...Abstract Medical Surgical floor and an Oncology floor have different management skills depending on the staff that care for these patients on a daily basis. Each floor has their own way of conducting the best possible care to the patients and the outcome is the same for each department. Making sure the patients and family have the best possible experience while in the hospital. This all begins at the lowest level employee that is employed on that particular floor. Case Study Proposal Introduction and Preparation Identify the Clinical Problem Early inception of palliative care to direct pain and symptoms offers the benefit to promote good positive life care for patients that are dealing with cancer. The avenue to provide the needs to giving the best palliative care and pain management services fluctuate congruent to the patient and their needs, resources, care giver training, and the hospital setting. This paper will help in describing the management of the Oncology unit in the clinical setting. Collective efforts, planning, support from administrators, and time are necessary in implementing the care needed for the cancer patients and their families (Marchetti, P., Voltz, R., Rubio, C., Mayeur, D., & Kopf, A. 2013). To accommodate this work established by resources, staff, and management different approaches were taken, including structuring of services within oncology units; creation of an integrated partnership between oncology and palliative care departments; establishment...
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...A lot of research has been recorded trying to figure out the issue between workload of nurses and mortality of patients. A study of 168 Pennsylvania hospitals in 1999 found that one additional patient added to a hospital staff nurse’s workload is associated with a seven percent increase in hospital mortality. A study of 799 hospitals in eleven states found a higher chance of infections when the nurses’ workload was high (Welton 4). The New England journal of Medicine published a study examining the association between mortality and day-to-day variations in unit level staffing and found that the risk of death is increased two percent each time a patient is exposed to shifts with below target RN staffing ("Safe-Staffing" 3). Researches that have been done have suggested that hospitals can avoid many deaths each year by raising staffing levels to those in the twenty-five percent best hospitals (Aiken 63). Linda...
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...Marie Oliver of York Risk Services Group Insurance Company referred this file for medical case management. Instructions were given to meet with Mr. Jones and assist with coordination of appropriate and related medical care, and identify needs to facilitate recovery. Ms. Oliver would like me to obtain prior medical records from Mr. Jones primary care physician Dr. Wetzel. INTERVIEW SETTING On 2/15/18 I met Mr. Jones at the office of Dr. Vakhariya. Mr. Jones was driven to the appointment by his mother. He is dressed neatly. Mr. Jones is willing to discuss his prior and current medical history. He is alert and oriented. MEDICAL FACTORS AS RELATED TO INJURY Mr. Jones said that while working on a conveyer belt on 2/1/18 he slipped on an...
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...determining medical courses of action. Nurses have long used tradition rather than evidence in making decisions about beside care; to convince them to switch practice, it is useful to draw a comparison between the efficacy of these disparate routes. Our study designed a research question based on the PICOT model for the cardiac floors and designed procedures using the Kotter and Cohen’s Model of Change. In order to study the effect discussed in our PICOT question, a web search was conducted and the quality of each pertinent study reviewed. Introduction In the nursing staff of an adult Cardiac Surgical Care unit, how does the buy-in from the staff for Evidence-Based Practice (EBP) changes in a new Coronary Arterial Bypass Graft (CABG) pathway affect the decreases in infection rate among this patient population when compared to the old way of delivering patient care through nursing tradition in a six month time frame? The formation of a guideline for practice in nursing is not a new occurrence; books and manuals have been a reality for many years. However, in the past these resources lacked the evidence for standards of care, which traditionally have been based on professional consensus and tradition. The Joint Commission has recognized processes that can be measured regarding patient outcomes and care in order to meet standards for Medicare qualification. These standards, known in cardiac care as the Surgical Care Incision Protocol (SCIP), help to guarantee that cardiac surgical patients...
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...Impact and Penetration of Nursing Research It is common nursing knowledge that patient quality of care is directly related to improved outcomes and is based on the safety of the patient. Nurses play a direct role in a patient’s quality of care, because nurses have the most direct contact with the patient. The issues that I noticed in each of the website’s evidence based practices (EBP’s) include nursing education level, staffing levels, working environments, and organizational policy/procedure and infrastructure. According to our Keele text (2007), nurses are expected to know and practice evidence based care to create the best outcome for the individual patient (Keele, 2007, p. 9). Nurses play a significant role in all patient outcomes due to their responsibilities for practicing and advocating for specific standards of practice outlined by EBP and defined within their scope of practice and the Nursing Code of Ethics. Therapeutical nursing practices include not just implementing treatments, but evaluating those treatments’ outcomes. Nursing research is essential in determining patient safety issues and improving patient outcomes due to the nurse being the closest point of care provider for the patient. It is the nurse’s observations that help direct and manage the path that a patient’s care may take. With the nurse as the closest observer of the patient, it only makes sense that nurses play the intricate role in the research of patient improvements or disparities, alike, especially...
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...‐‐‐‐‐‐‐‐‐‐‐‐ 8 GYNECOLOGIC AND GYNECOLOGIC ONCOLOGY SERVICES: FLORIDA HOSPITAL AND WINNIE PALMER HOSPITAL ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 11 COMMUNITY WEEK AND SPECIALTY CLINICS‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐14 TIPS FOR A SUCCESSFUL OB/GYN ROTATION ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 15 LOGGING PATIENT ENCOUNTERS (THE PATIENT PASSPORT) ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 16 CLERKSHIP ATTENDANCE POLICY ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 19 CLERKSHIP OBJECTIVES ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 20 THE CASE PRESENTATION ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 22 ETHICS CASE WRITE‐UPGRADING POLICY ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 23 GRADING POLICY ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 24 GRADING CRITERIA...
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...reported adverse event among adults admitted to inpatient setting. Up to twenty percentages of patients admitted, reported falling of at least once during an inpatient hospital stay period” (Oliver, Healey, & Haines, 2010). The author works at a city hospital located in Gilbert, Arizona and encounters a great amount of orthopedic patients along with other general surgery patients. All patients that are on that floor are at a risk of falls during the first 48 hours after surgery due to anesthesia that is still in the system and pain medication that is scheduled to help ease the patient during the post-surgical time frame. One of the side effects of anesthesia exiting the body is nausea and vomiting which can make the patient feel dizzy and lightheaded, thus making them a great risk for falls. This has been the reason that the topic was chosen; to attempt to improve this issue in the hospital setting and to provide a system in which all hospital staff collaborate to help increase the quality of patient care. The location that is being observed is the post-surgical/orthopedic floor where the author is currently working. A description of risks and concerns are provided and patient outcomes depend on implementing the proposed interventions. The two solutions that are presented are hourly rounding and the importance of an improved nurse call light button and education on proper usage. Each intervention is supported by evidence-based practice peer-reviewed journal articles. The proposal will...
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...Journal of Intensive Care Medicine http://jic.sagepub.com/ The Impact of a Simple, Low-cost Oral Care Protocol on Ventilator-associated Pneumonia Rates in a Surgical Intensive Care Unit Carrie S. Sona, Jeanne E. Zack, Marilyn E. Schallom, Maryellen McSweeney, Kathleen McMullen, James Thomas, Craig M. Coopersmith, Walter A. Boyle, Timothy G. Buchman, John E. Mazuski and Douglas J. E. Schuerer J Intensive Care Med 2009 24: 54 originally published online 17 November 2008 DOI: 10.1177/0885066608326972 The online version of this article can be found at: http://jic.sagepub.com/content/24/1/54 Published by: http://www.sagepublications.com Additional services and information for Journal of Intensive Care Medicine can be found at: Email Alerts: http://jic.sagepub.com/cgi/alerts Subscriptions: http://jic.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav Citations: http://jic.sagepub.com/content/24/1/54.refs.html >> Version of Record - Jan 14, 2009 OnlineFirst Version of Record - Nov 17, 2008 What is This? Downloaded from jic.sagepub.com at UNIV OF THE INCARNATE WORD on April 15, 2013 Original Research The Impact of a Simple, Low-cost Oral Care Protocol on Ventilator-associated Pneumonia Rates in a Surgical Intensive Care Unit Journal of Intensive Care Medicine Volume 24 Number 1 January/February 2009 54-62 # 2009 SAGE Publications 10.1177/0885066608326972 http://jicm.sagepub...
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...well as longer inpatient length of stays. The objective of this study is to measure the incidence and determine the predictors of re-admissions to the Adult Intensive Care Unit. Methods: Medline (1946-present) was searched using combinations of the following search terms ‘Intensive Care Units’ OR ’Critical Care’ AND ‘Patient re-admissions’. The searches were limited to abstracts in English language between 1990 and 2014. This search was then narrowed to ‘core clinical journals’ to increase the quality of the articles but this limitation cut the number of articles down to 2/3rd and even though these articles were saved under a separate folder, eventually all 91 articles were included in the final search. The term ‘Intensive Care Units’ were narrowed to include only ‘burn’, ‘coronary’ and ‘respiratory’ care units. The CINAHL and Cochrane Database search failed to reveal any relevant results. Results: My search generated 33 articles and their review shed light on a few recurrent themes identified as being the reason for early re-admissions. Premature discharge, time gaps between reaching the wards and being seen, lack of attention by ward nurses, lack of experience of medical staff in the wards were some of the themes identified. Conclusions: For a patient, coming back to the ICU is always a cause of concern for physicians, patients as well as their families. After reviewing a significant number of studies, we can see how certain factors have linear and non-linear relationships...
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...gland is part of a bony hollow called the pituitary fossa behind the bridge of the nose and below the brain’s base near the optic nerves. Maya and Pressman (2010) add that the pituitary gland is the most important part of the system because it produces hormones controlling the functions of other endocrine glands. The most common problem occurring in the pituitary gland is the development of a benign growth or tumor. The tumor causes the gland to secrete excess hormone, blocks its production or causes it to malfunction. Other causes of pituitary disorders include traumatic brain injury and pituitary infarction. Although pituitary disorder are able to alter quality of a person’s life significantly, medical or surgical treatment is available where efficient diagnosis is made. The present study investigates the role of imaging modalities in the evaluation of pituitary gland disorders. Particular emphasis is laid on the role of Magnetic Resonance Imaging (MRI) in diagnosing the pituitary gland. Anatomy of the pituitary gland The sellar region of the brain is anatomically complex being bounded by sinus arteroinferiorly, the brainstem posterioly, the dorsum sella, the hypothalamic sellae, the suprasella, and the cavernous sinuses laterally (Drouin, 2010). The hypothelamus consists of a layer of tissue that extends from the...
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...Brandy Eberly of Mackinaw Administrators Insurance Company referred this file for medical case management. Instructions were given to meet with Dale Stolicker and assist with coordination of appropriate and related medical care, and identify needs to facilitate recovery. INTERVIEW SETTING On 6/20/17 I met Mr. Stolicker at the office of Dr. Taha. Mr. Stolicker is alert and oriented. He is willing to provide current and prior medical information. He is open to working with a nurse case manager. Mr. Stolicker’s wife drove him to his appointment. He is able to maneuver using his wheeled scooter. MEDICAL FACTORS Mr. Stolicker said he was working out in the field. He walked over to an area being worked on when a piece of metal that was over...
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...Or Not Too Stay The use of surgical robots has increased greatly and is continuing to grow. Although these robots are already being used they have advantages as well as disadvantages. Surgical robots are only going to improve the outcomes for the patients, surgeons, and hospitals and will keep improving as time goes on, overcoming the disadvantages that are seen today. Many different types of robots are being used to carry out surgical procedures such as the Endowrist, AESOP, Zeus, PROBOT, ROBODOC, SOCRATES and the da Vinci being the most popular. Also there are many specific types of surgical procedures that are being carried out robotically such as urological, gynecological, cardiac, and general surgeries. “Shorter hospital stays, smaller incisions, less blood loss, quicker recovery, less painful, reduced rates of bacterial infections and blood transfusions, eliminating the surgeons hand tremors, more comfort and decrease in fatigue for the surgeon, 3D view, superior suturing skills, reverse fulcrum” are some of the advantages that affect the patient. Disadvantages involved with robot assisted surgery are “high cost, the large size of the robot, lack of compatible instruments and equipment, lengthy set up times, longer operative times, lack of haptic tactile feedback,” but are believed to disappear with more research and time. Surgical robots could be the most successful and most used technology in surgery in the future. “A surgical robot has been defined as a computer-controlled...
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...I. OUT PATIENT DEPARTMENT “Out patient department is defined as apart of the hospital with allotted physical facilities and medical and other staff in sufficient numbers, with regularly scheduled hours, to provide care for patients who are registered as inpatients. Categories of outpatients: • Emergency Outpatients – Patient given emergency care as a result of sudden severe illness or accident. • Referred Outpatients – Patient referred to the OPD by a physician or specialist. • General Outpatients – Patient referred by other physicians, given diagnosis and/or therapeutic services on an outpatient basis. PROCEDURE AT OPD Patient Visits the OPD reception Meet the executive – OPD Fill the OPD form which includes Patient’s Name, Age, Address, Consultants name etc. Pays the required amount at OPD registration counter OPD file preparation by OPD executive Prescription is given by the doctor Further investigation (pathological/radiological) is done if prescribed Consultation charges are to be repaid on every 14th day of previous consultation. Functions of OPD • General Diagnosis and Treatment. • Prescription for further investigation and diagnosis. Organization of OPD Staff of OPD is made up of four major organizational components: 1. Medical Staff. o Most important and central to the organization. o Include the Doctors and Consultants. 2. Nursing staff:...
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...circumstances and characteristics of why patients fall in the hospital setting. The article being critiqued defines a fall as an unexpected drop from a sitting, standing, and lying position, which include an assisted fall (where someone helps guide them to the floor), slipping from a chair to the floor, and when a patient is found on the floor (Hitcho et al., 2008). This critique will discuss data collection, data management, analysis, and interpretation of the findings. The Washington University Institutional Review Board gave their approval for this study. Written consent was waived due to the fact that this study was part of a hospital-based project to improve quality. The study did not pose any risks to the patients as the patients were not put in any situation to induce a fall, and no precautions were taken away from patients that prevent falls. Several sources and a comprehensive fall data collection tool was used to collect data on the patients that fell during their hospitalization which included: the database of adverse events, the electronic medical record, the paper chart, and patient/ family interviews, where no objections to being interviewed were noted (Hitcho et al., 2008). The variables that were identified in the study were the patient’s information, details of the fall, contributing factors, injuries sustained, and the actions that were taken as a result of the fall. The patient information included the patient demographics, cognitive status, admitting diagnosis, fall...
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...J Nurs Care Qual Vol. 27, No. 1, pp. 6–12 Copyright c 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Missed Nursing Care, Staffing, and Patient Falls Beatrice J. Kalisch, PhD, RN, FAAN; Dana Tschannen, PhD, RN; Kyung Hee Lee, MPH, RN Patient falls in hospitals continue to be a major and costly problem. This study tested the mediating effect of missed nursing care on the relationship of staffing levels (hours per patient day [HPPD]) and patient falls. The sample was 124 patient units in 11 hospitals. The HPPD was negatively associated with patient falls (r = − 0.36, P < .01), and missed nursing care was found to mediate the relationship between HPPD and patient falls. Key words: falls, missed nursing care, staffing P to 12% of hospitalized patients experience at least 1 fall during their hospital stay.1 A fall is defined as any event in which patients are found on the floor (observed or unobserved) or an unplanned lowering of the patient to the floor by staff or visitors.2 In 2008, and 2010, falls were identified as one of the top 10 sentinel event categories by the Joint Commission.3 Fall rates in hospitals range from 4 to 14 falls per 1000 patient days.4 With the adoption of the Centers of Medicare and Medicaid rule, which no longer reimburses hospitals at the higher diagnosis related group for the care and treatment associated with patient falls that occur during hospitalization, a clearer understanding of what factors U Author Affiliations: School of Nursing...
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