...evidence-based medicine, which was developed in Canada to teach medical students. “Evidence-based medicine has been defined as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.”3, p. 3 The National Quality Forum’s report A National Framework and Preferred Practices for Palliative and Hospice Care Quality is a consensus report that is a first step toward introducing evidence-based measures into palliative practice on a formal, national level.4 The Agency for Healthcare Research and Quality (AHRQ) supports organizations in their efforts to improve the quality and efficiency of healthcare by facilitating the use of evidence-based research findings in clinical practice.5 The nursing discipline has also embraced evidence-based practice over the past 25 years, initially through its support of “research utilization,” the integration of research into nursing curricula, and the education of nurse scientists. Sigma Theta Tau International, the Honor Society of Nursing, considers evidence-based nursing “as an integration of the best evidence available, nursing expertise and the values and preferences of the individuals, families, and communities who are served.”6...
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...JAN DISCUSSION PAPER JOURNAL OF ADVANCED NURSING The use of theory in qualitative approaches to research: application in end-of-life studies Hung-Lan Wu & Deborah L. Volker Accepted for publication 24 July 2009 Correspondence to D.L. Volker: e-mail: dvolker@mail.nur.utexas.edu Hung-Lan Wu PhD RN Nursing Instructor Meiho Institute of Technology, Pingtung, Taiwan Deborah L. Volker PhD RN AOCN Associate Professor The University of Texas at Austin School of Nursing, Austin, Texas, USA W U H . L . & V O L K E R D . L . ( 2 0 0 9 ) The use of theory in qualitative approaches to research: application in end-of-life studies. Journal of Advanced Nursing 65(12), 2719–2732. doi: 10.1111/j.1365-2648.2009.05157.x Abstract Title. The use of theory in qualitative approaches to research: application in end-of-life studies. Aim. This paper is a report of an analysis of the use of theory in qualitative approaches to research as exemplified in qualitative end-of-life studies. Background. Nurses researchers turn to theory to conceptualize research problems and guide investigations. However, researchers using qualitative approaches do not consistently articulate how theory has been applied, and no clear consensus exists regarding the appropriate application of theory in qualitative studies. A review of qualitative, end-of-life studies is used to illustrate application of theory to study design and findings. Data sources. A review of theoretical literature was carried out, focusing on definitions...
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...For my health care interview assignment I chose to interview Mayra Cruz, Certified Nurses Assistant. She works at Cuidado Casero Home Health and Hospice at 1617 E. Missouri Ave, El Paso, Texas. In my interview with her she described her job duties, her patients and how she interacts with others in her environment. In addition, she identified the length of time she has been in her current position, her career path that has led her to this position as well as her experience in the health care industry. Her education and what requirements were necessary for her certification. She also wonders if the education she received proper and adequately prepared for her position. Conclusively, she have me her recommendations for the educational preparation necessary to become a CNA and she discussed the necessary attributes for success in a career as a CAN. Finally, she described her role in the context of a broader healthcare industry. Cuidado Casero Home Health and Hospice is set in El Paso, Texas. Their hospice team consists of the patient’s physician, nurses, social worker, home health aides, clergy, therapists, and trained volunteers. Together this team provides comprehensive palliative care aimed to relieving symptoms and giving social, emotional, and spiritual support. Mayra’s customers at Cuidado Casero Home health and Hospice are patients that are dying and suffering from immense pain. They are in the last stages of life. The department customers go beyond the patients;...
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...delivery of a health information technology tool that will allow healthcare professionals Internet access to schedule the ordering and delivery of DME (durable medical equipment). This electronic ordering system will improve the hospice organization’s efficiency. The consultant’s description of StateServ Home Medical will reveal the program to significantly shift the telephone ordering process to Internet access. That leaves the hospice organization’s nursing staff with more time to mange patient care cases. In the ongoing evolution of adapt technologies, hospice organizations should factor integrated durable medical equipment ordering systems that will serve at enhancing patients’ level of care and lower delivery cost. This latest technology will also serve as a maintenance control function which results in complete and accurate billing procedures that will capture active supply use by patients. StateServe Home Medical network services will allow the hospice organization to continue to work alongside their local durable medical equipment providers and gain access to StateServ Home Medical’s real-time order management and in-depth utilization review reports. StateServ Home Medical’s main focus is serving mainly hospice organizations nationwide. DME (durable medical equipment) ordering technologies will allow the corporate executives opportunities to...
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...Nursing theories and their importance in nursing Jennifer J. Wilson Chamberlain College of Nursing NR 501: Theoretical Basis for Advanced Nursing Instructor Berens 1/12/15 Nursing Theory is often defined as,” an organized framework of concepts and purposes designed to guide the practice of nursing” (Medical Dictionary for the Health Professions and Nursing, 2012). Nursing theories can help patients, managers and other healthcare professionals to recognize what and how much that nurses do contribute to the healthcare field. I never did realize how important theories in nursing practice could be until I became a nursing student myself. Nurses use theories in their everyday practice, but never think about them as being responsible for guiding our clinical skills. However, in the student’s eye, it is very easy to see how important theories are in practice. The concepts of Florence Nightingale’s Environment theory will be discussed in relation to how it impacts the nursing profession and patient care. The key concepts of Nightingale’s theory and their relationships with one another will be summarized as well as its relationship to nursing education. Importance of Nursing Theory Nurses will use theories in their practice to help guide them through their daily tasks, patient assessments and also to help make and individualize patient goals and interventions to provide the best care. Nurses study theory as it helps assist the student in building their critical thinking skills...
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...Description of Theory: Nightingales theory is based on natural laws ("Current Nursing ", 2012). Florence Nightingale uses an environmental model. It is based on the idea that healing comes from within the individual. The emphasis of care is on placing that patient in an environment conducive to being and becoming well (Cruz, n.d.). She felt that nursing was a calling and defined it as an art and a science that requires a specific educational base of knowledge. She also went on to say that nursing was separate from medicine and that the goal of nursing was to place the patient in the best possible state in order for nature to work ("Current Nursing ", 2012). Nightingales concepts of nursing have directed both theoretical thought and nursing practice that are being utilized and practiced today (Daniels , 2003). Theory’s Historical background: Florence Nightingale is considered the founder of nursing and some say, to be the first nurse theorist ("Current Nursing", 2012). Alligood (2010) stated, “Nightingales work stemmed from a desire to serve humankind” (p. 84). Her work, during the Crimean War in Scutari, Turkey, and her later teachings, “will forever be linked with modern Nursing.” Nightingale has influenced three areas in modern day medicine; infection control, epidemiology, and hospice medicine. Nightingale cannot claim sanitation theories as her own; however, the improvements and changes that she had made were obvious, to the degree that infected patients were treated...
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...Mr Charles Winston is a forty two year old Afro-Caribbean male with end stage pancreatic cancer. He is married with two children and had previously worked as a solicitor- he has been admitted to the local hospice. For the purpose of this assignment the focus will be on pain, the importance of being pain free and what this would mean for Charles will be discussed through-out this case study. The World Health Organization (2008) say that freedom from cancer pain must be regarded as a human rights issue. Charles's pain was poorly controlled on admission so it took several hours for the nurse to assess and come to an agreement with Charles about how to manage his pain. The End of Life Care Strategy, written by the Department of Health have published the following guideline; " Ensure that pain amongst people approaching the end of life are kept to an absolute minimum with access to skilful symptom management for optimum quality of life." (Department of Health, 2008, p33). Historically, pain was seen as an emotion rather than a sensation that was experienced by the heart and not the brain (Meldrum, 2003). Pain in today’s society is seen as an unpleasant sensory and emotional experience associated with actual or potential tissue damage (International Association of the Study of Pain, 2011). Therefore, pain is not only experienced on a physical level such as intensity, location and quality but also with emotional feelings such as anxiety, frustration and depression. Pain is a multidimensional...
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...Nursing job is one of the most promising job fields. According to explorehealthcareers.org nursing jobs are projected to grow 19 percent from 2012 to 2022. Nurses can work at many different places such as, nursing home, hospitals, and clinics, rehab, schools, home health care, and assisted living homes Hospice facilities Correctional institutions, and other long-term care facilities. Certified nursing assistant’s make averaged of $25,620 a year. Their job title provides basic support in medical environments, performing duties such as dressing, bathing, feeding or transporting patients in need. Basic high school diploma and state certifications are needed for this particular nursing job. Licensed Practical nurse is another job title in the...
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...sense and has been known in other cases. This can also be done through other resources that have stated and proven similar facts. A third consideration is that the data is non-numerical and exploratory (Christensen, Johnson, & Turner, 2010). Many times there is some confusion between qualitative and quantitative research as qualitative research focuses on narrative or pictures while I would prefer more numerical data. 2. What factors should go into determining the sample size used in a qualitative study? When conducting research, quality sampling may be characterized by the number and selection of subjects or observations. Obtaining a sample size that is appropriate in both regards is critical for many reasons (Patel, Doku, and Tennakoon, 2003. A large sample size is more representative of the population, limiting the influence of outliers or extreme observations. A sufficiently large sample size is also necessary to produce results among variables that are significantly different (Patel, Doku, and Tennakoon, 2003). Sample size is also important for economic and ethical reasons. 3. Given that the researcher is considered an instrument in qualitative research, what are the implications for potential bias with this researcher role? How can a researcher minimize this inherent bias? When a researcher is aware of...
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...When you think about nurses, and what they actually do, you don’t normally think about anything other than them just helping out the doctors. In reality, being a nurse is much more than that. Nursing care is not only about nursing skills, it’s about providing a superior bedside manner. You have to be available to the patient whenever they may need you. Nursing is a profession within the health care sector, focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. My mom is a nurse, so I had a little preconceived knowledge about what a nurse actually does. I thought that nurses were just there to be an aid to the doctors. After my observation, I realize that being a nurse is much more than that. Nurses provide care both interdependently, for example, with physicians, and independently as nursing professionals. Nurses work along with the doctors, physical therapists, respiratory therapists, occupational therapists, social workers, discharge planning nurses, the pharmacies, and the palliative care team. I job shadowed Mellissa Bergman, who is an LPN at the Golden Living Center in Tekamah. To start off the early morning, we started giving each resident their medications. Each resident has different medications and supplements they have to take. Some residents only have a few pills, while others have so many, they have to take them mixed with pudding. Each resident has a certain way they like to do...
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...physical, psychological, social, emotional and safety needs. Maslow's hierarchy of needs is a theory of motivation and personality developed by the psychologist Abraham H. Maslow (1908-1970). Maslow's hierarchy (1954) explains human behaviour in terms of basic requirements for survival and growth. The needs hierarchy provides a useful framework for understanding clients, and this framework has been incorporated into several important theories of medical and nursing care. The most basic physical requirements, such as food, water, or oxygen, constitute the lowest level of the need hierarchy. These needs must be satisfied before other, higher needs become important to individuals. When these needs are unmet, human beings will focus on satisfying them and will ignore higher needs. Responsibility of the carer to meet the physical needs: assisting residents with their hygiene needs, pressure area care, helping at meal times ensure dietary needs are adhered to, the mobilisation of client, recording care plans, reporting to nursing staff any complaints from client, care of the unconscious and incontinent clients, preparing clients for therapy or medical treatment. Social needs include needs for belonging, love, and affection. Relationships such as friendships, romantic attachments, and families help fulfil this need for companionship and acceptance, as does...
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...Charting / Documentation Guide Nursing documentation should be clear, timely, accurate, reflective of observations, permanent and legible. This is a guide and not a complete list. Always follow policies in place at your facility. Medicare Documentation • Must reflect need/reason for skilled care • Must reflect Standard of Care • Describe intervention(s) • Describe resident’s response to intervention(s) • Daily evaluation of progress or lack of progress • Resident response to skilled therapy • ADL function • Changes in condition • Change Care Plan ASAP after change in condition • Notification to MD and family Respiratory/Pneumonia Medicare Documentation • Must reflect need/reason for skilled care • Daily vital signs • Daily and PRN O2 sat level • Daily and PRN lung sounds • SOB with exertion, when sitting at rest or when lying flat • Resident’s response to interventions and skilled therapy • Progress or lack of progress • Change in condition • Change Care Plan ASAP after condition change • Notification to MD and family Bladder and Bowel • Indicate status: always continent, occasionally incontinent, frequent- ly incontinent, always incontinent • Indicate if has catheter (indwell- ing or condom, intermittent), uri- nary ostomy, or no urine output • Toileting program in progress or attempted and outcome • Constipation? Which interventions used, and results? Anticoagulant Therapy Medicare Documentation...
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...this outcome. Data sources included Medline and the Database of Reviews of Effects. The review included relevant qualitative studies and intervention studies using satisfaction as an outcome from 1990 to 2005. Reviewing 24,423 citations yielded 21 relevant qualitative studies, four systematic reviews, and eight additional intervention studies. The qualitative literature described the domains of accessibility and coordination; competence, including symptom management; communication and education; emotional support and personalization of care; and support of patients’ decision-making. For collaboration and consultation interventions, eight of 13 studies showed a significant effect on satisfaction. A metaanalysis found that palliative care and hospice teams improved satisfaction, although most studies did not include satisfaction as an outcome. For other types of interventions, only two of six showed a significant effect. For heart failure coordination of care, only seven of 32 studies addressed this as an outcome; two of the three that compared satisfaction between groups showed a significant difference. Evaluations used many different measures, only one of which was designed for the end of life. In conclusion, researchers have conceptualized satisfaction in palliative care, and...
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...Ryan Somma Information Systems Proposal for XYZ Hospice Table of Contents I. Organization Environment and Requirements......................................3 A. Hospice Care...................................................................................................3 B. Assumptions....................................................................................................3 II. Inputs and Outputs...........................................................................................5 A . Inputs.............................................................................................................5 B. Outputs ...........................................................................................................5 C. Distributed Objects..........................................................................................6 III. System Hardware ...........................................................................................7 A. Client Systems ................................................................................................7 B. Peripherals ......................................................................................................8 C. Server..............................................................................................................8 IV. Software .............................................................................................................9 A. Operating System........................
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...Clinical Audit An audit of subcutaneous syringe drivers in a non-specialist hospital K Dunne, K Sullivan, A Garvey, G Kernohan, A Diamond, C Duffy, J Hutchinson drug administration can facilitate the management of pain, control of nausea and vomiting, restlessness, confusion and drying secretions in the throat. Abstract T he use of syringe drivers as a method of drug delivery to control symptoms in palliative care is a common and accepted practice, but one which has evolved rather than been subject to close multiprofessional scrutiny and guideline formation. There is evidence that adverse incidents may arise as a result of syringe driver use (Medical Devices Agency (MDA), 1998), for example, errors in drug calculations, drug stability, equipment failure (including disconnection) and the wrong rate of infusion. Inadequate user training, poor servicing of equipment and inadequate documentation and record keeping are all thought to be contributing factors (MDA, 1998). In the hospital where this audit was carried out, syringe drivers are used to administer drugs to patients with cancer during the palliative phase of illness. The purpose of this clinical audit was to establish the standard of current practice in wards where syringe drivers were being used. A retrospective study of 13 cases of syringe driver use is presented. The results highlight many areas of unregulated practice with regard to setting up, monitoring and maintenance of syringe drivers. The choice of...
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