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.
Intensive care nurses’ knowledge & practices regardingAlexander Decker
1. The study assessed the knowledge and practices of 77 intensive care unit nurses regarding infection control standard precautions at a cancer hospital in Egypt.
2. The results found that over 63% of nurses had unsatisfactory knowledge levels, though over 57% had satisfactory performance adhering to standard precautions.
3. There were negative correlations between knowledge/performance and age/experience, but positive correlations between knowledge and performance. The study concluded nurses had unsatisfactory knowledge despite satisfactory performance, and recommended continued education programs to update knowledge and adherence to best practices.
This document outlines the doctoral thesis of Dr. Svin Deneckere on improving teamwork and preventing burnout through the use of care pathways. It discusses the growing need for teamwork in healthcare due to factors like increasing specialization and fragmented structures. Care pathways are presented as a tool to improve teamwork by facilitating communication, coordinating roles, and documenting care processes. The thesis involved 4 studies: 1) developing a set of indicators for measuring teamwork; 2) a literature review finding care pathways can improve teamwork; 3) a cluster randomized controlled trial finding care pathways positively impact teamwork; and 4) process evaluations of implementation. The thesis examines how care pathways can enhance teamwork in healthcare organizations.
- A study compared rates of preventable adverse drug events (ADEs) in intensive care units (ICUs) vs. non-ICUs at two hospitals over 6 months.
- The unadjusted ADE rate was twice as high in ICUs, but when adjusted for number of drugs, there was no difference between ICUs and non-ICUs.
- Preventable ADEs occurred due to normal systems failures like poor communication rather than overworked individuals, showing the need for systems solutions over blaming individuals.
- A study was conducted at Green Pastures Hospital in Nepal to assess woundcare practices for pressure ulcers in leprosy patients and evaluate knowledge of wound prevention and treatment.
- A review of patient records from 2009-2014 showed reductions in ulcer healing time, readmissions for ulcers, and severe ulcers requiring surgery, suggesting improved care. However, current woundcare practices did not fully follow protocols.
- Focus groups and interviews with patients and staff found generally good knowledge of leprosy, ulcer causes, and prevention measures, but identified opportunities to strengthen woundcare and self-care management.
The number of missed appointments in healthcare institutions in Nigeria caused problems, hence the need
for integrated healthcare system to intervene and provide seamless care for patients. Appointment
scheduling system lies at the intersection of providing efficiency and timely access to health services. This
research presents an online National Health Insurance Scheme (NHIS) Outpatient Medical Appointment
Booking System where NHIS patients can access and view any available personnel or doctor schedule in
order to book an appointment with the corresponding time as specified by the available doctor. The system
was developed using PhP, macromedia dreamweaver, apache and MYSQL. This is to ensure that the
application is robust, cheap and is able to run on different platforms. The system provides the platform to
facilitate the booking and management of patients’ appointment bookings. Patients can also view their
appointment reports. It also provides the healthcare workers an easy access to manage patients’
appointments and to generate relevant reports.
Determine the Patients' Satisfaction Concerning In-hospital Information Progr...iosrjce
The document describes a study that aimed to determine patients' satisfaction with an in-hospital information program for coronary artery disease. Sixty patients were divided into a study group that received the information program and a control group. The study group showed improved satisfaction with health status, medication, lifestyle, diet and post-attack information compared to the control group. The results indicate that patient satisfaction is related to nurse quality of care, which improved more for the study group than the control group after the program. The study concluded that patients generally lack sufficient in-hospital information and recommended establishing standardized education programs and rehabilitation centers.
Barriers to Access Quality Healthcare Services among Physically Challenged Pe...Premier Publishers
This study examined barriers to accessing quality healthcare among physically challenged persons in Gem Sub County, Siaya County, Kenya. The researchers conducted a cross-sectional study using questionnaires with 108 physically challenged individuals. The results showed that environmental accessibility of hospitals, their locations, and infrastructure leading to the hospitals greatly influenced the ability of physically challenged persons to access healthcare. All healthcare facilities were not adequately equipped to handle people with disabilities. Healthcare system-related factors like distance to facilities, awareness of services, and staff attitudes negatively influenced access to quality care for physically challenged persons in Gem Sub County. The combination of these barriers created significant obstacles for physically challenged persons to overcome in accessing needed healthcare services.
Intensive care nurses’ knowledge & practices regardingAlexander Decker
1. The study assessed the knowledge and practices of 77 intensive care unit nurses regarding infection control standard precautions at a cancer hospital in Egypt.
2. The results found that over 63% of nurses had unsatisfactory knowledge levels, though over 57% had satisfactory performance adhering to standard precautions.
3. There were negative correlations between knowledge/performance and age/experience, but positive correlations between knowledge and performance. The study concluded nurses had unsatisfactory knowledge despite satisfactory performance, and recommended continued education programs to update knowledge and adherence to best practices.
This document outlines the doctoral thesis of Dr. Svin Deneckere on improving teamwork and preventing burnout through the use of care pathways. It discusses the growing need for teamwork in healthcare due to factors like increasing specialization and fragmented structures. Care pathways are presented as a tool to improve teamwork by facilitating communication, coordinating roles, and documenting care processes. The thesis involved 4 studies: 1) developing a set of indicators for measuring teamwork; 2) a literature review finding care pathways can improve teamwork; 3) a cluster randomized controlled trial finding care pathways positively impact teamwork; and 4) process evaluations of implementation. The thesis examines how care pathways can enhance teamwork in healthcare organizations.
- A study compared rates of preventable adverse drug events (ADEs) in intensive care units (ICUs) vs. non-ICUs at two hospitals over 6 months.
- The unadjusted ADE rate was twice as high in ICUs, but when adjusted for number of drugs, there was no difference between ICUs and non-ICUs.
- Preventable ADEs occurred due to normal systems failures like poor communication rather than overworked individuals, showing the need for systems solutions over blaming individuals.
- A study was conducted at Green Pastures Hospital in Nepal to assess woundcare practices for pressure ulcers in leprosy patients and evaluate knowledge of wound prevention and treatment.
- A review of patient records from 2009-2014 showed reductions in ulcer healing time, readmissions for ulcers, and severe ulcers requiring surgery, suggesting improved care. However, current woundcare practices did not fully follow protocols.
- Focus groups and interviews with patients and staff found generally good knowledge of leprosy, ulcer causes, and prevention measures, but identified opportunities to strengthen woundcare and self-care management.
The number of missed appointments in healthcare institutions in Nigeria caused problems, hence the need
for integrated healthcare system to intervene and provide seamless care for patients. Appointment
scheduling system lies at the intersection of providing efficiency and timely access to health services. This
research presents an online National Health Insurance Scheme (NHIS) Outpatient Medical Appointment
Booking System where NHIS patients can access and view any available personnel or doctor schedule in
order to book an appointment with the corresponding time as specified by the available doctor. The system
was developed using PhP, macromedia dreamweaver, apache and MYSQL. This is to ensure that the
application is robust, cheap and is able to run on different platforms. The system provides the platform to
facilitate the booking and management of patients’ appointment bookings. Patients can also view their
appointment reports. It also provides the healthcare workers an easy access to manage patients’
appointments and to generate relevant reports.
Determine the Patients' Satisfaction Concerning In-hospital Information Progr...iosrjce
The document describes a study that aimed to determine patients' satisfaction with an in-hospital information program for coronary artery disease. Sixty patients were divided into a study group that received the information program and a control group. The study group showed improved satisfaction with health status, medication, lifestyle, diet and post-attack information compared to the control group. The results indicate that patient satisfaction is related to nurse quality of care, which improved more for the study group than the control group after the program. The study concluded that patients generally lack sufficient in-hospital information and recommended establishing standardized education programs and rehabilitation centers.
Barriers to Access Quality Healthcare Services among Physically Challenged Pe...Premier Publishers
This study examined barriers to accessing quality healthcare among physically challenged persons in Gem Sub County, Siaya County, Kenya. The researchers conducted a cross-sectional study using questionnaires with 108 physically challenged individuals. The results showed that environmental accessibility of hospitals, their locations, and infrastructure leading to the hospitals greatly influenced the ability of physically challenged persons to access healthcare. All healthcare facilities were not adequately equipped to handle people with disabilities. Healthcare system-related factors like distance to facilities, awareness of services, and staff attitudes negatively influenced access to quality care for physically challenged persons in Gem Sub County. The combination of these barriers created significant obstacles for physically challenged persons to overcome in accessing needed healthcare services.
Knowledge and Practice of Documentation among Nurses in Ahmadu Bello Universi...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
This document discusses enhancing quality and safety standards for older people in Canadian hospitals. It notes that the population aged 80 and over is growing rapidly and will account for a large portion of the population by 2036. Older adults represent a significant portion of hospital patients due to increased rates of chronic conditions. However, the hospital environment can be difficult and hazardous for older patients, increasing risks of issues like falls, delirium, and functional decline. The document outlines a project to develop national standards, which included workshops with experts, a literature review, and an electronic survey to validate draft standards. It proposes five draft standards focused on issues like patient and family involvement, maximizing function, and an environment that supports transition between care settings.
Occupational exposure to blood & body fluids among the nursing staff in a ter...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Background: Nurse practitioners play a vital role in wound care and management because of the prevalence of wounds in the community and hospital setting. Aims and objectives: The purpose was to identify current knowledge and practices of nurses with respect to wound management. Method: A qualitative descriptive research was designed, nineteen nurses in wound care wards in Bingham University teaching hospital were recruited into this study. This was achieved with the aid of a self-administered questionnaire for a two-week period. Results: Three groups of nurses responded to this survey (73.7% males; 31.6% aged 31-40 years). Registered nurses dominated (68.4%), majority of them worked in male ward (36.8%) and private ward (36.8%). Almost on full-time (94.7%), more than half were diploma holders (57.9%) with 1 to 5 years of experience (47.4%). Majority (84.2%) were involved in wound treatment and management, there were significant association between years of experience and wound classification, wound treatment, treatment failure and treatment failure factors. Conclusion: Wound care practices require accurate knowledge and assessment skills, a better understanding of wound management provides comprehensible, rapid patient wound care and minimizes patient mortality as well as reduces health services financial costs.
An Epidemiological Data of Oral Health Status and Treatment Needs in Pamulapa...DrHeena tiwari
An Epidemiological Data of Oral Health Status and Treatment Needs in Pamulapadu Village of Guntur District, Andhra Pradesh, India: An Original Research
Problem And Description Of Terms For DisseratationJenniferlaw1
This document summarizes a research study on medical malpractice and errors in the hospital system. The study investigated the lack of education and understanding of tort law among healthcare workers. Medical errors cause up to 98,000 preventable deaths annually in the US. The study aims to determine if providing education on tort law concepts would improve healthcare workers' understanding of negligence and reduce errors. The null hypotheses are that there is no significant difference between errors and lack of education, and that quantitative strategies have no impact on error rates.
Work–related Musculoskeletal Disorders Among Healthcare Workers in a General ...CSCJournals
Background. Musculoskeletal disorders is the most common disease among healthcare workers. Which affects not only the quality of life but also the income, the health, the economy. In Vietnam, there are some research about the MSDs among healthcare workers and the factors affect this problem, especially, the ergonomic factors. Objective. To assess the prevalence of musculoskeletal disorders among healthcare workers in Cao Bang General Provincial Hospital, Vietnam and determine risk factors associated with musculoskeletal disorders. Material and methods. A cross-sectional study was conducted among 85 healthcare workers in a general provincial hospital in Vietnam using the Nordic questionnaire and questionnaire. Results. High prevalence of musculoskeletal among healthcare workers during the past 12 months (62.4%) and last 7 days (45.9%), with the two most common sites being low back pain (48.2%) and neck (40%). Gender, work experience, total working hours, night shift work, and stress level showed the association with the MSDs in the past 12 months. Conclusion. Due to the high prevalence of MSDs among healthcare workers in a general provincial hospital, preventive actions are needed to improve the working conditions and to raise the awareness of healthcare workers about MSDs prevention.
SIM™ Telemonitoring peer reviewed reseach paperPaul Fish
The study explored the effects of introducing a telemonitoring system for urinary continence assessment and adherence to care plans in a nursing home. Baseline data on urinary continence was collected for 32 residents over 72 hours using the telemonitoring system. Individualized care plans were developed and implemented for two weeks. Outcomes were assessed again after two weeks using the telemonitoring system. The study found statistically significant reductions in urine volume in continence aids, prescribed toileting visits, and increased actual and successful toileting visits and adherence to care plans by staff after introducing the telemonitoring system and staff training. The results suggest telemonitoring systems can improve continence assessment and management in nursing homes when combined with staff training.
The prognosis of unknown or unattended during hospital stay in
neuro-surgical department, JPNATC, AIIMS and the problems faced
during nursing care.
Anu Susan Mathew, Dr.Deepak Agrawal
BACKGROUND: The Delhi city alone witnessed 7,516(2009) road
traffic accidents and many were admitted to hospitals as unknown or
unattended.
AIMS: To assess the morbidity and mortality of unknown or
unattended patients and problems faced during nursing care.
MATERIALS AND METHODS: This is a retrospective analysis from
1st January 2010 to 31st December 2010 wherein all unknown
or unattended patients with head injury (GCS 1-15) admitted in
neurosurgery were included.The duration of hospital stay,admission
GCS and outcome were assessed and an attempt was also made
to analyse the problems faced by nursing personnel during their
hospital stay.
OBSERVATIONS: Total number of patients enrolled during the study
period was 111.105 patients were male and 6 were females.7%(7)
were below 18years and 93 % were more than 18 years of age.Of
these 95 were unknown and 16 were unattended. The average
hospital stay of unknown and unattended was 13(1-368) and 21(7-
120) days respectively.The mean GCS of unknown patients during
admission who discharged later was 9(3-15) and who expired later
was 6(3-15).The mean GCS of unknown patients during discharge
was 13(1-15). The mean GCS of unattended patients during
admission and discharge was 12(13-15) and 14(3-15) respectively.
Of the 95 unknown patients, 69 %( 66) became known during
hospital stay. Of the 66 who became known, 21 %( 14) shifted to
rehabilitation centre as unattended, 15 %( 10) expired on hospital
and 59 %( 39) discharged to home. Of the 95 unknown patients,
31% (29) remained unknown; out of which 66 % (19) expired on
hospital and 34 % (10) shifted to rehabilitation centre as unknown.
Of the 16 unattended patients, 25% went to home, 63% shifted to
rehabilitation homes and 12% expired. The most common problems
faced during nursing care were aspiration (2%), corneal ulceration
(4%), contractures (7%), UTI (7%), pressure sores (8%) and VAP (20%)
mainly because of long hospital stay.
CONCLUSION: Patients remaining unknown/unattended is a unique
problem as far as developing countries are concerned. Managing
these patients is difficult as they occupy hospital beds for longer
duration and require more nursing care with higher mortality and
morbidity. It remains surprising that in spite of advancements in the
field of mass communication almost 31 % of the unknown remain
unidentified.
Relationships of Providers’ Accountability of Nursing Documentations in the C...IJEAB
Documentation demonstrates the unique contribution of nursing to the care of clients. This study investigated the relationships of Providers accountability of nursing documentations in the clinical settings. Judgmental and simple random sampling techniques were used to select documented nursing actions for 264 clients. One research question and four null hypotheses guided the study. The instrument used for data collection was checklist on Nursing documentation in the clinical setting. Descriptive statistics of frequency, means and standard deviation (SD) were used to summarize the variables. Pearson Product Moment correlation was used to answer the research question, while analyses of variance (ANOVA) was adopted in testing the null hypotheses at 0.05 level of significance. The result indicated that significant correlation existed between legal implications of nursing documentation and the core principles of nursing documentation. Significant differences were also observed among providers’ accountability of nursing documentations with regard to promotion of interdisciplinary communication, legal implications of documentation, impacts on quality assurance and nursing science.
Defensive medicine effect on costs, quality, and access to healthcareAlexander Decker
This document discusses the practice of defensive medicine and its effects. Defensive medicine occurs when doctors order unnecessary tests or procedures in an attempt to reduce malpractice liability. The document finds that defensive medicine increases healthcare costs and can lower quality by leading doctors to avoid high-risk patients or procedures. It also discusses how defensive medicine practices like unnecessary referrals and extra diagnostic tests can limit access to care. The document examines factors that contribute to defensive medicine and its negative impacts on healthcare systems.
Prevalence of Back Pain among Nurses at Jos University Teaching Hospital, Pla...ijtsrd
This study was carried out to determine the prevalence of back pain among nurses at Jos University Teaching Hospital. Back pain is an occupational health challenge being experienced by nurses. Extant literature has established that the nature of nursing work predisposes them to this condition. The work environment is, sometimes, not too nurses’ friendly owing to an interplay of consortium of factors. The study aimed at determining the prevalence, use of back care techniques, and other related factors involved among the nurses working at the Jos University Teaching Hospital. The motivation arose from poor information and data as to the existence of this condition among nurses in the teaching hospital. This was necessary as the information about this would enable them to prepare and guard against the debilitating effects of this condition. A cross sectional research design was employed for the study purpose. Jos University Teaching Hospital was the study setting, nurses constituted the study population. A sample of 225 nurses was drawn from the population of 516 nurses using a multi stage sampling approach. Questionnaire was used to elicit responses on the items contained therein. Convenience sampling technique was adopted in gaining access to the respondents. Ethical prescriptions were adhered to as informed consent was sought, and their withdrawal from participation would not attract any victimization. Data collected were analyzed using frequencies and percentages. Findings were presented in table and bar chart. Results of the study shows a high prevalence of back pain among nurses working in JUTH. Findings further demonstrate a relationship between the occupational physical activities and the back pain among nurses. Oluwatoyin A. Ogunyewo | Juliana A Afemikhe "Prevalence of Back Pain among Nurses at Jos University Teaching Hospital, Plateau State, Nigeria" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-3 , April 2020, URL: https://www.ijtsrd.com/papers/ijtsrd30576.pdf Paper Url :https://www.ijtsrd.com/medicine/nursing/30576/prevalence-of-back-pain-among-nurses-at-jos-university-teaching-hospital-plateau-state-nigeria/oluwatoyin-a-ogunyewo
Improving Outcome for the Elderly Surgical Patients in a Singapore Teaching H...Crimsonpublisherssmoaj
Improving Outcome for the Elderly Surgical Patients in a Singapore Teaching Hospital by Si Ching Lim*, Peter Chow, Peter CL Chow, Fuyin Li, Swee Sim Hiew, Lau Soy Soy and Zhang Di in Crimson Publishers: Surgical Medicine Open Access Journal
The elderly patients admitted under surgery have longer lengths of stay and develop multiple complications during their hospital stay particularly with delirium, medical complications and functional decline. A Geriatrician’s input was helpful to identify incident and postop delirium early and put in measures to improve outcome, together with better nursing care and pharmacist’s input to reduce harm from medications.
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A Study on Awareness of Needle sticks injury in students undergoing paramedic...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Evaluation of a tool for assessing clinical competence of msc nurse studentsAlexander Decker
The document reports on the first phase of a study which evaluated an existing clinical competence assessment tool used for MSc nurse students in Kenya. Twenty-seven nurse experts participated in the study and found that the existing tool had low content validity and needed revision. Specifically, the study found that only 7 of 34 items met the minimum content validity index threshold, and the tool had an average congruency percentage of only 60%. This indicates a need to revise the tool by adding and removing some competencies to better assess clinical competence.
A Descriptive Study to Assess the Level of Anxiety among B.Sc. Nursing 1st Ye...YogeshIJTSRD
A quantitative descriptive study was undertaken to assess the level of Anxiety towards exposure to hospital environment among B.Sc. Nursing 1st year student at Apex College of Nursing, Varanasi, India. 100 students were selected through convenience sampling technique and data was collected by using beck anxiety inventory scale. Nursing 1st Year Students Regarding Exposure to Hospital Environment in Selected College of Nursing at Varanasi, India" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-5 , August 2021, URL: https://www.ijtsrd.com/papers/ijtsrd45024.pdf Paper URL: https://www.ijtsrd.com/medicine/nursing/45024/a-descriptive-study-to-assess-the-level-of-anxiety-among-bsc-nursing-1st-year-students-regarding-exposure-to-hospital-environment-in-selected-college-of-nursing-at-varanasi-india/ms-anushi
“What are the levels of patient satisfaction with the use of video consultation as a tool for care delivery since Coronavirus (COVID-19) pandemic started?”
Journal Club presentation in Nursing ResearchDhara Vyas
Journal presentation in Nursing Research,
Study of knowledge, attitude, anxiety & perceived mental healthcare need in Indian population during COVID-19 pandemic
Covid-19
Abstract
Introduction
Methodology
samples
Analysis
A randomized controlled trial tested the effects of a palliative care intervention on clinical outcomes in 322 patients with advanced cancer. The intervention consisted of 4 weekly educational sessions and monthly follow-up sessions led by advanced practice nurses, focusing on problem solving, communication, symptom management, and advance care planning. Compared to usual care, the intervention led to higher quality of life and mood scores but did not significantly reduce symptom intensity or hospital resource use. The intervention helped improve patients' well-being and engagement in their care near the end of life.
Observable effects of developing mathematical skills of students through team...Alexander Decker
This study investigated the effects of using team-based learning versus laboratory learning approaches to teach mathematics to students. Sixty students were divided into two groups, with one group taught using team-based learning and the other using the laboratory approach. Both groups were given tests after the instruction. Statistical analysis found a significant difference in performance between the two groups, with the team-based learning group scoring higher. The study concludes team-based learning is more effective for developing students' mathematical skills than the laboratory approach.
Issue involved in marketing of gm food products in indiaAlexander Decker
This document discusses issues involved in marketing genetically modified (GM) food products in India. It begins with an introduction to GM foods and their benefits, but also notes challenges to their market acceptance. The author aims to identify key factors affecting GM food acceptance in India, problems with their marketing, and potential solutions. The document outlines the study's objectives and methodology, which included a literature review, surveys of 150 consumers and 16 GM food marketers using structured questionnaires, and data analysis software. The responses would help address the research questions around acceptance factors, marketing problems, and recommended measures to improve GM food marketing.
Knowledge and Practice of Documentation among Nurses in Ahmadu Bello Universi...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
This document discusses enhancing quality and safety standards for older people in Canadian hospitals. It notes that the population aged 80 and over is growing rapidly and will account for a large portion of the population by 2036. Older adults represent a significant portion of hospital patients due to increased rates of chronic conditions. However, the hospital environment can be difficult and hazardous for older patients, increasing risks of issues like falls, delirium, and functional decline. The document outlines a project to develop national standards, which included workshops with experts, a literature review, and an electronic survey to validate draft standards. It proposes five draft standards focused on issues like patient and family involvement, maximizing function, and an environment that supports transition between care settings.
Occupational exposure to blood & body fluids among the nursing staff in a ter...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Background: Nurse practitioners play a vital role in wound care and management because of the prevalence of wounds in the community and hospital setting. Aims and objectives: The purpose was to identify current knowledge and practices of nurses with respect to wound management. Method: A qualitative descriptive research was designed, nineteen nurses in wound care wards in Bingham University teaching hospital were recruited into this study. This was achieved with the aid of a self-administered questionnaire for a two-week period. Results: Three groups of nurses responded to this survey (73.7% males; 31.6% aged 31-40 years). Registered nurses dominated (68.4%), majority of them worked in male ward (36.8%) and private ward (36.8%). Almost on full-time (94.7%), more than half were diploma holders (57.9%) with 1 to 5 years of experience (47.4%). Majority (84.2%) were involved in wound treatment and management, there were significant association between years of experience and wound classification, wound treatment, treatment failure and treatment failure factors. Conclusion: Wound care practices require accurate knowledge and assessment skills, a better understanding of wound management provides comprehensible, rapid patient wound care and minimizes patient mortality as well as reduces health services financial costs.
An Epidemiological Data of Oral Health Status and Treatment Needs in Pamulapa...DrHeena tiwari
An Epidemiological Data of Oral Health Status and Treatment Needs in Pamulapadu Village of Guntur District, Andhra Pradesh, India: An Original Research
Problem And Description Of Terms For DisseratationJenniferlaw1
This document summarizes a research study on medical malpractice and errors in the hospital system. The study investigated the lack of education and understanding of tort law among healthcare workers. Medical errors cause up to 98,000 preventable deaths annually in the US. The study aims to determine if providing education on tort law concepts would improve healthcare workers' understanding of negligence and reduce errors. The null hypotheses are that there is no significant difference between errors and lack of education, and that quantitative strategies have no impact on error rates.
Work–related Musculoskeletal Disorders Among Healthcare Workers in a General ...CSCJournals
Background. Musculoskeletal disorders is the most common disease among healthcare workers. Which affects not only the quality of life but also the income, the health, the economy. In Vietnam, there are some research about the MSDs among healthcare workers and the factors affect this problem, especially, the ergonomic factors. Objective. To assess the prevalence of musculoskeletal disorders among healthcare workers in Cao Bang General Provincial Hospital, Vietnam and determine risk factors associated with musculoskeletal disorders. Material and methods. A cross-sectional study was conducted among 85 healthcare workers in a general provincial hospital in Vietnam using the Nordic questionnaire and questionnaire. Results. High prevalence of musculoskeletal among healthcare workers during the past 12 months (62.4%) and last 7 days (45.9%), with the two most common sites being low back pain (48.2%) and neck (40%). Gender, work experience, total working hours, night shift work, and stress level showed the association with the MSDs in the past 12 months. Conclusion. Due to the high prevalence of MSDs among healthcare workers in a general provincial hospital, preventive actions are needed to improve the working conditions and to raise the awareness of healthcare workers about MSDs prevention.
SIM™ Telemonitoring peer reviewed reseach paperPaul Fish
The study explored the effects of introducing a telemonitoring system for urinary continence assessment and adherence to care plans in a nursing home. Baseline data on urinary continence was collected for 32 residents over 72 hours using the telemonitoring system. Individualized care plans were developed and implemented for two weeks. Outcomes were assessed again after two weeks using the telemonitoring system. The study found statistically significant reductions in urine volume in continence aids, prescribed toileting visits, and increased actual and successful toileting visits and adherence to care plans by staff after introducing the telemonitoring system and staff training. The results suggest telemonitoring systems can improve continence assessment and management in nursing homes when combined with staff training.
The prognosis of unknown or unattended during hospital stay in
neuro-surgical department, JPNATC, AIIMS and the problems faced
during nursing care.
Anu Susan Mathew, Dr.Deepak Agrawal
BACKGROUND: The Delhi city alone witnessed 7,516(2009) road
traffic accidents and many were admitted to hospitals as unknown or
unattended.
AIMS: To assess the morbidity and mortality of unknown or
unattended patients and problems faced during nursing care.
MATERIALS AND METHODS: This is a retrospective analysis from
1st January 2010 to 31st December 2010 wherein all unknown
or unattended patients with head injury (GCS 1-15) admitted in
neurosurgery were included.The duration of hospital stay,admission
GCS and outcome were assessed and an attempt was also made
to analyse the problems faced by nursing personnel during their
hospital stay.
OBSERVATIONS: Total number of patients enrolled during the study
period was 111.105 patients were male and 6 were females.7%(7)
were below 18years and 93 % were more than 18 years of age.Of
these 95 were unknown and 16 were unattended. The average
hospital stay of unknown and unattended was 13(1-368) and 21(7-
120) days respectively.The mean GCS of unknown patients during
admission who discharged later was 9(3-15) and who expired later
was 6(3-15).The mean GCS of unknown patients during discharge
was 13(1-15). The mean GCS of unattended patients during
admission and discharge was 12(13-15) and 14(3-15) respectively.
Of the 95 unknown patients, 69 %( 66) became known during
hospital stay. Of the 66 who became known, 21 %( 14) shifted to
rehabilitation centre as unattended, 15 %( 10) expired on hospital
and 59 %( 39) discharged to home. Of the 95 unknown patients,
31% (29) remained unknown; out of which 66 % (19) expired on
hospital and 34 % (10) shifted to rehabilitation centre as unknown.
Of the 16 unattended patients, 25% went to home, 63% shifted to
rehabilitation homes and 12% expired. The most common problems
faced during nursing care were aspiration (2%), corneal ulceration
(4%), contractures (7%), UTI (7%), pressure sores (8%) and VAP (20%)
mainly because of long hospital stay.
CONCLUSION: Patients remaining unknown/unattended is a unique
problem as far as developing countries are concerned. Managing
these patients is difficult as they occupy hospital beds for longer
duration and require more nursing care with higher mortality and
morbidity. It remains surprising that in spite of advancements in the
field of mass communication almost 31 % of the unknown remain
unidentified.
Relationships of Providers’ Accountability of Nursing Documentations in the C...IJEAB
Documentation demonstrates the unique contribution of nursing to the care of clients. This study investigated the relationships of Providers accountability of nursing documentations in the clinical settings. Judgmental and simple random sampling techniques were used to select documented nursing actions for 264 clients. One research question and four null hypotheses guided the study. The instrument used for data collection was checklist on Nursing documentation in the clinical setting. Descriptive statistics of frequency, means and standard deviation (SD) were used to summarize the variables. Pearson Product Moment correlation was used to answer the research question, while analyses of variance (ANOVA) was adopted in testing the null hypotheses at 0.05 level of significance. The result indicated that significant correlation existed between legal implications of nursing documentation and the core principles of nursing documentation. Significant differences were also observed among providers’ accountability of nursing documentations with regard to promotion of interdisciplinary communication, legal implications of documentation, impacts on quality assurance and nursing science.
Defensive medicine effect on costs, quality, and access to healthcareAlexander Decker
This document discusses the practice of defensive medicine and its effects. Defensive medicine occurs when doctors order unnecessary tests or procedures in an attempt to reduce malpractice liability. The document finds that defensive medicine increases healthcare costs and can lower quality by leading doctors to avoid high-risk patients or procedures. It also discusses how defensive medicine practices like unnecessary referrals and extra diagnostic tests can limit access to care. The document examines factors that contribute to defensive medicine and its negative impacts on healthcare systems.
Prevalence of Back Pain among Nurses at Jos University Teaching Hospital, Pla...ijtsrd
This study was carried out to determine the prevalence of back pain among nurses at Jos University Teaching Hospital. Back pain is an occupational health challenge being experienced by nurses. Extant literature has established that the nature of nursing work predisposes them to this condition. The work environment is, sometimes, not too nurses’ friendly owing to an interplay of consortium of factors. The study aimed at determining the prevalence, use of back care techniques, and other related factors involved among the nurses working at the Jos University Teaching Hospital. The motivation arose from poor information and data as to the existence of this condition among nurses in the teaching hospital. This was necessary as the information about this would enable them to prepare and guard against the debilitating effects of this condition. A cross sectional research design was employed for the study purpose. Jos University Teaching Hospital was the study setting, nurses constituted the study population. A sample of 225 nurses was drawn from the population of 516 nurses using a multi stage sampling approach. Questionnaire was used to elicit responses on the items contained therein. Convenience sampling technique was adopted in gaining access to the respondents. Ethical prescriptions were adhered to as informed consent was sought, and their withdrawal from participation would not attract any victimization. Data collected were analyzed using frequencies and percentages. Findings were presented in table and bar chart. Results of the study shows a high prevalence of back pain among nurses working in JUTH. Findings further demonstrate a relationship between the occupational physical activities and the back pain among nurses. Oluwatoyin A. Ogunyewo | Juliana A Afemikhe "Prevalence of Back Pain among Nurses at Jos University Teaching Hospital, Plateau State, Nigeria" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-3 , April 2020, URL: https://www.ijtsrd.com/papers/ijtsrd30576.pdf Paper Url :https://www.ijtsrd.com/medicine/nursing/30576/prevalence-of-back-pain-among-nurses-at-jos-university-teaching-hospital-plateau-state-nigeria/oluwatoyin-a-ogunyewo
Improving Outcome for the Elderly Surgical Patients in a Singapore Teaching H...Crimsonpublisherssmoaj
Improving Outcome for the Elderly Surgical Patients in a Singapore Teaching Hospital by Si Ching Lim*, Peter Chow, Peter CL Chow, Fuyin Li, Swee Sim Hiew, Lau Soy Soy and Zhang Di in Crimson Publishers: Surgical Medicine Open Access Journal
The elderly patients admitted under surgery have longer lengths of stay and develop multiple complications during their hospital stay particularly with delirium, medical complications and functional decline. A Geriatrician’s input was helpful to identify incident and postop delirium early and put in measures to improve outcome, together with better nursing care and pharmacist’s input to reduce harm from medications.
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A Study on Awareness of Needle sticks injury in students undergoing paramedic...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Evaluation of a tool for assessing clinical competence of msc nurse studentsAlexander Decker
The document reports on the first phase of a study which evaluated an existing clinical competence assessment tool used for MSc nurse students in Kenya. Twenty-seven nurse experts participated in the study and found that the existing tool had low content validity and needed revision. Specifically, the study found that only 7 of 34 items met the minimum content validity index threshold, and the tool had an average congruency percentage of only 60%. This indicates a need to revise the tool by adding and removing some competencies to better assess clinical competence.
A Descriptive Study to Assess the Level of Anxiety among B.Sc. Nursing 1st Ye...YogeshIJTSRD
A quantitative descriptive study was undertaken to assess the level of Anxiety towards exposure to hospital environment among B.Sc. Nursing 1st year student at Apex College of Nursing, Varanasi, India. 100 students were selected through convenience sampling technique and data was collected by using beck anxiety inventory scale. Nursing 1st Year Students Regarding Exposure to Hospital Environment in Selected College of Nursing at Varanasi, India" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-5 , August 2021, URL: https://www.ijtsrd.com/papers/ijtsrd45024.pdf Paper URL: https://www.ijtsrd.com/medicine/nursing/45024/a-descriptive-study-to-assess-the-level-of-anxiety-among-bsc-nursing-1st-year-students-regarding-exposure-to-hospital-environment-in-selected-college-of-nursing-at-varanasi-india/ms-anushi
“What are the levels of patient satisfaction with the use of video consultation as a tool for care delivery since Coronavirus (COVID-19) pandemic started?”
Journal Club presentation in Nursing ResearchDhara Vyas
Journal presentation in Nursing Research,
Study of knowledge, attitude, anxiety & perceived mental healthcare need in Indian population during COVID-19 pandemic
Covid-19
Abstract
Introduction
Methodology
samples
Analysis
A randomized controlled trial tested the effects of a palliative care intervention on clinical outcomes in 322 patients with advanced cancer. The intervention consisted of 4 weekly educational sessions and monthly follow-up sessions led by advanced practice nurses, focusing on problem solving, communication, symptom management, and advance care planning. Compared to usual care, the intervention led to higher quality of life and mood scores but did not significantly reduce symptom intensity or hospital resource use. The intervention helped improve patients' well-being and engagement in their care near the end of life.
Observable effects of developing mathematical skills of students through team...Alexander Decker
This study investigated the effects of using team-based learning versus laboratory learning approaches to teach mathematics to students. Sixty students were divided into two groups, with one group taught using team-based learning and the other using the laboratory approach. Both groups were given tests after the instruction. Statistical analysis found a significant difference in performance between the two groups, with the team-based learning group scoring higher. The study concludes team-based learning is more effective for developing students' mathematical skills than the laboratory approach.
Issue involved in marketing of gm food products in indiaAlexander Decker
This document discusses issues involved in marketing genetically modified (GM) food products in India. It begins with an introduction to GM foods and their benefits, but also notes challenges to their market acceptance. The author aims to identify key factors affecting GM food acceptance in India, problems with their marketing, and potential solutions. The document outlines the study's objectives and methodology, which included a literature review, surveys of 150 consumers and 16 GM food marketers using structured questionnaires, and data analysis software. The responses would help address the research questions around acceptance factors, marketing problems, and recommended measures to improve GM food marketing.
Gandhi nació en la India en 1869 y se convirtió en un líder espiritual y político que luchó por la independencia de la India del Imperio Británico a través de la no violencia y la desobediencia civil. Utilizó tácticas como huelgas de hambre y la Marcha de la Sal para presionar a los británicos. Finalmente logró la independencia de la India en 1947, pero fue asesinado por un extremista hindú en 1948.
Performance indicators for wastewater reuse systems in gaza governoratesAlexander Decker
This document summarizes a study on developing performance indicators for wastewater reuse systems in Gaza governorates. The study aimed to assess the impact of wastewater and greywater projects on the environment, labor costs, and consumers from technical, socio-economic and environmental perspectives. A field survey was conducted involving questionnaires distributed to 30 farmers. Data analysis found that most farmers were willing to use treated wastewater if properly educated on social, economic and environmental issues regarding reclaimed water reuse.
Production improvement function and equity capital of firms in the nigerian m...Alexander Decker
This document summarizes a study that investigated the impact of production improvement functions on the equity capital of manufacturing firms in Nigeria. The study surveyed 62 manufacturing firms listed on the Nigerian stock exchange. It found that production planning and control have a significant positive impact on enhancing equity capital, while production scheduling alone has an insignificant influence. This implies that effectively implementing production improvement functions, including aspects like planning and control, can help boost productivity and the equity capital of manufacturing firms in Nigeria. The study recommends that Nigerian manufacturers operationalize production improvement strategies to restore the industry and support economic development.
D elirium W hy Are Nurses ConfusedNidsa D. Baker Helejeniihykdevara
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 complication 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
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
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, ...
D elirium W hy Are Nurses ConfusedNidsa D. Baker Hele.docxwhittemorelucilla
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.
This document outlines the requirements for a 12-page nursing capstone paper relating a patient problem to an IOM/QSEN competency. It includes sections on introduction, literature review, case example, theory incorporation, and conclusion. It provides a PICO question about patient education and diabetes compliance and lists 7 references to include in the paper. An attachment previews a sample capstone paper on restraint use and patient safety in elderly patients with delirium.
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
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.
Identikit of the Person Seeking Care at Public Hospital in Italy in the Europ...asclepiuspdfs
The number of frail patients for whom the care of a single acute episode necessarily requires both a global approach and a close interaction with the local health services and social services is progressively growing. The issue of managing frail and complex patients at hospitals still needs to be resolved. Currently, care is fragmented in multiple specialized interventions and patients often find themselves moved from one ward to another, resulting in a perilous loss of information and continuity. The purpose of this paper is to analyze hospitalization modalities, the impact of internal medicine (IM) on the hospital activities, the relationship with emergency room (ER) and general patient characteristics, in order to explore putting the current discussion on the new role of IM in the future hospital into practice.
How Surgical Residency Has Derailed During The COVID-19 Pandemic: An Appraisalsemualkaira
COVID-19 pandemic has immensely impacted all walks of life and all professions including our surgical residency training program. To gauge this impact on surgical residencies around the world, we searched for literature in Medline database and shortlisted 25 articles that are relevant to this topic and reviewed them.
Reflection Journal 10Assessment DescriptionStudents are requir.docxcargillfilberto
Reflection Journal 10
Assessment Description
Students are required to maintain weekly reflective narratives throughout the course to combine into one course-long reflective journal that integrates leadership and inquiry into current practice as it applies to the Professional Capstone and Practicum course.
In your journal, you will reflect on the personal knowledge and skills gained throughout this course. The journal should address a variable combination of the following, depending on your specific practice immersion clinical experiences:
Please focus on the topic: Fall Prevention in Outpatient Radiology Clinic
New practice approaches
Intra-professional collaboration
Healthcare delivery and clinical systems
Ethical considerations in health care
Population health concerns
The role of technology in improving health care outcomes
Health policy
Leadership and economic models
Health disparities
Students will outline what they have discovered about their professional practice, personal strengths and weaknesses that surfaced, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and finally, how the student met the competencies aligned to this course.
While APA style is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
Benchmark Information
This benchmark assignment assesses the following programmatic competencies:
RN to BSN
1.3: Understand and value the processes of critical thinking, ethical reasoning, and decision making.
2.6: Promote interprofessional collaborative communication with health care teams to provide safe and effective care.
3.2: Utilize patient care technology and information management systems.
4.2: Preserve the integrity and human dignity in the care of all patients.
5.5: Provide culturally sensitive care.
20XXKRONA HOSPITAL OPERATING BUDGET FOR 20XXRevenuesInpatient $ 25,000,000Outpatient15,000,000Emergency Room10,000,000Laboratory5,000,000Pharmacy1,500,000Home Health and Hospice1,500,000Ambulance Services950,000Substance Abuse250,000Other850,000Subtotal$ 60,050,000Less Chartiy Care18,000,000Net Revenues$ 42,050,000ExpensesPayroll (including nursing salaries)$ 12,500,000Benefits3,000,000Contract Labor100,000Insurance300,000General Services (laundary, security, etc)3,000,000Depreciation 1,500,000Interest Expense300,000Professional Services10,000,000Total Operating Expenses$ 30,700,000Net Income$ 11,350,000
Sheet2
Sheet3
Benchmark - Capstone Project Change Proposal
Mananita Gerochi-Caparas
Grand Canyon University
NRS-493-O503 Professional Capstone and Practicum
Davida Murphy Smith
October 23, 2022
Benchmark - Capstone Project Change Proposal
Background
Falling incidences are prevalent among older patients. In so.
Operartions research in US Healthcare IndustryPrasant Patro
1. This document describes how operations research (OR) models can help reduce delays in healthcare. It identifies three major sources of delays: emergency department delays, delays for medical appointments, and delays for nursing care.
2. Within emergency department delays, it notes long wait times to see physicians and delays in getting inpatient beds once admitted. For medical appointments, it describes waits of several weeks on average to see primary care physicians. Delays for nursing care can compromise patient safety due to insufficient staffing levels.
3. It argues that healthcare delays remain prevalent because they have not been well measured or reported, hospitals face cost pressures to maximize occupancy, and national shortages of healthcare professionals exacerbate delays. OR models have
Knowledge of palliative care among bachelors nursing studentsAhmad Aydi
This document summarizes a study that assessed the palliative care (PC) knowledge of 198 nursing students in Palestine using the Palliative Care Quiz for Nursing (PCQN). The students scored an average of 40.58% on the PCQN. There were no statistically significant differences in PC knowledge based on gender, academic level, personal or professional experience with PC, or having taken a PC course. Age was highly statistically significantly related to PC knowledge. The study concluded that the nursing students lacked adequate PC knowledge and did not meet expectations for registered nurses regarding PC knowledge.
PROVIDERS CHALLENGE FOR TREATING INFECTIOUS3PROVIDERS CHALLENGE.docxwoodruffeloisa
PROVIDERS CHALLENGE FOR TREATING INFECTIOUS 3
PROVIDERS CHALLENGE FOR TREATING INFECTIOUS 15
Providers Challenge for Treating Infectious Disease
Amy Nicole Elders
Grand Canyon University
Science Communication & Research
Bio- 317V-0500
Michael Rothrock
September 6, 2019
Abstract
Running head: PROVIDERS CHALLENGE FOR TREATING INFECTIOUS 1
High mortality results from infection within healthcare institutions whether community or hospital acquired. Hospitalists provide inpatient care with increasing frequency due to the overwhelming workload upon primary care physicians. However, hospitalists are generalists and are minimally prepared to attend patients with serious infections which may rapidly overwhelm particularly in vulnerable populations. Duplication of diagnostic testing, prolonged length of stay drives up costs for institutions and patients. Erroneous or inadequate prescription of antibiotics costs lives, Infectious disease specialists are inadequately utilized despite statistical evidence that such specialty care improves outcomes. Education, collaboration between providers, and prescribing guidelines are recommended to address these needs.
Providers Challenge for Treating Infectious Disease
Technology has become increasingly advanced and the ability to diagnose, treat, and manage patients is ever evolving. Although advancements in imaging, surgical procedures and medication therapies make possible a better quality of life, they are often required to self-manage very serious disease and infection. Insurance companies and healthcare regulations often guide the path providers must take to care for patients. The length of stay in hospitals are decreasing and patients are being treated on an outpatient basis. Patients often receive care in outpatient rehabs, infusion centers, and home health agencies with medications supplied by specialty pharmacies. Drug resistant organisms are becoming more common and the risks associated with treating these organisms can often be challenging to manage. Treatment is often received for an extended amount of time and many primary care providers no longer see patients on an inpatient basis. This means that hospitalists assume care when they are admitted into the hospital but are unable to follow the patient for the remainder of treatment when they are discharged. When complications arise for these patients, they have limited ways of seeking help. There is fragmented care and lack of continuity. In the case of patients diagnosed with infection, questions about when hospitalists should consult specialists such as infectious disease physicians often occur. Mortality and morbidity for patients as well as hospital stays and readmission are decreased when an Infectious Disease physician is consulted early (CDC, 2013). Research is focused on the education of these two types of physicians, why some providers decide not to pursue a specialty, as well as success rates of patients treated by both. Fact ...
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.
Telehealth and Geriatrics How telehealth improves medicati.docxAASTHA76
Telehealth and Geriatrics:
How telehealth improves medication management
and patient safety in the geriatric patient
Avrakham Rubinov
Adelphi University
College of Nursing and Public Health
December 3rd, 2018
What is Geriatrics?
Geriatrics is a subspecialty of internal medicine and primary care that was named in 1909 by Ignatz Leo Nascher.
Geriatrics is that specialty of medicine that addresses the health needs of the elderly.
Gellis, Z. D., Kenaley, B., McGinty, J., Bardelli, E., Davitt, J., & Ten Have, T. (2012).
2
Telemedicine is a highly effective
and necessary tool in geriatrics.
The global population of elderly people is increasing at a remarkable rate,
This is expected to continue for some time.
Older patients require more care.
The current model of care delivery indicated costs are expected to rise.
Telemedicine is a great opportunity for medical practice to evolve to cost effective and new levels of engagement with patients
Chang, W., Homer, M., & Rossi, M. (2018).
3
Geriatics, HIT and Patient Safety
CONCERNS:
SOLUTIONS:
Patient safety is a concern.
Telehealth: Difficult to monitor conditions in a patient’s home.
Safety risks such as falls and inability to get in and out of the tub or shower.
Fewer In-Person Consultations
Doctors worry about technical problems associated with telemedicine. poor broadband connections could lead to “possible patient mismanagement.”
Many physicians and patients alike still like a “personal touch,” and not all procedures – even simple checkups – can be performed digitally.
Difficult to monitor depression or other emotional issues.
Health information technology (HIT) is the future of improving care and outcomes for older adults.
There is a growing program of research. HIT are solutions to improving the safety, quality and efficiency of care.
Gerontological nurse scientists are at the forefront of advancing this work.
Electronic health records (EHRs)and telehealth will blend care of older adults.
Multimedia/advanced directives from HIT provided to patients recovering from critical illness have increased the intent to sign an advanced directive by 25 times
Liu, L., Stroulia, E., Nikolaidis, I., Miguel-Cruz, A., Rincon, A. R. (2016).
4
The HITECH Act resulted growth in the development and implementation of the EHR.
The impact of an integrated EHR in 29 Kaiser Permanente hospitals was significant on process and outcome indicators for patient falls and hospital acquired pressure ulcers and other measures of patient safety.
The EHR system was associated with improved documentation of falls/pressure ulcers and significant improvements for pressure ulcer risk assessment documentation.
Bowles, K. H., Dykes, P., & Demiris, G. (2015).
5
NICHE
(Nurses Improving Care for Healthsystem Elders)
NICHE builds decision support within the workflow of nurses caring for old.
The document discusses evidence-based medicine (EBM) and functional medicine. It notes that EBM aims to provide optimal health rather than just treat disease, taking a patient-centered rather than disease-centered approach. Functional medicine uses a systems-based approach and considers lifestyle, environmental, and genetic factors to identify the underlying causes of disease. It factors in influences like genomics, epigenomics, and the microbiome to build on previous paradigms and improve disease prediction and prevention strategies.
Impact of a designed nursing intervention protocol about preoperative liver t...Alexander Decker
This document summarizes a study that assessed the impact of a designed nursing intervention protocol on patient outcomes for liver transplantation. The study was conducted at a university hospital in Egypt and included 14 adult patients scheduled for liver transplantation. Patients who received the nursing intervention protocol were compared to a control group of 52 past patients from the previous 3 years. Outcomes measured included changes in patient knowledge and practice scores before and after the intervention, as well as post-operative complication rates. The results showed statistically significant improvements in knowledge and practice scores for patients who received the protocol, as well as lower rates of respiratory and rejection complications compared to the control group. The study concluded the nursing intervention protocol had a positive impact on patient outcomes.
Running head INFECTION PREVENTION1INFECTION PREVENTION.docxjeanettehully
Running head: INFECTION PREVENTION 1
INFECTION PREVENTION 15
Phase # 2 Infection Prevention
Literature Review
Healthcare acquired infections constitute a major public health issue and it is affecting millions of people on a yearly basis. The approximation from the recent studies is showing more than 5 percent of the hospitalized patients are exposed to nosocomial infections. Many studies further show that the surgical site infections are the common infections associated with nosocomial infections and it is contributing to about 30 percent of all healthcare acquired infections cases.
Study by Ayed et al (2015) shows that healthcare providers are continuously exposed to pathogens which are sometimes severe and lethal. Nurses specifically are more exposed to different infections during the course of providing healthcare services to the patients. This study indicates that it is therefore crucial for nurses to possess sound knowledge as well as strict adherence to the infection control practices. Updating the acquaintance and the practices of nurses through involvement in ongoing in-service educational programs and putting more focus on the role of the current evidence-based practices of infection prevention in the continuous training is important. Provision of the training to the newly recruited nurses regarding the infection control frequently as well as replicating the study through observation checklist is necessary in assessing the level of practice (Imad, Ayed, Faeda, & Lubna, 2015).
Study by Desta et al (2018) reveals that working experience is a stronger predictor of the knowledge in relation to the prevention of the infection. In this study, the goal was to the relationship between the acquaintance, practice and connected aspects of infection prevention among healthcare employees. Education level is a key determinant to the level of experience when it comes to the control or the prevention of infections. According to this study, it is clear that healthcare providers with advanced experience as well as advanced age are significantly linked with the knowledge. This is basically based on the fact that as healthcare providers are getting older, they are more likely to have advance knowledge due to their experiences as well as having worked with their seniors (Desta, Ayenew, Sitotaw, Tegegne, Dires, & Getie, 2018).
Teshager et al (2015) also studies the knowledge, practices, and the related aspects towards the reduction or prevention of the surgical site infections among nurses who were employed in Amhara Regional State Referral healthcare facilities, in the Northwest Ethiopia. This study looked at some of the factors linked with the knowledge of the nurses regarding the preventi ...
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.
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
Knowledge of staff nurses on management of deconditioning in older adultsAlexander Decker
This document summarizes a study that examined nurses' knowledge of managing deconditioning in older adults. 130 nurses from 3 hospitals completed a 65-item questionnaire assessing their knowledge. Overall, nurses demonstrated good knowledge but some gaps. Years of nursing experience, hospital affiliation, and continuing education affected nurses' knowledge. The study concluded it is important to establish continuing education programs on deconditioning to improve nurses' knowledge and the care of older adult patients.
ABSTRACT Handover, or the communication of patient information be.docxransayo
ABSTRACT: Handover, or the communication of patient information between clinicians, is a fundamental component of health care. Psychiatric settings are dynamic environments relying on timely and accurate communication to plan care and manage risk. Crisis assessment and treatment teams are the primary interface between community and mental health services in many Australian and international health services, facilitating access to assessment, treatment, and admission to hospital. No previous research has investigated the handover between crisis assessment and treatment teams and inpatient psychiatric units, despite the importance of handover to care planning. The aim of the present study was to identify the nature and types of information transferred during these handovers, and to explore how these guides initial care planning. An observational, exploratory study design was used. A 20-item handover observation tool was used to observe 19 occasions of handover. A prospective audit was undertaken on clinical documentation arising from the admission. Clinical information, including psychiatric history and mental state, were handed over consistently; however, information about consumer preferences was reported less consistently. The present study identified a lack of attention to consumer preferences at handover, despite the current focus on recovery-oriented models for mental health care, and the centrality of respecting consumer preferences within the recovery paradigm.
INTRODUCTION Handover is the transfer of verbal and written communication of patient information between members of the health-care team. It is integral to the practice of all healthcare clinicians (Millar & Sands 2012). The Australian Commission for Safety and Quality in Health Care (ACSQHC 2011) recognizes the importance of handover in the continuum of health care, and acknowledges that information transferred between clinicians during the handover can directly affect the quality of care delivered to patients. Poor-quality handover practice has been linked to a number of unfavourable patient outcomes, including increased hospital stays, consumer dissatisfaction, delays in treatment, and other adverse clinical outcomes (Hill & Nyce 2010; Manser & Foster 2011; Siemsen et al. 2012; World Health Organization Collaborating Centre for Patient Safety
Solution
s (WHOCCPSS) 2007). In the present study, we report on the findings of a study that investigated handover between the crisis assessment and treatment team (CATT) and the inpatient psychiatric unit (IPU).
There is little in the published literature that reports on handover practices in acute psychiatric settings, and no previous research that has specifically investigated handover between the CATT and the IPU. The lack of studies in this area is concerning, given that in Australia and internationally, CATT service models are in wide use to facilitate community access to psychiatric assessment and care for people who are experien.
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Nursesí practices and perception of delirium in the intensive care units of a selected university hospitals in egypt
1. Journal of Education and Practice
ISSN 2222-1735 (Paper) ISSN 2222-288X (Online)
Vol.4, No.19, 2013
www.iiste.org
Nurses’ Practices and Perception of Delirium in the Intensive
Care Units of a Selected University Hospitals in Egypt
Hanaa Ali Elfeky, Fatma Shoeib Ali
Lecturers of Critical care and Emergency Nursing, Faculty of Nursing -Cairo University.
*Email of the corresponding author: hanaa_elfeky@yahoo.com
Abstract:
Delirium is a common but frequently undetected complication in hospitalized critically ill patients leading to
poor outcomes, prolonged hospital stays, and increased costs of care. Therefore, because of their daily contact
with critically ill patients, critical care nurses are at the frontline of patients’ care and are in a unique position to
improve their outcomes through timely identification of individuals at risk, early detection of signs and
symptoms of delirium, and providing the needed intervention. Aim of the study: to assess critical care nurses’
practices and perception of delirium among critically ill patients in different critical care settings. Research
Design: A descriptive exploratory research design was utilized in this study. Research questions: To achieve
the aim of the present study, the following two research questions were formulated: 1-What is the current nurses’
practice of delirium assessment in the critical care units? 2- How critical care nurses perceive delirium among
critically ill patients?. Setting: The study was carried out at different Critical Care Departments at Cairo
University Hospitals, in Egypt. Sample: A sample of convenience including all nurses (120) working at different
critical care departments was included in the current study. Tools of data collection: Two tools were used to
collect data pertinent to the current study: Socio demographic data sheet (covers data such as gender, age, years
of experience, attended staff development courses, working hours, etc……); and Nursing practices and
perceptions assessment sheet: was adopted from Devlin, et al., (2008). It covers data related to frequency of
evaluating patients for level of sedation and presence of delirium; presence of delirium; frequency of using
delirium assessment sheet; received education regarding ICU sedation assessment and ICU delirium assessment,
and statements that pertain to delirium in the ICU. Results: the current study revealed that inspite of having
many years of experience in working with critically ill patients, all ICU nurses (100%) ranked delirium
assessment as the fourth priority after level of conscious, pain assessment, handling agitation, and caring for
devices. More than half of the studied nurses (54.2%) never assessed delirium, and 100% of nurses never
received training about assessing and handling delirium. Conclusion: delirium is an under diagnosed problem in
the ICU; it is a common response to the ICU environment. It is challenging to be assessed among critically ill
patients and represents a problem that requires active intervention on the part of caregivers. Recommendations:
Incorporating cognitive assessment in general, and delirium assessment in particular into nursing education
courses; Integration of delirium assessment and management into daily nursing care of critically ill patients, and
training critical care nurses about early recognition of delirium among critically ill patients
Keywords: delirium, delirium assessment & nurses' perception and practices.
1. Introduction
Delirium or acute brain dysfunction is a potentially reversible organic brain syndrome. It is a common
consequence of critical illness among critically ill patient (Thomason, et al., 2005, Ely, et al., 2001 & Mc Nicoll,
et al., 2003, In Cadiz, 2012). Delirium is prevalent across different treatment settings and is more frequent in
critically ill patients, elderly, and patients with cognitive impairment (Jackson, et al. 2010, and Mattoo 2010 In
Grover & Kate 2012). It is characterized by changes in mental status, inattention, disorganized thinking, and
altered consciousness that may be accompanied by agitation. In the intensive care unit (ICU), delirium is
independently associated with several complications and adverse outcomes, such as cognitive decline, prolonged
mechanical ventilation, self-extubation, failed extubation, removal of catheters, functional impairment,
significant increase in the length of hospital stay, increased healthcare costs, increased burden to the patient and
family, and independently predicts higher mortality rate (Ely, Shintani, Bernard et al, 2008, and Cadiz, 2012). In
addition, approximately one third of ICU patients receiving mechanical ventilation have long-term cognitive
impairment that has been documented up to 6 years after hospital discharge. This post-ICU long-term cognitive
impairment involves memory, attention, and executive function problems and leads to inability to return to work,
impaired activities of daily living, increased risk of institutionalization, and decreased quality of life
(Pandharipande , et al. 2007).
Several risk factors have been identified to increase the risk and severity of delirium, of these are advanced
age, prolonged ICU stay, in addition to sedative and narcotic use (Adamis, Treloar, Martin, Macdonald, 2006,
Inouye, 2006 & Grover, & Shah, 2011, In Grover & Kate, 2012 and Ely, et al. 2004, In Banerjee, Vasilevskis,
and Pandharipande, 2010). Delirium is a multi-factorial problem for ICU patients and requires an
61
2. Journal of Education and Practice
ISSN 2222-1735 (Paper) ISSN 2222-288X (Online)
Vol.4, No.19, 2013
www.iiste.org
interdisciplinary approach for assessment, and management (Lin, et al., 2008). The prevalence of delirium in
medical and surgical ICU varies from 20-80% depending on the severity of illness (Department of Surgical
Education, Orlando Regional Medical Center, 2011). Greater incidence of delirium of up to 87% was reported to
occur in ICU patients receiving mechanical ventilation (Devlin, et al 2008, and Inouye, Foreman, Mion, Katz &
Cooney 2001, In Cadiz, 2012). Despite high prevalence of delirium, it is often under-recognized in 66-84 % of
critically ill patients and may be difficult to assess due to severity of illness, frequent use of sedation and
analgesia, lack of verbal communication, and lack of an easy to use screening tool which may lead to difficulty
in diagnosis (Department of Surgical Education, Orlando Regional Medical Center, 2011, Devlin, Fong, Fraser
& Riker 2007, In Devlin, et al 2008, and McNicoll, 2005 In Grover & Kate, 2012).
Numerous national and international surveys have highlighted the importance of recognizing delirium in
the ICU. Most of these studies show disconnection between the perceived importance of delirium and steps taken
to improve diagnosis and treatment. Delirium was found among approximately one quarter (23.69%) of the
totally admitted critically ill patients (N = 650) during the first 36-48 hours of their stay in the ICU in a study
done by Shoeib, Abdelhalim, Radwan & Sayed (2012), in Egypt. However, the medical records of the critical
care departments at Cairo University-Kasr Elani hospital didn’t have statistical data about delirium in the ICU.
As well, delirium is associated with a threefold increase in risk for 6-month mortality after adjusting for age,
severity of illness, co-morbidities, coma, and exposure to psychoactive medications. It may be a predictor of
long-term cognitive impairment in survivors of critical illness. It is associated with cognitive decline over 1 to 3
years after hospital discharge (Ely, Shintani, Bernard et al, 2008). The serious threat of delirium among ICU
patients should spark the urgency of its prevention, identification, and treatment. However, due to severity of
illness, frequent use of sedation and analgesia, and lack of verbal communication, it may be difficult to assess
delirium in the critically ill population. Practice guidelines for sedation and analgesia in the ICU recommended
that patients must be routinely screened for delirium using a validated assessment tool (Jacobi, 2002, in Gesin,
etal., 2012 ).
Given the fluctuating nature of delirium symptoms, the bedside nurse is the ICU caregiver who is best suited
to screen for delirium (Ely, etal, 2004 In Devlin, 2008). As indicated by Sona, (2009), nurses caring for ICU
patients do not recognize delirium in up to two thirds of cases. Whereas many barriers to the recognition of
delirium have been hypothesized, and patients’ related factors contributing to under recognition have not been
directly examined. As well, baseline assessment of ICU patients for delirium is often limited. That is why there
is a need for interdisciplinary approach to assess, and manage delirium. Critical care nurses should assume a
leading position in the ICU regarding delirium monitoring. They are the best suited members of the ICU team to
successfully implement this essential component of patient management (Lin, et al 2008). Through assessment
and management of delirium, reduction of morbidity and mortality in critically ill patients can be achieved.
Prompt recognition of delirium in the ICU allows caregivers to differentiate patients symptoms (eg, pain,
anxiety) from other conditions with similar features (eg, psychomotor agitation) and facilitates the initiation of
both pharmacological & non pharmacological therapies (Devlin, et al 2008).
More specifically, integration of delirium assessment and monitoring into the daily workflow of the ICU
nursing staff may be the least disruptive, most reliable method and potentially effective strategy of incorporating
delirium monitoring into routine patients’ care (Mehta, Meade, Hynes, 2007, In Devlin, et al 2008.). Nursing
interventions should not only be aimed at minimize factors that contribute to delirium, but also utilizing curative
measures such as: frequent reorientation of patients to date, time, places, and persons; providing cognitive
stimulating activities; following non-pharmacological sleep protocols; early mobilization activities; range-ofmotion exercises; removal of catheters and restraints; use of patients eye glasses and magnifying lenses; use of
hearing aids and removing earwax; correcting dehydration; scheduled pain relive protocols; minimizing
unnecessary noise and stimuli; and decreasing interruptions in the sleep- wake cycle (Devlin, Fong, Fraser &
Riker, 2007). However, health care providers are facing major problems related to early detection and
management of patients experiencing ICU delirium; some of these problems are; absence of assessment tool, and
subsequently delirium is misdiagnosed, treated inappropriately or even neglected. Therefore this study could
highlight the role of the nurse in the assessment and care of delirious patients. Also it is hoped that findings of
this study might help in shaping or describing the role of ICU nurses in identification, assessment and perception
of delirium among critically ill patients. It could provide evidence based data about nursing practice of delirium
management.
2. Subjects and Method:
2.1. Aim of the study: To assess critical care nurses’ practices and perception of delirium among critically ill
patients in different critical care settings.
2.2. Research Design: A descriptive exploratory research design was utilized in this study.
62
3. Journal of Education and Practice
ISSN 2222-1735 (Paper) ISSN 2222-288X (Online)
Vol.4, No.19, 2013
www.iiste.org
2.3. Research questions: To achieve the aim of the present study, the following two research questions were
formulated:
2.3.1. What is the current nurses’ practice of delirium assessment in the critical care units?
2.3.2. How critical care nurses perceive delirium among critically ill patients?
2.4. Setting: The study was carried out at different Critical Care Departments at Cairo University Hospitals, in
Egypt.
2.5. Sample: A sample of convenience including all nurses (120) working at different critical care departments
was included in the current study.
2.6. Tools of data collection:
Two tools were used to collect data pertinent to the current study: Socio demographic data sheet, and nursing
practices and perceptions assessment sheet.
2.6.1. Socio demographic data sheet: was developed by the researchers. It covers data such as gender,
age, years of experience, attended staff development courses, working hours, etc……);
2.6.2. Nursing practices and perceptions assessment sheet: was adopted from Devlin, et al., (2008). It
covers data related to how often nurses evaluate patients for level of sedation and presence of delirium?
Conditions that require nurses’ evaluation of level of sedation and/or for the presence of delirium, frequency
of using delirium assessment, factors that might prevent/ hider the nurse from evaluating patients for the
presence of delirium, received education regarding ICU sedation assessment and ICU delirium assessment,
and statements that pertain to delirium in the ICU.
3. Tools validity and reliability:
The adopted tool (nursing practices and perceptions assessment sheet) is a valid and reliable assessment tool for
delirium assessment. It has an intrarater reliability of 86%.
4. Pilot study: A pilot study was done on 10 nurses to test clarity, applicability and to estimate the needed time
to complete the data collection tools. No modifications were done in the data collection tools, and the pilot study
sample was not included in the main study sample.
5. Protection of human rights: The current study was approved by human research, and ethical committees at
the faculty of nursing – Cairo University. Official permissions to conduct the study were obtained from medical
and nursing directors of ICUs. Official permission was obtained from John W. Devlin, (the developer of the
Nursing practices and perceptions assessment sheet) to use the assessment sheet in the current study. As well
written consents were obtained from critical care nurses after their informing about the purpose and nature of the
study. Each nurse was informed that participate is volunteer and has the right to withdraw from the study at any
time without any rational.
As well, obtained data will be used only for research purpose and not for their evaluation. Also, nurses were
informed that data will not be included in any further researches without another new consent. Confidentiality
and anonymity of each nurse were assured through coding of all data.
6. Procedure:
Conduction of the current study started with extensive literature review, selection and preparation of the data
collection tools and obtaining managerial agreements to carry out the study. Once official permissions were
granted, actual implementation of the study was done. The researchers visited the selected ICUs on daily basis,
and approached the involved nurses during the morning shifts, and explained the purpose and nature of the study.
Nurses who agreed to participate in the study were submitted with the data collection tools. The researchers were
available at the ICUs during the time of filling the questionnaires by the involved nurses to answer any question,
and to provide the needed explanations. Filling the data collection questionnaire required 30- 45 minutes from
each nurse.
7. Results:
7.1. Figure (1) clarifies percentage distribution of the studied sample as regards to their age. It reveals that
74.2% of the studied sample was in the age groups ranged from 20 to less than 36 years old.
7.2. Figure (2) shows percentage distribution of the studied sample as regards to their Qualifications. It indicates
that the great majority (95.8%) was diploma nurses.
7.3. Figure (3) shows percentage distribution of the studied sample as regards to years of experience. It clarifies
that more than half (53.3%) of the studied nurses had 6 -16 years of experience in working with critically ill
patients.
63
4. Journal of Education and Practice
ISSN 2222-1735 (Paper) ISSN 2222-288X (Online)
Vol.4, No.19, 2013
www.iiste.org
7.4. Figure (4) represents nurses’ rank of conditions that routinely evaluated during their work in the ICU. It
reveals that all ICU nurses (100%) ranked level of conscious as the first priority, pain assessment as the second
priority, and assessing and caring for devices as the fifth priority. However, 80% ranked handling agitation as the
third priority and delirium as the fourth priority.
7.5. Figure (5) clarifies that more than half of the studied nurses (51.7%) revealed unavailability of sedation
protocol to be utilized by critical care nurses.
7.6. Figure (6) shows frequency of delirium and degree of anesthesia assessment by ICU nurses. It reveals that
more than half of the studied nurses (54.2%) never assessed delirium, while approximately the other half
(45.8%) rarely assessed delirium, and usually assessed degree of anesthesia.
7.7. Figure (7) shows frequently used methods of assessing delirium by ICU nurses. It clarifies that asking for
psychiatric consultation was the only used approach to examine for presence of delirium by 100% of the ICU
nurses, and done only once.
7.8. Figures (8) shows barrier to nurses’ evaluation of ICU patients for presence of delirium. It clarifies that
100% of the studied nurses indicated that only doctors are concerned with assessment of delirium among
critically ill patients, in addition to unavailability of delirium assessment sheet in the ICU. As well, 77.5% of the
studied nurses indicated unreliability of their assessment by ICU doctors.
7.9. Figure (9) shows percentage distribution of the studied sample as regards to received education / training
about assessment and handling sedation and delirium. It indicates that 100% of the studied nurses never receive
training about assessing and handling delirium; however, 44.5% of the nurses indicated that, from clinical
experience they acquired the ability to assess and handle sedation.
7.10. Figure (10) shows percentage distribution of the studied sample as regards to their perception of delirium
assessment. It clarifies that all the studied nurses (100%) strongly agreed that: delirium is an under diagnosed
problem in the ICU; it is a common response to the ICU environment; and it is a problem that requires active
intervention on the part of caregivers. As well, more than two thirds (67.5%) of the studied nurses agreed that
delirium is challenging to assess in intensive care unit patients.
8. Discussion:
Critical care nurses are the health care providers who have the opportunity to early detect delirium symptoms
and continuously monitor critically ill patients for these symptoms. In their daily assessment of critically ill
patients in the current study, most of the studied nurses gave delirium the fourth priority after handling agitation
(as the third priority), and before assessing and caring for devices (the fifth priority). However, all of the studied
critical care nurses gave the first priority to assessing level of consciousness; and the second priority to pain
assessment. This may be due to unawareness or inability of the studied nurses to identify patients’ needs and
preferences. In agreement with the current study findings was that of McNicoll, etal., (2003) who revealed that
delirium in the critical care unit may incorrectly be perceived or often goes unrecognized by healthcare providers
as a “normal” reaction by patients to a potentially life-threatening situation, or incorrectly attributed to dementia,
depression, or ICU syndrome. It has been linked to adverse outcome, increased length of stay and higher
mortality (Kress, etal, 2008).
Concerning frequency of assessing patients for delirium and degree of anesthesia, the current study clarifies
that, more than half of the studied nurses never assessed delirium, while less than half of them rarely assessed
delirium, and usually assessed degree of anesthesia. They reported that they assessed patients’ condition as if
they had mental confusion and not exactly as delirium. This finding is similar to that of Devlin et al (2008) who
found regular screening for delirium to be only practiced by fewer than half of their studied sample despite local
institutional guidelines, advocating assessment of delirium and the crucial role that delirium assessment plays in
enabling nurses to reassure and comfort patients.
Frequency of assessing patients for delirium in the current study did not differ significantly among the studied
nurses in relation to their age, qualifications (the great majority are diploma nurses), and years of experience
(ranged from 6-16 years) in working with critically ill patients. Findings of the present study are in part
contradicted with that of Hashim & Ismail, (2012) who found a remarkable positive correlation between years of
experiences and knowledge of the nurses about delirium. However, the present study findings are in agreement
with that of the same author who found no relation between nurses’ age and their knowledge about delirium.
In this regards, the American Nursing Association (2000) revealed that nurses with years of experiences may
require a minimum of additional instructions before they are ready to deal with patients and nurses with years of
experiences in one clinical specialty may need a moderate amount of instructions to acquire though educational
training.
In an attempt to identify why nurses don’t routinely assess patients for delirium, and sedation in the current
study, more than half of the studied nurses revealed unavailability of sedation protocol to be utilized by nurses.
When observing abnormal behaviors by the patients, all the studied nurses reported that, the only used approach
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to examine for presence of delirium was asking for psychiatric consultation which is done only once. They also
indicated that only doctors are concerned with assessment of delirium among critically ill patients. As well,
nurses in the current study revealed unavailability of delirium assessment sheet in the ICU, and most of them
revealed that critical care physicians don’t rely on their assessment of critically ill patients. This could be due to
unreliability of their assessment especially where all the studied critical care nurses indicated that they never
receive training about assessing and handling delirium. In this regards, Hashim & Ismail (2012) revealed the
effectiveness of assessment for delirium in the ICU especially if nurses are trained about it. They added that the
ability to identify delirium in the ICU improves when a validated and standardized delirium assessment tools is
used.
Concerning their perception of delirium assessment in the current study, all the studied critical care nurses
revealed their strong agreement that delirium is an under diagnosed problem in the ICU. It is a common response
to the ICU environment; and it is a problem that requires active intervention on the part of caregivers. As well,
more than two thirds of the studied nurses agreed about the challenging nature of assessing critically ill patients
for delirium. In this regards Pandharipande, Jackson, & Ely, (2005) revealed that nurses’ perception, when
categorized by frequency of assessing delirium, provides some helpful clues about the low frequency of their
assessment. Nurses who do not routinely evaluate patients for delirium are unaware that: delirium is an under
diagnosed problem in the ICU; patients with delirium are often hypoactive; and often have fluctuating signs and
symptoms therefore, non pharmacological therapies should be considered before antipsychotic therapy. In this
regards Roberts et al (2005) highlighted three major barriers to assessment of delirium: difficulty in evaluating
delirium in patients who are intubated; the inability to complete delirium assessment in sedated patients; and the
use of delirium assessment tools that are too complex.
Concerning nurse-patient ratio, Park, et al (2001) indicated that it is unclear if the increasing ratio of patients
to staff nurses in some ICUs is compromising the ability of nurses to screen for delirium or if the increasing level
of acuity of care of patients is resulting in deeper sedation of patients and a greater emphasis on sedation rather
than delirium. As well, Hashim & Ismail, (2012) revealed that health care providers are facing major problems
related to early detection and management of critically ill patients with delirium. They commented that delirium
is commonly misdiagnosed, inappropriately treated or even neglected. Thus could increase the risk for morbidity
and mortality.
Also, Devlin, Fong, & Fraser, (2007), & Pisani, etal, (2007) revealed that it may sometimes be difficult to
separate manifestations of pain, anxiety and delirium due to their overlapping and confounding symptoms and
commonality among critically ill patients. As revealed by, Devlin et al., (2008), despite the complexity
associated with detecting delirium in the ICU, more than one third of the nurses reported receiving no training
about delirium. They attributed low frequency of delirium assessment to lack of any published studies that
evaluate the impact of delirium screening in the ICU on patients’ outcomes.
The same authors added that lack of institutional teaching about assessment of delirium most likely is due
in part to a lack of clarity about the optimal way to educate nurses about assessment of delirium or due to that
decisions about nursing curriculum are made by persons who are either not aware of delirium assessment in the
ICU or who think that assessment of delirium is not important. Therefore, critical care nurses require clinical
reasoning to optimally evaluate patients for the presence of delirium and/or sedation. On the same line were
Devlin, Brumme, & Al-Qadheeb (2012) who suggested ICU clinical road map that should be used on daily basis
to promote delirium assessment, establish a targeted sedation goal and define the analgesic/sedative regimen that
is best suited to maintain patients’ comfort, prevent delirium and promote wakefulness. Therefore, critical care
nurses should assume a leading position in the ICU regarding delirium monitoring, as they are the best suited
members of the ICU team to implement successfully this essential component of patient management (Lin, etal,
2008).
9. Conclusion:
Based on findings of the current study, it can be concluded that, inspite of being at the front line in the
management of critically ill patients, all critical care nurses in the current study revealed that delirium is an under
diagnosed problem in the ICU; it is a common response to the ICU environment. It is challenging to be assessed
among critically ill patients and represents a problem that requires active intervention on the part of caregivers.
In the current study, critical care nurses didn’t give a priority to delirium assessment in the current study. More
than half of the studied nurses never assessed critically ill patients for delirium. The only used approach to
examine critically ill patients for presence of delirium was asking for psychiatric consultation by all the studied
nurses who reported that they never received any training about assessing and handling delirium. They also
indicated unavailability of delirium assessment sheet in the ICU.
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10. Recommendations:
Based upon finings of the current study, the followings are recommended:
• Incorporating cognitive assessment in general and delirium assessment in particular into nursing
education courses.
• Integration of delirium assessment and management into daily nursing care of critically ill patients.
• Training critical care nurses about early recognition of delirium among critically ill patients
Recommendations for further researches:
• Repetition of the study on a larger population.
• Monitoring nursing interventions regarding assessment and management of delirium in the ICU.
• Carrying out educational programs about delirium assessment and management in critically ill
patients.
Acknowledgement:
The authors would like to express their sincere gratitude to the hospital administrating team who helped in
facilitating conduction of this study. Great appreciation as well is to the critical care nursing staff who accepted
to participate in the current study. The authors also acknowledge the expertise of Critical Care Medicine and
Critical Care Nursing staff for their efforts in revising the data collection instruments.
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List of figures:
Fig. (1): Percentage Distribution of the studied Group as regards Age, (N=120).
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Fig. (2): Percentage Distribution of the studied Group as regards Qualifications (N=120).
Fig. (3): Percentage Distribution of the studied Group as regards Years of Experience (N=120).
Fig. (4): Nurses’ Rank of Conditions that Routinely Evaluated among critically ill patients, (N=120).
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Fig. (5): Availability of Sedation Protocol as Indicated by Nurses, (N=120).
Availability of sedation protocol
40.8
51.7
7.5
No
Yes
Not sure
Fig. (6): Frequency of Assessing Delirium and Degree of Anesthesia by ICU Nurses, (N=120).
54.2
60
45.8
45.8
40
Degree of anesthesia
21.7
20
Presence of delirium
0
0
0
Never
Rarely
Usually
Fig. (7): Frequently used Methods of Assessing Delirium by Critical Care Nurses (N=120).
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Fig. (8): Barrier to Nurses’ Evaluation of ICU Patient for Presence of Delirium (N=120).
100
77.5
100
0
20
40
60
There is no available delirium assessment sheet
80
100
Doctors don’t rely on nurses’ assessment
Doctors always do this assessment
Fig. (9): Percentage Distribution of the Studied Sample as Regards to Received Education / Training about
Assessment and Handling Sedation and Delirium (N=120).
Fig. (10): Percentage Distribution of the Studied Sample as Regards to their Perception of Delirium Assessment
(N=120).
Delirium is challenging to assess in
intensive care unit patients
Intensive care patients with delirium
are rarely agitated
Delirium is associated with higher
patient mortality
Delirium is a problem that requires
active intervention on the part of…
Delirium is a common response to
the intensive care unit environment
Delirium is an under diagnosed
problem
0%
67.5
32.5
70
30
Strongly agree
30.8
2.5
66.7
Agree
To some extent
100
Don’t agree
100
Don’t Know
100
20%
40%
70
60%
80%
100%
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