequent to the original
study; thus, validation and reliabili-
ty may have been established w ith-
out the knowledge of the developers
(M. Hare, personal communication,
September 22, 2011).
The NKD questionnaire has two
sections: a 10-question section for
demographic data collection and 36
specific delirium-related questions
called the knowledge section. The
demographic section required par-
ticipants to provide age, sex, prac-
tice setting, specialty, level of educa-
tion, and years of nursing experi-
ence. Participants also were asked if
they had experience in caring for a
patient with delirium; if so, how fre-
17. quently had they provided care and
had they received any formal deliri-
um-related continuing education?
Respondents also were asked to pro-
vide their perceptions of their cur-
rent personal knowledge of deliri-
um by selecting one of the follow-
ing descriptors: lack competency,
minimal competency, average compe-
tency, above average competency,
advanced competency, or expert com-
petency. The demographic section
required written responses and con-
tained m ultiple-choice questions
except respondent age.
In the knowledge section of the
questionnaire, participants identi-
fied the definition of delirium in a
multiple-choice question, and seven
scales/tools comm only used when
assessing patients with delirium,
dementia, and/or depression. All 28
remaining questions in this section
assessed respondents' general
knowledge of delirium and its risk
factors using a Likert-scale (agree,
disagree, or unsure). This section
contained one definition question,
seven scales/tools questions, 14
general questions about delirium,
and 14 questions about risk factors
in a random ly mixed sequence.
Participants independently com -
pleted just one of the forms in its
entirety and placed finished ques-
18. tionnaires in a collection folder
located in the nurses' lounges on
each unit. The tool did not request
any identifying inform ation from
participants so anon y m ity was
maintained.
C o llectio n o f D ata a n d
A nalysis o f D ata
Once th e questionnaires were
collected, answers were compared
to a codebook or key created to pro-
vide quick, accurate assignment of
numerical values to the different
answers for analysis. Com pleted
questionnaires were crosschecked
manually with the answer key and
entered into an Excel spreadsheet to
construct a database. Percentages
and means were used to describe
th e dem ographic variables. The
com pleted database th e n was
exported to SPSS version 15 (IBM,
Chicago, IL) for detailed analysis.
Researchers used analysis of vari-
ance (ANOVA) to determine if a cor-
relation existed betw een nurses'
dem ographic characteristics and
their knowledge of delirium and
delirium risk factors, and nurses'
perceptions of personal com peten-
cy related to delirium. For the pur-
pose of this study, p<0.05 indicated
statistical significance.
19. F in d in g s
D em ograp h ics
Of the targeted 150 potential
nurse participants, 60 (40%) com -
pleted survey questionnaires; one
questionnaire was excluded as com-
pleted by a non-nurse. Researchers
categorized respondents by age: 19
respondents (31.67%) were ages 20-
30, 17 (28.33%) were ages 31-40, 10
(16.67%) were ages 41-50, and 14
(23.33%) were age 50 or older.
Eighty-three percent of respondents
were female.
Thirty-four respondents (56.67%)
held a BSN degree, 18 (30%) held an
ADN degree, six (10%) held an MSN
degree with preparation as either a
nurse practitioner or clinical nurse
specialist, and two (3.33%) indicat-
ed they held a diploma in nursing.
Twenty respondents (33%) indi-
cated they had practiced as nurses
4-7 years, 14 (23.33%) had practiced
20 years or more, and nine (15%)
less th an 3 years. All respondents
worked in an acute care setting; 35
(58.33%) practiced on a medical-
surgical unit, 20 (33.33%) in a criti-
cal care unit, two (3.33%) in a surgi-
cal area, two (3.33%) in "other"
20. areas (e.g., rehabilitation or primary
care area), and one (1.67%) in a
post-anesthesia care unit. Forty-two
(75%) respondents reported having
received no prior delirium-related
education and 50 (83.33%) indicat-
ed they would be interested in
receiving education about delirium.
Finally, 51 respondents (85%) said
they had provided care previously
to patients with delirium.
January-February 2015 • Vol. 24/N o. 1 MEDSURG N U RS IN
G -18
Delirium: Why Are Nurses Confused?
Knowledge and Risk Factors
Scores
Of 36 questions on the NKD ques-
tionnaire, respondents answered an
average of 23.10 (64.17%) correctly.
Only 12 respondents (20%) scored
75% or greater on the question-
naire. Total knowledge and risk fac-
tor scores included only respon-
dents who correctly answered ques-
tions, n o t those who responded
incorrectly or "unsure."
Research Question 1: W hat is
nurses' level o f knowledge o f delirium?
Twenty-two questions specifically
21. required participants to answer gen-
eral knowledge questions about
delirium. The average num ber of
knowledge questions answered cor-
rectly was 15.32 (42.55%) (see Table
3). Twenty-one (35%) respondents
scored 75% or greater on the deliri-
um questions.
Research Question 2: W hat is
nurses' level o f knowledge o f delirium
risk factors? Fourteen questions
required correct identification of
delirium risk factors. The average
num ber of risk factor questions
answered correctly was 7.78
(21.62%). However, only six (10%)
respondents scored greater th a n
75% on this group of questions (see
Table 4).
Research Question 3: Is there a
correlation between nurses' years o f
experience, level o f education, and prac-
tice area, and their knowledge o f deliri-
um and its risk factors? No significant
correlation was found between the
level of education and the number of
correct answers to general delirium
questions (/;=().063) or risk factor
questions (p=0.629). Researchers
found no statistical significance in
correlating the number of years of
nursing practice and the number of
correct answers in general delirium
questions (p=0.217) and risk factor
22. questions (/;=().809). Finally, no sig-
nificant correlation existed between
the correct answer of delirium ques-
tions and risk factor questions and
the specific areas of practice (p=0.823
and /;=0.560).
Research Question 4: How do
nurses perceive their own competency o f
delirium? Just one (1.67%) partici-
pant self-described as having
advanced competency. Nine (15%)
considered themselves to have above
average competency about delirium,
33 (55%) perceived themselves of
average competency, 11 (18.33%)
reported minimal competency, and
six (10%) said they lacked compe-
tence. Less than half the participants
scored at least 75% on both the gen-
eral delirium and risk factor ques-
tions. No statistical significance was
found between knowledge and nurs-
es' level of education, experience, or
area of practice. In addition, re-
searchers found no significant corre-
lations between knowledge (general
and risk factors) and receipt of previ-
ous education about delirium
(p=0.352 and p=0.270). However,
this study incidentally determined a
statistically significant difference in
nurses who previously had cared for
patients with delirium and the num -
ber of correctly answered general
23. knowledge questions (p=0.028).
However, there was no statistical sig-
nificance for the risk factor questions
(p=0.212).
Nurses had a significant lack of
knowledge about delirium and its
risk factors. Only 12 of 60 respon-
dents (20%) scored at least 75% to
be considered generally knowledge-
able. Further, the study found no
correlation betw een education
level, years of experience, or area of
practice, and nurses' general knowl-
edge of delirium and its risk factors.
However, nurses with experience
caring for patients with delirium
scored higher in the general deliri-
um knowledge th an those who
lacked that experience. While more
th an half the respondents described
themselves as having an average
knowledge of delirium, exactly 80%
(?z=48) failed to score 75% (having
average competency).
Lim itations
The study tool was not validated
formally. However, the question-
naire's authors explained all or part
of the instrum ent had been used in
other studies and programs, and
may in fact, have been validated
elsewhere. In addition, this study
was conducted in only one hospital
24. and, as a result, response rates were
too low to achieve statistically sig-
nificant results.
Nursing Implications
Because delirium may be difficult
to recognize, it subsequently is
under-recognized and under-treated
by health care professionals (O'Ma-
hony et al., 2011; Rice et al., 2011).
However, all nurses have the
responsibility to identify risk factors
and signs and symptoms of deliri-
um to lessen complications in acute
and primary care settings (Rice et
al., 2011). Com pleting routine
assessments, recognizing predispos-
ing and precipitating risk factors,
and using delirium scales for pre-
vention and treatm ent are key nurs-
ing responsibilities.
Assessing the knowledge of nurs-
es is a crucial step toward quantify-
ing any knowledge deficit before
creating appropriate remedial edu-
cation programs. Hare and col-
leagues (2008) determined the nurs-
ing delirium risk factors knowledge
deficit was lower (46.15%) than
general knowledge (64.91%). This
finding also was confirmed in this
study where the average risk factor
questions answered correctly was
7.78 (21.62%) and th e average
25. knowledge questions answered cor-
rectly was 15.32 (42.55%). The cur-
rent study findings differed from
those of Hare and colleagues in that
scores on both risk factor and gener-
al knowledge questions were lower
th an those reported by Hare. Nurses
m ust continue to expand their
knowledge of delirium in order to
provide frequent and accurate
assessments required to intervene
before delirium further complicates
patients' health (Martinez, Tobar,
Bedding, Vallejo, & Fuentes, 2012).
Conclusion
Delirium is a common disorder. If
the condition is not treated properly
or if preventive interventions are
delayed, the patient may continue to
deteriorate and become functionally
impaired. This could lead to long-
term care placement and even death.
In this study, a nursing knowledge
deficit regarding general characteris-
tics of delirium and its risk factors
was identified. Education of nurses
in all care settings is vital for future
MEDSURG i s r u r i R B r j s r o , ja nu ary-F ebru ary 2015 •
Vol. 24/N o. 1 19
Research for Practice
26. TABLE 3.
Questionnaire Results for Knowledge of Delirium
Question
Correct A nsw er
n (%)
Incorrect A nsw er
n (%)
Unsure A nsw er
n (%)
2.1 Delirium: an acute confusion, fluctuating mental
state, disorganized thinking, altered level of
consciousness.
51 (85.00%) 9 (15.00%) 0
2.2 Mini Mental State Examination
(Delirium /D em entia)
9 (15.00%) 51 (85.00%) 0
2.3 Glasgow Com a Scale (None) 43 (71.67%) 17 (28.33%) 0
2.4 Delirium Rating Scale (Delirium) 51 (85.00%) 9 (15.00%) 0
2.5 Alcohol W ithdrawal Scale (Delirium) 25 (41.67%) 35
(58.33%) 0
2.6 Confusion Assessm ent Method (Delirium) 16 (26.67%) 44
(73.33%) 0
27. 2.7 Beck’s Depression Inventory (Depression) 50 (83.33%) 10
(16.67%) 0
2.8 Braden Scale (None) 52 (86.67%) 8 (13.33%) 0
2.9 Fluctuation between orientation and
disorientation is not typical of delirium. (False)
43 (71.67%) 11 (18.33%) 6 (10.00%)
2.10 Sym ptom s of depression may mimic delirium.
(True)
36 (60.00%) 17 (28.33%) 7 (11.67%)
2.11 Treatm ent for delirium always includes
sedation. (False)
43 (71.67%) 6 (10.00%) 11 (18.33%)
2.12 Patients never rem em ber episodes of delirium.
(False)
43 (71.67%) 4 (6.67%) 13 (21.67%)
2.13 A Mini Mental Status Examination (MMSE) is
the best w ay to diagnose delirium. (False)
28 (46.67%) 11 (18.33%) 21 (35.00%)
2.15 Delirium never lasts for more than a few hours.
(False)
51 (85.00%) 4 (6.67%) 5 (8.33%)
2.28 A patient who is lethargic and difficult to rouse
28. does not have a delirium. (False)
29 (48.33%) 16 (26.67%) 15 (25.00%)
2.29 Patients with delirium are always physically
and/or verbally aggressive. (False)
52 (86.67%) 3 (5.00%) 5 (8.33%)
2.30 Delirium is generally caused by alcohol
withdrawal. (False)
35 (58.33%) 18 …