Research Korner: Nursing Research Proposals

HOSPITAL ACQUIRED PRESSURE ULCERS RESEARCH PROPOSAL

HOSPITAL ACQUIRED PRESSURE ULCERS CAN BE PREVENTED   Introduction             There are some rules and eventualities which neither can be control nor easy to deal with. Alongside with our lives are tensions between two different poles of entities - a cause-effect relationship. That is why Aristotelian ethical doctrine suggests the need for moderation is the greatest good for man. However, even in various interactions we cannot avoid some circumstances in which affect our well-being. Natural illnesses are caused not only because of our carelessness or lack of sense of responsibility over our health, but also some factors which are external and uncontrollable causes us to feel sick and acquired illnesses to some extent. Background of the Study                 One of the most popular illness that can be found in hospitals is what we call pressured ulcer, some uses bed sores or scientifically known as decubitus ulcer. This illness is caused by the unrelieved pressure to the skin which cuts off the circulation to the area. This can be developed as an upshot of prolonged period of immobility. Moreover, literatures provide scientific explanation accounting the unrelieved pressure on the skin as critical and can be severe to some extent. It compresses tiny blood vessels which supply the skin with oxygen and nutrients. When skin is famished of nutrients and oxygen for too long, the tissue dies and a pressure ulcer forms. Hence, in the attempt to prevent this, nurses usually reposition patients every two hours when they also assess the skin for evidence of pressure damage. There are alternatives in which a patient suffered from ulcer can use as a device to alleviate the injury like sheep skin padding, air mattresses, silicone pads and specialized flotation mattresses. Purpose             This research proposal aims to provide sufficient accounts and scientific information on the regulation, nursing education, assessment, planning interventions for the prevention of hospital acquired pressure ulcers. Moreover, these accounts will be significant in proving that pressure ulcers can be prevented in many ways and means. Significant of the study             The need to evaluate and assess the accounts on pressure ulcers is significantly relevant owing to the fact that it can be a means to recreate new effective and efficient procedures and regulations to which it can highly minimize the cases.  Objectives             The use of scientific research information and other empirical research data will support these research objectives. In general, the objective of this study is to examine the preventive and regulatory measures along with assessment gathered from empirical and experiential observation of authorized agencies. This in particular will give us a lead to deepen our research for further effective measures contra pressure ulcers. Discussion             The Centers for Medicare & Medicaid Services showed that the national predominance rate for bed sores in long-term care is approximately 8.9 %. With this rate in a long-term basis needs to be addressed and revised its body of regulations. CMS made this a priority over some issues due to the predominance and high number of citation by surveyors. The intent of the regulation is to “ensure that a resident does not develop pressure ulcers unless his or her clinical condition rendered the ulcer unavoidable (retrieved internet source August 1, 2008). Moreover, the regulation stresses that long-term care facilities “provide adequate care services to promote the prevention of pressure ulcer developments, healing and prevent progress of additional cases. On the other hand, the prevention measures must be individualized and monitored for their effectiveness. Risk assessment is a vital component responding to identifying resident risk factors. The treatment guidelines underline the focus on the importance of accurate assessment of pressure ulcers, mainly reinforcing residents to have a self-inquiry asking their selves the “why’ of the occurrence and its cause.  In managing such injurious and vicious physical illness assessment, product implementation or prescription and skin care guidelines should be enforced by the clinicians or any medical authorities formally inclined to such expertise. Moreover, reporting of changes of condition is highly upheld. Any changes in condition must be reported to the assigned nurses who are held accountable. A formal system includes skin integrity checks occurring upon dressing, undressing and at scheduled bathing times of patients. Proper documentation of reports held in utmost importance.     References: www.leedergroup.com. FTag 314 Pressure Ulcer. Retrieved August 01, 2008 Lyder, C (2004). Implications of Pressure Ulcers and Its Relation to Federal Tag 314. Annals of Long-Term Care, Volume 14, No. 4 A Systems Approach to Quality Improvement in Long-Term Care: Pressure Ulcer Prevention and Management. MassPRO: The Healthcare Quality Improvement Organization, 2003

HOSPITAL ACQUIRED PRESSURE ULCERS RESEARCH PROPOSAL

HOSPITAL ACQUIRED PRESSURE ULCERS CAN BE PREVENTED Introduction There are some rules and eventualities which neither ...

Research Study Sample on Nurses’ and Doctors’ Knowledge of Pain after Surgery

1          The first article, “Nurses’ and Doctors’ Knowledge of Pain after Surgery” aims to analyze the links between levels of acute pain management knowledge, perceptions of clinical skills, and the acute pain management education history of doctors and nurses working in orthopedics and general surgery in an acute hospital. This aim of the research is clearly stated in the study. An abstract was also given at the beginning of the study.             Various literature have already emphasized that despite the ideals of professionalism, education and the establishment of acute pain management, some health care practitioners still lack knowledge of pain management and have misconceptions of pain behaviors and pain relief methods, which are not conducive to high-quality care. It must be noted that pain is the most common symptom for which patients seeks help and can reflect either physical or emotional discomfort (The Merck Manual, 1999). Knowledge of pain assessment and management is therefore vital.             To gather data, the researchers structured a questionnaire that was designed to identify professional demographics and educational input, barriers to acute pain management, perceived competence in clinical skills and to test knowledge using an abridged version of a validated questionnaire which was annotated to trust standards.             A convenience sample was taken from one of the three acute hospitals in the trust. It consisted of 101 permanent, trained doctors and nurses from three orthopaedic and two surgical wards. The sample was purposefully selected to coincide with the end of the junior doctors' six-month appointments, when they should have had greatest knowledge of the trust's standards.             An ethics approval to perform the study was not sought since the researchers reasoned out that there were no vulnerable subjects. However, a proposal outlining the study's method of enquiry was registered and scrutinised for scientific worthiness by the trust's research and development department through a process of peer review and supervision. Questionnaires were distributed by hand in sealed envelopes with guidelines on the purpose and objectives of the study. Participant anonymity was assured. In an attempt to reduce bias the respondents were requested not to disclose, discuss or reproduce the questions with anyone else to ensure that the respondents' answers were not influenced by others.             The results identified the most useful sources of acute pain management education and who accessed these; barriers to good acute pain management, other than a lack of education; differences between doctors and nurses in standards of education, levels of perceived competence and knowledge in assessment, pharmacology and analgesic delivery systems.             The evaluation of pain is one of the many physician (Bickley & Szilagyi, 2003) and nursing responsibilities that require effective critical thinking (Potter & Perry, 2004). The patient’s behavioral response to pain relief management and interventions is not always obvious, thus the physicians and nurses must be knowledgeable in observing and knowing patient responses to pain relief interventions and management. 2          The second article is “Nurses’ Knowledge, Attitudes, and Practices: Regarding Children’s Pain” by Catherine Van Hulle Vincent. It aims to describe the knowledge and attitudes of nurses about relieving children’s pain, perceived barriers to optimal pain management, and analgesics administered by nurses in relation to levels of children’s pain. Management of pain is a prime consideration for many health care professionals (The Merck Manual, 1999).             The data used in the study is collected from 67 nurses and 132 children in their care. This is appropriate since from the sample mentioned in the study, the population comprised of children with different racial identities and different sexes. The age of these children ranges from 3.5 to 17 years, experiencing pain of variety. The sample could therefore be considered as a representative of a whole. An approval was obtained from the Behavioral Institutional Review Board at the participating agency. Nurses were recruited and consent was obtained, children who were patients cared for by the sample nurses were recruited, and parental consent for their child to participate and child assent were obtained.             The nurses’ knowledge and attitudes were measured with a 33-item instrument derived from the 37-item Nurses’ Knowledge and Attitudes Survey Regarding Pain. This instrument was used with permission from the original developer. As this instrument has already been used, it is likely that the results from the answers of the nurses would be valid. On the part of the children levels of pain were measured on a scale of 0 to 5 using six photographic scales of the Oucher. The photographs of a child’s face on each vertical scale represent increasing levels of pain. It must be noted that this is more of an observation on the part of the one observing the faces of the children. Misinterpretation could likely occur. The nurse must therefore be aware of possible errors in pain assessment. Using the right tools and methods can help to avoid errors and to ensure that the right pain interventions are chosen. Failure of clinicians to assess a patient’s pain, accept the findings, and treat the report of pain is a common cause of unrelieved pain and suffering (Kozier & Erb, 2004).             The results of the study show that most nurses demonstrated knowledge and positive attitudes about relieving children’s pain but lacked knowledge about the incidence of respiratory depression and thought that children over-repot pain. Inadequate or insufficient physician medication orders for pain were identified by 99% of nurses as the greatest barrier to optimal pain management. Of the 117 children who reported pain, 74% received analgesia. Nurses administered means of 37.9% of available morphine and 22.8% of available total analgesia.             Several pain assessment tools have been developed for children, but these tools have not been consistently used in practice. Similarly, pharmacological and nonpharmacological advances in the management of pain have been documented to be effective, but their use in practice has not been maximized (Puntillo, 1999), as could be seen in the study.             The use of analgesics is the most common method of pain relief. The nurses using this in the study could significantly affect the children’s perception of pain. Although analgesics can effectively relieve pain, nurses and physicians still tend to undertreat the patients because of incorrect drug information, concerns about addiction, anxiety over errors in using opioid analgesics, and administration of less medication than was ordered (Potter & Perry, 2004).          Nurses in practice therefore need to become more aware of the adequacy of their analgesic administration, the value of children’s self-report of pain, and the limitations of relying on children’s behavioral manifestations to judge pain intensity. It is therefore necessary for nurses to understand the drugs available for pain relief and their pharmacological effects on the children. This study also demonstrates the importance of examining attitudes about children’s pain relief and learning more about respiratory depression in children receiving. 3          The third article is “Influences of Patient Behavior on Clinical Nurses’ Pain Assessment: Implication for Continuing Education” by Horbury, Henderson, and Bromley. This study was realized as a result of poor attendance by nurses at inservice sessions discussing pain assessment and management.             The aim of this investigation was to study nurses' intention to treat pain in different patients. The study participants were registered nurses working in the inpatient areas of the Divisions of Surgery, Medicine, and Oncology, including critical care areas in a tertiary Australian teaching hospital. All nurses on the roster for each ward area during 1 calendar month were targeted. Consent was obtained from the Nursing Directors of the participating areas together with ethics approval from the Nursing Research Committee at the hospital. A 10-page questionnaire with eight different patient scenarios was distributed to 886 nurses across all clinical divisions of an acute tertiary facility. A questionnaire, comprising eight vignettes was used. Each vignette described a hypothetical situation and asked the respondents to select a dosage of pain relief medication they would administer. Data were analyzed using descriptive statistics. It was an expectation that further analysis could be undertaken between the different groups within the hospital. However, given the low response rate, there were not significant numbers representative of any specific group to make reliable comparisons. Results indicate knowledge deficits regarding optimum pain relief for patients. These findings support existing literature that nurses do not necessarily accept patients' self-report of pain. They suggest nurses are influenced by patients' age and behavior when rating pain. Nurses were more comfortable accepting the self-report from elderly patients, particularly with a grimacing expression, than from the younger group. However, they were reluctant to administer appropriate levels of analgesia due to fear of respiratory depression. These trends were also consistent with the literature. But nurses must remember that respiratory depression is only clinically significant if there is a decrease in the rate and depth of respirations from the patient’s baseline assessment (Potter & Perry, 2004). The study also mentioned its limitations, that being the sample not a representative of the whole population. But despite that, the findings suggest that a more active role in the provision of education about pain assessment and management to nursing staff is required. This article highlights the need for innovative teaching strategies and approaches in the clinical context to heighten nurses' awareness of their lack of knowledge of pain assessment and management.

Research Study Sample on Nurses’ and Doctors’ Knowledge of Pain after Surgery

1 The first article, “Nurses’ and Doctors’ Knowledge of Pain after Surgery” aims to analyze the links between levels of acute ...

Management of Diabetes Mellitus Type 2 through Consumption of Garlic - A Research Proposal Paper

Research Proposal on Management of Diabetes Mellitus Type 2 through Consumption of Garlic   Research problem Although at present diabetes cannot be cured, it can be treated very successfully. Treatment for diabetes varies from person to person and will depend on the type of diabetes one has. Type 1 diabetes is treated by injections of insulin and a healthy diet, and regular exercise is recommended. Type 2 diabetes is treated by a healthy diet and exercise or by a combination of a healthy diet, exercise and tablets. Eventually people with type 2 diabetes may also need insulin injections, although they are not totally dependent on the insulin. If one has just been diagnosed as type 2, it is bound to take them some time to adjust to the idea, but with the right information and back-up from their diabetes care team, they will soon realize that they will be able to cope and keep themselves well (Brodsky & Edelwich 1998). It seems clear that a person's motivation for change is affected by a variety of conditions, some of which are external to the individual and some of which are internal. Psychologists suggest that motivation should not be thought of as a characteristic that an individual either has or has not. Rather, motivation can best be seen as a state of readiness or eagerness to change, which may fluctuate from one time or situation to another. Importantly, from this perspective, people can see that this state is therefore one that can be influenced (Clark 2004). Diabetes is a serious condition that requires attention from both the one who has the disease and his/her family. Diabetes Mellitus or commonly known as Diabetes is a medical situation wherein one’s body does not produce enough insulin from the pancreas. People who have diabetes needs care not only from their doctors but the person’s family. This paper is a proposal to create a study on the management of diabetes mellitus type 2 through consumption of garlic.   Aims and objectives 1.    Understand Diabetes and its causes. 2.    Know the cure or treatment for diabetes. 3.    Analyze the plight of diabetes patients. 4.    Determine the beneficial components of garlic. 5.    Analyze how garlic is used to manage diabetes mellitus.   Literature review Diabetes is characterized by absolute lack of insulin production due to auto immune destruction of the pancreatic cell. This type of diabetes usually begins before the age of 40, often in childhood or adolescence. Insulin resistance plays a major role in subjects within diabetes. The onset is usually during mid-life. In 60% to 90% of the patients, diabetes is accompanied by obesity. Individuals affected by diabetes must learn self-management skills and make lifestyle changes to effectively manage diabetes and avoid or delay the complications associated with this disorder (Walford 2000). Contrary to type 2-diabetes, insulin therapy is required in type 1-diabetes once symptoms have developed. Intense&#64257;cation of insulin therapy combined with comprehensive diabetes education lead to a sign&#64257;cant and lasting improvement of metabolic control. In diabetes symptoms begin more gradually and the diagnosis is frequently made when an asymptomatic person is found to have elevated plasma glucose on routine laboratory examination. Weight reduction is considered the treatment of choice for obese patients with diabetes. On the condition that diabetic patients with an eating disorder usually had an intensive diabetic education in the past, the common assumption that there is a knowledge deficit about the risk of diabetic complications is often inaccurate. On the contrary, their knowledge about therapy regimen is usually excellent often exceeding the knowledge of ordinary nurses or even medical doctors not working in the field of diabetes. Educational efforts may be more effective when directed toward themes typically addressed in eating disorder treatment. These include information on attitudes about shape and weight in Western societies, the role of dietary restriction as a precipitant of binge eating, and the biological determinants of body weight (Furth, Schmidt & Treasure 2003). Methodology Sample collection To determine the number of respondents that will be asked to participate and give information regarding the study convenience sampling will be used. Convenience sampling means to collect or interview individuals who actually experience the phenomenon. Convenience sampling will focus on individuals that experienced diabetes mellitus or has someone in the family that experienced such disease. Methodology/Data Collection Surveys will the primary method of data collection.  Internet surveys would be used. Internet surveys have been both hyped for their capabilities and criticized for the security issues it brings. Internet surveys require less finances since there would be no printing of paper and there would be no need to travel just to gather data. Internet surveys would also require less time for the researchers and the respondents. Data Analysis     The will be analyzed through descriptive statistics and it would focus on graphical and tabular analysis. Tabular analysis involves presenting the results of analysis in tables. Frequently the information contained in a table can be presented as a graph.   References Brodsky, A & Edelwich, J 1998, Diabetes: Caring for your emotions as well as your health, Perseus Books, Reading, MA. Clark, M 2004, Understanding diabetes, Wiley, Hoboken, NJ. Furth, E, Schmidt, U & Treasure, J 2003, Handbook of eating disorders, John Wiley & Sons, Chichester, England. Walford, RL 2000, Beyond the 120-year diet: How to double your vital years, Four Walls Eight Windows, New York.

Management of Diabetes Mellitus Type 2 through Consumption of Garlic - A Research Proposal Paper

Research Proposal on Management of Diabetes Mellitus Type 2 through Consumption of Garlic Research problem Although at present di...

NURSES EXPERIENCES OF MENTORSHIP: A QUALITATIVE DESCRIPTIVE STUDY

Nurses Experiences of Mentorship: A Qualitative Descriptive Study   Research Question What are the lived experiences of mentorship of newly qualified nurses in the first year of clinical practice in an approved centre?   Aim of the Study The purpose of this study is to clarify the concept of mentoring by exploring and describing the nurses’ experiences of mentorship from the perspective of mentors as well as mentees.   Objectives <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> To clarify and develop a comprehensive understanding of the concept of mentoring </li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> To describe the nurses experiences of mentorship and identify the outcomes of mentoring </li> </ul>   Literature Review In preparation for this study a preliminary search has been conducted using the following databases: CINAHL, PUBMED, Medline and EBSCO Host. Articles published in English in the last ten years were reviewed. Different perspectives on mentoring occur in the literature. The concept mentorship and preceptorship is used interchangeably. It is also not restricted to nursing but also used in medical and allied health professions. In the United Kingdom the term mentor is described as a supervisor of post qualification of Registered nurses who give support to enhance competences and clinical skills (Kelly et al, 2002). Similarly, this role exists in Hong Kong (Suen & Chow, 2001) as well as in the United States of America (Santucci, 2004). These sources agree that the mentor is a role model, teacher, coach, sponsor, guide, advisor and in general is older, wiser, more experienced and more powerful (Neary, 2000; Goran, 2001) However, Lieb (1995) suggests that there is an existing conflict of opinions regarding mentor-mentee match.   Methodology A qualitative descriptive design will be used to describe nurses lived experiences in their own natural setting, through talking and interaction in order to generate rich, in-depth descriptive data. An inductive process will be used in the discovery and development of meaning, with a view to explaining and understanding the social world (Bryman 2004:20).This approach will be used in describing the experiences of newly qualified graduate mental health nurses to present their views of mentorship.   Research Method The semi-structured interview schedule will be used to facilitate the in depth, rich, face to face interview of the nurses in understanding their clinical experience of mentorship (Parahoo 2006:206). Use of this tool is favoured because it uses open-ended questions and is flexible and adaptable (Bryman 2004:319-321). Interviews will be audio taped and transcribed verbatim.   Data Analysis Thematic analysis will be using Colaizzi’s seven steps method. Phenomenological Analysis Mapped against Coding and Analysis 1. The researcher reviews the collected data and become familiar with it. Through this process they gain a feeling for the subject’s inherent meanings. 2. The researcher returns to the data and focus on those aspects that are seen as most important to the phenomena being studied. From the data they extract significant statements. 3. The researcher takes each significant statement and formulates meaning in the context of the subject’s own terms. 4. The meanings from a number of interviews are grouped or organised in a cluster of themes. This step reveals common patterns or trends in the data. 5. A detailed, analytic description is compiled of the subject’s feelings and ideas on each theme. This is called an exhaustive description. 6. The researcher identifies the fundamental structure for each exhaustive description. 7. The findings are taken back to the subjects who check to see if the researcher has omitted anything. This is called a member check.   Sampling Non probability, purposive sampling will be used whereby the newly qualified mental health nurses are hand-picked, who will have had exposure to a mentorship programme and are likely to produce the most valuable data. The size will consist of four pairs of graduate mental health nurses and their mentors employed at the approved centre (Parahoo 2006:268).   Site The interviews will be conducted at the approved centre, where the nurses are employed which will provide a familiar and relaxed environment for participants.   Inclusion Criteria <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Those nurses that have successfully completed the induction programme and have been allocated a mentor and have worked at the approved centre for at least one year. </li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Registered mental health nurses who are registered with the nursing board. </li>   Exclusion Criteria <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Nurses who have not completed the induction programme and have not been allocated a mentor.</li>   Ethical Considerations  ETHICAL CONSIDERATIONS -          The research study will be submitted for ethical approval to the ethics committee of the approved centre as well as the faculty of the university. -          The principle of respect for autonomy includes the right to self-determination and full disclosure, informed consent and issues relating to the principle of respect. The principle of justice includes the right to fair treatment and privacy (Polit, Beck & Hungler, 2001). -          Informed consent of staff will be sought, and participation will be voluntary with an option to ask for a clarification at any stage or withdraw from the study. -          Confidentiality, dignity and privacy will be maintained throughout the study by using codes and pseudonyms (Bryman 2004: 509-513).   Timeframe - 8 months 8 months   Limitations -          Small sample size has limitations in terms of generalizability of the study. -          The scale of the study will be limited by the scope of the Masters Programme which has a limited time frame.   Expected Outcomes of the Study a)    It is hoped that this study will yield a better understanding of the concept of mentoring. b)    It is expected that this study will enhance and advance academic research on the concept of mentorship. c)    Health care organisations can use the results to assess their mentoring and develop a mentorship programme and train mentors.

NURSES EXPERIENCES OF MENTORSHIP: A QUALITATIVE DESCRIPTIVE STUDY

Nurses Experiences of Mentorship: A Qualitative Descriptive Study Research Question What are the lived experiences of mentorship...

Research Proposal on Effectiveness of Nursing Review Centers among Nursing Students Who Will Take Nursing Board Exam

Effectiveness of Nursing Review Centers among Nursing Students Who Will Take Nursing Board Exam Introduction The nursing education is an exciting, challenging adventure that will demand much of nursing students in terms of time and energy. Nursing is a profession that requires alleviating the pain and promoting the health of others. And the primary aim of nursing is the goodness of others; it is a value laden profession. This specific nature of nursing requires nurses to do what is right during their practice. Background of the Study and Problem Statement A nursing student encounters complex situations and conflicts which cannot be resolved only through theoretical knowledge and skills.  Moreover, the nursing students are seeking professional knowledge as they go on through series of studies and practice. Such situations may involve moral components that require the skills of ethical decision making for nurses. Yet, learning the skills of ethical decision making cannot be enough to resolve ethical problems due to many factors including the complex nature of a given problem. Pursuing the professionalism in the medicine industry gives a lot of stress in the part of the students especially when they are entering the world of the real nursing duty.Based on the background of the paper, there are two interrelated problems that are associated in the study: ·         What is the essence of the Nursing Review Centers? ·         How can the Nursing Review Centers emphasize the nursing ethics and knowledge? Research Aim and Objectives The main aim of the study is to investigate the effectiveness of Nursing Review Centers for the nursing students who will take Nursing Board Exam. In order to facilitate the investigation, there are objectives that need to consider. First is to identify the issues that are related in the nursing review centers and their service offering for the students. The second objective is to assess the issues and determine if the review centers answered the issues or not. Through that assessment, the gaps can be identified and can lead to the third objective which is to measure the effectiveness of the nursing review centers in providing various strategies that can result in a quality service. Research Questions There are several questions prepared that can serve as the engine of the study in the process in meeting the objectives. The health care system and management are the focus of the questions to ensure that there is an alignment between the literature reviews and empirical situations. 1.      What are the common challenges being faced by the nurses as well as the nursing review centers? 2.      What are the recognized difficulties of the management in terms of nursing education? 3.      What are the actions of the management about the area of their weakness? Literature Review One study identified the various problems of the nursing students and pointing out that the main cause of these problems is a big amount of stress during their life a student. Nursing students, actually in a broad sense, all of the students’ faces some series of challenges and stressors. But more likely, the nursing students are the one who are in the center of experiencing stress. The stress maybe came from their friends, professors, colleagues, family or relatives, and even relationships and competition. Every day, students doesn’t only needs a brain to do a workload and be happy to grab it fast but they also founding certain emotions in dealing with the other people and not always facing the thick pages of a book. Nursing students experience stress severe enough to induce mental health problems such as anxiety and depression. The source of the stress in nursing students is related in their learning experience and the programs that they enrolled into. The learning experience is a series of planned activities in the community that would prepare students technically and professionally should they decide to pursue higher education in the health profession. Another factor is the time allocated in the nursing college’s classroom and laboratory. Students also advised, or rather required by the professors to present some research based procedures and clinical conferences. The continuous activities making the students accumulated the burnout behaviors which are characterized by reduction in their performance. And just like the domino effect, everything else follows.  The students are destined to feel slight health failure, physical illness and emotional stress. There is also physical and psychological symptoms of stress that are present in every nursing students that suffered pressure such as irritability, inability to concentrate, insomnia, depression, muscular tension and aches, palpitations, lack of appetite and others. But actually, not all the case of a nursing student finds a negative response on the stress factor. The existence of the review centers is believed, at some point, to increase and improve the nurses’ intelligence and performance. Methodology The proposed method in the study is the use of the interview. Firstly, the participants are consisted of the nurses and management team in Black Lion Hospital. Their information will be provided such as their age, gender, position in the hospital, and number of years in practice and service. That information is believed to create an influence on to what the nurses and the management ideas and how the way they will act on the issues of nursing practice. Through the application of the interview, the conducted material can serve as the evidence for the development of the analysis.   Sources: Factors Affecting the Academics of Nursing Students: Conducted at a selected College of Nursing located in Makati City. [Online] Available at: http://www.slideshare.net/lanel09/final-paper-1717456 [Accessed 26 January 2011]. Factors Affecting the Academics of Nursing Students According to Ethics [Online] Available at: nursing.yale.edu/Centers/International/.../docs/98_Erdil.doc [Accessed 26 January 2011].

Research Proposal on Effectiveness of Nursing Review Centers among Nursing Students Who Will Take Nursing Board Exam

Effectiveness of Nursing Review Centers among Nursing Students Who Will Take Nursing Board Exam Introduction The nursing education ...

Reduction of Pressure Ulcers

Reduction of Pressure Ulcers by Risk Assessment and Prevention in Hospital Setting   Introduction             Pressure ulcers continue to be a distressing medical problem. Not only do patients experience pain and discomfort but intensive wound care also incurs considerable costs to both patients and hospitals. Therefore both health care professionals and patients should consider the prevention of pressure ulcers of extreme importance. Hospital nursing teams are especially concerned with the prevention of pressure ulcers that develop during hospitalization, i.e. the nosocomial pressure ulcers.             The aim of this project is to improve pressure ulcer risk assessment and prevention through the implementation of guideline recommendations, many of which related to accurate and timely documentation of risk, adequate care planning and the provision and review of appropriate equipment. To achieve this, clinical audit will be used. The clinical areas audited provided care to patients identified anecdotally at higher risk of pressure ulcer development due to their physical condition. A quantitative form of research is applied in this project.   Background of the medical condition Pressure ulcer is most commonly known as bedsore. Other names for it include pressure sore, decubitus ulcer and tropic ulcer. It is an ischemic necrosis and ulceration of tissues overlying a bony prominence which has been subjected to prolonged pressure against an external object like a bed, wheelchair, cast or splint for example (Beckley & Silage, 2003). The condition results to impaired skin integrity related to unrelieved, prolonged pressure (Potter & Perry, 2004). Such a condition is seen most frequently in patients who have diminished or absent sensation, or are debilitated, emaciated, paralyzed, or otherwise long bedridden. Any patient experiencing decreased mobility, decreased sensory perception, fecal or urinary incontinence and/or poor nutrition can therefore be at risk for pressure ulcer development. Tissues over the sacrum, Ischia, greater trochanters, external malleoli, and heels are especially susceptible but other sites may be involved, depending on the patient’s position. Pressure ulcers can affect not only superficial tissues, but also muscle and bone.             Both intrinsic and extrinsic factors precipitate pressure ulcers. Intrinsic factors include loss of pain and pressure sensations that ordinarily prompt the patient to shift position and relieve the pressure, and the thinness of fat and muscle padding between bony weight-bearing prominences and the skin. Disuse atrophy, malnutrition, anemia, and infection play contributory roles. The most important of the extrinsic factors is pressure. Its force and duration directly determine the extent of the ulcer. Pressure severe enough to impair local circulation can occur within hours of an immobilized patient, causing local tissue anoxia that progresses, if unrelieved, to necrosis of the skin and subcutaneous tissues.             The best treatment for pressure ulcers is prevention. Pressure on sensitive areas must be relieved. Unless a full-flotation bed such as a water bed is used, providing even distribution of the patient’s weight. If the patient is using braces or plaster casts, a protective padding at bony prominences should be used under braces or plaster casts, and a window in the cast should be cut over potential pressure sites.             Skin inspection is also important. Pressure points should be checked for erythematic or trauma at least once/day in an adequate light. Able patients, mobile or immobile, and their families must be taught a routine of daily visual inspection and palpation of sites for potential ulcer formation. Exquisite skin care for neurologically damaged parts is necessary to prevent maceration and secondary infection. Maintaining cleanliness and dryness helps to prevent maceration.             The prevention of pressure ulcers is a priority in caring for patients and is not limited to patients with restrictions in mobility. Impaired skin integrity may not be a problem in healthy, immobilized individuals but is a serious and potentially devastating problem in ill or debilitated patients. Prompt identification of the high-risk patients and their risk factors aids in prevention of pressure ulcers. A well-balanced diet, high in protein, is important in the treatment of pressure ulcers. Blood transfusions may be needed for anemia. Threatened pressure sores require energetic use of all the above mentioned prophylactic measures to prevent tissue necrosis. The area should be kept exposed, free from pressure, and dry.             The major problem in treating pressure ulcer is that the ulcer is like an iceberg, a small visible surface with an extensive unknown base, and there is no good method of determining the extent of tissue damage.             More advanced ulcers require surgical treatment. Surgical debridement and closure is required for fat and muscle involvement. Affected bone tissue requires surgical removal; disarticulation of joint may be needed. Necrotic tissue can promote pathogen growth and delay healing, so it should be removed. An exception may be scharr or necrotic tissue on a heel ulcer because an open heel wound can easily become infected and lead to osteomyelitis. Several debridement methods are available; the choice depends on the amount of necrotic tissue, absence or presence of infection, patient preferences, and economic considerations (Baranoski, 2006).   Evidence-based pressure ulcer prevention and treatment             Evidence-based practice, which is often referred to as evidence-based nursing or evidence-based medicine, is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. (1) It involves integrating the individual clinical expertise of the physician or nurse with the best available external clinical evidence from systematic research and individual patient preferences. (2) Research shows that patients' outcomes are at least 28% better when clinical care is based on evidence rather than tradition or common sense (Bryan-Brown, 2006). The following paragraphs would discuss health care practices and interventions on pressure ulcers which are evidence-based and are widely used in health care settings today. A major aspect of nursing care is the maintenance of skin integrity. Consistent, planned skin care interventions are critical to ensuring high quality of care ( 2004). Nurses constantly observe their patient’s skin for breaks or impaired skin integrity. Impaired skin integrity occurs from prolonged pressure, irritation of the skin, or immobility, leading to the development of pressure ulcers. Nursing care interventions aimed at the prevention, assessment and treatment of pressure ulcers should be based on research (Potter & Perry, 2004) or evidence-based practice.             There are several instruments for assessing patients who are at high risk for developing a pressure ulcer. Patients with little risk for pressure ulcer development are spared the unnecessary and sometimes costly preventive treatments and the related risk of complications.             Prevention and treatment of pressure ulcers are major nursing priorities. The incidence of pressure ulcers in a facility or agency is an important indicator of quality of care. There is evidence that a program of prevention guided by risk assessment can simultaneously reduce the institutional incidence of pressure ulcers by as much as 60% and bring down the costs of prevention at the same time (Potter & Perry, 2004).             Evidence-based practice shows that lack of documentation of patients at risk demonstrates the need for hospitals to increase prediction and prevention strategies. Use of a risk scale can provide triggers to plan care to decrease risk factors.             As a predictive measure, individuals should be assessed for risk of pressure ulcer development upon admission to acute care and rehabilitation hospitals, nursing homes, home care programs, and other health care facilities (2004). Pressure ulcer risk assessment should be done systematically.             Evidence-based practice also shows that extended stays of over 7 days increase the risk of pressure ulcer development (Lyder, et al, 2001). Nurses must therefore remain vigilant in the prevention of pressure ulcers in patients with longer hospital stays.             Evidence-based practice shows that the use of care practices such as daily skin assessment, use of pressure-relief surfaces and objective risk assessment measures, such as the Braden scale, identified at risk patients and reduce evidence of pressure ulcers (Lyder, et al, 2001). The Braden scale was developed based on risk factors in a nursing home population. It is highly reliable when used to identify patients at greatest risk for pressure ulcers. It is also the most commonly used assessment scale for pressure ulcer (Potter & Perry, 2004).             Evidence-based practice also shows that the use of nutritional consultation was associated with decreased incidence of pressure ulcers, suggesting a nutritional consultation may sensitize the staff that the older adult is at risk for pressure ulcer development (Lyder, et al, 2001).             Nursing interventions for reducing and treating pressure ulcers are evaluated by determining the patient’s response to nursing therapies and by determining whether each goal was achieved. To evaluate outcomes and responses to patient care, the nurse measures the effectiveness of interventions. The optimal outcomes are to prevent injury to the skin and tissues, reduce injury to the skin and underlying tissues, and restore skin integrity (Potter & Perry, 2004). The care of a patient with a pressure ulcer requires a multidisciplinary team approach.             There is a strong relationship between nutritional status and pressure ulcer development, yet nutrition is an area often overlooked by clinicians in pressure ulcer care. Nutrition, including adequate hydration, plays an important role in pressure ulcer prevention and healing, and is critical in maintaining tissue integrity. Patients defined as malnourished at hospital admission are twice as likely to develop pressure ulcers as well-nourished patients. Therefore, nurses and dietitians should work together to assess the patient's nutritional and hydration status and ensure that these factors are addressed in the patient's care plan (Voss, 2000).             Pressure ulcers, regardless of their origin, represent negative outcomes for patients. These negative outcomes may include pain, additional treatments and surgery, longer hospital stays, disfigurement or scarring, increased morbidity; and increased costs. Although all negative outcomes are of concern, a hospital-acquired pressure ulcer can result in increased cost of treatment, patient dissatisfaction with care, and a potential litigious situation (Schultz, 2005).   The project plan   Objectives             The aim of this research is to improve pressure ulcer risk assessment and prevention to reflect the guideline recommendations. The objectives are: <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"><li class="MsoNormal" style="text-align: justify; line-height: 200%"> Develop a dissemination and implementation strategy to accompany the guideline;</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Audit care in pressure ulcer risk assessment and prevention, using criteria based on the guideline; and</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Make recommendations for practice and future research based on the findings of the study.</li> </ul>   Defining quality In keeping with the classical audit cycle this project seeks to identify current best practice in prescribing, survey the actual practice, and then institute measures to improve prescribing up to the identified standards. The audit tool was used to collect data on length of stay, mattresses and repositioning provided to patients in each of the following hospital wards: medical, orthopedic or older patients ward, groups considered to have a higher risk of pressure ulcer development, recovery room for the postoperative stay until first ambulation. This audit tool included demographic data as well as data on the modified Norton scale for evaluation of a patient's risk of developing a pressure ulcer. A score of 16 or less indicates increased risk for developing a pressure ulcer. The audit tool will also include data on accompanying medical conditions, i.e. continence, diabetes, heart insufficiency and peripheral vascular diseases. Continence means that a patient has full control on urine and feces. Inserting a Foley catheter into the bladder can bypass the problem of urine incontinence. In case of urine incontinence, continued contact between skin and urine weakens the cell wall and may alter the skin pH, making it more susceptible to breakdown ( 2004).   Recruitment of pilot sites and link nurses As the project had a short timeframe, a decision was taken with the advisory panel that four to six sites would provide sufficient patient numbers to allow improvement in practice to be detected between the audits. Sites were included if they provided tare to medical, orthopedic or older patients, groups considered to have a higher risk of pressure ulcer development. As this was an audit project, ethics committee approval will not be required, however, confirmation of this will be sought and obtained from all hospital sites involved in the project.             The audit criterion is that a practitioner with 'appropriate and adequate training' should undertake the initial risk assessment and document findings. For audit purposes, the grade of the nurse or health care professional will be recorded.   Dissemination and implementation strategy The dissemination and implementation strategy was informed by evidence and reflected the advice of site link nurses and staff from the clinical areas on possible barriers to change. This ensured the strategy reflected best evidence to bring about change, and encouraged local ownership of the guideline. Dissemination comprised the identification of a nurse from each clinical area who could support clinical staff involved in the project and assist with the audits; circulating copies of the project proposal, quarterly newsletters and summaries of the guideline recommendations to all relevant staff.   Implementation Implementation focused on the development of an evidence-based resource pack by the project team and provision of education sessions by the project manager. A resource pack was given to each senior member of staff in the clinical area to be audited, the site link nurses and directors of nursing, and included an implementation guide and copies of the audit tools.             The project manager shall lead education sessions at each site, with the assistance of the site link nurse, following audit 1. The sessions were to be attended by nursing staff from the clinical areas to be audited, senior nurses and/or ward managers. The sessions focused on a description of evidence-based practice and clinical guideline development; the development and recommendations of the RUN guideline; an outline of the project; site specific feedback and recommendations for practice from audit 1.             To ensure standardization of pressure ulcer grading for the audit, the PUPA tool was used by the project team (Stephens, 2003). Reduction in pressure ulcer prevalence is not a study outcome due to the time constraints and need to take account of potential contributory factors. Nevertheless, it is considered important to assess prevalence to enable audit findings to be more generalisability. Each site will be asked to identify clinical areas that met inclusion criteria and arrange dates for the project manager to undertake audit 1. Audit 2 will commence at each site five to six months later.             Development of Audit Tools             Two audit tools will be developed; one for the patient and one for the clinical area. The tools are developed using recommendations for audit criteria proposed by Baker and Fraser (1995), which included the following: <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"><li class="MsoNormal" style="text-align: justify; line-height: 200%"> Criteria should be based on evidence where possible.</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Criteria should be prioritized according to the strength of the evidence and effect on patient outcome.</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Criteria should be measurable and appropriate to the clinical setting.</li> </ul>   Audit criteria will then be derived from the guideline. This will be followed with a consultation with the advisory panel where and agreement will take place on what the audit would comprise.   Measuring and comparing             On the first audit and data analysis, to be included are all patients admitted to the hospital with no skin breakdown during a six-month period, but are at risk for pressure ulcer development. The nurse will collect the data, using the audit tool. The information sources are patients' records, interviews with patients and/or patients' families, and nurses. This is quantitative form of research wherein patient age range and mean will be computed both in the first and second audit. Pressure ulcer risk was elicited using clinical assessment and a tool to obtain a risk assessment score. Risk assessment scores for each patient were verified by the auditors (Stephens, 2003).             Data from audit 2 will then be compared with audit 1. Data will be coded and entered onto an Excel spreadsheet, and results collated in an anonyms form using simple descriptive statistics to enable comparative analysis to be undertaken. Each site will then receive feedback comparing results from both audits by clinical area in an anonyms form.   Taking action to improve             An intervention program will be prepared and implemented based on the results of the project. The program will be prepared as an addition to the basic health care practice that is common for bedridden patients and other patients at risk for pressure ulcer development.   Conclusion Patient safety should be the number one concern during hospital stay and also before, during and after each hospital procedure performed. A detailed knowledge of the epidemiology, based on adequate surveillance methodologies, is necessary to understand the Pathophsiology and the rationale of preventive strategies that have been demonstrated to be effective in preventing and treating pressure ulcers. The principles of general preventive measures such as the implementation of standard and isolation precautions, following guidelines, and the control of antibiotic use should be reviewed. Some patients are more at risk for pressure ulcer development than others, and this should be taken into account by health care professionals. The necessity to audit is seen in the high prevalence of pressure ulcer development in hospital stays despite established clinical guidelines. There is a need to improve pressure ulcer risk assessment and prevention through the implementation of guideline recommendations, many of which related to accurate and timely documentation of risk, adequate care planning and the provision and review of appropriate equipment involved. The success of the health care professional who practices pressure ulcer prevention and control techniques is measured by determining whether the goals for reducing or preventing infection are achieved. A comparison of the patients’ response with expected outcomes determines the success of the health care interventions. Credit:ivythesis.typepad.com

Reduction of Pressure Ulcers

Reduction of Pressure Ulcers by Risk Assessment and Prevention in Hospital Setting Introduction Pressure ulcers contin...