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Work Health Safety Assessment



Work Health Safety Assessment

Rajandeep Kaur

[Name of the Institution]

Work Health Safety Assessment

Introduction

Work and safety in workplace imply that the workers in the workplace are ensured safety and abstinence from harm. The workplace is an environment which can be conclusive of many hazards that affect the worker socially, economically and psychologically. Therefore the workplace ensures the health and safety assessments to determine, identify and resolve the potential risks in the health and safety of workers in the work-place. The thorough assessment of persistent or predicted risk factors. Hazards are continuously assessed to measure the level of risk involved. The recognition of risk leads to the adoption of appropriate measures to avert or reduce their impact. Therefore the effective management of risk improves workers health. The global health framework describes that certain trans-national economic behaviours can contain the incomes for certain groups and workers leading them to find opportunities in informal economy, leading to social stratification, differential exposure and health inequalities leading to a decline in essential health care,nutrition and in many cases exposure to risk to sustain economic well being CITATION Did01 \l 1033 (Diderichsen F, 2001). The most vulnerable groups who become targeted to the workplace hazards are those in the lower management of labour, who are directly exposed to the threat. Australia has recently incorporated within its national policy to make arrangements for effective risk assessment across the country. The regulations, acts and agencies have been formed as part of the initiative which defines workplace standards, responsibilities and penalties for not complying with them CITATION WHS18 \l 1033 (WHS/OH&S acts, regulations and codes of practice, 2018). The Australian government regulates workplace safety through agencies like Safe Work Australia, who is primarily responsible for minimising the risk eminent in the workplace CITATION Abo19 \l 1033 (About us, 2019).

Thesis Statement

The paper incorporates the importance of work health safety and how the risk assessment can minimize the effects of risks exposed to the employes in the workplace. The paper focuses on hazard identification, the vulnerable groups at risk, and involved and strategies to minimize the associated risks by employing relevant strategies.

Discussion

Key agencies institutions and influences in structures

The goals of the work health safety organisations lead to a better comprehension of the ideals of occupational health safety. The Safe Work Australia initiative is a statutory agency with the primary objective of improving health and safety conditions for workers in their working spheres CITATION Saf19 \l 1033 (Safe Work Australia Act 2008, 2019). The agency through its codes of implementation ensures a reduction in the government, industry and unions towards injury, disease and death of workers in the workplace.

Globalisation and Work health safety.

The World Health Organization and International Labour Organization illuminate health and safety workers in the developed developing states. The relations between e employers and the workers change with little and no regard for working conditions in the developing states. The multinationals all around the world are accused of inequalities in working conditions through the liberalization and globalization projects CITATION Pau99 \l 1033 (Mitchel, 1999). The women, children, poor and men especially working in the mines are exposed to higher risks and are vulnerable when it comes to disease, injury and death. These groups are vulnerable due to lack of policies and their implementation, the spell of poverty which forces them to earn., and income inequalities which lead to a diminishing intake of nutrition and health care facilities.

SDG and Work Health Safety

The sustainable developments goals address the vulnerable groups and the work environment challenges they face due to them. They incorporate and recognize the need for unpaid and equal wages and policies to promote shared responsibility through gender equality CITATION HOW \l 1033 (HOW TO MANAGE WORK HEALTH AND SAFETY RISKS). The SDG goal for decent work and economic growth similarly protects labour rights and secure working environment, including the migrant worker and those in risk-prone employment CITATION Rel19 \l 1033 (Relevant SDG Targets related to Working Conditions, 2019). This also renders the effective management in the workplace environments to reduce ongoing occupational illnesses, diseases and deaths. The management can cohesively work to induce healthy lifestyles by ensuring work health standards and eliminating risks through risk managementCITATION The19 \l 1033 (Improve Occupational Health, 2019).

Ethics in the work health safety

Ethics play an important role in the reduction and limiting the risk associated with a healthy workplace for the employees. The management shall mitigate and respond to the conflicts and vacuums which to the risk escalation in a workplace CITATION Koh95 \l 1033 (Koh D, 1995). The moral obligation of knowing the risk and yet exposing the workforce to the risks, and not administrating the risks identified by the workforce for them is more of an ethical before it becomes a management issue. The management is responsible for creating awareness and training amongst individuals who might be at risk in their working spheres and taking measures before any issue arises. Management is enti8rely responsible for implementing guidelines given under government policies to overcome and reduce risks at the workplace CITATION LRo87 \l 1033 (L Rosenstock, 1987).

Case Study

The office manager of a law firm conducted a risk assessment at their office, which is also neighboured by a construction site of a building under construction. A staff of 50 lawyers and associates work at the office with two associates on the wheelchair. The welfare facilities of the office are available to the employees such as kitchen and restroom facilities on all three floors. The office space is cleaned regularly with the cleaning chemical stored in the sanitation storage rooms. The office timing is from 9 am to 5 pm. A risk assessment survey was carried out in the office by the quality assurance manager. He found that apart from existing risk factors, Asbestos was also found in the building. The residue must have remained since the construction of the building, and insulation fittings in the office.

Work Health Risk Assessment Sheet.

The risk Matrix

1-5 from least to most likely to happen.

1-4 defines the severity at maximum on 4.

Task/Scenario

Hazards

Associated Harm

Existing Risk Controls

Current risk Rating

Additional controls are required

Residual Risk rating

Contact with bare wires and plugs.

Electrical

Faulty wires and fittings; electrical shocks

Burns

Lead to fires.

Reporting defective plugs and wires.

Replacing equipment

Staff asked no to bring appliance along on work.

2

Regular safety checks shall be maintained in the office.

1

Work station environment

Computers

Upper limb and eyesight disorders.

Breaks scheduled

Lightning and temperature

Posture maintain sitting equipment

8

Supervisors to ensure breaks

Avoiding pressure on sight by fixing

blinds and

sunlight

exposure during

work.

2

Office setup and interior.

Slips and trips

The staff may slip or trip and fall from objects.

Precaution boards for wet floor

Railings and fixed cables.

Cleaning office past off-timings.

2

Trained housing managing fewer issues like wet floor cleaning.

The floor shall be carpeted instead of slippery tiles.

1

Inhaled

Asbestos

Harm lungs of employees.

Precaution signs for the asbestos.

Partitioning the between

the existent residue of partition.

9

The asbestos may not be disturbed and dealt with

proper immunization.

3

Alienation and work responsibilities

Stress

Work deadlines

Behaviour and attitudes of co-workers.

Training in staff to inculcate time management.

No discrimination policy

6

Psychologists can be recruited for the staff and manage their work.

Communication and unconscious bias can be reduced.

8

Smoking and

Burning of appliances.

Fire

Suffer from smoke inhalation

Burns from fire.

Fire exits in the building

Fire extinguishers

3

The passage for disabled /on wheelchairs shall be constructed alongside the fire exit channels.

1

Findings

The case study reflects upon the risks that are persistent in the work environment of the Law firm and that can potentially affect the workers in the working environment. The risks portrayed in the work environment suggest that risk is high for computers, fire, stress, electricity and Asbestos. It is assessed that after risk controls for the electrical risks the residual risk has reduced to 1, as the wire and electrical shocks can be easily averted through these measures.

The installation of furniture posed a high risk of eyesight and upper limb body posture, however, the risk has been reduced to two as the supervisors regulate and ensure break timings and the furniture has been installed for reducing the risk to 2. Moreover, the risk involved with Asbestos was high to 9 as they involve life-threatening risks for the employs but the separation of the area from the workplace has contained the risk assessment. Similarly the stress in employs is considered one of the leading causes of lower productivity and exposure of employs to higher psychological risk, however, the risk is further reduced if a psychologist is employed to reduce the stress levels amongst those facing disparities in the workplace.

The slips and trips are a common occurrence and the risk can be easily reduced by taking vigilant preventive measures. Show Although the firm has undertaken measure to avert the risks, however, there are still strategies that can be taken to further reflect upon the issues and eliminate the threats posed to employees by working in the Law firm. In this regard women, those of colour and the disabled shall be managed according to their needs, for instance, those who operate on wheelchairs shall have their own fire exit and those of who get stressed should be managed according to their respective needs as mentioned in the Work Health Risk Assessment Sheet.

References

BIBLIOGRAPHY About us. (2019). Retrieved from Safe Work Australia: https://www.safeworkaustralia.gov.au/about-us

Diderichsen F, E. T. (2001). The social basis of disparities in health. In Challenging Inequities in Health: From Ethics to Action. (pp. 13–23). New York:: Oxford University Press.

HOW TO MANAGE WORK HEALTH AND SAFETY RISKS. (n.d.). Retrieved from Safe Work Australia: https://www.safeworkaustralia.gov.au/system/files/documents/1702/how_to_manage_whs_risks.pdf

Improve Occupational Health. (2019). Retrieved from Sustainable development Goals: https://sustainabledevelopment.un.org/partnership/?p=885

Koh D, M. L. (1995). Health and safety ethics for management. Asia Pac J Public Health. , 144-147.

L Rosenstock, A. H. (1987). Ethical dilemmas in providing health care to workers.

Mitchel, P. (1999). The impact of globalisation on health and safety at work. World Health Organisation and the International Labour Organisation.

Relevant SDG Targets related to Working Conditions. (2019). Retrieved from International Labour Organisation: https://www.ilo.org/global/topics/dw4sd/themes/working-conditions/WCMS_558586/lang--en/index.htm

Safe Work Australia Act 2008. (2019). Retrieved from Federal Register of Legislation: https://www.legislation.gov.au/Details/C2009A00084

WHS/OH&S acts, regulations and codes of practice. (2018). Retrieved from Department of Industry, Australian Government. : https://www.business.gov.au/risk-management/health-and-safety/whs-oh-and-s-acts-regulations-and-codes-of-practice

Subject: Healthcare and Nursing

Pages: 5 Words: 1500

Wound

HLTENN006

[Author Name(s), First M. Last, Omit Titles and Degrees]

[Institutional Affiliation(s)]

Author Note

[Include any grant/funding information and a complete correspondence address.]

Holistic Assessment of Patient

Medical History and Examination

A widowed 70 years old lives in a retirement village with a supportive son and 4 grandchildren. She got admitted with acute abdominal pain and tenderness having generalized abdominal swelling after one month of hysterectomy and developed a dehiscence wound. The patient was examined and suggested to have a split-thickness skin graft. She also refused to take a diabetic diet. She is under close observation in wound care management however, she was physically active and alert.

Types of Wound

Dehiscence Abdominal Wound

Dehiscence wound is a major wound after an abdominal surgery that can lead to serious complications. Wound dehiscence can be produced due to a problem with suturing. There is various kind of suture that often cause dehiscence. It is formed as a result of the disruption of a wound. Certain factor such as fever, infection and surgical incision can interfere with the healing of the wound.

Pressure ulcer

Usually develop due to the prolonged stay on the bed, usually observed in elder people. It progresses because of pressure and compression of the blood vessels.

Burn injury

These are usually caused by the burn and can damage skin superficially. It may cause a blister and painful skin.

Split Thickness Skin Graft Wound

It is standard management usually done for non-healing wounds. It involves the care and closure of wound which utilizes epidermis and dermis to enable skin heal and subordinate ways.

Wound Management Principles

Management of an open wound is complicated as the wound is a disruption which can lead to infection (Ramshorst et al., 2010). The management can be done by using vacuum-assisted closure. The wound management of this case was completed by split-thickness graft. This kind of graft would take 3 weeks to completely heal the wound. This is a procedure to heal and repair the abdominal wall of this patient. Antibiotic therapy would be suggested for the prevention of the infection. Risk patients would be more at risk if the age is above 65 years. Obese patients, systematic and other local infections, having previous surgery, dirty and soft skin is also associated with a high risk of these wounds. Inappropriate wound management, carelessness, excessive coughing, fever, intra-abdominal pressure and constipation can lead to major complication to dehiscence wound (Ramshorst et al., 2010). Accurate and precise calculation of the wound such as oedema, seroma and signs of swelling. Disrupt skin, haemorrhage and abdominal pressure and anatomical region would be assessed. Odour, colour, and pain would be noticed.

2. Evaluation of Wound

Category

Dehiscence Abdominal Wound

Pressure Ulcer

Split Thickness Skin Graft Wound

Burn Injury

Wound bed status

Painful, disruption of the skin.

Red, painful blister

Red skin

Painful blisters

Wound characteristics

Dull wound, presence of infection, dehiscence and slough

Reddened, blistering skin and itching

Dehiscence

Red in colour with tenderness and swelling

Width=5 cm length=7cm, depth=1cm (approximate values)

Width=0.5 cm length=0.3cm, depth=0cm (approximate values)

Width=5 cm length=7.5cm, depth=0cm (approximate values)

Width=1 cm length=1cm, depth=0cm (approximate values)

Condition of skin

Degenerative

Deteriorating

Red and blisters

Wound exudate

Formed. Exudate is a mass of tissue and fluid that has leaked out of blood vessels or an organ, particularly in swelling. Cuts, infection or inflammation caused exudate to form.

Nil

A mass of fluid observed.

Nil

Other assessment

Itching

Scar assessment and pain assessment

Itching and burning

3. The expectation of Wound Healing

Dehiscence Abdominal Wound

The healing process may be prolonged by diabetes type II disease.

The detection of infection can help prevent the increasing healing process

Mobility and movement should be implied in the context of the abdominal area and abdomen.

The time of healing varies with integrity and nutrition intake. Different stages of wound healing are described in four steps, including hemostasis, swelling, proliferation and tissue remodelling. Neutrophils and platelets, along with macrophages work in coordination to prepare a mass to stop bleeding and help in restoring healthy tissue. First, blood clotting occurs that help to stop bleeding and form a protective barrier against the external environment. Then following blood clotting, the phase of inflammation occurs, which assists the growth of tissue, and later remodelling and maturation of tissue heal the wound.

Split Thickness Skin Graft Wound

After surgery, it took 3 to 5 weeks to heal wounds.

Mobility and stretching may injure the site.

Skin tear or redness can itch surrounding skin.

The systematic process of hemostasis involves repair, swelling and physiology of healing. Different stages of wound healing are described in four steps, including hemostasis, swelling, proliferation and tissue remodelling. Neutrophils and platelets, along with macrophages work in coordination to prepare a mass to stop bleeding and help in restoring healthy tissue. First, blood clotting occurs that help to stop bleeding and form a protective barrier against the external environment. Then following blood clotting, the phase of inflammation occurs, which assists the growth of tissue, and later remodelling and maturation of tissue heal the wound.

Burn Injury

The time frame of healing of the burning wound is one to three weeks.

Blisters can be infected that may delay the healing process.

If there is blood coming from blisters, then healing would be delayed.

The physiology of wound healing consists of blood clotting, inflammation, proliferation and maturation stages. Different stages of wound healing are described in four steps including hemostasis, swelling, proliferation and tissue remodelling. Neutrophils and platelets, along with macrophages work in coordination to prepare a mass to stop bleeding and help in restoring healthy tissue. First, blood clotting occurs that help to stop bleeding and form a protective barrier against the external environment. Then following blood clotting the phase of inflammation occurs which assists the growth of tissue and later remodelling and maturation of tissue heal the wound.

Pressure Ulcer

Pressure ulcers are an injury to the skin due to prolonged pressure on skin tissue.

In this integrated skin become thin and may have blood supply less than normal.

Moisture is a reason for the pressure ulcers.

Repositioning of the patient will help the wound to heal within the time frame.

Physiology of wound is pressure, shearing, friction and moisture.

4. Wound Management Plan

Category

Dehiscence Abdominal Wound

Pressure Ulcer

Split Thickness Skin Graft

Burn Injury

Moist wound healing

Is required to keep the wound heal faster, an action plan for the management of wound, would take the least time to heal, less infection risk, this procedure promoted the production of collagen and protective growth factors that will enhance healing and repair.

Required to provide adequate time for healing, to reduce infection and enhance the healing process.

It is required to be managed by moist wound healing as this would prevent the desiccation and excavating of the wound. Mechanical damage can be repaired

Not required.

Skin & risk assessment

Skin will lead the wound to develop infection and healing will be slow, grafting will make the skin tough to absorb abdominal pressures and will make the skin intact.

Blistering and rough skin. Any fungal or bacterial infection may lead to fever and other skin disorders (Boyko, Longaker & Yang, 2018).

Fungal or other skin infections may lead to skin disorders and fever.

Blistering requires to be properly handled such as the risk of infection and bleeding.

Wound cleaning

An important step for the cleansing of the wound includes removal of debris and dead cells, and dressing scums, and to reduce contamination. Use antiseptics for cleansing along with an appropriate dressing. The dressing will prevent infections, always use sterile gloves for cleansing.

Special dressing such as alginate dressing which will enhance healing as it contains seaweed (Boyko, Longaker & Yang, 2018). Hydrocolloid dressing gel.

Use of aquacel can prevent patient discomfort and healing time would be short. Aquacel is used as a primary dressing for wounds. It is prepared from sodium carboxymethylcellulose. The dressing engrosses and interrelates with wound exudate and forms a soft, gel of hydrophilic. It is permeable that ruses bacteria and imitates to the curves of the wound whereas having a micro-environment that is supposed to enable the healing process.

Antibiotic ointment will be used as the skin wound is superficial and at the epidermis.

Pressure support and relieving devices

Prevention programs

Regular dressing, cleansing of the wound, use of sterile gloves, adequate nutrition, cotton swab and antibiotic medications, foams and dry dehiscence films. Safe and clean environment and proper advocacy of prevention of wounds.

Prescribed dressing regularly, less contact with air and water to prevent contamination, sterile gloves

Regular dressing and less comfort with the environment particularly water and contaminated air. A safe environment is recommended.

Avoid in contact with air and water. The dressing should be dry and warm. Ointment therapy regularly. It is the therapy used to treat wounds by providing the viscous and greasy external environment. It helps in healing as it emulsifies bases and dryness is removed by providing a moisturizing environment for wounds. It removes irritation and ease in application of dressings on wounds.

Selection of wound dressing

Hydrocolloid dressing. Saline solution with sterile gloves, dry dehiscence agents, antiseptics for dressing (Ramshorst et al., 2010).

Alginate dressing

Aquacel, a Hydrofiber wound dressing.

Antibiotic Ointment

Secondary dressing

Pain management timeframe

Pain killers Panadol 1000mg. healing in 4 to 5 weeks

Pain killer

Painkiller

Ointment and pain-relieving cream for skin

5. Health Education

a) Dehiscence Abdominal Wound

Adequate nutrition is required for the nourishment and energy to regain strength. Bed rest with minimum movement as the wound is located at the abdomen (Ramshorst et al., 2010). Eggs, zinc, grains and protein diet can help patients recover faster from wounds as eseential minerals and nurtoetes are provided by these food items. These food items are essentially required to help the patient provide enough energy, and requirements of proteins, mineral to enhance wound healing. Multidisciplinary care management, including clean and safe environment, suitable temperature, appropriate dressing. Use of analgesics can help managing pain. The tenacity of analgesia is not only to ease patients feel well but to enable primary ambulation, satisfactory oxygenation and diet. It is used to diminish the pressure reaction to surgery, enhances wound healing, and decrease the threat of emerging chronic wound soreness.

b) Pressure Ulcer

An appropriate and balanced diet along with supplements which includes sodium and calcium. Bed rest and minimum contact with air and water, suitable room temperature and appropriate dressing (Qu et al., 2018). The tenacity of analgesia such as the use of pain killer is not only to ease patients feel well but to enable primary ambulation, satisfactory oxygenation and diet. It is used to diminish the pressure reaction to surgery, enhances wound healing, and decrease the threat of emerging chronic wound soreness.

c) Split Thickness Skin Graft Wound

An appropriate and balanced diet is required along with the supplement. Multidisciplinary care management, including clean and safe environment, suitable temperature, appropriate dressing. Cleaning and proper dressing would help the healing process faster.

d) Burn Injury

Appropriate care and minimum contact with air and water, regular dressing and care. Education regarding adequate nutrition such as: to consume vegetables rich in vitamin C because it supports healing. Zinc, grains and protein diet can help patients recover faster from wounds. These food items are essentially required to help the patient provide enough energy, and requirements of proteins, mineral to enhance wound healing. Maintain hygiene near burnt skin.

6. Pain Management

Category

Dehiscence Abdominal Wound

Pressure Ulcer

Split Thickness Skin graft Wound

Burn Injury

Medications

Pain killer

Pain killers

Pain killer

Antibiotic ointment

Pain management

Pain-relieving cream for skin

Frequency of dose

Endone twice a day, esomeprazole once daily, metformin twice a day, hydromorphone twice a day and Panadol 3 times in a day.

Endone twice a day, esomeprazole once daily, metformin twice a day, hydromorphone twice a day and Panadol 3 times in a day.

Hydromosphone twice a day. Panadol 3 times a day. Aquacel as per prescription.

Three times a day

Justifications for medication

Panadol and endone will be administered to relieve pain, Esomeprazole will be used to relief acidity of the stomach.

Panadol and endone will be administered to relieve pain, Esomeprazole will be used to relief acidity of the stomach.

Aquacel and Panadol will be administered to relieve pain.

For pain relief

Patient education for pain management

Adequate sleep to increase the healing process (Ramshorst et al., 2010). Avoid stress and also avoid aggravating factors such as inappropriate diet and unnecessary movement.

Adequate sleep to increase the healing process (Qu et al., 2018). Avoid stress and also avoid aggravating factors such as inappropriate diet and unnecessary movement (LeBlanc et al., 2018).

Appropriate diet and sleep are essentially important to improve healing.

Proper sleep to increase the healing process. Avoid stress and also avoid aggravating factors such as inappropriate diet and unnecessary movement.

References

van Ramshorst, G. H., Nieuwenhuizen, J., Hop, W. C., Arends, P., Boom, J., Jeekel, J., & Lange, J. F. (2010). Abdominal wound dehiscence in adults: development and validation of a risk model. World journal of surgery, 34(1), 20.

Caneppele, L., Conceicão, G. N. R., Eknoian, M. W., da Silva Macedo, C., Narcizo, A., & de Godoy Oriani, P. C. (2018). U.S. Patent No. 10,016,310. Washington, DC: U.S. Patent and Trademark Office.

Qu, J., Zhao, X., Liang, Y., Zhang, T., Ma, P. X., & Guo, B. (2018). Antibacterial adhesive injectable hydrogels with rapid self-healing, extensibility and compressibility as wound dressing for joints skin wound healing. Biomaterials, 183, 185-199.

Boyko, T. V., Longaker, M. T., & Yang, G. P. (2018). Review of the current management of pressure ulcers. Advances in wound care, 7(2), 57-67.

LeBlanc, K., Campbell, K. E., Wood, E., & Beeckman, D. (2018). Best Practice Recommendations for Prevention and Management of Skin Tears in Aged Skin: An Overview. Journal of Wound Ostomy & Continence Nursing, 45(6), 540-542.

Subject: Healthcare and Nursing

Pages: 2 Words: 600

Wound

Wound Management

Author

Institution

Case 1

Mr. Will Jakson, a 77-year-old man is admitted to the ward for pain and wound management having recurring pain from his wounds. The patient has diabetic foot ulcer underneath his left toe, arterial ulcer on his lower right leg, and pressure ulcer on his sacrum bone L5, massive bruise over his face due to a recent fall, and has 2nd degree burn on his left arm. Patient has a medical history of Ischemic heart disease (IDH), chronic obstructive pulmonary disease (COPD), Gastro-oesophageal reflux disease (GORD), Postural hypotension, and diabetes. And Patient is taking Telmisartan 40 mg. b.d, Ventolin 4 puffs t.d.s, Esomeprazole 20 mg daily, Lantus 20 units (mane), warfarin 2 mg (daily), Frusemide 20 mg b.d. PRNs, Endone 10mg (tds), Hydromorphone 2 mg (b.d). He is using a wheelchair for mobility. In this case study we will examine the patient’s current condition of wound, discuss in detail the causes and effects of those wounds, and will recommend the treatment for such conditions.

Patient’s Assessment

Medical history of the patient is discussed above in detail. Patient has total of 4 wounds; arterial ulcer wound on the right leg, diabetic foot ulcer wound below his left toe, pressure ulcer wound on his sacrum bone, and second degree burn on his left hand.

Arterial Ulcer

Arterial ulcer is developed by poor delivery of blood to lower part of the body. The condition is also called poor perfusion in which lower extremities lack nutrient-rich blood resulting in weak tissue and skin ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"kAOEISHW","properties":{"formattedCitation":"(Spentzouris & Labropoulos, 2009)","plainCitation":"(Spentzouris & Labropoulos, 2009)","noteIndex":0},"citationItems":[{"id":437,"uris":["http://zotero.org/users/local/uHsb2Xzj/items/8YXVHEB7"],"uri":["http://zotero.org/users/local/uHsb2Xzj/items/8YXVHEB7"],"itemData":{"id":437,"type":"article-journal","title":"The Evaluation of Lower-Extremity Ulcers","container-title":"Seminars in Interventional Radiology","page":"286-295","volume":"26","issue":"4","source":"www.thieme-connect.com","abstract":"Thieme E-Books & E-Journals","DOI":"10.1055/s-0029-1242204","ISSN":"0739-9529, 1098-8963","journalAbbreviation":"Semin intervent Radiol","language":"en","author":[{"family":"Spentzouris","given":"Georgios"},{"family":"Labropoulos","given":"Nicos"}],"issued":{"date-parts":[["2009",12]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Spentzouris & Labropoulos, 2009). Due to lack of good blood supply, tissues in the area lack oxygen resulting in killing those tissues. Because of dead tissues, open wound is formed over the skin in that area. In this condition, it is hard for a patient’s body to heal the wound as it lacks adequate blood supply ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"YN26jetN","properties":{"formattedCitation":"(\\uc0\\u8220{}Arterial Ulcers,\\uc0\\u8221{} 2012)","plainCitation":"(“Arterial Ulcers,” 2012)","noteIndex":0},"citationItems":[{"id":423,"uris":["http://zotero.org/users/local/uHsb2Xzj/items/GMXZXRQD"],"uri":["http://zotero.org/users/local/uHsb2Xzj/items/GMXZXRQD"],"itemData":{"id":423,"type":"webpage","title":"Arterial Ulcers","container-title":"WoundSource","abstract":"Information on arterial ulcer symptoms, causes, complications, diagnosis and treatment of arterial ulcer wounds.","URL":"http://www.woundsource.com/patientcondition/arterial-ulcers","language":"en","issued":{"date-parts":[["2012",12,22]]},"accessed":{"date-parts":[["2019",5,28]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (“Arterial Ulcers,” 2012). Prolonged presence of such wound results into the development of arterial ulcer. Lack of blood supply usually occurs when arteries becomes narrow or completely blocked.

Treatment, Precaution and Wound Management

Feet should be examined daily for development of any sores or just change in color. Smoking should be quit immediately under such circumstances. Sitting and standing for prolonged period, sitting with crossed legs, and cold temperature should be avoided. Good footwear, which does not put pressure at a certain point should be used ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"DSfyt9ny","properties":{"formattedCitation":"(\\uc0\\u8220{}Arterial Ulcers,\\uc0\\u8221{} 2012)","plainCitation":"(“Arterial Ulcers,” 2012)","noteIndex":0},"citationItems":[{"id":423,"uris":["http://zotero.org/users/local/uHsb2Xzj/items/GMXZXRQD"],"uri":["http://zotero.org/users/local/uHsb2Xzj/items/GMXZXRQD"],"itemData":{"id":423,"type":"webpage","title":"Arterial Ulcers","container-title":"WoundSource","abstract":"Information on arterial ulcer symptoms, causes, complications, diagnosis and treatment of arterial ulcer wounds.","URL":"http://www.woundsource.com/patientcondition/arterial-ulcers","language":"en","issued":{"date-parts":[["2012",12,22]]},"accessed":{"date-parts":[["2019",5,28]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (“Arterial Ulcers,” 2012).

Diabetic Foot Ulcer

High glucose level in blood tightens the arteries and vessels of the body which affects the flood of blood and oxygen throughout the body CITATION DrC12 \l 1033 (Dr. Christian Münter, 2012). Healing abilities of the body fails under such circumstances, patient even loses the ability to feel pain ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Na59BcLm","properties":{"formattedCitation":"(Vinik, 2008)","plainCitation":"(Vinik, 2008)","noteIndex":0},"citationItems":[{"id":442,"uris":["http://zotero.org/users/local/uHsb2Xzj/items/NELBYT9S"],"uri":["http://zotero.org/users/local/uHsb2Xzj/items/NELBYT9S"],"itemData":{"id":442,"type":"chapter","title":"Diabetic Neuropathies","container-title":"Controversies in Treating Diabetes: Clinical and Research Aspects","collection-title":"Contemporary Endocrinology","publisher":"Humana Press","publisher-place":"Totowa, NJ","page":"135-156","source":"Springer Link","event-place":"Totowa, NJ","abstract":"SummaryClinical trials of agents for the treatment of diabetic neuropathy have been confronted with a lack of agreement on appropriate endpoints and have generated controversy on why ample demonstration of efficacy of an agent in animal studies has not been readily translated into success in human clinical trials. There has been a failure to recognize that the relief of symptoms does not equate to change in the underlying biological disorder and great disagreement on indices, which can reliably measure changes in nerve function which translate into changes in the quality of life, activities of daily living, and health of the individual. Here, one will focus on the various measures that have been used for the evaluation of symptoms and those that quantify nerve function and compare and contrast the reasons for failure of different measures neurological deficits, prevention of degeneration of specific small fiber, large fiber and autonomic nerve deficits and those that have potential for reversal of these deficits.","URL":"https://doi.org/10.1007/978-1-59745-572-5_8","ISBN":"978-1-59745-572-5","note":"DOI: 10.1007/978-1-59745-572-5_8","language":"en","author":[{"family":"Vinik","given":"Aaron I."}],"editor":[{"family":"LeRoith","given":"Derek"},{"family":"Vinik","given":"Aaron I."}],"issued":{"date-parts":[["2008"]]},"accessed":{"date-parts":[["2019",5,28]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Vinik, 2008). If not treated in early stages, can result into an infection which will later on become an open wound. Around 15 percent of diabetic patients are affected by foot ulcers.

Treatment, Precaution and Wound Management

To treat the wound, silver releasing dressings should be applied on the infected area and antibiotics should be prescribed to the patient. Infection should be treated with surgical debridement and be drained properly. Moisture dressing should never be used for DFU, it may result into life threatening situations CITATION DrC12 \l 1033 (Dr. Christian Münter, 2012).

Pressure Ulcer

Pressure Ulcer or Pressure sore occurs due to immobility, this mostly happens to a person who cannot move easily CITATION Nor17 \l 1033 (Nordqvist, 2017). It effects specially on bony part of body, in our case it develops on the sacrum bone of the patient. Due to his inability to move without assistance, patient stays in one position for a long time. This prolonged stay in one position produces pressure on the sacrum bone affecting blood circulation to lower part of the body ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"5uvXAWMj","properties":{"formattedCitation":"(Black et al., 2007)","plainCitation":"(Black et al., 2007)","noteIndex":0},"citationItems":[{"id":443,"uris":["http://zotero.org/users/local/uHsb2Xzj/items/I5V73S67"],"uri":["http://zotero.org/users/local/uHsb2Xzj/items/I5V73S67"],"itemData":{"id":443,"type":"article-journal","title":"National Pressure Ulcer Advisory Panel's Updated Pressure Ulcer Staging System","container-title":"Advances in Skin & Wound Care","page":"269","volume":"20","issue":"5","source":"journals.lww.com","abstract":"An abstract is unavailable.","DOI":"10.1097/01.ASW.0000269314.23015.e9","ISSN":"1527-7941","language":"en-US","author":[{"family":"Black","given":"Joyce"},{"family":"Baharestani","given":"Mona Mylene"},{"family":"Cuddigan","given":"Janet"},{"family":"Dorner","given":"Becky"},{"family":"Edsberg","given":"Laura"},{"family":"Langemo","given":"Diane"},{"family":"Posthauer","given":"Mary Ellen"},{"family":"Ratliff","given":"Catherine"},{"family":"Taler","given":"George"},{"family":"Panel (NPUAP)","given":"and The National Pressure Ulcer Advisory"}],"issued":{"date-parts":[["2007",5]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Black et al., 2007). First sore develops on the affected area and if not treated well, it rapidly develops into a wound and ulcer. Bitain with or without the presence silver should be used as they are comfortable dressing and are best solution for the wounds which are at the risk of become deadly infection at grade 3.

Treatment, Precaution and Wound Management

Pressure should be removed by adjusting the patient’s posture with the help of foam pads or pillows. Mild wound can be cleaned with water and soap but in the case of open wounds with presence of infection, saline solution should be used for cleaning. Frequently moving the patients not only prevent pressure ulcer from developing, but it will be of great benefit in later stages also. Dead tissues should be removed for proper healing and the wound should always be dressed after cleaning. Oral antibiotics and antibiotic creams are also a great help in treating the infection CITATION Nor17 \l 1033 (Nordqvist, 2017).

Second Degree Burn

Our patient is also affected by a 2nd degree on his left arm. Epidermis and Dermis layers of the skin are effected by Second degree burn and the affected area swells up and appears red. Main characteristics of second degree burn are; deep redness, affected area appearing shiny, and the area is painful to touch CITATION Vil19 \l 1033 (Villines, 2019). It can be caused by many reasons starting from flames, contact with hot object, sunburn, electricity or chemicals. In our case, patient has spilled a hot coffee on his hand which results in second degree burn CITATION Dae07 \l 1033 (Daeschlein G, 2007)

Treatment, Precaution and Wound Management

First Aid treatment of the wound of a second-degree burn is to apply antibiotic ointments. The wound should be cleaned daily so that dead skin and ointment should be removed properly CITATION Vil19 \l 1033 (Villines, 2019). These processes excel the healing process of the wound.

Patient is also affected with a bruise on his face due to fall and after careful examination it is realized that it is not such a major issue compared to the other wounds the patient had. So, this bruise will not be discussed here in detail.

Case 2

Mr. Miriam Gold, 85-year-old women is admitted to the ward for palliative treatment having swear pain from her wounds. The patient has malignant wound on her left groin, and venous ulcer on her leg. Patient has a medical history of Chronic obstructive pulmonary disease (COPD), Gastro-oesophageal reflux disease (GORD), and Coronary artery bypass grafting (CABG) has performed on the patient. Patient is taking Fentanyl 200 mcg and Midazolam 10 mg. Her malignant wound is releasing a lot of puss and she also have a cervical cancer.

Patient’s Assessment

Medical history of the patient is discussed above in detail. The Patient has a total of 2 wounds; malignant wound on her left groin which is producing a lot of puss and have very a strong smell, and venous ulcer which is not recovering.

Malignant Wound

Cancerous cells penetrate the patient’s skin and the vessels supporting the area causing the veins to swell up, this phenomenon results in the death of tissues. An open wound or cavity is formed on the affected surface of the skin. Malignant wound grows with time and characteristics are access bleeding, puss, strong smell, and swear pain effecting the way of life ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"XyCEHQzO","properties":{"formattedCitation":"(Wen & Kesari, 2008)","plainCitation":"(Wen & Kesari, 2008)","noteIndex":0},"citationItems":[{"id":193,"uris":["http://zotero.org/users/local/uHsb2Xzj/items/YU8GJFQP"],"uri":["http://zotero.org/users/local/uHsb2Xzj/items/YU8GJFQP"],"itemData":{"id":193,"type":"article-journal","title":"Malignant Gliomas in Adults","container-title":"New England Journal of Medicine","page":"492-507","volume":"359","issue":"5","source":"Taylor and Francis+NEJM","abstract":"Malignant gliomas, the most common type of primary brain tumor in adults, are associated with disproportionate cancer-related morbidity and mortality. Recently, there have been important advances in our understanding of the molecular pathogenesis of malignant gliomas and progress in treating them. This review summarizes the diagnosis and management of these tumors in adults, highlighting new advances.","DOI":"10.1056/NEJMra0708126","ISSN":"0028-4793","note":"PMID: 18669428","author":[{"family":"Wen","given":"Patrick Y."},{"family":"Kesari","given":"Santosh"}],"issued":{"date-parts":[["2008",7,31]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Wen & Kesari, 2008).

Treatment, Precaution and Wound Management

Selecting a proper treatment for malignant wound is necessary as the treatment may result into harmful side effects ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"pd9VYM9O","properties":{"formattedCitation":"(Wen & Kesari, 2008)","plainCitation":"(Wen & Kesari, 2008)","noteIndex":0},"citationItems":[{"id":193,"uris":["http://zotero.org/users/local/uHsb2Xzj/items/YU8GJFQP"],"uri":["http://zotero.org/users/local/uHsb2Xzj/items/YU8GJFQP"],"itemData":{"id":193,"type":"article-journal","title":"Malignant Gliomas in Adults","container-title":"New England Journal of Medicine","page":"492-507","volume":"359","issue":"5","source":"Taylor and Francis+NEJM","abstract":"Malignant gliomas, the most common type of primary brain tumor in adults, are associated with disproportionate cancer-related morbidity and mortality. Recently, there have been important advances in our understanding of the molecular pathogenesis of malignant gliomas and progress in treating them. This review summarizes the diagnosis and management of these tumors in adults, highlighting new advances.","DOI":"10.1056/NEJMra0708126","ISSN":"0028-4793","note":"PMID: 18669428","author":[{"family":"Wen","given":"Patrick Y."},{"family":"Kesari","given":"Santosh"}],"issued":{"date-parts":[["2008",7,31]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Wen & Kesari, 2008). In our case as the wound has a very strong smell and is continuously releasing puss, palliation should be preferred and the wound bed should be prepared accordingly. Dead cells and bacteria should be carefully debride to reduce the smell and infection. The patient has a malodorous wound, the main goal in nursing should be the cleaning of wound, removal of debris, reducing the odour.

Venous Ulcer Wound

Failure or the malfunctioning of venous valves causes pressure in the veins to increase. This pressure results in blood pooling and the veins are stretched and the proteins and nutrient in them leaches to the tissue. This pooling of the blood affects the pumping of blood back to the heart, resulting in the development of Venous Ulcer CITATION Leo18 \l 1033 (Leonard, 2018). In this case, it is observed that the patient has venous ulcer which never got treated at all. This is a very serious issue as this may lead to vein thrombosis and even heart failure.

Treatment, Precaution and Wound Management

As it is observed that the wound is not healed, medical personnel should make sure that the wound is infection free so that the healing process starts. The wound should be moist, and the dressing should be changed CITATION Leo18 \l 1033 (Leonard, 2018). Compression therapy should also be provided. The patient should be kept in a warm environment.

References

Arterial Ulcers. (2012, December 22). Retrieved May 28, 2019, from WoundSource website: http://www.woundsource.com/patientcondition/arterial-ulcers

Black, J., Baharestani, M. M., Cuddigan, J., Dorner, B., Edsberg, L., Langemo, D., … Panel (NPUAP), and T. N. P. U. A. (2007). National Pressure Ulcer Advisory Panel’s Updated Pressure Ulcer Staging System. Advances in Skin & Wound Care, 20(5), 269. https://doi.org/10.1097/01.ASW.0000269314.23015.e9

BIBLIOGRAPHY Daeschlein G, A. O. (2007). Feasibility and Clinical Applicability of Polihexanide for Treatment of Second-Degree Burn Wounds. Skin Pharmacol Appl Skin Physiol, 20(6), 292-296. Retrieved from https://www.karger.com/Article/Abstract/107577

Dr. Christian Münter, P. P. (2012). Diabetic foot ulcers – prevention and treatment A Coloplast quick guide. Coloplast. Retrieved from https://www.coloplast.us/Global/US/Wound%20Care/Diabetic%20Foot%20Ulcers%20Quickguide_M4007N.pdf

Leonard, J. (2018, June 18). What to know about peripheral vascular disease. (M. M. Alana Biggers, Editor) Retrieved from Medical News Today: https://www.medicalnewstoday.com/articles/322182.php

Nordqvist, C. (2017, December 22). Bed sores or pressure sores: What you need to know. Retrieved May 27, 2019, from Medical News Today: https://www.medicalnewstoday.com/articles/173972.php

Villines, Z. (2019, May 16). Second-degree burn: Everything you need to know. Retrieved May 27, 2019, from Medical News TOday: https://www.medicalnewstoday.com/articles/325189.php

Vinik, A. I. (2008). Diabetic Neuropathies. In D. LeRoith & A. I. Vinik (Eds.), Controversies in Treating Diabetes: Clinical and Research Aspects (pp. 135–156). https://doi.org/10.1007/978-1-59745-572-5_8

Wen, P. Y., & Kesari, S. (2008). Malignant Gliomas in Adults. New England Journal of Medicine, 359(5), 492–507. https://doi.org/10.1056/NEJMra0708126

Subject: Healthcare and Nursing

Pages: 6 Words: 1800

Wound Assignment

Wound Management Plan

[Name of the Writer]

[Name of the Institution]

Wound Management Plan

Introduction

Jessica Adams is a 60-year-old woman was part of a house explosion that resulted in the fire. She had a son and two daughters. At the scene, she was awake and conscious but suffered from grave thermal injuries as per the EMS report. She suffered from the fourth-degree burns. Facial burns, with inhalation injury, were the prominent menace for which she was admitted in the hospital on an emergency basis. The secondary survey manifested no additional injuries. She was activated with level trauma alert and it is essential to highlight that a thermally ill patient is still deemed a trauma patient.

Wound Evaluation

Jessica was evaluated in the specialized burn operating room immediately. The upper body burns were critically debrided and dressed with the antimicrobial dressings. She suffered from the fourth- degree burns. The full thickness burns were apparent on the neck, ear, face, torso, bilateral legs, bilateral arms and anterior For the next two days, she was resuscitated. She received wound preparation procedures and serial excisional debridement for a few weeks. The evaluation of the burn size can prove challenging to be untrained. The symptoms revealed that Jessica was suffering from grave burns on different parts of her body. The size of the burns made the application of cultured epidermal autografts plausible for assistance with the wound and skin coverage.

Impact of the Wound

The wound cast several detrimental impacts on Jessica’s life. The burn trauma manifested adverse consequences on all areas of burn. The fundamental adversity she faced was deeming herself helpless in the face of the tragedy. It was both physically and psychologically overwhelming. She lost a significant sense of power and self-esteem after losing her natural bright skin. For instance, post-traumatic stress caused her to confront difficulties while staying or falling asleep. The flashbacks and intrusive recall of the house explosion make her sense the smell the smoke of the fire. The bottom line is that it was not only the physical structure that received adverse impacts. The cognitive complications and remorse of being the victim deteriorated her very purpose of living a healthy life ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"OmSvlMfg","properties":{"formattedCitation":"(Gacto-Sanchez, 2017)","plainCitation":"(Gacto-Sanchez, 2017)","noteIndex":0},"citationItems":[{"id":2363,"uris":["http://zotero.org/users/local/H8YOvGFC/items/HAEDIZCK"],"uri":["http://zotero.org/users/local/H8YOvGFC/items/HAEDIZCK"],"itemData":{"id":2363,"type":"article-journal","title":"Surgical treatment and management of the severely burn patient: Review and update","container-title":"Medicina Intensiva","page":"356-364","volume":"41","issue":"6","source":"www.medintensiva.org","abstract":"Since one of the main challenges in treating acute burn injuries is preventing infection, early excising of the eschar and covering of the wound becomes critical. Non-viable tissue is removed","DOI":"10.1016/j.medin.2017.02.008","ISSN":"0210-5691","shortTitle":"Surgical treatment and management of the severely burn patient","journalAbbreviation":"Med Intensiva","language":"es","author":[{"family":"Gacto-Sanchez","given":"P."}],"issued":{"date-parts":[["2017",8,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Gacto-Sanchez, 2017). Such perilous were the consequences of the wound on Jessica. Moreover, she hardly sleeps at night because of pain and has to take sleeping pills and painkillers to feel comfortable. The essential quality of life degraded to a significant extent and these proved to be the worst days of her life.

Wound Physiology

In Jessica’s case, her tissues burnt to a significant extent that comprised microvascular reactions and direct coagulation in the surrounding areas. It is critical to comprehend and take effective steps to mitigate the impact or the condition is likely to get further worse. Her face suffered injuries which covered a major portion of her face and thus was associated with an integral response as a consequence of skin barriers, subsequent infection and the release of the vasoactive edema from the burn wounds. The primary phase is the resuscitation of the wounds. These responses are triggered by the assistance of insulin resistance, accelerated gluconeogenesis and enhanced protein catabolism supplement the response. For Jessica, peculiar benchmarks have been set ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"E46ZMf5R","properties":{"formattedCitation":"(Rinkinen et al., 2015)","plainCitation":"(Rinkinen et al., 2015)","noteIndex":0},"citationItems":[{"id":2356,"uris":["http://zotero.org/users/local/H8YOvGFC/items/VZB5H8DS"],"uri":["http://zotero.org/users/local/H8YOvGFC/items/VZB5H8DS"],"itemData":{"id":2356,"type":"article-journal","title":"The Systemic Effect of Burn Injury and Trauma on Muscle and Bone Mass and Composition","container-title":"Plastic and reconstructive surgery","page":"612e-623e","volume":"136","issue":"5","source":"PubMed Central","abstract":"Background\nBy understanding the global inflammatory effects on distant myopathies, surgeons can better guide the rehabilitative process for burn patients. The authors tested the systemic effect of burn injury on distant injured muscle and native bone using immunohistochemistry and validated a new morphometric analytic modality to reproducibly quantify muscle atrophy using computed tomographic imaging.\n\nMethods\nIn vivo studies were performed on C57/BL6 mice using an Achilles tenotomy with concurrent burn injury model. Total muscle and bone (tibia and fibula) volume/density were quantified near the site of Achilles tenotomy using micro–computed tomography at 5, 7, and 9 to 12 weeks after surgery. The impact of burn injury on the inflammatory cascade [nuclear factor (NF)-κB, p-NF-κB] and the interconnected protein catabolism signaling pathway (Atrogin-1) was assessed by immunohistochemistry.\n\nResults\nMuscle volume and density at the site of Achilles tenotomy in burned mice were significantly diminished compared with nonburned mice at 5 weeks and 9 to 12 weeks. Similar decreases in muscle volume and density were observed when comparing tenotomy to no tenotomy. Cortical bone health remained stable in burn/tenotomy mice compared with tenotomy. Muscle atrophy was associated with up-regulation of p-NF-κB, NF-κB, and Atrogin-1 assessed by immunohistochemistry.\n\nConclusions\nBurn injury significantly decreases muscle volume and density. Increased muscle atrophy using our computed tomographic morphometric analysis correlated with a significant increase in intramuscular inflammatory markers and proteolysis enzymes. This study demonstrates a unique characterization of how burn injuries may worsen local myopathy. Moreover, it provides a novel approach for quantifying muscle atrophy over an expanded period.","DOI":"10.1097/PRS.0000000000001723","ISSN":"0032-1052","note":"PMID: 26505718\nPMCID: PMC4876821","journalAbbreviation":"Plast Reconstr Surg","author":[{"family":"Rinkinen","given":"Jacob"},{"family":"Hwang","given":"Charles D."},{"family":"Agarwal","given":"Shailesh"},{"family":"Oluwatobi","given":"Eboda"},{"family":"Peterson","given":"Jonathan"},{"family":"Loder","given":"Shawn"},{"family":"Brownly","given":"Robert C."},{"family":"Cummings","given":"Timothy"},{"family":"Cederna","given":"Paul S."},{"family":"Levi","given":"Benjamin"}],"issued":{"date-parts":[["2015",11]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Rinkinen et al., 2015). For instance, modification of the nature of physiology through the supervision of beta-adrenergic blockade, nonsteroidal and anti-inflammatory agents, beta-adrenergic supplementation, insulin-like growth factor and androgenic steroids will be utilized to modify the peculiar physiology.

The fourth-degree burns of Jessica demonstrate the graded capillary leak that enhances as the size of the injury grows. For resuscitation, hypertonic saline will best serve the purpose for her. Another critical adversity identified in the process of the burn physiology of deep thermal injury of Jessica is the pigmented urine. It will be imperative to prompt the pigment to explicitly avoid renal failure. This is essentially accomplished through administration of supplementary crystalloid.

Throughout the process, the electrolytes level is critically corrected and monitored persistently. In case of severe hyponatremia, seizures and cerebral edema are likely to occur. Jessica suffered the fourth-degree burns which must be addressed in an organized manner. For instance, monitoring the potassium, serum sodium, magnesium levels, ionized calcium and phosphorus ought to be kept in the physiologic range ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"i2ujHjt8","properties":{"formattedCitation":"(\\uc0\\u8220{}Classification of Burns - Health Encyclopedia - University of Rochester Medical Center,\\uc0\\u8221{} n.d.)","plainCitation":"(“Classification of Burns - Health Encyclopedia - University of Rochester Medical Center,” n.d.)","noteIndex":0},"citationItems":[{"id":2359,"uris":["http://zotero.org/users/local/H8YOvGFC/items/KPE4NPCK"],"uri":["http://zotero.org/users/local/H8YOvGFC/items/KPE4NPCK"],"itemData":{"id":2359,"type":"webpage","title":"Classification of Burns - Health Encyclopedia - University of Rochester Medical Center","URL":"https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P09575","accessed":{"date-parts":[["2019",4,12]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (“Classification of Burns - Health Encyclopedia - University of Rochester Medical Center,” n.d.). Since Jessica is suffering from fourth-degree burns, the nerve endings in her skin are nearly destroyed. Thus, implementing the process of eternal feedings during resuscitation must be thoroughly assessed to keep her safe.

The Wound Management Plan

Jessica, a 60-year-old woman has a fourth-degree burn. Her burn includes the demolition of the parts of the dermis and epidermal layer. Moreover, it does not spread by both layers. Her wounds are critically affected by the intensity of the fourth-degree burn and hence require an immediate examination and care to her highly damaged nerve tissue. Each of the depth deals with a foreseeable time of healing, outcome and treatment modality. Her fourth-degree burns have gone through both; skin's layers and tissues which lie underneath the skin. Microvessels that are perfusing this particular area are wounded, it is further leading to the leakage of the great amount of plasma. This causes a blister to form and lifts off the epidermis that was destroyed by heat. Jessica’s resulting wounds are wet, painful and pink. These wounds are the extremely painful wounds as the endings of nerves are revealed to air. Infection risk is low and blood flow which remains is adequate. It is possible that her wounds heal in 1-2 weeks. In Jessica’s case scaring is uncommon unless and until her wound gets contaminated very grossly.

Her treatment starts with the debridement and cleansing of remaining big blisters and loose epidermis from the surface of the wound. Big blisters would remain no more than 4 days as the risk of infection is elevated. An antibiotic is not necessarily required. Her area of wounds; ears and face will be treated openly without even dressing them. For her wounds, an ointment like bacitracin is usually required to retain the moisture of the wound and take predominantly control of the gram-positive bacteria on her face. Her wound areas will be gently cleansed on a daily basis with a dilute solution of chlorhexidine to remove surface exudate and crust. A fourth-degree burn can also be handled with a substitute for temporary skin that shields the surface of the wound and delivers moist healing of the wound. Gauze's outer layer should be changed if gets soaked with the plasma oozing out of the surface of the wound. Once the wounds stop oozing, substitute of the skin can possibly be left open for healing. Furthermore, if her case gets serious, treatment of her burns require instant wound closure and surgical debridement with permanent skin substitute or skin graft. If her case requires surgery, her wounds will be treated with dressing, anti-biotic cream that is silver-based and by using a closed technique of dressing.

Her burn requires special care. Her burns of hands, face, ears and feet have an ultimate risk of cosmetic abilities, complications and potential function. Such burns need immediate care and management in a burn care facility ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"hZEXb1me","properties":{"formattedCitation":"(\\uc0\\u8220{}Wound Care After Burn Injury | Model Systems Knowledge Translation Center (MSKTC),\\uc0\\u8221{} n.d.)","plainCitation":"(“Wound Care After Burn Injury | Model Systems Knowledge Translation Center (MSKTC),” n.d.)","noteIndex":0},"citationItems":[{"id":2361,"uris":["http://zotero.org/users/local/H8YOvGFC/items/DQD5MX9N"],"uri":["http://zotero.org/users/local/H8YOvGFC/items/DQD5MX9N"],"itemData":{"id":2361,"type":"webpage","title":"Wound Care After Burn Injury | Model Systems Knowledge Translation Center (MSKTC)","URL":"https://msktc.org/burn/factsheets/Wound-Care","accessed":{"date-parts":[["2019",4,12]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (“Wound Care After Burn Injury | Model Systems Knowledge Translation Center (MSKTC),” n.d.). Burns on the face of Jessica are at great risk of functional and cosmetic disability. Her deep face burns need a more attentive approach to aid in the prevention of the infection, involving loose necrotic tissues' frequent debridement and use of products of silver. Typically, surgical management is needed. Moreover, her ears burns can be treated with a similar approach that is used in treating her facial injuries. Although, pressure from outside must not be functionally applied to the helix that is injured. In this area, the cartilage is poorly vascularized already and any pressure will ruin the injury more. In addition, burns on the feet and hands of Jessica may result in functional disability. Such burns are handled with a skin substitute and petroleum-impregnated gauze. This helps in pain control and wound protection. As her burns are deep, they will require therapy of silver-based products. Each wound needs to be wrapped particularly to allow body part of the patient to functionally move. Her major burns may lead to serious mortality or morbidity. Treatment of her wounds requires professional help in the burn care centre.

The need for giving Health Education to the Patient

First, the critical intensity of the burn wound will make Jessica ignorant of maintaining a schedule to look after her because of the post-traumatic stress. It is imperative to recommend her a seasoned therapist during and after her treatment or she may face detrimental ramifications. The principle which defines the need for giving essential health education to the patient is dispensing awareness. Jessica is always conscious of her hygiene and taking showers on a persistent basis. If she advances to take shower in such critical condition even after her burns reflect significant healing, her skin may swell or become prone to establishing an infection ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"qo46vjWa","properties":{"formattedCitation":"(\\uc0\\u8220{}Burn Wound Infections | Clinical Microbiology Reviews,\\uc0\\u8221{} n.d.)","plainCitation":"(“Burn Wound Infections | Clinical Microbiology Reviews,” n.d.)","noteIndex":0},"citationItems":[{"id":2365,"uris":["http://zotero.org/users/local/H8YOvGFC/items/HWK3CEP9"],"uri":["http://zotero.org/users/local/H8YOvGFC/items/HWK3CEP9"],"itemData":{"id":2365,"type":"webpage","title":"Burn Wound Infections | Clinical Microbiology Reviews","URL":"https://cmr.asm.org/content/19/2/403","accessed":{"date-parts":[["2019",4,12]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (“Burn Wound Infections | Clinical Microbiology Reviews,” n.d.). She has to thoroughly adhere to the directions of the doctors.

Jessica will have to follow the directions of the doctor to keep her wounds safe from bacteria and keep a tab on the wounds. Surrounding the wound with a bandage is crucial irrespective of personal likings or disliking of Jessica. To take a shower, a cloth should be soaked in water and then cleaned on the body. However, the burnt body parts ought not to be exposed to even a drop of water. In addition, the antibiotics and gel tubes play an instrumental role to rejuvenate the healthy tissues of the body and thus should not be missed at any instance. The fourth-degree burn is very critical and inflicts severe pain. She will have to keep a strict check on the condition of the affected skin and in case of swelling; she must consult the doctor immediately. Diet will also play a fundamental. The diet rich in essential proteins and vitamins will serve as the primary trigger to establish the damaged skin surface and deep tissues in an expedite manner. Jessica loves to eat vegetables which are an added benefit for her. Moreover, the incorporation of several fruits and their juices in the diet plan will be imperative to confront the critical burns.

Pain Management

Pain management lies at the very heart of ensuring that Jessica is able to confront the critical burns in an organized and systematic manner. Anxiety and depression will take a severe toll on the patient which will require her to modify her lifestyle through deep pressure therapy. In case she suffers a severe emotional breakdown, sedatives will be essential to keep her in a sustainable emotional state. Therefore, pain management of the burn wounds is an integral part of the treatment besides surgical methods and care.

References

ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Burn Wound Infections | Clinical Microbiology Reviews. (n.d.). Retrieved April 12, 2019, from https://cmr.asm.org/content/19/2/403

Classification of Burns - Health Encyclopedia - University of Rochester Medical Center. (n.d.). Retrieved April 12, 2019, from https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P09575

Gacto-Sanchez, P. (2017). Surgical treatment and management of the severely burned patient: Review and update. Medicine Intensiva, 41(6), 356–364. https://doi.org/10.1016/j.medin.2017.02.008

Rinkinen, J., Hwang, C. D., Agarwal, S., Oluwatobi, E., Peterson, J., Loder, S., … Levi, B. (2015). The Systemic Effect of Burn Injury and Trauma on Muscle and Bone Mass and Composition. Plastic and Reconstructive Surgery, 136(5), 612e-623e. https://doi.org/10.1097/PRS.0000000000001723

Wound Care After Burn Injury | Model Systems Knowledge Translation Center (MSKTC). (n.d.). Retrieved April 12, 2019, from https://msktc.org/burn/factsheets/Wound-Care

Subject: Healthcare and Nursing

Pages: 6 Words: 1800

Wound Case Study

Wound Management

Author

Institution

Case 1

Arterial Ulcer

Holistic assessment

Wound examination

Wound is located on lower right leg and is infected

Type of wound

Chronic wound

Cause of wound

Poor blood supply to lower right leg (detail is mentioned above)

Further investigation

Wound swab is taken and sent to pathology, results from pathology shows that the wound is infected. No further investigation is required.

Wound management principle

Debridement of necrotic tissues, improve blood circulation by providing thinner blood, proper dressing, moist wound bed, and also pain control.

Evaluation

Wound examination

Punched out wound with infection

Wound bed status

Wound bed is pale, yellow in color with sign of infection, and exudate is present.

Wound characteristics

According to the history wound is existed for a long time and is infected as well, it will take more time to heal.

It is located on the lower right leg where blood flow is lower as compare to the other parts of the body

Other characteristics that effects the healing process is mentioned below.

Wound measurement

Length: 2.1 cm

Width: 2 cm

(this calculated by sourcing link of an actual image and comparing the size of a wound to the surrounding area using ruler)

Condition of surrounding skin

Surrounding skin is dry and rough due to dead tissues in the area.

Wound exudate

Sanguineous drainage

Further assessment

No further assessment is needed. Although taking weight of a patient is recommended. As weight can also play a role in treating the wound and there is no information provided on the weight of this patient in this report.

Expectation of healing process

It takes time to heal arterial ulcer. It is located at lower part of leg, where the blood flow is apparently low. His age (77 years), history of diabetes, difficulty in mobility, and poor oral intake results in slow healing process of the wound. To overcome these obstacles, various steps and recommendations are discussed in wound and pain management section.

Age: healing of ulcer wound at this age is delayed due to angiogenesis and diminishing of hypoxia-inducible factor CITATION Soc15 \l 1033 (Soc, 2015).

Chronic health Condition: As the patient has history of diabetes, it impairs wound healing by decreasing blood supply and by increasing chances of infection so it impairs wound healing.

Mobility: Mobility improves blood circulation so it improves healing. Patient has difficulty in moving so it affects the healing process of the wound

Nutrition: Due to poor oral intake, his body lack zinc and vitamin C it slows his healing process.

Wound management Plan

Moist wound healing

Moist wound healing is must for healing arterial ulcer wound. In addition to that wound temperature should be kept warm for better management.

Skin & risk assessment

Skin assessment includes factors like temperature, color, pulse, hair distribution, and skin appearance

In this case all signs show decreased blood supply with dry ragged discolored skin.

Risk assessment: Arterial ulcer accounts for 5 to 20% of all leg ulcers in diabetic patient CITATION Doy16 \l 1033 (Doyle, 2016).

Wound cleansing

Wound can be cleaned with water (not in excess). Cadexomer iodine ointments should be applied around the wound margins. This ointment draws out the exudate and also fights the bacteria present at wound site.

Pressure support and relieving devices

No pressure support and relieving devices are needed in treating this wound.

Prevention program

List of things that should be prevented in treating this wound are:

Quit smoking if the patient is smoker

Protect legs and feet from injuries

Avoid Prolonged sitting and standing

Avoid cold temperatures

Dressing product

Ketanserin ointment with moist dressing should be applied on the wound. This dressing should be changed twice a day CITATION For15 \l 1033 (Forster R, 2015).

Secondary dressing

No Need

Pain management time frames

Usually arterial ulcer wound takes long time to heal. In our case due to many factors mentioned above, healing of the wound can take more time than normal or maybe it will never healed at all. In one year period, pain can be reduced to 3 times by following the step mentioned in wound cleaning and dressing product section.

Health education for the patient

Chronic Disease: Being a diabetic patient, his glucose level should be maintained.

Mobility: As it is hard for a patient to be mobile, he should get assistance in getting physically active. In addition physio like ultrasound treatment and compression therapy are recommended. Compression therapy will induce thermal effect which is good for wound healing

Weight: Patient should also lose weight (not provided with case study) if he is overweight.

Nutrition: Patient should increase zinc and Vitamin C intake as it helps in the healing of wound

Addition wound care: wound should be kept moist CITATION Pál09 \l 1033 (Pálsdóttir, 2009).

Pain management

Medication

Patient is already taking Endone, which is a good for relieving pain. No other medication is advised for pain management.

Although for wound management, patient should take zinc and vitamin C CITATION Des05 \l 1033 (Desneves KJ, 2005).

Frequency and dose

Dose of Endone should be remained same i.e; 10mg (tds).

Zinc - 30mg (tds)

Vitamin C - 500 mg (tds) CITATION Dae07 \l 1033 (Daeschlein G, 2007)

Reason for medication

To relief pain and excelling the healing process

Patient’s education

As the patient is 77 years old and he lives alone in a retirement home, he or the personnel at retirement home should be educated about his condition.

Daily physical activity should be planned in future, because mobility plays an important role in the healing of arterial ulcer.

Protect the patient from any injuries in future

Medicines prescribed/ advised are important for his recovery

Smoking is very dangerous for the patient in his current condition

Diabetic Foot Ulcer

Holistic assessment

Wound examination

Located of left toe, requires debridement

Type of wound

Chronic wound

Cause of wound

Poor blood and oxygen supply to lower body due to tightening of arteries and vessels because of high glucose level.

Further investigation

No deep tissue infection found. A sample should be collected from the wound for culture.

Wound management principle

Drainage and surgical debridement, improve blood circulation and also pain control. Wound should be treated with antibiotics and proper dressing.

Evaluation

Wound examination

Grade 2 Open ulcer wound with no deep tissue infection

Wound bed status

Pale yellow outer skin, dark red from inside, no sign of exudate, with sign of infection and necrotic tissue.

Wound characteristics

According to the patient’s history wound is existed for a long time and is infected as well, it will take more time to heal.

It is located on left toe Other characteristics like wound size, depth, edge are mentioned below

Wound measurement

Length: 3 cm

Width: 3.6 cm

(this calculated by sourcing link of an actual image and comparing the size of a wound to the surrounding area using ruler)

Condition of surrounding skin

Surrounding skin is normal.

Wound exudate

Not present

Further assessment

A sample should be collected from wound for culture.

Expectation of healing process

At his age (77 years) along with the history of diabetes and poor oral intakes, wound will take time to heal wound is located at left toe, poor blood circulation may results in slowing the healing process

Age: healing of ulcer wound at this age is delayed due to angiogenesis and diminishing of hypoxia-inducible factor CITATION Soc15 \l 1033 (Soc, 2015).

Chronic health Condition: As the patient has history of diabetes, it impairs wound healing by decreasing blood supply in the area. There is a risk of increase in infection.

Mobility: Mobility improves blood circulation which improves the healing process. Patient has difficulty in moving so it affects the healing process of the wound

Nutrition: Due to poor oral intake, his body lack zinc and vitamin C it slows his healing process.

Wound management Plan

Moist wound healing

After surgical debridement provide moist wound care for healing.

Skin & risk assessment

Skin assessment Poor blood supply with hard skin at wound edge. Surrounding skin is normal.

Risk assessment: Risk factors includes bacteriology, wound care choices, type of debridement, and wound dressing

It should be examined whether the patient feels numbness and has he loss protective sensation. In addition foot deformity and injuries may result in additional risk.

Patient with history of diabetes has 15 to 20% risk of developing Diabetic foot ulcer CITATION Nal05 \l 1033 (Nalini Singh, David G. Armstrong, & Benjamin A. Lipsky, 2005)

Wound cleansing

Treatment process should start with careful drainage and sharp surgical debridement. Debridement will not only clear the necrotic tissues but will also help clean the wound. After than wound should be cleaned with using saline.

Pressure support and relieving devices

No pressure support and relieving devices are needed in treating this wound.

Prevention program

List of things that should be prevented in treating this wound are:

Quit smoking if the patient is smoker

Protect legs and feet from injuries

Avoid Prolonged sitting and standing

Avoid cold temperatures

Dressing product

Silver releasing dressing

Secondary dressing

silicon impregnated dressing along with hyperbaric oxygen therapy

Pain management time frames

Wound should be frequently assessed throughout the treatment as it will take long to recover. Once the treatment is started, healing time of the wound can be estimated by taking etiology and wound size into account. With proper nutrition and antibiotics pain can be reduced during the healing process.

In our case due to many factors mentioned above, healing of the wound can take more time than normal. Pain can be reduced to 3 times by following the step mentioned in wound cleaning and dressing product section. In addition intermitted pain due to wound debridement and frequent change of dressing will remain throughout the process of healing.

Health education for the patient

Chronic Disease: Being a diabetic patient, his glucose level should be maintained.

Mobility: As it is hard for a patient to be mobile, he should get assistance in getting physically active.

Weight: Patient should also lose weight (not provided with case study), if he is overweight.

Nutrition: Patient should increase zinc and Vitamin C intake as it helps in the healing of wound

Pain management

Medication

Same as Arterial ulcer

Patient is already taking Endone, which is a good for relieving pain. No other medication is advised for pain management.

Although for wound management, patient should take zinc and vitamin C CITATION Des05 \l 1033 (Desneves KJ, 2005).

Frequency and dose

Same as arterial ulcer

Dose of Endone should be remained same i.e; 10mg (tds).

Zinc - 30mg (tds)

Vitamin C - 500 mg (tds) CITATION Dae07 \l 1033 (Daeschlein G, 2007)

Reason for medication

To relief pain and excelling the healing process

Patient’s education

As the patient is 77 years old and he lives alone in a retirement home, he or the personnel at retirement home should be educated about his condition.

Daily physical activity should be planned in future, because mobility plays an important role in the healing of arterial ulcer.

Protect the patient from any injuries in future

Medicines prescribed/ advised are important for his recovery

Smoking is very dangerous for the patient in his current condition

Pressure Ulcer

Holistic assessment

Wound examination

Stage 3 pressure ulcer located on patient’s sacrum bone

Type of wound

Chronic wound

Cause of wound

Due to his inability to move without assistance, patient stays in one position for a long time. This prolonged stay in one position produces pressure on the sacrum bone affecting blood circulation to lower part of the body and resulting into a pressure ulcer.

Further investigation

Subcutaneous tissue exposed, with no sign of infection. A sample should be collected from the wound for culture.

Wound management principle

Wound debridement for the removal of dead tissue.

Improve blood circulation by frequently moving the patient

Pain control

Wound should be treated with antibiotics and proper dressing.

Evaluation

Wound bed status

Skin loss with damage to necrosis of subcutaneous tissue.

Red granulation tissue exposed

No sign of exudate

Wound characteristics

According to the patient’s history, he was unaware of the wound so it was not treated in time. It may take time to heal and depends on the assistance required in changing position while lying down.

It is located on his sacrum bone

Other characteristics like wound size, depth, edge are mentioned below

Wound measurement

Length: 3.2 cm

Width: 3.1 cm

(this calculated by sourcing link of an actual image and comparing the size of a wound to the surrounding area using ruler)

Condition of surrounding skin

Maceration of surrounding skin is observed

Wound exudate

Not present

Further assessment

A sample should be collected from wound for culture.

Expectation of healing process

Due to his inability to move resulting in pressure and poor blood circulation, healing process will take long.

Age: healing of ulcer wound at this age is delayed due to angiogenesis and diminishing of hypoxia-inducible factor CITATION Soc15 \l 1033 (Soc, 2015).

Chronic health Condition: As the patient has history of diabetes, it impairs wound healing by decreasing blood supply in the area. There is a risk of developing infection.

Mobility: Mobility improves blood circulation which improves the healing process. It will also reduce the pressure in the region of wound. Patient has difficulty in moving so it affects the healing process of the wound.

Nutrition: Due to poor oral intake, his body lack zinc and vitamin C. It slows his healing process.

Wound management Plan

Moist wound healing

After cleaning of the wound, moist saline or iodine gauze can be used as a dressing.

Make sure that no pressure is applied in the area when the wound is dressed.

Surrounding skin should be dry

Skin & risk assessment

Skin assessment Full skin loss and subcutaneous tissue is visible.

Risk assessment: Although the risk of pressure ulcer should be assessed before its development, in our case the ulcer is already developed and is in stage 3.

Norton risk assessment will be used as its parameters are useful for pre and post ulcer development. Loss score should be greater than 14 CITATION eun09 \l 1033 (eunice park-lee, 2009).

Norton risk assessment parameters include  mobility, activity, mental condition, physical condition, and incontinence

Wound cleansing

Wound should not be cleaned with plain water and soap, use saline solution instead.

Pressure support and relieving devices

Alternating pressure surfaces which includes specially designed bed, cushion, and mattress should be used.

These devices will provide support and also act as a pressure relieving.

Prevention program

List of things that should be prevented in treating this wound are:

Quit smoking if the patient is smoker

Provide adequate padding while sitting

Surrounding skin should be kept dry as the skin maceration of skin is present

Patient should be proper fitted into wheelchair with padding on pressure points

Avoid Prolonged sitting and standing

Avoid cold temperatures

Dressing product

As there is no exudate present, silver releasing dressing should be used

Secondary dressing

Honey or foam dressing

Pain management time frames

The pain associated with pressure ulcers depends on deep infection, moisture related incontinence, pre-ulcer irritation, and friction/shear.

In our case due to pain is directly associated with the location of the wound, patient’s poor nutrition, and his inability to move will. Wound should be frequently assessed throughout the treatment as it will take long to recover. Swear pain will remain through the process of healing. Main focus is to reduce the healing time with proper care.

Pain can be reduce with time with proper care, precaution, and wound management explained in this table.

Health education for the patient

Chronic Disease: Being a diabetic patient, his glucose level should be maintained.

Mobility: As it is hard for a patient to be mobile, he should get assistance in getting physically active.

Weight: Patient should also lose weight (not provided with case study), if he is overweight.

Nutrition: Patient should increase zinc and Vitamin C intake as it helps in the healing of wound

Pain management

Medication

Same as Arterial and diabetic foot ulcer

Patient is already taking Endone, which is a good for relieving pain. No other medication is advised for pain management.

Although for wound management, patient should take zinc and vitamin C CITATION Des05 \l 1033 (Desneves KJ, 2005).

Secondary medication: antibiotic should be given depending on the result from culture.

Frequency and dose

Same as arterial ulcer and foot ulcer

Dose of Endone should be remained same i.e; 10mg (tds).

Zinc - 30mg (tds)

Vitamin C - 500 mg (tds) CITATION Dae07 \l 1033 (Daeschlein G, 2007)

Reason for medication

To relief pain and excelling the healing process

Patient’s education

As the patient is 77 years old and he lives alone in a retirement home, he or the personnel at retirement home should be educated about his condition.

Daily physical activity should be planned in future, because mobility plays an important role in the healing of pressure ulcer.

Proper padding should be used on pressure points.

Avoid lying in supine position.

Medicines prescribed/ advised are important for his recovery

Smoking is very dangerous for the patient in his current condition

Second Degree Burn

Holistic assessment

Wound examination

2nd degree on his left hand.

Type of wound

2nd degree burn

Cause of wound

He spilled a coffee on his hand

Further investigation

Not needed

Wound management principle

Clean gently with soap and water

If the blister is break during the treatment, it should be drained and cleaned properly

Apply petroleum based ointments

Evaluation

Wound bed status

Epidermis and Dermis layers of the skin are effected and the affected area is swelled up, appears shiny, surrounding are shows redness, and the area is painful to touch

Wound characteristics

Size of the wound is nominal, blister is formed on top layer, surrounding skin shows redness, and the wound is not deep.

Other characteristics like wound size and the nature of surrounding are mentioned below

Wound measurement

Length: 2 cm

Width: 1.4 cm

(this is calculated by sourcing link of an actual image and comparing the size of a wound to the surrounding area using ruler)

Condition of surrounding skin

Burning causes redness in surrounding skin

Wound exudate

Not present

Further assessment

No need

Expectation of healing process

With proper care and treatment, wound can be healed in two to three weeks period. Scar may form during the healing process depending upon the nature of skin and management plan.

Wound management Plan

Moist wound healing

Dressing should be soaked in water before applying

Skin & risk assessment

Skin assessment Visible blister with redness in surrounding skin.

Risk assessment: Burn may leave a scar during the healing. Proper and in time treatment may reduce the risk of scar.

It the blister is break, there is a risk of getting infection. It should drained properly and should be cleaned periodically.

Wound cleansing

Wash gently with soap and water.

Pressure support and relieving devices

No need

Prevention program

List of things that should be prevented in treating this wound are:

Extreme hot temperature

Avoid scratching

Dressing product

Moist dressing with presence of saline

Secondary dressing

No need

Pain management time frames

Wound is expected to heal within 2 to 3 weeks. And pain will remaining until the wound is completely healed.

Saline dressing will reduce the pain with time.

Health education for the patient

Educate the patient about healing process.

Avoid scratching

Wash the wound with cool with cool water (avoid cool water contact to his ulcer wounds)

Dressing should be changed at least twice a day

Pain management

Medication

Petroleum ointment and saline dressing

No pain killer as the patient

Frequency and dose

At least twice a day

Reason for medication

To relief the pain and heal the wound.

Patient’s education

In future, always use capped container for drinking hot beverages

Drink excess water as the burn causes the body to lose fluid

Case 2

Malignant Wound

Holistic assessment

Wound examination

Malignant wound on groin area.

Type of wound

Chronic wound

Cause of wound

The patient has cervical cancer. Therefore cancerous cells infiltrate the skin and the blood and lymph vessels supporting it which cause a loss in vascularity leading to tissue death causing a malignant wound on the groin area.

Further investigation

The wound was oozing pus and developed into a sinus,

As the main goal is to improve the quality of life, no further investigation regarding wound is required.

Wound management principle

The patient should be given pain killers prior to any treatment.

The patients wound are chronic hence it is important that they do not tear while dressing, therefore blood thinners like aspirin can be given.

The dressing shall be soaked in water before removal.

The wound has a very odor and is releasing puss therefore it should cleaned with saline water and frequent change of dressing is advised.

Evaluation

Wound bed status

Infected wound bed with moderate to high exudate with presence of sinus as well

A regular change in pads to control the blood from discharge is required.

The bed linens should also be regularly changed to avoid infection from malignant wounds puss.

Wound characteristics

Raised irregular margins with infected wound base and erythema all around the wound

Surrounding skin also shows signs of infection

Moderate amount of exudate also seen

Wound measurement

Length: 4 to 5 cm

Width: 2.5 cm

(this calculated by sourcing link of an actual image and comparing the size of a wound to the surrounding area using ruler)

Condition of surrounding skin

Erythema of surrounding skin is observed

Wound exudate

Moderate amount seen along with fouls smelling discharge from the sinus

Further assessment

A sample should be collected from wound for culture and sensitivity under aseptic conditions

Expectation of healing process

Because we are treating patient on palliative lines, so the main goal is to keep the patient pain and smell free. Since healing process in this patient is not much expected.

Improving pain management techniques and keeping the wound clean are the main goals

Wound management Plan

Moist wound healing

Protection and prevention of the damage skin by controlling exudate, protecting surrounding skins by barrier ointments.

Prevention of odor management by local cleansing (saline irrigation), gentle removal of necrotic tissue. Use of topical antibiotics activated charcoal dressing.

Essential oil or other aroma therapies

Skin & risk assessment

Skin assessment Raised irregular margins with infected wound base and erythema all around the wound. Surrounding skin also shows signs of infection. Moderate amount of exudate also seen

Risk assessment: low immunity due to malignancy, poor oral intake, lack of self-care on account of weakness and malignant disease are the main risk factor involved that need to be kept in mind while managing the patient.

Wound cleansing

Cleansing of wound by saline

And cleansing of exudate by absorbent hydro fiber and absorbent cover dressings with high absorbent capacity

If exudate is still not controlled, then consider pouching or consultation with enterostomal therapy nurse.

Pressure support and relieving devices

Not needed

Prevention program

Not applicable because we giving her palliative care

Dressing product

hydro fiber and absorbent cover dressings with high absorbent capacity

Secondary dressing

Layered dressing or consultation with enterostomal therapy nurse

Pain management time frames

Pain management is the main goal for this patient.

Pain is of mixed etiology, monitoring of pain level and providing analgesia whether topical or systemic along with relaxation therapies and emotional support.

Health education for the patient

Emotional support and relaxation techniques along with spiritual healing techniques are the main helping factors for this patient.

Pain management

Medication

As the patient is already taking fentanyl 200mcg and midazolam 10 mg, if needed topical pain killers can be added for local pain of the wound

Frequency and dose

patient is on syringe driver: Fentanyl 200 mcg + Midazolam 10 mg

and topical pain killer (sos)

Reason for medication

To relief pain and improve patient’s quality of life.

Patient’s education

Family should be explained clearly about the patient’s condition and they should also participate in improving the remaining time of her life.

They should be explained that only palliative care is being provided to this patient.

Venous Ulcer Wound

Holistic assessment

Wound examination

Venous ulcer on her leg

Type of wound

Chronic wound

Cause of wound

Venous insufficiency

Further investigation

Doppler ultrasound, venography, and ankle brachial index

Wound management principle

Primary goal in this patient is keeping the ulcer site infection free and alleviating edema of the sight.

Debridement to remove dead tissue.

Oral and topical antibiotics dressing

Surgical skin graft (since we are providing palliative care, it is less useful in this patient)

Compression therapy

Evaluation

Wound bed status

Infected edematous skin (wound bed not visible in the picture)

Wound characteristics

Infected

Erythematous

edematous

Wound measurement

Length: 8 cm

Width: 6 cm

(this calculated by sourcing link of an actual image and comparing the size of a wound to the surrounding area using ruler)

Condition of surrounding skin

Erythema and edema of surrounding skin is observed

Wound exudate

Not present

Further assessment

Not applicable

Expectation of healing process

Because we are treating patient on palliative lines, so the main goal is to keep the patient pain and smell free. Since healing process in this patient is not much expected.

Improving pain management techniques and keeping the wound clean are the main goals

Wound management Plan

Moist wound healing

Wound debridement

Dressing (compression)

Oral and topical antibiotics dressing

Skin & risk assessment

Skin assessment Surrounding skin is erythematous and edematous.

Risk assessment:

Wound cleansing

Debridement of wound with saline solution and application of topical antibiotics along with compressing dressing will be used in wound cleaning.

Pressure support and relieving devices

Compression therapy

Maggots or biotherapy

Surgical skin graft

Prevention program

Avoid prolonged siting and standing

Protection from injury and infection

Avoid extreme temperature

Dressing product

Simple ascetic dressing

Secondary dressing

Compression dressing or therapy

Pain management time frames

Pain management is the main goal for this patient.

Pain is of mixed etiology, monitoring of pain level and providing analgesia whether topical or systemic along with relaxation therapies and emotional support.

Health education for the patient

Emotional support and relaxation techniques along with spiritual healing techniques are the main helping factors for this patient.

Pain management

Medication

As the patient is already taking fentanyl 200mcg and midazolam 10 mg, if needed topical pain killers can be added for local pain of the wound

Frequency and dose

patient is on syringe driver: Fentanyl 200 mcg + Midazolam 10 mg

and topical pain killer (sos)

Reason for medication

To relief pain and improve patient’s quality of life.

Patient’s education

Family should be explained clearly about the patient’s condition and they should also participate in improving the remaining time of her life.

They should be explained that only palliative care is being provided to this patient.

Examine wound regularly

Elevate leg regularly

References

Arterial Ulcers. (2012, December 22). Retrieved May 28, 2019, from WoundSource website: http://www.woundsource.com/patientcondition/arterial-ulcers

Black, J., Baharestani, M. M., Cuddigan, J., Dorner, B., Edsberg, L., Langemo, D., … Panel (NPUAP), and T. N. P. U. A. (2007). National Pressure Ulcer Advisory Panel’s Updated Pressure Ulcer Staging System. Advances in Skin & Wound Care, 20(5), 269. https://doi.org/10.1097/01.ASW.0000269314.23015.e9

BIBLIOGRAPHY Daeschlein G, A. O. (2007). Feasibility and Clinical Applicability of Polihexanide for Treatment of Second-Degree Burn Wounds. Skin Pharmacol Appl Skin Physiol, 20(6), 292-296. Retrieved from https://www.karger.com/Article/Abstract/107577

Desneves KJ, T. B. (2005, November 15). Treatment with supplementary arginine, vitamin C and zinc in patients with pressure ulcers: a randomised controlled trial. Clin Nutr. 2005 De, 979-987. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/16297506

Doyle, G. R. (2016). Clinical Procedures for Safer Patient Care. Columbia Ministry of Advanced Education. Retrieved from https://lib.hpu.edu.vn/handle/123456789/21931

Dr. Christian Münter, P. P. (2012). Diabetic foot ulcers – prevention and treatment A Coloplast quick guide. Coloplast. Retrieved from https://www.coloplast.us/Global/US/Wound%20Care/Diabetic%20Foot%20Ulcers%20Quickguide_M4007N.pdf

eunice park-lee, p. c. (2009). Pressure ulcers among nursing home residents; United States, 2004. NCHS, health care statistics. DHHS Publications. Retrieved from https://stacks.cdc.gov/view/cdc/5315

Forster R, P. F. (2015). Dressings and topical agents for arterial leg ulcers (Review). ochrane Database of Systematic Reviews2015. Retrieved from https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001836.pub3/epdf/full

Leonard, J. (2018, June 18). What to know about peripheral vascular disease. (M. M. Alana Biggers, Editor) Retrieved from Medical News Today: https://www.medicalnewstoday.com/articles/322182.php

Nalini Singh, M., David G. Armstrong, D. M., & Benjamin A. Lipsky, M. (2005, January 12). Preventing Foot Ulcers in Patients With Diabetes. JAMA, 217-228. Retrieved from https://jamanetwork.com/journals/jama/article-abstract/200119

Nordqvist, C. (2017, December 22). Bed sores or pressure sores: What you need to know. Retrieved May 27, 2019, from Medical News Today: https://www.medicalnewstoday.com/articles/173972.php

Pálsdóttir, G. (2009). Chronic leg ulcers in Iceland; Prevalence, aetiology and management. University of Iceland, Faculty of Nursing. University of Iceland, faculty of Nursing. Retrieved from https://skemman.is/bitstream/1946/2296/1/Chronic%20leg%20ulcers%20in%20Iceland%3B%20Prevalence%2C%20aetiology%20and%20management_fixed-1.pdf

Soc, J. A. (2015, Sep 25). Chronic Wound Repair and Healing in Older Adults: Current Status and Future Research. PMC, 427-438. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4582412/

Villines, Z. (2019, May 16). Second-degree burn: Everything you need to know. Retrieved May 27, 2019, from Medical News TOday: https://www.medicalnewstoday.com/articles/325189.php

Subject: Healthcare and Nursing

Pages: 5 Words: 1500

Wound Management

Wound management principals and their application in clinical environment

[Name]

[Institute]

[Date]

Case#1. Wound management principals and their application in clinical environment

Holistic Assessment of the Patient (medical history and examination of the patients)

Mr. Will is a 77 years old man and is identified with Rectal Ca. He has got an arterial, ulcer diabetic foot ulcer, and issues with oral intakes. Two years ago he has done Coronary Artery Bypass Graft surgery and also has the issues of Gastro-esophageal reflux disease, postural hypotension, chronic obstructive, type 2 diabetes and pulmonary disease, He cannot take compact foods, is unable to control his bowel and is living alone in his house. He had also got a head stroke while he was coming to the hospital and it is because of that he got a bruise on his face.. The doctor suggested taking warfarin for the bruise. He is in the hospital for the infection of his arterial ulcer on the lower side of his right.

However, Mr. Jackson is also suffering from rectum cancer and his ulcer has damaged granular tissue by 30% and damaged up to 70% of his slow tissues. He burnt his left arm and that is a second-degree burn.

Type of Wounds and their Causes

Diabetic foot ulcer:

A Diabetic foot ulcer is a fully thicken wound and is mostly present in the ankle levels. The pathologies include are arterial disease and diabetic peripheral neuropathy (Jhamb, Vangaveti, & Malabu, 2016).

Arterial ulcer:

This type of ulcer is also known as the ischemic ulcer and is caused due to the less delivery of blood and this disorder is known as poor perfusion. Poor perfusion should be applied to the lower extremities (Kim, Wattanakit, & Gornik, 2012).

Pressure Ulcer:

This type of ulcer is well known as the pressure sore or bed sore. It is an injury to the skin caused by continues pressure and can be cured by changing sitting habits (McInnes et al., 2015).

Burn:

The burning of tissues due to heat, sun or exposed to another sort of radiations. There are various degrees of burn and the severe degree of burn destroys the whole skin and nervous system (Bairy, Somayaji, & Rao, 1997).

Investigations Required for the Wound

Mr. Will was having visible wounds that can be easily diagnosed and the sample has been investigated through pathological tests. His bruise was observed through a CT scan but no particular internal infection was found. Rectum cancer was spotted at the time of treatment of other causes and it was spotted because he was having severe pain.

Wound Management Principles

Wound management principle focuses on the reasons and condition of the disease. It also includes the maintenance plan after proper dressing (McInnes et al., 2015)

Evaluation of wound:

Wound bed status:

The foot ulcer has turned yellow and is fully damaged may need steroid treatment. The pressure ulcer and the infected arterial ulcer look pink in color and are giving the granular appearance. Burn on his hand looks black and needs medication.

Wound characteristics:

Puss is being seen in the pressure ulcer, the foot ulcer an also in the arterial ulcer. All three wounds are given granular appearances. A burn is also been swollen with black skin surrounded the affected tissues.

Condition of surrounding skin:

The surrounded skin of the burn is black in colour as it is damaged, the skin around the foot ulcer is damaged as well and it is inflamed. Arterial and presser ulcer is surrounded by skin that is going to be damaged and looks stretched out.

The Expectation of the Healing Process for Each type of Wound

The healing process of the wounds of Mr. Will Jackson needs to go through four stages. The healing process where the wound oozes out and change color. Second is proliferation then, decelerated by epidermal restoration, angiogenesis, and finally shrinkage of wound is focused (Gould et al., 2015).

His rectum ulcer can be cured by chemotherapy and his hand burn needs medication and dressing. His age and mobility can affect the process of healing because he is also having pressure ulcer and his sitting position needs to be frequently changed which is not possible because he has infected his lower leg. Diabetes may also need to be cured because till will also affect the treatment of pressure ulcer.

Wound Management Plan

The risk assessment tool used for the pressure ulcer, foot ulcer, Arterial ulcer, and burn is to identify the Braden Scale Risk Factors that is the mobility, nutrition, friction and sensory perception of the wound need to be examined (Gruen, 2010). The patient needs to take protein more in order to get down with the healings of the wounds. Mr. Jackson cannot move his foot which is making the healing process even worse. The healing process of pressure ulcer needs positing devices and generally do not needed any dressings. But steroid dressing is needed time to time.

Arterial ulcer needs a management that included pain control by the help of occlusive dressing and by debridement. The threat for potential infection is further checked. Silver-impregnated in used as addressing for taking care of the ulcer (Boike, Maier, & Logan, 2010). While the burn needs to be dressed by the help of sterilized bandages.

Health Education for the Patient Regarding the Wound

The patient needs a support system as he is having a diabetic foot ulcer, arterial ulcer and he is suffering from pressure ulcer as well so he needs to change his sitting position on time to time. He needs to take in protein frequently.

Pain management relating to the wound including:

Mr. Jackson is been given the medications Ventolin 4, Telmisartan 40 mg , puffs t.d.s, warfarin two mg daily, Telmisartan 40 mg at a bad time, b.d, , Furosemide 20 mg b.d, Hydromorphone, Endone 10mg (tds) and 2 mg (b.d) . To cure burns and bruise he is recommended painkillers and antibiotic. The patient needs palliative care for the different types of ulcers he is suffering from.

Case#. Wound management principals and their application in a clinical environment

Medical history and Examination of the Patient and the Wounds

Mrs. Miriam Gold is an old lady in her 80s and is suffering from various health issues including cervical cancer, pneumonia and oozing of fluids due to dialysis. She also suffered from GORD, CABGS and COPD. She is using pads and is incontinent. She is in RIB condition and cannot move. Her left groin has a malignant wound and a sinus has been developed due to the release of puss. The puss has a strong odor and it is, therefore, her house members do not want to be involved in the treatment. She has got rectovaginal fistula due to radiotherapy and her venous ulcer is also not showing any improvement.

Type of wounds and their Causes

Malignant wound:

A malignant wound is also known with another name called tumor necrosis and is a tumorous wound. It happens due to the intrusion of metastatic tumors or primary tumors (Lazarus et al., 1994).

Venous ulcer:

Venous ulcer is also called stasis ulcer and is due to extremity ulceration (Collins, & Sera, 2010).

Investigations Required for the Wound

Mrs. Gold was under palliative treatment and the malignant wound has a visible sinus and is releasing pus as well. The malignant wound can also be investigated based on its odor. Her cervical cancer was also showing some discharges. The side effect of radiography has caused her Rectovaginal fistula ad her venous ulcer was also not healing. So the symptoms of all the ulcers were clear which helped in further investigations.

Wound Management Principles

Although the patient needs a palliative treatment her the wounds of the Venous Ulcer can be managed by compression therapy that is a therapy to increase the blood flow to the lower limb. That is needed to be done for 30 minutes and should be done 3-4 times per day (Collins, & Sera, 2010).

The malignant wound can be managed by Interdisciplinary team management as teamwork is needed for dressings and cleanings and its order can be controlled by the addition of necrotic materials (Lazarus et al., 1994).

Evaluation of Wound

Wound bed status:

The wound of venous ulcer has yellow puss and the skin looks firm and is giving a pinkish appearance. The Malignant wound is also oozing out some fluid and the redness of the skin is also visible.

Wound characteristics

Leakage of fluids and swelling is visible in the wounds of venous ulcer. The malignant wound has a very strong odor, bleeding, pain, and exudation. The malignant wound also interferes with the moment of legs as it is in the groin area.

Wound measurements

Venous ulcer goes up to the depth of the legs because of the development of fistula and sinus, while the malignant wound is spreading horizontally.

Condition of the surrounding skin

The skin is tight and looks damaged from venous cancer. It is red and giving a granular appearance. The Malignant wound is surrounded by minor swollen skin and it is giving a pinkish appearance.

Wound exudate:

The malignant wound can be cured but it has also a very strong smell which is making its treatment difficult. Venous cancer is going deep due to the formation of sinus and has no odor but is constantly occurring again and again. Doppler ultrasound is needed to locate the tumor in both cases.

The Expectation of the Healing Process of Wounds

Both of the wounds should be free of infection and oedema should be continuously checked. Venous cancer is a constantly occurring type of disease and the wound cannot be cured easily so it needs constant care. The pathology of the malignant wound is also be controlled in order to control the spread of the tumor. The patient needs to take care of her hygiene and needs to increase protein intake that will help in the healing of the wounds.

Wound Management Plan

Moist wound healing

The healing of malignant wound can be accelerated by the use of moistures and hydrated gels and moistures (Lazarus et al., 1994). Occlusive dressings are needed for the treatment of

Venous ulcer as it will keep the wound moist which will help in the healing process.

Skin risk assessment:

The risk assessment in case of a malignant wound is done by checking the release of blood and odor from the wound which makes the treatment difficult. Sue to high exudate level the risk of skin damaged is also been found. In the case of venous ulcer, the wound assessment should be carefully done to check the healing process.

Wound cleansing:

The wound cleaning for venous ulcer and the malignant wound includes non‐woven gauze swabs to reduce the number of dead tissues and flushing the wounds with normal saline water to control infection (Lazarus et al., 1994).

Pressure support & relieving device:

Both the disease needs a pressure support device including a comfortable mattress and pillow to divert the pressure. Vacuum-assisted closure is mostly useful to get mechanical assistance for the patient of venous ulcer.

Prevention program:

The family of the patient needs to be educated regarding the given diseases and the risk factors should be controlled for reoccurring of venous ulcer and malignant wounds. Body movement is necessary to increase the blood circulation to the limb and nutrient level of the patient should be taken good care.

Dressing product (primary dressing)

Semi-occlusive or occlusive wound dressings will improve the healing process of both the wounds (Lazarus et al., 1994).

Health Education that may be provided to the Resident in Regards to their Wound

The local and the family members should know that the patient needs emotional and financial support to fight against cancer. The wounds should be kept infection free and the patient nutrient level should be perfectly managed. The odor of the malignant wound might irritate the resident but they need to think of measures to lessen down this smell.

Pain Management

The patient is taking palliative treatment and is taking Midazolam 10 mg (24/24), Fentanyl 25-50 mcg (S/C ), Midazolam 2.5-5 mg (S/C), and Fentanyl 200 mcg.

The patient needs the support of her family to go through this tough time of her life.

References

ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Boike, A., Maier, M., & Logan, D. (2010). Prevention and treatment of leg and foot ulcers in diabetes mellitus. Current Clinical Medicine.

Gould, L., Abadir, P., Brem, H., Carter, M., Conner‐Kerr, T., Davidson, J., Gardner, S. (2015). Chronic wound repair and healing in older adults: current status and future research. Wound Repair and Regeneration, 23(1), 1–13.

Gruen, D. (2010). Wound healing and nutrition: going beyond dressings with a balanced care plan. The Journal of the American College of Certified Wound Specialists, 2(3), 46–49.

Kim, E. S., Wattanakit, K., & Gornik, H. L. (2012). Using the ankle-brachial index to diagnose peripheral artery disease and assess cardiovascular risk. Cleve Clin J Med, 79(9), 651–661.

LAUREN COLLINS, & SAMINA SERA. (2010). Diagnosis and Treatment of Venous Ulcers . 8, 989–996.

Lazarus, G. S., Cooper, D. M., Knighton, D. R., Margolis, D. J., Percoraro, R. E., Rodeheaver, G., & Robson, M. C. (1994). Definitions and guidelines for assessment of wounds and evaluation of healing. Wound Repair and Regeneration, 2(3), 165–170.

McInnes, E., Jammali‐Blasi, A., Bell‐Syer, S. E., Dumville, J. C., Middleton, V., & Cullum, N. (2015). Support surfaces for pressure ulcer prevention. Cochrane Database of Systematic Reviews, (9).

LAUREN COLLINS, & SAMINA SERA. (2010). Diagnosis and Treatment of Venous Ulcers .8, 989–996.

Subject: Healthcare and Nursing

Pages: 6 Words: 1800

Wound Management Plan

Wound Management Plan

[Name of the Writer]

[Name of the Institution]

Wound Management Plan

Introduction

Martha Stewart is a 75-year-old woman who was admitted in the hospital with a Venous Leg Ulcer. She lives with her son, daughter in law and 2 grandchildren. Her husband passed away 5 years ago. Martha has two more children as well, a son and a daughter who occasionally visit her (Park, Hwang & Yoon, 2017). They seem like a close-knit family as all Martha's family members seemed quite concerned about her wound. Martha has had a past history of osteoarthritis, total knee replacement, thyroidectomy and hypertension. All in all, Martha has a well-balanced diet and takes care of herself the best she can (Park, Hwang & Yoon, 2017).

Wound Evaluation

The leg ulcer occurred on the gaiter portion of Martha's right leg around five months ago. The initial dimensions of her wound were 10cm x 5cm. The wound was being measured on a regular basis by the last caregivers she was a patient for, but no alterations were seen in the wound size. In the start, the wound was red in colour and also shallow (Park, Hwang & Yoon, 2017). The skin which was surrounding the wound was quite discoloured and varicose vein could be seen on the leg that was affected. They gave the indication of varicose eczema. Given the classic symptoms, it was safe to say that Martha was suffering from a venous leg ulcer.

Impact of the Wound

The wound impacted Martha’s life in more ways than one. She has severe pain, swelling and itching on her leg. These symptoms are taking a toll on the quality of her life, she cannot move around like she used to (Raffetto et al., 2016). Her movement is limited, which also has an impact on her weight. Her sleeping patterns are also quite disturbed. There are certain nights when she hardly gets any sleep due to the pain. Further, she has not been able to spend family time like she used to. She has not been able to play with her grandchildren either. This is also causing her to suffer from depression.

Wound Physiology

There are three stages to the healing of the wound. The first stage being inflammation, second being proliferation and the last being the maturation phase. Martha's wound is still in the inflammation stage (Raffetto et al., 2016). This is the first stage in which the initial healing starts. This has more to do with the body's natural reaction to trauma. When the human body suffers from a wound, it starts the homeostasis. In this step, the blood vessels seal and constrict themselves as the platelets start to form a substance that will form a clot which will stop the bleeding. Once this process is over and done with the blood vessels start to dilate, which further lets in the white blood cells, nutrients, enzymes, antibodies and other elements that are essential for the promotion of good wound healing and aid in controlling the infection (Franks et al., 2016). This is also the step when Martha would be facing the inflammation; swelling, pain, redness, and heat is experienced in the affected area.

Then comes the stage of proliferation. In this phase, the wound starts to rebuild itself via healthy and new granulation tissue. It is a known fact in the medical world that the hue of the granulation tissue specifies the health status of the wound. If the wound is red or pinkish in colour it is an indicator that the wound is healing properly but if the wound is dark in colour that means that an infection is developing or has developed (Franks et al., 2016). In Martha's case, the wound was red in colour in the beginning but it started to change colour within the five-month span. That means that the wound got infected.

The final stage of the healing process is maturation. It starts when the injury has closed, it can take around 1-2 years of time. In this stage, the dermal tissues are repaired to improve their stretchable strength. The fibroblasts that are nonfunctional are substituted by functional ones. Further, cellular activity decreases by time and the number of blood vessels that are present in the area that has been affected also decline and retreat. It should be kept in mind that even if the wound is in the maturation stage the patient should go on with the treatment plan. If the patient neglects the wound, there is a chance of risk that the wound will start to break down again as it has still not healed completely. Even after the wound has gone under complete maturation, it still stays 20% weaker than it was initially. In cases when the patient is older, they should take care of the area that had the wound even after the maturation process has taken the full course.

The Wound Management Plan

Before the wound management can be initiated, it should be made sure that the wound and the surrounding areas are in preferable conditions to start the healing process. If the wound has moisture in it, bacteria will be produced that will lead to the wound getting infected. In Martha's case, the wound was badly infected. Over the course of time, there were various dressing regimens that were followed in order to initiate healing. Since the wound got infected the patient was eventually asked to take Flaxopen. Later, Kaltostat and Intrasite gel were also discontinued as Martha felt like they were making the skin around the wound rough, regardless of the use of petroleum jelly on the good skin (Green, Jester, McKinley, & Pooler, 2018). Healthcare givers around the world have claimed that when it comes to wound management the bandaging and dressing are key and the main factor that helps in the wound healing. The idea is to boost and aid the healing process by keeping the wound clean and creating a fit environment for it to heal.

When it comes to wound management plan, it starts by the cleaning of the wound properly in a manner that all the access dead skin around the damaged area has been removed and the wound has been cleaned with the help of normal saline. This step makes sure that all the debris and exude around and on the wound has been removed. After that, an effective antiseptic is used to clean the wound further. This step is essential as it gets rid of all the bacteria that can become the cause of an infection. After this, the healthcare nurse prescribed Martha to take an oral supplement which is high in protein to initiate the healing process. Further, she has been prescribed a Profore compression bandage, which would be applied to the wound twice a week. This will be done for two weeks straight (Green, Jester, McKinley, & Pooler, 2018). After those two weeks, the bandage will be applied to the wound once in a week. The care plan also required her to wear elastic stockings on top to keep everything secure.

Choosing the bandaging technique or dressing is one of the most crucial steps of wound management. In this case, no second dressing was required for the wound. It was evident by the second week of the changing of the bandage that the wound had started to heal. Martha added that the wound was less itchy and the skin around it was not getting rough either. She also said that the inflammation and pain were much better. It took some time but within four months the wound had completely healed. The Profore compression bandage did its work. The healthcare givers started applying it on Martha at the beginning of April and by the end of August, she was completely healed (Green, Jester, McKinley, & Pooler, 2018). The healthcare givers were very happy with the results. They could see that the wound had completely closed and the maturation period had started. There are studies that have proven the fact that a single layer of compression bandage system has worked tremendously well for venous leg ulcers.

The need for giving Health Education to the Patient

It is essential that Martha is given awareness in regards to the factors that aid in the healing of the wound. In fact, Martha herself asked that how can she take a shower. She likes to keep herself clean so skipping shower was not a solution for her. In this regard, it was essential that she bathes in a manner that the wound stays dry. It is important that the wound is kept dry so it heals properly, so it should not be under any circumstances be exposed to moisture (Norman et al., 2016). In order to take a shower, she can wrap a plastic sheet around her leg so the water does not seep in through the bandages. Further, it is also necessary that the area around the wound is kept clean as well to avoid any kind of infection. For that, Martha can take a wet and warm towel to clean the area around the wound.

Even after the patient goes home they should always keep tabs on the wound; that the bandage does not have any kind of discharge or there is no unique feeling in the wound. Additionally, even after the wound has been healed completely, it is necessary that an eye is kept on it. If there is an abnormal swelling, redness or pain the healthcare giver should be approached immediately (Norman et al., 2016). Lastly, Martha should keep an eye on her diet. She needs to take a diet that is rich in protein and vitamins. It is also necessary that she avoids taking any high-calorie diet as she had already gained weight due to her movement being restricted. She should focus on the greens and take in lean protein on a daily basis. Other than that, she should also incorporate fruits in her diet that speed up the healing process. Food items that are high in vitamin C are perfect for this, citrus is the best bet. Her son and daughter in law have been given the diet plan that is fit for Martha's health (McGregor, 2016). However, she will be also prescribed some multivitamins and supplements that will aid in the healing as well.

Pain Management

The kind of wound that Martha has had, pain management is essential. She has been complaining of pain every now and then throughout the healing process. Since the pain is not extreme she will be prescribed with Paracetamol 500mg. This is a drug that is used to treat mild pain and fever. Since the nature of Martha's pain in similar, this is perfect for her. Having said that she will be asked to take it only when it is needed most (McGregor, 2016). The combination of the compression bandage technique and the paracetamol will help with the pain management and fast healing of the wound.

References

Park, J., Hwang, S., & Yoon, I. S. (2017). Advanced growth factor delivery systems in wound

management and skin regeneration. Molecules, 22(8), 1259.

Raffetto, J. D., Eberhardt, R. T., Dean, S. M., Ligi, D., & Mannello, F. (2016). Pharmacologic

treatment to improve venous leg ulcer healing. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 4(3), 371-374.

Franks, P. J., Barker, J., Collier, M., Gethin, G., Haesler, E., Jawien, A., ... & Weller, C. (2016).

Management of patients with venous leg ulcers: challenges and current best practice. Journal of wound care, 25(Sup6), S1-S67.

Green, J., Jester, R., McKinley, R., & Pooler, A. (2018). Chronic venous leg ulcer care: Putting

the patient at the heart of leg ulcer care. Part 1: exploring the consultation. British journal of community nursing, 23(Sup3), S30-S38.

Norman, R. E., Gibb, M., Dyer, A., Prentice, J., Yelland, S., Cheng, Q., ... & Edwards, H.

(2016). Improved wound management at lower cost: a sensible goal for Australia. International wound journal, 13(3), 303-316.

McGregor, H. (2016). Australian Wound Management Association becomes Wounds

Australia. Wound Practice & Research: Journal of the Australian Wound Management Association, 24(1), 4.

Subject: Healthcare and Nursing

Pages: 6 Words: 1800

Wound Management Plan 2

Case No. 1

Holistic Assessment of Patient

Mr. Will Jackson is a 77 years old man, diagnosed with Rectal Ca almost 5 years ago. Currently, he is suffering because of poor oral intake, intermittent pain from his wounds both from diabetic foot ulcer & arterial ulcer. He had CABG 2 years ago alogn with COPD, ETOH, GORD, Postural hypotension & T2DM on insulin. Patient experiences intermittent confusion at times. His medications include Telmisartan 40 mg. b.d, Ventolin 4 puffs t.d.s, Esomeprazole, 20 mg daily, Lantus 20 units (mane), warfarin 2 mg (daily), Frusemide 20 mg b.d. PRNs : Endone 10mg (tds), Hydromorphone 2 mg (b.d).

He was admitted to the ward for pain management, SOB & wound management. Prior to admission, he had a fall at home with a head strike and had a massive bruise over his face. CT scan result: NAD. The doctor stopped his warfarin dose for a week due to this massive bruise.

Mr. Jackson has a diabetic foot ulcer behind his L) toe that requires debridement while in hospital. Apart from this he also has arterial ulcer on his R) lower leg which looks infected. The treating doctor ordered a wound swab to be taken and send to pathology. The result shown that it is infected.

He also has 1 pressure ulcer on his sacrum bone which was discovered when he first admitted into hospital post fall. It is a stage 3 pressure ulcer and caused him a lot of pain especially if he is lying in supine position. Mr Jackson thought it was pain from his cancer in the rectum. The wound base of the ulcer consists of 70% sloughy tissue and 30% granulation tissue.

On day 3 in hospital, patient suffered from a burn because he spilled a hot coffee over his L) arm. He sustained a second degree burn because of this.

Evaluation and Wound Management Plan

Diabetic Ulcer

The management of diabetic ulcers require offloading the wound and cleaning it with saline daily. Furthermore, it requires treatment that would provide moist wound environment.

Wound Management Plan

Moist Wound Healing

Saline or similar dressing

Skin & Risk Assessment

Improper care can lead to infections and gangrene. The care also requires optimal control of blood glucose with the correction of peripheral arterial insufficiency.

Wound Cleansing

Clean with saline on daily basis.

Pressure Support and Relieving Devices

Use therapeutic footwear to provide pressure relief

Preventive Programs

Control blood glucose through proper diet and medications

Wound Dressing Products

Moist dressing. antibiotic ointments

Secondary Dressing (if required)

None

Pain Management Time Frame (if required)

The pain will persist till the wound is open. Pain relief medications are necessary.

Infected Arterial Ulcer

These are poor perfusions i.e. lack of nutrient rich blood delivering vessels to the lower extremities. The covering skin and tissues are deprived of oxygen that kill the tissues and cause the area to create an open wound.

Wound Management Plan

Moist Wound Healing

Saline wash and open dressing to avoid infections.

Skin & Risk Assessment

This can lead to foot deformity, callus formation and lack of joint mobility. Furthermore, it can lead to tissue necrosis and even amputation in case of extreme conditions.

Wound Cleansing

Saline wash for cleansing the wound with topical ointment.

Pressure Support and Relieving Devices

Wearing therapeutic footwear.

Preventive Programs

Physiotherapy, diabetes control and management.

Wound Dressing Products

Open dressing and saline wash. antibiotic ointments

Secondary Dressing (if required)

None

Pain Management Time Frame (if required)

Severe and persistent pain. Pain relief medications are necessary.

Pressure Ulcer

Also known as Bed sores, these pressure ulcers are injuries to the underlying tissues and the skin because of the prolonged pressure of the skin. People with limited capability to move are more prone to these ulcers.

Wound Management Plan

Moist Wound Healing

Dry treatment is required

Skin & Risk Assessment

Improper care can lead to risks such as cellulitis, bone and joint infections, cancers and sepsis.

Wound Cleansing

Saline cleaning is required. However, the wound must be dried off.

Pressure Support and Relieving Devices

The site must avoid any pressures or contact with hard surfaces.

Preventive Programs

Constant repositioning can avoid bedsores. Good nutrition and exercise also helps in avoiding bed sores.

Wound Dressing Products

Dry and open dressing is required, antibiotic ointments

Secondary Dressing (if required)

None

Pain Management Time Frame (if required)

2-4 weeks based on the severity of the wound.

Second Degree Burn on Arm

Second degree burns are the ones in which the epidermis and partial dermis layer is damaged due to burns. The site appears red, blistered, swollen and painful.

Wound Management Plan

Moist Wound Healing

Dry wound healing is required

Skin & Risk Assessment

Improper care can lead to infections and sepsis.

Wound Cleansing

Dry cleansing

Pressure Support and Relieving Devices

Pressure and any contact must be avoided

Preventive Programs

Avoid any hot or burning contact.

Wound Dressing Products

Antibiotic ointments, change of dressing twice a day, daiy cleaning, dead skin removal.

Secondary Dressing (if required)

None

Pain Management Time Frame (if required)

Pain relief medications are required until the wound is fresh.

Health Education Regarding Wound

Since the patient is suffering from immobility and multiple ulcers and wounds, it is important that he must be assisted in cleaning and dressing the wounds as per needed. While other ulcers need once a day cleansing and dressing, the burns must be cleaned twice or thrice day. Patient is unable to do this himself, therefore, he needs assistance at home.

Case No. 2

Holistic Assessment of Patient

Mrs. Miriam Gold, 85 years old patient has fluids overload (dialysis will be ceased due to palliative approach), Pneumonia & metastatic cervical cancer. She is also often drowsy and vague. She : lives home with husband. Pt & family wants no further treatment. Mrs. Gold was admitted to the ward for palliative treatment. Husband and children are not coping at home and she was in a lot of pain due to her malignant wound on her L) groin.

The malignant wound on her groin is oozing a lot of pus and it has developed a sinus. The odour that coming out from the wound is quite strong. The patient requires pain relief before dressing change and for any pad changes/hygiene care. It was reported that her groin and peri-anal area is burning red due to bowel incontinence & discharge from her cervical cancer.

In patient history notes stated that, Mrs.Gold had developed a rectovaginal fistula as a result of disease progress and radiotherapy. In addition to this, the patient has a long standing venous ulcer that is not healing.

Evaluation and Wound Management Plan

Malignant wound on groin

This is an open wound that can be cancerous in nature if nor treated properly. The wound is draining and looks like an open cavity on surface of the skin. The appearance is bumpy and irregular.

Wound Management Plan

Moist Wound Healing

The wound requires dry healing process.

Skin & Risk Assessment

The wound can lead to infections, sepsis, odour, inflammation, extreme pain, etc.

Wound Cleansing

Daily cleansing with saline is important to ensure no infection develops.

Pressure Support and Relieving Devices

The site should be avoided from any pressures or clothing contact.

Preventive Programs

Quality nutrition, skin assessment.

Wound Dressing Products

Antibiotic ointment, dry dressing

Secondary Dressing (if required)

None

Pain Management Time Frame (if required)

4-6 weeks based on the severity. Pain relief medications are important.

Venous Ulcer

This ulcer is more common in women and older individuals. This is also associated with venous hypertension. The clinical features of this ulcer include painful site, bony appearance, etc.

Wound Management Plan

Moist Wound Healing

Daily saline wash is required.

Skin & Risk Assessment

The condition is often associated with edema, venous dermatitis, varicosities, and lipodermatosclerosis

Wound Cleansing

Saline

Pressure Support and Relieving Devices

Leg elevation, compression therapy

Preventive Programs

Thorough skin tests and health assessment

Wound Dressing Products

Open dressing, antibiotic ointment, aspirin, surgical management

Secondary Dressing (if required)

None

Pain Management Time Frame (if required)

Depends on severity of issue.

Health Education Regarding Wound

For this patient, it is important to understand the critical nature of the wounds. Since she has two wounds at the moment – both having similar characteristics but different diagnosis. It is important that she must ensure constant cleaning and draining of her wounds to avoid sepsis and infections. Furthermore, she must ensure healthy and balanced nutrition intake to avoid further skin complications, rashes, blood supply, etc. Personal hygiene is also important to allow good blood supply to the skin and avoiding any infections.

References

Schultz, G. S., Sibbald, R. G., Falanga, V., Ayello, E. A., Dowsett, C., Harding, K., ... & Vanscheidt, W. (2003). Wound bed preparation: a systematic approach to wound management. Wound repair and regeneration, 11, S1-S28.

Bowler, P. G., Duerden, B. I., & Armstrong, D. G. (2001). Wound microbiology and associated approaches to wound management. Clinical microbiology reviews, 14(2), 244-269.

Baranoski, S., & Ayello, E. A. (2008). Wound care essentials: Practice principles. Lippincott Williams & Wilkins.

Meaume, S., & Gemmen, E. (2002). Cost-effectiveness of wound management in France: pressure ulcers and venous leg ulcers. Journal of wound care, 11(6), 219-224.

Jeffcoate, W. J., & Harding, K. G. (2003). Diabetic foot ulcers. The lancet, 361(9368), 1545-1551.

Trent, J. T., Falabella, A., Eaglstein, W. H., & Kirsner, R. S. (2005). Venous ulcers: pathophysiology and treatment options. Ostomy/wound management, 51(5), 38-54.

Alexiadou, K., & Doupis, J. (2012). Management of diabetic foot ulcers. Diabetes Therapy, 3(1), 4.

Subject: Healthcare and Nursing

Pages: 5 Words: 1500

Wound Managment

Title page

Wound management

Medical history

The patient is a 68-years old man who developed ulcers on both legs. The patient suffers from acute arterial ischemia that appears on the legs and swift inception is linked to the embolic occurrence. The patient remained smoker and is socially active. The plaque has settled on the arterial walls and they float around the smaller blood vessels. The condition reflects that ulnar artery and palmar arch are affected. The nature of the wound indicates that it is round shaped and caused by putting pressure on hand that damaged the skin. The ulcer is painful and drains a larger amount. Acute arterial ischemia causes tissue necrosis and required immediate amputation. The symptoms and signs are not quite visible in case of hand wound. The injury is associated with intense spasm including the distal arterial tree. It causes coagulates blood that gets darker and coarser in the pattern. Larger patches of staining appear that causes blistering and liquefaction. If not treated appropriately this leads to reperfusion injury. The fungal infection is apparent in the injury. The visible mold or plaque is formed that can spread to other parts. Viral infection reflects the serious implications of this wound. This is caused by certain bacteria that are capable of growing at other parts of the body.

Wound management principles stress on understanding the physiology of the wound and anticipate the process of healing. Normal stages of wound healing are identified and adequate care standards are adopted for managing the injury. Provision of adequate care and treatment is critical for attaining the quality of care and minimizing the extent of pain. Various methods are constructed for stimulating cellular adhesion. The management principles stress on identifying the right dressing including; silver dressing, soft silicone and scaffolding CITATION CDa12 \l 1033 (Daunton, Kothari, Smith, & Steele, 2012).

Evaluation of wound

Wound bed status exhibits the time framework established for assisting practitioners in examining and managing patient with a wound. This emphasizes on treating the patient as a whole by implementing wound bed preparation care cycle. Bed preparation stresses on Tissue, Infection, Moisture and wound Edge (TIME). As the wound is acute so the practitioner follows a well-defined process. This involves coagulation, inflammation, the proliferation of cells and epithelialisation. TIME framework is considered as an effective method for treating the patient that has experienced serious wound injury. It determines the barriers of the healing process and removing them that promotes the overall health status of the patient.

Wound characteristics based on the TIME framework are explained. Time: the examination of the wound indicates that the cell debris will influence the process of healing. Infection: high bacterial counts are recorded that causes prolonged inflammation. Protease activity is also linked with the growth of bacteria in the wound. Moisture: imbalance shows that excessive fluids have resulted in maceration of the wound margin. Edge: the non-responsive wound cells are capable of causing abnormality in the cellular matrix and abnormal protease activity. The wound occurred due to the limited or curtailed blood supply.

Wound measurement uses scale photograph for identifying the exact affected area. Ultrasonic digitizer provides a clear view of the wound. It is critical to measure the width and breadth of the wound. This required examining the edges of the wound and writing description. The redness and the puffiness are defined.

Skin conditions reveal that the area is reddened and black. There is swelling and skin lesions are visible. The skin is shiny and not normal. Patches appear on the edges. Wound exudate depicts that it appears to be grey or black in colour. Swelling is apparent around the wound and in case of pressure, the condition will get worst. The wound doesn't seem to be bleeding and is sunken in appearance.

Healing process

Physiology of healing process identifies the stages that are initiated with the inflammatory stage. The aetiology of the wound indicates that comorbid alignments lead to chronic wounds including immune suspension, pyoderma and ischemia. The pathophysiology indicates that the wound affects the dermis and epidermis of the infected area. The wound is classified on the basis of discolouration, swelling, warmth and hardness. Stage 2 of the assessment depicts that wound penetrates the skin. In the next stage, the thickness of the wounds is identified that does not penetrate through the white membrane. The fascia separates the skin from the fat of the deepest tissue. The fourth stage finds if the wound causes damage to the muscle bone and tissue or not.

The stages of wound healing are identified in the physiology. Inflammatory start begins a few days after the injury. The wounded area attempts to restore and return to its normal stage through improved blood supply and circulation. Thromboplastin and platelets are responsible for making the clot. The redness and healing are recorded that are seen as visible indicators of the immune response. The bacteria is cleaned with the white blood cells. The second stages of the healing process include the proliferation stage that constitutes of three weeks or more. The severity of the wound affects the stage and process of healing. The fibroblasts are special cells that work for filling the wounds. New blood vessels are also developed in this stage CITATION Nay13 \l 1033 (Naylor, 2013). Maturation and remodelling is the last stage that constitutes two years. The alteration in the shape of the wound is the sign of active healing.

Evaluation of wound management plan

The wound care department of the hospital provides instructions to treat the wound appropriately. The assessment of the injury provides information (started III wound on hand, started from the small wound and progressed). The possible solutions for the case involve wound Vac placement and complex dressing change. Complex wound requires more care. The nursing staff needs to adopt appropriate steps to prevent any complications CITATION Adi14 \l 1033 (Sood, Granick, & Tomaselli, 2014). The pre-procedural care involves the teaching of steps that help nurses to manage wounds. Wound care dressing requires appropriate procedures and adequate care. The initial step includes using an adequate hygiene process such as washing hands and wearing sterile gloves. The second step is to clean the wound with warm water. The nursing staff must take care that the wound does not bleed more and clean it gently. Negative pressure wound therapy helps to manage the wound effectively CITATION Jan151 \l 1033 (Hioldens, 2015). Hydro-conductive dressings also provide immediate results and are easily managed. Only professionals can manage the wound with proper care and treatment.

The possible complications about dressing involve delay in healing. Chronic wounds present a more alarming situation as the wounds can lead to further complications such as foot ulcers and other skin diseases. The common medicines and drugs used for wound dressing include Vancomycin IV, Lidoderm 4%, silver sulfadiazine, and lidocaine topical. One possible outcome of post-procedure is wound failure to progression. When the wound fails to progress, it results in delayed healing, wounds breakdown, and deterioration. Right assessment of wounds is important. Treatment often helps to manage wounds effectively and on time. The psychosocial impact of delayed healing and prolonged recovery is negative on the patient and the family. The patient gets restless and aggressive at times CITATION Mic151 \l 1033 (Dreifke, Jayasuriya, & Jayasuriya, 2015).

Provision of health education

Wound education is provided to the patient for self-management. This is crucial for ensuring that the patient follows the procedures that will ensure his recovery. The process will explain steps that the patient will take for managing wound at home. The patient will be advised to avoid walking or doing activities that demand more physical input. Self-management is an effective intervention employed for reducing the adverse impacts of ulcer wounds. The patient is taught preventive behaviours that are effective for the patient cohort. Increasing patient knowledge about the wounds and adherence to therapy promotes chances of timely recovery. The content used for sharing information includes written verbal and visual material. Education is provided about the use of medicines, dressing, washing and avoiding activities that could worsen the condition of the wound CITATION Azi11 \l 1033 (Nather, Hong, Lin, & Sakharam, 2011).

A comprehensive care plan is established and shared with the patient. The plan explains the procedures that the patient will manage himself. This plan includes information about the dressing, a way of treating the wound, dosage and time for taking medication CITATION Azi11 \l 1033 (Nather, Hong, Lin, & Sakharam, 2011). Dietary guidelines are also provided to the patient that will increase the process of healing. The instructions include; gently washing the leg, with mild soap recommended by the physician. The prescribed soaps are Dreft and Ivory Snow. The patient will be advised to use lukewarm water when he is treating the wound. The patient is advised to examine the legs and the affected area daily and observe if any change takes place. The observations taken for reporting changes include redness, harshness or increased warmth. The patient is advised to take the medications and apply lotion or cream twice a day.

Guidance about natural intervention is also provided to the patient that include the use of amino acids that increases the process of healing. The patient will use Omega 3 fatty acids in the diet because it also improves the recovery of the wound. Consumption of vitamin A will increase the process of tissue and skin repair. Vitamin C is effective in eliminating the risks of slow healing. The patient is provided with the knowledge on factors that could slow healing such as stress, diabetes, neglecting daily medication or excessive washing CITATION Nay13 \l 1033 (Naylor, 2013).

Pain management

Pain management is another critical stage in improving the health of the patient who has experienced ulcer wounds. Managing pain in ulcer wounds is important because it can slow the process of recovery. It is crucial to determine the quality and intensity of pain. Use of proper medications and drugs reduce the extent of pain. The medications like ibuprofen are used for five days that lessens the intensity of pain. The common medicines used for curing the patient with ulcer wound include anti-biotic. This is effective when the patient has developed an infection. The regular doses of paracetamol are advised with the frequency of 500mg x 2. This reflects that the right dosage is to take the medication two times a day CITATION CDa12 \l 1033 (Daunton, Kothari, Smith, & Steele, 2012). Lidocaine patch over the wound is also a useful intervention for providing relief from the pain CITATION Ham15 \l 1033 (Hampton, Kerr, & Crossley, 2015).

Dressing creams and ointments are also used for controlling pain in patients. The common ointment used for managing pain is local anaesthetic cream EMLA 5%. The medication is effective for the removal of pain before the procedure and improves the healing process. Creams are applied to the affected area two times a day for keeping the wound protected from the environment and infections.

References

BIBLIOGRAPHY Daunton, C., Kothari, S., Smith, L., & Steele, D. (2012). History of materials and practices for wound management. Wound Practice and Research, 20 (4).

Dreifke, M. B., Jayasuriya, A. A., & Jayasuriya, A. C. (2015). Current wound healing procedures and potential care. Mater Sci Eng C Mater Biol Appl, 48, 651–662.

Hampton, S., Kerr, A., & Crossley, M. (2015). Summary of five case studies on the treatment of venous leg ulcers with a new two-layer compression system in a community setting.

Hioldens, J. (2015). Top tips for a skin graft and donor site management. Wound Essentials, 10 (2).

Naylor, W. (2013). Malignant wounds: Aetiology and principles of management. Nursing Standard, 16 (52).

Nather, A., Hong, N. Y., Lin, W. K., & Sakharam, J. A. (2011). The effectiveness of bridge V.A.C. dressings in the treatment of diabetic foot ulcers. Diabetic Foot & Ankle, 2 (1).

Sood, A., Granick, M. S., & Tomaselli, N. L. (2014). Wound Dressings and Comparative Effectiveness Data. Adv Wound Care (New Rochelle), 1; 3(8), 511–529.

Subject: Healthcare and Nursing

Pages: 6 Words: 1800

Wound Managment Assignment

Wound Management Plan

[Name of the Writer]

[Name of the Institution]

Wound Management Plan

Case study

Patient

John Levine is a 47-year-old man who lives with his wife and two teenage daughters. He was admitted to the hospital with a diabetic foot ulcer. John was diagnosed with type two diabetes around five years ago. He was a loving family and has his brother living in the neighbourhood as well. John stopped working two years ago and has been focusing on writing a book ever since. This has caused him to gain weight as well. he does not smoke or even drinks. However, John does not have a very good diet (Khalil, Cullen, Chambers, Carroll & Walker, 2016). He loves processed food and has been exposing his body to high amounts of sugar every now and then and trying to counterbalance it by taking insulin. He is on insulin and metformin currently to manage his diabetes.

Wound Assessment

The foot ulcer developed on the lower portion of John’s leg two months ago. The dimensions have stayed the same over the course of time as per the measurements that the healthcare givers have been taking of the wound. In accordance with the last measurement, the wound was around 12cm x 4cm in dimension (Khalil, Cullen, Chambers, Carroll & Walker, 2016). The wound is not showing any signs of getting smaller. Initially, the wound was quite red and shallow but now it seems to be deeper. Recently, the skin around the wound started to get darker and the wound turned slightly darker as well. this fact indicates that the wound on John's leg is undergoing an infection.

Influence of the Wound on John’s life

The wound has had a bad impact on John's life. He suffers from social anxiety as he no longer can move around his social circle like he used to. Further, he claims that he has severe pain in his wound which has been causing discomfort. This discomfort is also influencing his sleep pattern, he hardly gets any sleep now (Khalil, Cullen, Chambers, Carroll & Walker, 2016). He feels like his quality of life is being compromised. He cannot make to both his daughters' school recitals anymore which is adding to his depression. The added stress is also making him eat more than he usually does, which has caused weight gain. The access weight and the wound has taken a toll on his self-esteem.

Wound Composition

There are a total of three phases to wound healing which are as follows:

Inflammatory stage

The healing process starts with the inflammatory stage in which the primary curing starts. This has more to do with the body's own feedback to trauma. When the human physique faces a wound, it starts the homeostasis. In this step, the blood vessels cover and tighten themselves as the platelets start to form a matter that will form a lump which will halt the bleeding. Once this procedure is over and done with the blood vessels start to dilate, which further lets in the white blood cells, nutrients, enzymes, antibodies and other elements that are vital for the advancement of good wound curing and help in regulating the infection (Goodwin, Spinks & Wasiak, 2016). This is also the step when John would be facing the inflammation; swelling, pain, redness, and heat is experienced in the area that has been affected.

Proliferative stage

This is the second stage, the stage of proliferation. In this phase, the wound starts to reconstruct itself through healthy and new granulation tissue. It is a known fact in the medical world the colour of the granulation tissue stipulates the health status of the wound. If the wound is red or pinkish in colour it is a pointer that the wound is curing correctly but if the wound is dark in colour that means that an infection is emerging or has developed (Armstrong, Boulton & Bus, 2017). In John's case, the wound was red in colour in the beginning, but it started to change colour within the three-month span. That means that the wound has undergone an infection.

Maturity stage

This is the last stage of the healing process. It initiates when the injury has healed, it can take two-three years of time. In this stage, the dermal tissues are mended to improve their stretchable strength. The fibroblasts that are nonfunctional are substituted by functional ones. Further, cellular activity decreases by time and the number of blood vessels that are present in the area that has been affected also decrease and withdraw. It should be kept in mind that even if the wound is in the maturation stage the patient should go on with the treatment plan. If the patient ignores the wound, there is a chance of risk that the wound will start to deteriorate again as it has still not healed totally. Even after the wound has gone under complete maturation, it still stays weaker than it was originally (Armstrong, Boulton & Bus, 2017). In cases when the patient is older, they should take care of the area that had the wound even after the maturation process has been experienced.

The Wound Management Plan

Before the initiation of the wound management plan, it should be made sure that the conditions are preferable for the wound to go under the process of healing. There are certain factors that can hamper the healing of the wound. If the wound is kept in a manner that moisture develops, it can lead to the affected area getting infected. In John's case, the wound was badly infected. In the past three months, John was prescribed with many regimens to initiate the healing process of his wound. Since the wound was infected John was asked to take an antibiotic to contain the infection (Bus & van Netten, 2016). He was also prescribed with intrasite gel to be used on the wound, but later he was asked to discontinue the use because of the dryness the gel was causing. There are many nurses who swear by the fact that good dressing and bandaging is key in the healing of the wound. 80% of the work is done if the patient's wound is properly cleaned and dressed. So, it is made essential that all the caregivers out there are trained well in regards to dressing a wound.

To initiate a good wound healing, the caregiver should start by cleaning the wound with normal saline. They should make sure that the wound has been cleaned properly and all the dead skin that is around the affected area has been removed carefully. Further, a good antiseptic should be used to take the extra step in making sure that the wound is completely cleaned. This step is essential as it gets rid of all the bacteria that can become the cause of an infection. After this, the healthcare nurse prescribed John to take oral supplements and vitamins that will aid in the healing process (Bus & van Netten, 2016). Now comes the key, choosing the perfect dressing, as it will be the primary factor that will aid in the healing. John has been prescribed to get inadine dressing done. Inadine is a non-adherent surgical dressing. It is said to be one of the most effective disinfectants. However, it cannot be used on patients who have a hypersensitivity to iodine. So, one has to be careful when using it on a patient.

Choosing the bandaging technique or dressing is one of the most crucial steps of wound management. In this case, no second dressing was required for the wound. The second dressing that was used on John was Mesorb. This dressing is very absorbent and works very quickly. The first dressing was changed every four days and the second dressing was changed weekly. It was evident by the second week of the changing of the bandage that the wound had started to heal. John added that the wound was less itchy and the skin around it was not getting rough either. He also said that the inflammation and pain were much better. The combination of both the dressings had started to work and the wound eventually healed completely towards the end of the treatment. The healthcare givers were very happy with the results (Zhang, Lu, Jing, Tang, Zhu & Bi, 2017). They could see that the wound had completely closed and the maturation period had started. There are studies that have proven the fact that good dressing and bandaging are vital and the key factors that aid in

The Importance of giving Health Education to the Patient

It is necessary that John is educated and made aware of the factors that can have an impact on the wound management process. John was concerned about his hygiene and how can he take showers with a wound on his leg. It is pretty simple, all he has to do is wrap a plastic sheet on the affected area before stepping in the shower (Zhang, Lu, Jing, Tang, Zhu & Bi, 2017). It is vital that the wound is kept dry, so it heals faster, but the hygiene of the area around the wound is also necessary. For this purpose, John can take a small soft body brush, wet it and gently remove all the dead skin around the area and clean it.

Even after the patient is discharged they should take care of themselves and keep a close eye on the wound. If they witness any abnormality in the wound or the area around it, they should immediately consult their doctor. John should make sure that he is taking proper care of the wound and keeping tabs on all the symptoms. Lastly, he should take proper care of his diet. He has already gained more weight that he already has. He has type two diabetes and on top of that diabetic foot ulcer can reoccur. In order to manage both the issues, he should have a weight that is easier for his bone structure to manage and carry (Zhang, Lu, Jing, Tang, Zhu & Bi, 2017). Eating unhealthy can also increase his cholesterol levels, which is not good for his health. He should exclude processed food form his life and add leafy greens and lean meat to his diet. This will also help him feel energetic and more active. He should also incorporate fruits in his diet, especially the ones that aid in the healing process. Further, he will also be given multivitamins and supplements that will aid in the healing process.

The Management of Pain

Just like every other patient who has had a diabetic foot ulcer, John also complained about pain. The main management is essential in this case since the pain has an impact on his sleep pattern and daily life. For this he will be given ibuprofen, it is mild enough to not have side-effects and strong enough to manage the pain (Zhang, Lu, Jing, Tang, Zhu & Bi, 2017). This medication along with the two dressing will aid in the pain management and healing of the wound. Further, a person starts to feel 50% better when the pain subsides, so this step is crucial in order to help John feel better.

References

Khalil, H., Cullen, M., Chambers, H., Carroll, M., & Walker, J. (2016). Reduction in wound

healing times, cost of consumables and number of visits treated through the implementation of an electronic wound care system in rural Australia. International wound journal, 13(5), 945-950.

Goodwin, N. S., Spinks, A., & Wasiak, J. (2016). The efficacy of hydrogel dressings as a first

aid measure for burn wound management in the pre‐hospital setting: a systematic review of the literature. International wound journal, 13(4), 519-525.

Armstrong, D. G., Boulton, A. J., & Bus, S. A. (2017). Diabetic foot ulcers and their

recurrence. New England Journal of Medicine, 376(24), 2367-2375.

Bus, S. A., & van Netten, J. J. (2016). A shift in priority in diabetic foot care and research: 75%

of foot ulcers are preventable. Diabetes/metabolism research and reviews, 32, 195-200.

Zhang, P., Lu, J., Jing, Y., Tang, S., Zhu, D., & Bi, Y. (2017). Global epidemiology of diabetic

foot ulceration: a systematic review and meta-analysis. Annals of medicine, 49(2), 106-116.

Subject: Healthcare and Nursing

Pages: 6 Words: 1800

Writers Choice

Healthcare and nursing

[Name of the Writer]

[Name of the Institution]

Analyzing Research Articles

(Qualitative Research)

Background of the problem

The background or the purpose of the study was to examine the relationship that exists between patient readmittance and the patient compliance that includes both patient-related setting or the role of a healthcare center (Hayes, et al. 2015).

Review of the Literature

Heart Failure care in Canada was used as a source that can help to collect related literature. It was meant to identify the appropriate resources that are allocated in hospitals as well as the community that is found to be posing a serious threat to the health of the patients suffering from chronic heart failure. (Hayes, et al. 2015).

Data Analysis

Modified thematic approach as used to analyze the collected data. It comprises of three major parts such as, familiarization which was followed by data coding and it was followed by the identification of underlying theme. This inductive approach was designed to get an in-depth analysis of the data that was collected.

Methodology

Qualitative survey technique was used to collect data. This technique involved semi-structured telephonic interviews that were conducted with administrators of healthcare providers and the other people who are linked with the tertiary care of the patients in Canadian provinces. Sampling technique involved a purposive sampling strategy that enrolled maximum variation to obtain diverse opinion and perspectives. However, the participant has to have experience of five years in the field of healthcare (Hayes, et al. 2015).

Evaluation

After a review of the research, it is asserted that the researcher has proposed evidence similar to the proposed outcome. All the four areas of the research journal adhere to the outcomes and they are directly linked with the result because the outcome was proposed in accordance with the views of healthcare professionals (Hayes, et al. 2015).

The implication of future research was more oriented towards patient advocacy that refers to the recruitment of health care providers in a community setting. It is asserted that this implication is a bit diverging because the core of the study was referring to the healthcare professionals and the role of professionals is more limited to the hospital setting. Community approach is another dimension which is a bit misdirecting. So, it can be said that the idea of the future implication of the research is not directly related to the context and content of the four implications mentioned in the research (Hayes, et al. 2015).

Protection of Human Subjects and Culture Implications

Taking into account the necessity of ethical considerations, it is found that the study was submitted to the Institutional Research Boards for the approval of ethical considerations. Moreover, the participants of the research were also offered with research honoraria with an aim to ensure the application of ethical consideration. It is evident that the two frameworks are equal representative of the protection of human subjects and the cultural implications because that are included in the ethical considerations. Approval from the Institutional Research Board asserts that all the ethical and moral implications are addressed.

Strengths

One of the major strength of this research is the evaluation of data and the techniques that are used for the evaluation of data, because quality research is sometimes assumed to present flawed data.Limitation

One of the significant limitations that are found in this research is the area in which research was conducted. There are several chances of the manipulated data because of the large number of sample population. If there had been a limited count, then the research would have been more effective.

Current Nursing Practices

The current nursing practice is heterogeneous in its context. There are different acre models that are used to address in lowering the readmittance of patients who are suffering from chronic heart disease. Moreover, these models are directed by different discrepancies to age and gender.

Quantitative Research

Background of the problem

There is a large ratio of people who are suffering from different diseases related to the heart where half of the population is found to be readmitted suffering from heart disease. There are several preventive strategies that are introduced to address the readmittance of patients, where those strategies are not productive in terms of their results (Brittany, 2014). It is also added that the cause of heart disease plays a major role in determining the causative agents that can facilitate or act as a cause of readmittance in the hospital. This study deals with the identification of the causative agents for which palliative care can be given with aspect to that disease and it can act as a guide to ensure that the ratio of readmittance of the patient can be reduced and controlled.

Review of the Literature

The literature comprises of articles addressing the causes of heart failure and how palliative care is used to treat heart failure. For better evaluation, the content was classified into four major categories i.e. life quality and healthcare, organizational framework analyzing heart failure, experiencing the symptoms of heart failure after getting discharged from hospital and the burden of patient or caregiver (Brittany, 2014).

Data Analysis

The section of data analysis was classified into two main phases. Phase I referred to the collection and then the examination of the questionnaires. The questionnaires were evaluated on a scale from 0-6. In phase II, information collected from questionnaires was classified into different themes that were related to or different from each other. After that, the results collected from phase II were sued to determine the role of palliative care in addressing the readmittance of patients in hospitals (Brittany, 2014).

Methodology

Qualitative study design was used to define, test and then analyze the cause-effect relationship between different variables. The study was conducted by using ‘Minnesota Living with Heart Failure Questionnaire’ so as to define and determine the symptoms associated with heart failure.

Evaluation of the article

After an exegetical analysis of the article, it can be asserted that the implications mentioned in the introduction sections are directly and completely addressing the perceived and then the calculated outcomes. The evidence proposed in the initial section of articles is completely addressed in the form of outcomes.

Protection of Human Subjects and Culture Implications

With the text of the journal, there is no section in which ethical considerations are addressed. Although it is one of the most significant and important section of any kind of research. Still, there is no account dealing with the cultural implications and other ethical considerations that are associated with the participants.

Strength

One of the major strength of the research article is quoting the ideologies of the participant. It authenticates the research by adhering to the type of information that is conveyed by the text. Usually, studies do not quote the direct information from the participants and it is a kind of gap because there is no direct approach to the authenticity of the information on which decisions are made.

Limitation

Lack of ethical considerations and any approach that could define ethical considerations is one of the major approaches because it hampers the authenticity of the research. Although interview questions are designed in such a way that they can address cultural or ethical consideration until it was mandatory to add consent or implication of ethical considerations.

Current Nursing Practices

Going critically through the text, it is asserted that the there is no clear identification of the current practices but the identification of the issues highlight that the healthcare administration has been using traditional approaches such as recommendations and prescriptions to teach patients about the safety measures that they should take in order to keep themselves healthy.

References

Hayes, S., Peloquin, S., Howlett, J., Harkness, K., Giannetti, N., Rancourt, C., & Ricard, N. (2015). A qualitative study of the current state of heart failure community care in Canada: what can we learn for the future? BMC Health Services Research, 15(1). doi:10.1186/s12913-015-0955-4

Brittany farmer, (2014) Pdfs.semanticscholar.org. Retrieved 18 September 2019, from https://pdfs.semanticscholar.org/1c78/3ac41813a51ae1bcb3e7cfead9d24cafec56.pdf

Subject: Healthcare and Nursing

Pages: 4 Words: 1200

Writers Choice Matching First Paper

Healthcare and Nursing

[Name of the Writer]

[Name of the Institution]

Healthcare Problem

Heart failure readmission is one of the most critical problems that is faced by the United States. Research has highlighted that the treatment of heart problem is one of the most expensive and critical treatments, that is made more expensive because of the readmission of people who are suffering from heart disease. About half of the number of patients are readmitted in hospitals because of the same problem and so it is a serious problem that invites attention from doctors and nurses all around the globe. Under this problem, the role of patients and the hospital is questioned on the same board.

Significance of problem

Patient education to reduce readmittance of heart failure is a significant problem because about 25% of the patients are readmitted within 30 days of discharge from hospitals as a recovery sign for those problems. It is asserted that if people continue to be admitted with the same ratio, then there would be lesser chances of complete health recovery because medical tests should be effective enough to address heart failure from its core. Moreover, such strategies should be used that could help to cure this issue because the treatment for heart failure is very expensive. In the long run, this issue can even compromise the economy of the country.

Current Practice

In the present time, safety techniques like “Parent education at the time of discharge” and “healthcare management strategies” are used that can help to reduce the readmission of patients in hospitals. It is quoted that there are issues at both, patient as well as management end that causes the readmission of the patients. Usually, people have unsafe life practices; patients don’t obey the medical chart and the suggestions that are given to keep them safe from the consequences. So, special attention and instructions are given to the agents and their family members in order to make them aware of the safe practices that can help to curtail readmission in hospitals. Moreover, in a number of cases, the management of hospitals is found guilty, therefore, stress maintains healthy management of hospitals so as to avoid the readmission of patients within hospitals.

Impact of the problem

As the problem is multidimensional, it has multidimensional impacts. Taking into account the workplace culture, readmission of patient automaticity increases the number of absentees of the employee that make it hard for the employee to earn a living. Sometimes, the healthcare policies formulated by the workplace are also minimum because of continued health issues. The economy and the working of the company is also affected because it casts a negative impact on the working of the company as each employee plays a central role in making up the reputation of the company. It is also asserted that the other employees are also impacted because of a single employee, in terms of the policy framework, attitude towards workplace and the workload that is to be given to the other employee because of the absence of a single employee.

Description of research articles

Chamberlain, et al. (2017) conducted quantitative research so that they can determine the scale of readmission of the patient suffering from heart failure after they are discharged from the hospitals. It is asserted that about 5 million Americans suffer from Chronic Heart Failure, taking into account that the Medicare reimbursement for the impatient CHF has been recorded to be very high. It also promotes the establishment of certain strategies that can help to penalize the hospitals in which there are a great number of readmission of heart failure patients. Adhering to the current scrutiny of healthcare spending, a scale of RAHF was formulated that was used to predict the number of patients who are readmitted within the 30 days of discharge from the hospitals. It is found that there are some serious risks found associated with the patients as they are readmitted because by then, the problem has been maximized with other surrounding factors. As a result, the rescuer affirmed that individualized precautionary and preventive care strategies would be brought into practice so that the rate of readmission of patients can be reduced.

Vera, et al. (2015) conducted a retrospective cohort study in order to analyze the readmission of the patient suffering from Chronic Heart Failure, adhering to the primary care organizational factors. After an in-depth analysis of the research material, the researcher found that the readmission of patients increasing over the course of time, it is one of the crucial points to address because it has the potential to question the life of patients as well as the overall framework of the progress of the country. The study found that the orientation of CHF care has specific pathways that can act as a basic tool to incorporate prime care level that is directly associated with lowering the readmission of patients in the hospitals. It is also concluded that the management of the primary care professional session after discharging patients can also be one of the major steps that can assert the management of the patient with Heart Failure.

Description of non-research articles

According to the research that was conducted by Imperial College London and The British Heart Foundation, it is quoted that there are about 16% of the patients who actually die because of heart failure, taking into account that these patients die within last 28 days. It is found that the only way that can help to overcome this issue is to get clerk instructions from the doctors and take the symptoms of being well seriously. The study highlighted that there are a lot of patients who have been recovered because they took the symptoms seriously and consulted their doctors on time.

According to the study conducted by Brent Walker, it is found that about $30.7 billion dollars are spent each year for the treatment of the patients who are suffering from different types of heart disease especially heart failure. The research study concluded that special attention should be given to the “Patient Education before and after discharge” because it is one of the ways that can help to overcome the problem. It was proposed because there is a lot of patients who die because of lack of education. The study also quoted that post-discharge appointments should be scheduled, because it will not only help the patient get clear and off the direct assistance but it will also help the patient learn what is required of him over the course of time.

PICO Questions

P: What are the preventive measures for mitigating readmittance of patients with chronic heart failure

I: What are the possible healthcare intervention to treat the subject issue

C: What are the control states that can help to reduce readmittance of the patient with chronic heart failure

O: What are the expected outcomes of the preventive measures

“What are the possible healthcare interventions that can help to reduce the readmittance of patients with chronic heart failure”.

Evidence Matrix

Author Names

Journal Names

Research Design

Sample Size

Outcome Variables

Quality

Results

Chamberlain, R. S., Sond, J., Mahendraraj, K., Lau, C. S. and Siracuse, B. L.

International Journal of General Medicine

Quantitative Research

Data from State Inpatient Database

CHF readmission investigated in smaller scale clinical trials.

A

demographic and clinical factors risk stratification models such as the RAHF scale should be used to reducing overall health care expenditures of readmittance.

Avaldi, V. M., Lenzi, J., Castaldini, I., Urbinati, S., Di Pasquale, G., Morini, M., Protonotari, A., Maggioni, A. P. and Fantini, M. P.

Journal of Public Health

Regression Analysis

elderly residents in the Local Health Authority of Bologna (Northern Italy) discharged with a diagnosis of HF from January to December 2010

patient lifestyle behaviors (smoking, diet, and physical activity)

A

It is suggested that the engagement of primary care professionals starting from the early post-discharge period may be relevant in the management of patients with HF.

Howie-Esquivel, J., Carroll, M., Brinker, E., Kao, H., Pantilat, S., Rago, K. and De Marco, T.

Journal of Cardiac Research

prospective cohort design with a historical comparison group

Consecutive patients who were 65 years and older, admitted to the cardiology and medical services and had a primary or secondary diagnosis of HF.

Group baseline characteristics such as (19% usual care vs. 12% for the intervention respectively (P = 0.003)

A

A very high cost is associated with the readmission of patients.

Pacho, C., Domingo, M., Núñez, R., Lupón, J., Moliner, P., de Antonio, M., González, B., Santesmases, J., Vela, E., Tor, J. and Bayes-Genis, A.

Revista Española De Cardiología (English Edition), 

Qualitative Research

STOP-HF-Clinic Referral Area (∼250000 people) with that of the rest of the Catalan Health Service (CatSalut) (∼7.5 million people)

518 consecutive patients were included (age, 82 years; Barthel score, 70; Charlson index, 5.6, CORE-HF 30-day readmission risk, 26.5%)

A

The STOP-HF-Clinic, an approach that could be promptly implemented elsewhere, is a valuable intervention for reducing the global burden of early readmissions among elder and vulnerable patients with HF.

Robb D. Kociol, MD; Eric D. Peterson, MD, MPH; Bradley G. Hammill, MS; Kathryn E. Flynn, PhD; Paul A. Heidenreich, MD; Ileana L. Piña, MD, MPH; Barbara L. Lytle, MS; Nancy M. Albert, RN, PhD; Lesley H. Curtis, PhD; Gregg C. Fonarow, MD; Adrian F. Hernandez, MD, MHS

Aha Journals

Qualitative Research

GWTG-HF registry

a semi-structured focus group, with 3 sites identified as leading performers on the basis of 30-day readmission data among GWTG-HF participating centers.

A

Hospitals’ use of inpatient care processes, discharge processes, and quality improvement methodologies for patients hospitalized with heart failure varies widely.

Recommended Practice Change

It is recommended that patients should be taught about safety measures that can help them to stay healthy. The patient study was used to address the issue of readmittance of patients. (Pacho, et al. 2017). Financial penalty assessment is used to reduce the risk of readmittance of patients (Kripalani, et al. 2014). Care domains and patient education were used to analyze the readmittance of the patients (Rob, et al. 2017). RAHF scale was used to learn about the techniques of readmittance for the patients (Chamberlain, et al. 2018). Organizational factors were used to study the prevention strategies for reducing the readmittance of patients (Avaldi, et al. 2015). Teaching patients was used as a preventive measure that can help to reduce the readmittance of the patients (Howie-Esquivel, et al. 2015).

Key Stakeholders

There are several key stakeholders that are directly or indirectly associated with the issue. These stakeholders range from the dimensions in which the patient is playing its role. One of the major stakeholders is the managerial staff of the hospital because they are responsible to ensure that the setting of the hospital is efficient to address the job description. Head nurse and the family of the patients are also included in the category of stakeholders taking into account that both the parties are responsible for the health of the patients.

Barriers

One of the major barriers in addressing the issue is education. Lack of education and lack of training and instructions from the doctors and the nurses is one of the significant barriers in bringing about the required change. Sometimes, there is a very bleak and insufficient approach because of the workload of nurses which lead to the sufferings of the patients.

Strategies for Barriers

Training is one of the strategies that can be used to address the barrier because nurses should be trained in such a way that they can help to train patient during his stay or visit to the hospital

Public awareness is another way that can help to overcome the barriers of education because if the issue goes public, then there would be more stress towards the undertaking of the issue leading to a safe and healthy lifestyle.

Indicators for Measuring Outcomes

There are several indicators that can be used to address the issue. The number of readmittance of the patients is one of the indicators that would act as a tool to measure if the set outcomes are achieved or not.

References

Pacho, C., Domingo, M., Núñez, R., Lupón, J., Moliner, P., & de Antonio, M. et al. (2017). Early Postdischarge STOP-HF-Clinic Reduces 30-day Readmissions in Old and Frail Patients with Heart Failure. Revista Española De Cardiología (English Edition), 70(8), 631-638. doi:10.1016/j.rec.2017.01.003

Kripalani, S., Theobald, C., Anctil, B., & Vasilevskis, E. (2014). Reducing Hospital Readmission Rates: Current Strategies and Future Directions. Annual Review Of Medicine, 65(1), 471-485. doi:10.1146/annurev-med-022613-090415

Chamberlain, R., Sond, J., Mahendraraj, K., Lau, C., & Siracuse, B. (2018). Determining 30-day readmission risk for heart failure patients: the Readmission After Heart Failure scale. International Journal Of General Medicine, Volume 11, 127-141. doi:10.2147/ijgm.s150676

Avaldi, V., Lenzi, J., Castaldini, I., Urbinati, S., Di Pasquale, G., & Morini, M. et al. (2015). Hospital Readmissions of Patients with Heart Failure: The Impact of Hospital and Primary Care Organizational Factors in Northern Italy. PLOS ONE, 10(5), e0127796. doi:10.1371/journal.pone.0127796

Heart attack warning signs 'missed'. (2019). BBC News. Retrieved from https://www.bbc.com/news/health-39114326

Brent Walker, S. (2019). How to Prevent Hospital Readmissions for Congestive Heart Failure. Insights.patientbond.com. Retrieved 18 September 2019, from https://insights.patientbond.com/blog/how-to-prevent-hospital-readmissions-for-congestive-heart-failure

(2019). Ahajournals.org. Retrieved 18 September 2019, from https://www.ahajournals.org/doi/pdf/10.1161/CIRCHEARTFAILURE.112.967406

Subject: Healthcare and Nursing

Pages: 8 Words: 2400

Writing Assignment

Writing Assignment

[Author Name(s), First M. Last, Omit Titles and Degrees]

[Institutional Affiliation(s)]

Author Note

Writing Assignment

Introduction

Trauma was previously considered a sporadic event. However, it has recently exhibited signs of being a chronic conditions. A significant proportion of recently hospitalized trauma patients have had previous admissions for trauma. This has been termed as trauma recidivism and has serious implication for those suffering from it. Thus, the article chosen for the purpose of this assignment is called “Alcohol or Drug Use and Trauma Recidivism” ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"FxrbYSm8","properties":{"formattedCitation":"(Cordovilla-Guardia, Vilar-L\\uc0\\u243{}pez, Lardelli-Claret, Guerrero-L\\uc0\\u243{}pez, & Fern\\uc0\\u225{}ndez-Mond\\uc0\\u233{}jar, 2017)","plainCitation":"(Cordovilla-Guardia, Vilar-López, Lardelli-Claret, Guerrero-López, & Fernández-Mondéjar, 2017)","noteIndex":0},"citationItems":[{"id":573,"uris":["http://zotero.org/users/local/0omESN17/items/7P7UJYBN"],"uri":["http://zotero.org/users/local/0omESN17/items/7P7UJYBN"],"itemData":{"id":573,"type":"article-journal","title":"Alcohol or drug use and trauma recidivism","container-title":"Nursing research","page":"399-404","volume":"66","issue":"5","author":[{"family":"Cordovilla-Guardia","given":"Sergio"},{"family":"Vilar-López","given":"Raquel"},{"family":"Lardelli-Claret","given":"Pablo"},{"family":"Guerrero-López","given":"Francisco"},{"family":"Fernández-Mondéjar","given":"Enrique"}],"issued":{"date-parts":[["2017"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Cordovilla-Guardia, Vilar-López, Lardelli-Claret, Guerrero-López, & Fernández-Mondéjar, 2017).

Purpose

The article deals with the study to quantify the association that exists between the various types of substances that were detected in patients admitted in the hospital for traumatic injury and TR i.e. the history of past trauma.

Design

For analytical purposes, a cross-sectional study was performed where the relationship between current use and TR was researched among patients admitted to the University Hospital of Granada, Spain. The patients with a substance abuse problem hospitalized here are referred to as Screening, Brief Intervention, and Referral to Treatment (SBIRT). It is a comprehensive approach used to treat patients and individuals between the ages of 16 to 70 are screened and later subjected to brief intervention by the nurses.

Sampling Method

According to the data obtained from the SBIRT database to screen, a total of 1,789 patients screened were admitted for traumatic injuries and recruited for the program over a period of 5 years (2011 to 2015). Of all the admitted patients, about 65.3 percent exhibited signs of second-hand trauma. On the other hand, 1.6 percent experienced a second trauma during the study and were excluded.

Outcomes

Out of the 1,156 patients being screened, alcohol based substance abuse was most frequent with 23.4 percent prevalence. This was followed by other substances such as cannabis, benzodiazepines, and tricyclic antidepressants. Furthermore, the presence of any one of the aforementioned substances was associated with single recidivist patients. While those suffering from multi-recidivist, the outcomes showed strongest associations.

Evidence Grid

Article citationin APA format

Purpose ofstudy/researchquestions

Research elements:

Major findings

Strengths andWeaknesses RTvalidity, bias

Cordovilla-Guardia, S., Vilar-López, R., Lardelli-Claret, P., Guerrero-López, F., & Fernández-Mondéjar, E. (2017). Alcohol or drug use and trauma recidivism. Nursing Research, 66(5), 399–404.

Quantify the association that exists between the various types of substances that were detected in patients admitted in the hospital for traumatic injury and TR i.e. the history of past trauma

- Design

Cross-sectional study, finding association between substance use and TR.

- Sampling method and size

Screening of hospitalized patients using SBIRT.

- Brief description ofmethods/interventions

SBIRT was seen as the most effective practice.

156 patients were screened, 23.4 percent prevalence for alcohol being the highest.

Other substances such as cannabis, benzodiazepines, and tricyclic antidepressants.

The study lasted over a span of five years, which makes it valid and is its greatest strength. However, it does not go into vivid detail about the screening process. Needs better mode for assessment.

References

ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Cordovilla-Guardia, S., Vilar-López, R., Lardelli-Claret, P., Guerrero-López, F., & Fernández-Mondéjar, E. (2017). Alcohol or drug use and trauma recidivism. Nursing Research, 66(5), 399–404.

Subject: Healthcare and Nursing

Pages: 1 Words: 300

Writing Assisgnment

Writing Assignment

Your Name (First M. Last)

School or Institution Name (University at Place or Town, State)

Writing Assignment

Gallup surveyed different profession's honesty and ethical rate from the general public in a survey conducted based on telephone interviews on 8 December 2014. A sample of 805 Adults was considered of age 18 and above. All the participants were residents of the US states and the District of Columbia. All the adults included with a minimum quota of 50% cellphone respondents and 50% of the landline respondents. For this survey numbers of the residents were randomly selected. Survey results showed that 80% of the American consider curses to have a “high” or “very high” standards of ethics and honesty, in comparison to the various professions. Whereas members of the Congress received "low" and "very low" percentage, which shows that Congressmen members are viewed as extremely un-honest and unethical in sense of their professionalism and profession. This survey takes place annually since 1990 and periodically since 1976. Nurses top this list each year since they were included in the survey in 1999. This change was observed just once in 2001, after the 9/11 attack when firefighters topped the list. But since than 80 % of the American's consider it as the most sincere, honest and ethical profession. Since 2013, all professions have dropped or maintained their position in the list of ethics and honesty. The only profession that managed to increase its ratings is the layers, but it only increased by 1 % within the margin of error. The biggest drop is observed in the ratings of the police officers, business executives and the pharmacists. “But medical doctors, bankers, and advertising practitioners also saw drops”.Despite the fact that medical professions are considered as honest overall, no profession was able to increase their honesty and ethics rating in views of the public ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"HWV98ltr","properties":{"formattedCitation":"(Inc, n.d.)","plainCitation":"(Inc, n.d.)","noteIndex":0},"citationItems":[{"id":1715,"uris":["http://zotero.org/users/local/KZl8ZL3A/items/TZY4M9PG"],"uri":["http://zotero.org/users/local/KZl8ZL3A/items/TZY4M9PG"],"itemData":{"id":1715,"type":"webpage","title":"Americans Rate Nurses Highest on Honesty, Ethical Standards","container-title":"Gallup.com","abstract":"Nurses again top Americans' list of professions with the highest honesty and ethical standards while members of Congress and car salespeople are rated worst. Ratings of bankers and business executives declined this year.","URL":"https://news.gallup.com/poll/180260/americans-rate-nurses-highest-honesty-ethical-standards.aspx","language":"en-us","author":[{"family":"Inc","given":"Gallup"}],"accessed":{"date-parts":[["2019",4,3]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Inc, n.d.).

A similar kind of survey takes place in Australia each year to take into account the public view of the best honest and ethical profession in terms of its services. This survey is called the Roy Morgan survey, it took place on 4-5 May 2016 over the telephone. Around 655 Australian men and women participated in the survey. All the participants belonged to the age group 14 and above. Survey findings were very interesting, 92% of the Australians rated Nursing as the most ethical profession in comparison to the other professions. Nursing secured the highest position 22nd time in a row after its addition in the survey. Around 30 professions were included in the survey. And 23 of these professions observed the drop in their ratings in ethics and honesty, while the ratings of the three professions remained unchanged. The professions that gained the highest ratings included Doctors with ratings of 86%, Pharmacists with 86%, engineers with 78%, and School teachers with 77% and High court judges with 71%. The professions that received the lowest ratings included religious Ministers with 35% which received the severe drop in rating up to 59%, Bank managers received 30% ratings with a drop of 13 %, and Union Leaders received ratings of 13%. The biggest gainers of the survey were University lecturers, Accountants, public servants, lawyers, Directors of Public companies, Federal MP's, cars salesmen, advertising agents, and real estate agents. But interestingly Federal MP’s have seen the biggest rise in their rating since the year 2009, with 17 % that was 13% before. However, car salesmen again maintained their low ratings with 4%. Nursing was the only profession that maintained its high ratings in ethics and honestly ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"E8lqDEM6","properties":{"formattedCitation":"(\\uc0\\u8220{}Roy Morgan Image of Professions Survey 2016,\\uc0\\u8221{} n.d.)","plainCitation":"(“Roy Morgan Image of Professions Survey 2016,” n.d.)","noteIndex":0},"citationItems":[{"id":1717,"uris":["http://zotero.org/users/local/KZl8ZL3A/items/A49W6WAC"],"uri":["http://zotero.org/users/local/KZl8ZL3A/items/A49W6WAC"],"itemData":{"id":1717,"type":"webpage","title":"Roy Morgan Image of Professions Survey 2016: Nurses still easily most highly regarded – followed by Doctors, Pharmacists & Engineers","container-title":"Roy Morgan","URL":"http://www.roymorgan.com/findings/6797-image-of-professions-2016-201605110031","shortTitle":"Roy Morgan Image of Professions Survey 2016","language":"en","accessed":{"date-parts":[["2019",4,3]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (“Roy Morgan Image of Professions Survey 2016,” n.d.).

References

ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Inc, G. (n.d.). Americans Rate Nurses Highest on Honesty, Ethical Standards. Retrieved April 3, 2019, from Gallup.com website: https://news.gallup.com/poll/180260/americans-rate-nurses-highest-honesty-ethical-standards.aspx

Roy Morgan Image of Professions Survey 2016: Nurses still easily most highly regarded – followed by Doctors, Pharmacists & Engineers. (n.d.). Retrieved April 3, 2019, from Roy Morgan website: http://www.roymorgan.com/findings/6797-image-of-professions-2016-201605110031

Subject: Healthcare and Nursing

Pages: 2 Words: 600

Written Report

Reducing Patient Waiting Time

[Name of the Writer]

[Name of the Institution]

Abstract

The key objective of any healthcare centre is to make sure that such value is needed to be provided to the patient to make sure that they are provided high quality patient care. One of the major components of this system is that how the management of the waiting time for the patient is supposed to be carried out. There are different ways through which this time can be cut down. For instance, by integration of the technology as well as better time management and staff allocation, there can be some degree of control in terms of how patient waiting time turns out.

Contents

TOC \o "1-3" \h \z \u Discussion PAGEREF _Toc8893411 \h 4

Understanding Difference Between Supply and Demand PAGEREF _Toc8893412 \h 5

Bring About Better People on Board PAGEREF _Toc8893413 \h 5

Gathering Patient Information beforehand PAGEREF _Toc8893414 \h 6

Usage of the Secure Messaging PAGEREF _Toc8893415 \h 7

Carrying out the Survey for the Identification of the Bottlenecks PAGEREF _Toc8893416 \h 7

Encouraging Patients for Scheduling Early Appointments PAGEREF _Toc8893417 \h 8

Encouraging Stakeholders to Use Technology PAGEREF _Toc8893418 \h 9

Conclusion PAGEREF _Toc8893419 \h 10

References PAGEREF _Toc8893420 \h 11

Reducing Patient Waiting Time

One of the major purposes of any healthcare establishment is to make sure that the provision of the quality healthcare is supposed to be provided to the patient (Zhu et al, 2017). Effort must be made to make sure that the patient satisfaction has to be provided and it is needed to be made priority of the whole process. One of the major issues that any healthcare establishment is likely to be facing is that how the waiting time they have to face before they find their way into the doctor’s office. The increase in the waiting time is one of the major challenges for any healthcare centre. Even though, there are instances when the longer wait times are inevitable, but there are certain ways through which it can be made sure that the waiting time can be brought down. Following are some of the methods through which it can be made sure that the waiting time is decreased (Chen et al, 2017).

Discussion

Even though there are going to be some unexpected circumstances in which the waiting time is bound to increase, the effort can be made that some sort of amendment in the healthcare operation has to be made possible to ensure that there is decline in the waiting time (Oche & Adamu, 2013). During this paper, some of the ways through which waiting time can be brought down are discussed (Cayirli & Veral, 2018).

Understanding Difference Between Supply and Demand

The first thing that is needed to be done by the healthcare workers is that they must understand the supply and demand of the healthcare centre. By doing that, they are able to make sure that they are able to allocate their time in an effective manner (McCarthy et al, 2017). The balance has to be there in terms of the number of the appointments and the supply of the appointments that are happening at the healthcare centre. Not only that, the other thing that evaluation of the supply and demand would do is that it would make sure that the healthcare staff is able to prioritize their work in an appropriate manner (Cayirli & Veral, 2018). As stated earlier, there are a number of accidents and emergencies that can occur throughout the day, which can throw anyone's agenda off. To play it safe, Bola Oyeyipo, MD, a board-certified family physician and geriatrician recommended encouraging your patients to schedule their appointments for the early morning slots.

Bring About Better People on Board

One of the major problems that the healthcare workers tend to face is that they have to juggle between lot of responsibilities, and even though it brings about the increase in their utilization, the ideal thing that has to be done is to make sure that the delegation has to be carried out effectively to make sure that the level of control is achieved in this regard (Cayirli & Veral, 2018). The idea must be to make sure that there has to be dedicated staff for each of the corresponding activity as it would allow much more streamlined provision of the healthcare service to the users at the given point of time (Fetter & Thompson, 2016).

Gathering Patient Information beforehand

The other thing that is needed to be done is to make sure that the all the information that is needed to be acquired with regards to the patient has to be done beforehand. The reason that it is an important factor is due to the fact that how the improvement has to be there in terms of the way waiting time is needed to be determined (Aeinparast et al, 2018). For instance, the gathering of the information about the insurance of the patient has to be done. The other thing that is quite important is to make sure that how the referrals and how the patient records in terms of the way ready and waiting time lags are supposed to be managed at the given point of time. Not only that, patients must be asked beforehand to make sure that they have send all the necessary forms so that the time is not wasted in the complications. It has to be noted that how this situation is not going to be relevant in every situation and every situation might require different situational analysis among the part of the user (Cayirli & Veral, 2018). So, this aspect is quite important in terms of how decision is supposed to be made at the given point of time (Mardiah & Basri, 2013). The other thing that can be done is that the core medical staff has to be refrained from carrying out the documentation and instead effort has to be made to make sure that the documentation, paperwork and other such office formalities are being kept for the other staff so that the core medial staff is able to take care of the responsibilities are needed to be taken care off (Anderson et al, 2017).

Usage of the Secure Messaging

If an HER system is being used in the organization, then the likelihood is quite high that the secured messaging feature in terms of the way alternative way of communication the information in terms of how the stakeholder management is needed to be done (Anderson et al, 2017). The impression might be this is that how this whole thing goes a long way towards making sure that the secure messaging and other corresponding decision is being made at the end of the stakeholders. It also makes sure that physicians are able to make sure that they are able to ensure that the prompt response is being provided to the all the stakeholders in a good manner (Anderson et al, 2017). Not only that, the patients love is also going to be increased in terms of the way accessibility has to be there in terms of the way treatment for the doctor is needed to be carried out. The communication would also take much less time as compared to the other instances where such issues are witnessed (Leddy et al, 2018).

Carrying out the Survey for the Identification of the Bottlenecks

At times, it is quite appropriate to make sure that the employees are themselves being asked about the issues that are faced by them at the official level in terms of the way identification of the bottlenecks is being done (Aeinparast et al, 2018). The hospital management must create a survey, and there are two purposes for which this survey is going to be used. The employees must be expected to know that what are some of the daily activities, and how they are spending most of their times. It has to be noted that some level of honesty is needed in this regard (Aeinparast et al, 2018). There are going to be instances when the workload is going to be quite on the higher side, whereas, there is an instance when the identification of the bottlenecks is going to be an issue (Aeinparast et al, 2018). Not only that, the employees themselves must be asked what are some of the things that are needed to be done on their end to make sure that the level of control is there in terms of how they are managing their activity at the given point of time and how the level of control is needed to be achieved in this regard (Harper & Gamlin, 2018). The other thing that is needed to be done that when the results have been achieved, some concrete steps can be done to make sure that how the staff allocation is needed to be done (Aeenparast et al, 2014). The idea must be to make sure that how many hours the employees are spending at their workplace, and instead, it should be about how productive they are during the course of their shift and how the right balance is being achieved in terms of the management of the timing in their regard (Aeenparast et al, 2014). For that to happen, they should be allowed certain level of flexibility in terms of the start time. It should not be about when they have started, but idea must be to make sure that each of the respective staff member is managing their things in an appropriate manner at the given point of time (Klassen & Rohleder, 2016). Technology has a way of making many of life's daily tasks easier. It's especially beneficial in the healthcare industry, for physicians, administrators and patients alike. Beyond EHRs and patient portals, doctors can take advantage of web-based technology like an online check-in system that allows patients to wait for an appointment at a location of their choice.

Encouraging Patients for Scheduling Early Appointments

As discussed in the earlier section, not everything has to be blamed at the end of the workers of the healthcare centre, but the patients must also be briefed about how they are going to be in the position to make sure that they are saving their own time as well as the time of the other healthcare workers (Aeinparast et al, 2018). The idea is that how some of the formalities regarding the paperwork and the appointment are needed to be carried out beforehand so that the last-minute hassle, which is one of the greatest contributors to the waiting time can be managed. There has to be some impetus and realization at the end of the patients as well that how the whole process has to be managed, and thus they can bring on their part to make sure that the healthcare provision is being managed in an appropriate manner (Gijo & Antony, 2014). With the integration of technology these things have become much easier (Aeinparast et al, 2018).

Encouraging Stakeholders to Use Technology

One of the things that can be done by the different stakeholders is to make sure that they are encouraging all the stakeholders to make sure that they integrate technology during the way healthcare processes are supposed to be carried out. And that is not limited to the way treatment is supposed to be carried out but instead there are some other ways as well through which it can be made sure that the technology can be used to ensure that some sort of value is being brought into the life of the patient (Kaandorp & Koole, 2017). For instance, they should use the online check in systems when it comes to the way management of the bookings and some of the other subsequent systems is supposed to be carried out (Aeenparast et al, 2014). Not only that, it goes beyond EHR’s as well, like how the patient doctor portals can be taken advantage of in terms of how it can be made sure that the lag time that goes between reporting and other such issues can be managed in an appropriate manner at the given point of time (Aeenparast et al, 2014). According to Physician's Practice, patients have the opportunity to fill out paperwork, submit insurance information and gain access to updates using the patient portal. This will cut the amount of time they spend in the waiting room filling out such information, or placing a call to the practice only to be put on hold. Healthcare professionals who wish to motivate their patients into using the portal should make sure it's simple to use - certain individuals may be reluctant if the application isn't user friendly.

Conclusion

In the hindsight, it can be said that it is quite simple to make sure that the patient lag time is needed to be improved in terms of how the patient management is needed to be carried out. The idea is to make sure that how the allocation of the resources is supposed to be done (Aeenparast et al, 2014). Not only that, the integration of the technology and how the usage of the technology can be used to make sure that how value systems can be differentiated at the different point of time (Aeenparast et al, 2014).

References

Aeenparast, A., Tabibi, S. J., ShahanaMohebbifar, R., Hasanpoor, E., Mohseni, M., Sokhanvar, M., Khosravizadeh, O., & Isfahani, H. M. (2014). Outpatient waiting time in health services and teaching hospitals: a case study in Iran. Global journal of health science, 6(1), 172.ghi, K., & Aryanejhad, M. B. (2013). Reducing outpatient waiting time: a simulation modeling approach. Iranian Red Crescent Medical Journal, 15(9), 865.

Aeinparast, A., Tabibi, S. J. A. D., Shahanaghi, K., & Arianezhad, M. B. (2018). Estimating outpatient waiting time: a simulation approach.

Anderson, R. T., Camacho, F. T., & Balkrishnan, R. (2017). Willing to wait?: the influence of patient wait time on satisfaction with primary care. BMC health services research, 7(1), 31.

Cayirli, T., & Veral, E. (2018). Outpatient scheduling in health care: a review of literature. Production and operations management, 12(4), 519-549.

Chen, B. L., Li, E. D., Kazunobu, Y., Ken, K., Shinji, N., & Miao, W. J. (2017). Impact of adjustment measures on reducing outpatient waiting time in a community hospital: application of a computer simulation. Chinese medical journal, 123(5), 574-580.

Fetter, R. B., & Thompson, J. D. (2016). Patients' waiting time and doctors' idle time in the outpatient setting. HKaandorp, G. C., & Koole, G. (2007). Optimal outpatient appointment scheduling. Health Care Management Science, 10(3), 217-229.ealth services research, 1(1), 66.

Gijo, E. V., & Antony, J. (2014). Reducing patient waiting time in outpatient department using lean six sigma methodology. Quality and Reliability Engineering International, 30(8), 1481-1491.

Harper, P. R., & Gamlin, H. M. (2018). Reduced outpatient waiting times with improved appointment scheduling: a simulation modelling approach. Or Spectrum, 25(2), 207-222.

Kaandorp, G. C., & Koole, G. (2017). Optimal outpatient appointment scheduling. Health Care Management Science, 10(3), 217-229.

Klassen, K. J., & Rohleder, T. R. (2016). Scheduling outpatient appointments in a dynamic environment. Journal of operations Management, 14(2), 83-101.

Leddy, K. M., Kaldenberg, D. O., & Becker, B. W. (2018). Timeliness in ambulatory care treatment: an examination of patient satisfaction and wait times in medical practices and outpatient test and treatment facilities. The Journal of ambulatory care management, 26(2), 138-149.

Mardiah, F. P., & Basri, M. H. (2013). The Analysis of Appointment system to reduce outpatient waiting time at Indonesia’s public hospital. Human Resource Management Research, 3(1), 27-33.

McCarthy, K., McGee, H. M., & O'Boyle, C. A. (2017). Outpatient clinic waiting times and non-attendance as indicators of quality. Psychology, health & medicine, 5(3), 287-293.

Oche, M. O., & Adamu, H. (2013). Determinants of patient waiting time in the general outpatient department of a tertiary health institution in north Western Nigeria. Annals of medical and health sciences research, 3(4), 588-592.

Zhu, Z., Heng, B. H., & Teow, K. L. (2017). Analysis of factors causing long patient waiting time and clinic overtime in outpatient clinics. Journal of medical systems, 36(2), 707-713.

Subject: Healthcare and Nursing

Pages: 7 Words: 2100

WSJ Article 1

Wall Street Journal

Institutional Affiliation

Student’s Name

Instructor

Course

Date

Wall Street Journal

Benefits of Weight-Loss Surgery

One of the article in Wall Street Journal talks about the benefits of weight loss surgery. The article explains that this form of surgery has more benefits other than easing diabetes and heart disease. According to the health research, people who have heard weight loss surgery have very lower chances of experiencing heart attack or any other stroke related event. Some of the benefits associated with this surgery include reduced weight of the patients as well as preventing them from having any form of cardiovascular diseases (Marlow 2016). The surgery also elevates other medical condition as well as reducing depression among the patients. There is also pain relief experienced by the patients, which also contributes to their healthy kind of living. In general, the article explains more other benefits associated with weight loss surgery, thereby encouraging people to practice it whenever there is need.

As much as the article discusses more advantages associated with weight loss surgery, I feel that the practice should not be encouraged among patients. This is because there are still more side effects which result from this kind of surgery. Some of the short term effects include wound infection, excessive bleeding as well as difficulties in breathing. The patients may also experience much vomiting, diarrhea and even malnutrition as long term effects. The only advantage of surgery is that it requires very little time before the weight is lost, but then the side effects tend to have much impacts on the patients. I feel the patients should be advised to participate in natural activities as a better way of losing weight. They need to be taught on the importance of taking a specific form of diet, engage themselves in physical activities among many other things. Such natural approaches tend to take much time but then they are more appropriate in maintaining the health condition of the patient.

References

Marlow, M. (2016). Weight-Loss Nudges: Market Test or Government Guess?. In Nudge Theory in Action (pp. 195-224). Palgrave Macmillan, Cham.

Subject: Healthcare and Nursing

Pages: 1 Words: 300

XAP Task 1

XAP Task 1

YourName (First M. Last)

Name of School/Institute (University at Place or Town, State)

XAP Task 1

Quantitative Journal:

Introduction:

The article “Nurse-Driven Protocol to Reduce Catheter-Associated Urinary Tract Infections” is the research paper related to Catheter-associated urinary tract infections (CAUTIs). It is one of the major infections acquired from the hospital. The scientific research is made to use the nurse-driven protocol to decrease the Catheter-associated urinary tract infections. The main purpose of the study is to improve the quality of the hospitals with the help of the medical-surgical units and nursing staffs. It is assumed that through evidence-based prevention can be useful to resolve the issue ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"lgPHDWwP","properties":{"formattedCitation":"(Hamilton, n.d.)","plainCitation":"(Hamilton, n.d.)","noteIndex":0},"citationItems":[{"id":98,"uris":["http://zotero.org/users/local/mlRB1JqV/items/ZBRVGAWG"],"uri":["http://zotero.org/users/local/mlRB1JqV/items/ZBRVGAWG"],"itemData":{"id":98,"type":"article-journal","title":"Nurse-Driven Protocol to Reduce Catheter Associated Urinary Tract Infections","page":"78","source":"Zotero","language":"en","author":[{"family":"Hamilton","given":"Elva"}]}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Hamilton, n.d.).

Review of the literature:

Most of the literature research is made from the web. The main sources that are used for literature review include governmental organizations, professional health care organizational data along with some databases obtained from Cumulative index to allied health literature. The articles used for review are generally from the year 2013-18. Literature review covers the research factors including; urinary tract, infections, prevention tool for infection, guidelines for CAUTI prevention use, useful agencies, nurse-driven protocol, and role of information technology. The literature on all these elements helped the researcher analyze the efficient result for the case.

Data Analysis:

The research used a quantitative design to collect data. A group of twenty-eight nurses from a South Florida hospital became a volunteer for the research. An educational intervention was delivered. A demographic survey was also administered for protests and post tests on the Catheter-associated urinary tract infections. To analyze the acquired data, 2-proportion z-test was used. The other methods for data analysis include paired t-test and descriptive statistics.

Methodology:

The research method used in the project is a descriptive method. Within the descriptive method, a demographic survey is conducted. Also, an educational intervention was delivered to the selected nurses of South Florida hospital. Samples were collected from based on standardized evidence protocol. Later through test was conducted to analyze the descriptive and sampling data and result was explained with the help of test values and result in tables.

Evidence:

The evidence in all four areas of the journal supports the results and implications of the research and can be used for future research. In the introduction section, scholars have used the evidence from the previous researches which indicates that four lac annual fatalities happened due to the medical error in America. Most of the deaths result provides evidence that the infection is acquired from the hospital and was preventable. Evidence from the Institute for healthcare improvement is used which reveals that about eighty percent of UTIs are linked with indwelling urinary catheters. This evidence is supporting the outcome of the result which indicates that the main reason of the infection is due to the safety issues of the patients in the hospitals and for future research, it will be significant as it is indicating the most crucial factor related to the research.

In review of literature, many articles have highlighted the evidence, factors, and recommendations for the Catheter-associated urinary tract infections. Evidence of literature review explains that improvement of patient’s outcome is the core element in the evolution of healthcare. Hospitals, their management, professionals, and regulatory agencies are working to make hospitals free of infections that are causing CAUTIs and HAIs. Implications show that nurses can play a vital role to improve the quality of the hospital environment and reduce CAUTIs in hospitals. The scientific evidence supports the establishment of an evidence-based protocol for nurses. The evidence is useful for the project as it highlighted the role of nurses for the Catheter-associated urinary tract infections prevention. Also, it can be used in future research to make nurses more efficient and for hospital betterment.

In the methodology and analysis section, evidence used is relevant to the project and useful for future research. For instance, evidence in both the section used was of twenty-eight nurses who helped in developing the data through intervention program and survey based on their knowledge and skills obtained by the protocol. The evidence is the main result of the project which indicates the importance of nurses in Catheter-associated urinary tract infections prevention and for future researches where this method can be used to improve the evidence-based protocol.

Ethical consideration:

The protection of human subjects and cultural considerations were addressed by the researchers. The project was started after the approval from the Nova Southeastern University Institutional Review Board. The approval was taken on the basis that the researcher will make sure to minimize risk to human subjects. Researches added into the literature review were properly cited, and references were provided at the end of the project. This shows that researchers have taken the human subject into consideration and avoided any plagiarism. They have developed an original work.

To take care of ethical consideration, researchers have provided an approval letter to the nurses who participated in the project. The letter was given to the participants prior to the project process in which they have informed them all the important information like nature, time, risks, and benefits related to the project. A participant agreed to the letter as a volunteer; there was no penalty on withdrawing at any time. Further their personal information was confidential. They have filled the questionnaire as being an anonymous person.

The University of the Participants was their identity while their personal information like name, age, education, and occupation was confidential. Furthermore, the documents were kept into the locker to ensure the privacy of the participants.

Strength and limitation:

Every research has some strengths and limitations. This project has also some specific limitations and strengths. The limitations of the project are the sample size. There were only twenty nurses who participated in the project. The project is made to analyze the result for all nurses from the population where the representation of the project through only twenty nurses was weak. The small size of the sample cannot represent all nurses. Another limitation of the project was the unknown number of the patents. The total number of the patients with CAUTIs was not added in the project. This weakness limited the value of the projects.

Besides the limitation of the project, there were some strengths as well. For instance, the research was well accepted by the nurses, and the result shows the role of the nurses in CAUTIs prevention. Also, a well-structured approach was made for nurses. It helped the nurses to identify the interventions easily. The protocol development was useful to upgrade the hospitals for the betterment of the patients.

Current Nursing Practice:

The literature review section has some evidence which informs the current nursing practice. Also, the questionnaire that nurses filled showed their current knowledge and skills for the CAUTIs. Theoretical framework addressed the structures and processes which highlighted the current nursing practices and outcome of the protocol prevention. Also, the nursing practice section in the significance of the project informs the current nursing process. It implies that infection control is one of the core focuses of the nurses today. The positive response over the questions asked in the questionnaire indicated that nurses today, are familiar with the problems like CAUTIs and are looking forward to playing their role for the prevention of inflection that is hospital acquired.

Qualitative Journal

Introduction:

The article “A qualitative study exploring the value of a catheter passport” explores the communication gap between the patients and nurses. The reason behind the research was to highlight the problem that is over thirty-seven percent of patients had no statement about the catheter on their discharge slips. They are unaware of the safety measure that is required to be safe from the infection. One basic reason for the problem is the communication gap ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"DNTTU9CB","properties":{"formattedCitation":"(Jaeger, Fox, Cooney, & Robinson, 2017)","plainCitation":"(Jaeger, Fox, Cooney, & Robinson, 2017)","noteIndex":0},"citationItems":[{"id":99,"uris":["http://zotero.org/users/local/mlRB1JqV/items/LCMC2ZD6"],"uri":["http://zotero.org/users/local/mlRB1JqV/items/LCMC2ZD6"],"itemData":{"id":99,"type":"article-journal","title":"A qualitative study exploring the value of a catheter passport","container-title":"British Journal of Nursing","page":"857-866","volume":"26","issue":"15","source":"Crossref","DOI":"10.12968/bjon.2017.26.15.857","ISSN":"0966-0461, 2052-2819","language":"en","author":[{"family":"Jaeger","given":"Melanie De"},{"family":"Fox","given":"Fiona"},{"family":"Cooney","given":"Geraldine"},{"family":"Robinson","given":"Jacqueline"}],"issued":{"date-parts":[["2017",8,10]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Jaeger, Fox, Cooney, & Robinson, 2017). Nurses do not convey basic knowledge about the infection and health care to the patients which sometimes turned into a severe infection. Three main themes are developed through the project it includes; informing nursing, informing patients, and supporting the transition.

Review of the literature:

There is no section of the literature review in the project. Researchers did not discuss the previous researches in the separate section. They have added information from the other research throughout the project which is directly linked to their topic. For instance, in the introductory paragraph they have added the result of some other research, which indicated the profound impact of the catheter over the human health not only physically but also psychologically and socially.

Data Analysis:

The project is based on qualitative data. Qualitative data includes an interview and a questionnaire filled by the focused groups. Thematic analysis was the method chosen by the researchers. Through thematic analysis, suitable interpretive and descriptive data was collected. Three participants groups were arranged, these groups were divided, and the topic/project was identified to all participants. The division of groups was made manually, i.e. through the collaborative process. The process was used between research nurses and qualitative researchers. They both made discussion and codes were compared to identify the themes.

Methodology:

The research is made on qualitative data. The main focus of the study is made between nurses and patients. Therefore, the study was developed to get information about the experiences of both nurses and patients through catheter passport. The results are developed by analyzing these interviews and free text questionnaire. Thematic analysis was chosen because it is a flexible tool for research. Participants above eighteen became part of the research. Purposive sampling was the method that was used to collect the information from the patents while for nurses focus groups were developed.

Evidence:

Evidence related to projects was discussed in detail within the section "improving catheter care." Evidence indicates that while patient gets a discharge with improper or incomplete information related to their catheter, it affects their health in many ways. The main effect that patients face includes social and psychological adjustment. This evidence was taken from past research that was conducted in 2007. Researchers have cited the evidence in a proper manner so it would not affect the credibility of their project. The evidence further argues over the relationship between the patient and hospital staff. The hospital trust is the main factor which can control the catheter infection and therefore become a crucial element of the study. Researchers have used the action of the hospital to take care of their patient, and regarding enough information, they need to provide are considered the main theme of the project. Therefore the same evidence is used in the introduction section to let the readers know about one of the main themes of the project.

As there is no separate section for literature review, therefore, evidence cannot be discussed for this section. Evidence within the data analysis is used which indicates the performance of the nurses and satisfaction of the patient. Evidence shows that many patients complained and explained the fact that no prior information was granted before they got discharged from the hospital. The people above 18 shared their experiences. Another evidence was used based on the guidance provided to the patients. The finding of the research shows that the patients who have proper knowledge about the infection became part of self-care and infection rate among these people is very less. The guidance was provided by the hospital which decreases the gap between the patient and hospital.

The methodology section has not discussed any evidence; rather the researchers used the evidence discussed in the introduction section is the core in for their research. They conducted a questionnaire based on the question that arises from this evidence. Not only questionnaire but interviews also revolved around that one basic evidence. Therefore we can conclude that although different evidence throughout the project is discussed the one discussed in the introduction was the base of the project. It is useful for the results, findings, and future researches.

Ethical consideration:

The project showed the proper ethical consideration. The project was started after taking approval from the research ethics committee NHS. The approval letter ensures that ethics consideration would be the priority while doing the research. As research is based on qualitative data which was collected through interviews and questionnaire, that means different people and their personal information was required to make the sample for analyzing. The researchers took approval from the nurses and patients who were recently discharged from the particular hospitals.

For ensuring the ethical consideration, researchers created a comfortable environment for the patients who were unable or uncomfortable to give the interview. The researchers conducted the interviews on the telephone for the patients’ convenience. Besides these all personal information including the phone number, address, age, name of both patients and nurses were confidential. Even the names of hospitals were not listed to provide the proper privacy for both groups of participants.

Strength and limitation:

The limitation of the project is the small sample size. Few patients and nurses were the participants and data was collected through their information. Due to the small sample size, knowledge gathered through interviews and questionnaire cannot be considered as the representative data for the whole population. Another limitation of the project is related to the nurses. Many participant nurses who filled the questionnaire had no catheters passport, and also only five nurses had contacted to researcher personally.

The strength of the project is the presentation of answers given by the nurses and patients. Mostly researchers make tables and analyze the data, but in this project, researchers have shared the responses of the patient which make their project more credible. The sample size was small still researcher successfully highlighted the three theme for their research and result to present some useful information that can be used by nurses for improvement and researchers for further research.

Current Nursing Practice:

The evidence shows the gap between nurses and patient indicating the current nursing practice. It indicates that current nursing practice is not efficient. The relationship between the patient and nurses should be improved. Beside this, a proper training program is required. Through nursing training, they can enhance their skill of communication as well as can learn about how to teach the patient and their families about basic health care so that patient can adopt self-care after being discharged. The hospital should play their role to decrease the gap between nurses and patients. Nurses are not providing guidance to the patient that they should provide for the infection prevention.

References

ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Hamilton, E. (n.d.). Nurse-Driven Protocol to Reduce Catheter Associated Urinary Tract Infections, 78.

Jaeger, M. D., Fox, F., Cooney, G., & Robinson, J. (2017). A qualitative study exploring the value of a catheter passport. British Journal of Nursing, 26(15), 857–866. https://doi.org/10.12968/bjon.2017.26.15.857

Subject: Healthcare and Nursing

Pages: 8 Words: 2400

XAP Task 2

xap task 2 CAUTI

[Name of the Writer]

[Name of the Institution]

xap task 2 CAUTI

Introduction:

CAUTI a Healthcare Problem:

A urinary tract infection is reported as the most common infection associated with healthcare known as Catheter-associated urinary tract infection (CAUTI). Seventy-five percent of urinary tract infection cases are associated with the urinary catheter. Infection can be involved in various body organs include kidney, urinary bladder, urethra, and ureters. The urinary catheter is a tube that is inserted through the urethra into the bladder to drain urine. Lack of proper care during and after the catheter removal can cause CAUTI. Therefore, there is a need for the proper indication for using catheter, and it should be removed as soon as it is no longer required. The main element related to the CAUTI is nurses. Nurses are associated with both stages, i.e. during the insertion of catheter and removal of the catheter. Therefore, they can play a vital role to control the infection. The existence of CAUTI as a common infection also indicates the lack of proper intervention by the nurses for the cause. Hence, there is a need to study the current healthcare practice performed by the nurses. The problems which result in CAUTI should be understood for the reduction of infection as fifty percent of the infection cases are preventable.

The significance of the Problem:

Catheter use sometimes becomes necessary in the hospital. This is why it is the most common infection associated with the hospital. Therefore it is significant to identify the causes for infection prevention. From the collection bag, bacteria can travel up the tube. Hence, CAUTI is an infection that can be a threat to the safety of the patient. CAUTI can occurs one day after the catheter is removed and two days after the insertion. It can cause infections like sepsis, cystitis, prostatitis, meningitis, and arthritis. Therefore it is significant to identify the problem. Through problem identification, a proper plan, recommendations, and implementations can be developing to increase the safety measure of the CAUTI’s patent. The significance of the problem is related to three people, i.e. patient, nurses, and hospital management. Through proper training of nurses, CAUTI can be controlled and therefore can result in the patient's good health, standardized hospital, and empowered nurses.

Current Healthcare Practice:

Various healthcare practices are being used by the hospitals to reduce the infection. CAUTI prevention initiatives are taken by The Hospital Research and Education Trust. The main goal of the organization is to develop learning collaborative for hospitals. Activities and incentives are introducing to enhance the safety of the patents. The model is applied known as the Comprehensive Unit-based Safety Program (CUSP) to disseminate the tools and knowledge to the hospitals. Also, the hospitals are promoting daily urinary catheter assessment tool. It helps to acquire the condition of the patient so the catheter can be removed when no longer required.

CAUTI Affects:

CAUTI affects not only the patients but hospitals as well. CAUTI is a hospital-acquired infection. Which means hospital reputation and efficiency can be questioned if the infection increases. Hospitals are required to make sure about fulfilling all the measures of cleanliness to fight with the bacteria. Hospital's preference is also linked to the performance and satisfaction of the patients. Health behavior of the patient due to the CAUTI indicates the inefficiency of the organization and it cannot only harmful for human life but also the organization economically.

The patients who got catheters are assessed so that the catheter can be removed as soon as it no more required. Patients remain unaware of the problem when they get discharged, and therefore the risk of infection increases. Infection lowers health behavior as it not only affects the patient physically, but its psychological impact is also severe. Patient's preference is to acquire a good and healthy life which is possible only by taking the CAUTI issue seriously.

Literature Review:

In the article "Nurse-Driven Protocol to Reduce Catheter-Associated Urinary Tract Infections" researcher Hamilton discussed the issue of CAUTI and its preventions. Hamilton argued that infection is preventable ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"enFRLVWc","properties":{"formattedCitation":"(Hamilton, n.d.)","plainCitation":"(Hamilton, n.d.)","noteIndex":0},"citationItems":[{"id":378,"uris":["http://zotero.org/users/local/rVaVAHaF/items/S94R5PGP"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/S94R5PGP"],"itemData":{"id":378,"type":"article-journal","title":"Nurse-Driven Protocol to Reduce Catheter Associated Urinary Tract Infections","page":"78","source":"Zotero","language":"en","author":[{"family":"Hamilton","given":"Elva"}]}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Hamilton, n.d.), and it can be reduced by improving the quality of hospital through advance and well-trained nursing staffs and surgical units. For his argument, he presented evidence of medical error in America. Due to the error lac of people died because of CAUTI which was preventable. Evidence from the Institute for healthcare improvement is used which tells that about eighty percent of UTIs are linked with indwelling urinary catheters. Hamilton used quantitative data for analysis. Data was collected 28 nurses from a South Florida Hospital. A demographic survey was taken which was analyzed with the help of t-test and descriptive statistics. Results indicate that CAUTI is preventable if it gets identified on time. Evidence-based prevention can be essential for the problem. Programs that provide nurses staffs and surgical units proper training to acknowledge the patients about the issue and also the assessment tool can be helpful for CAUTI prevention.

In the article "The Impact of an Evidence-Based Practice Protocol on Catheter-Associated Urinary Tract Infections and Urinary Catheter Days," Herber discussed the chronic critically ill population. These patients are mostly diagnosing with CAUTI. The main purpose of the study is to identifies the significance of evidence-based urinary catheter protocol. Researcher claims that catheter protocol is the most effective tool to reduce the CAUTI. For the purpose, two methods used to collect data. Firstly, online education was to the hospital team, and secondly, assessments of the patients using catheter were collected. By focusing on the evidence that chronic critically ill get CAUTI due to various factors like aging, the trajectory of recovery and care, and laden with social burdens, the researcher analyzed the data collected from three month of online education and patient's assessment ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ybr5VU7S","properties":{"formattedCitation":"(\\uc0\\u8220{}2015_Helber_DNP_Document.pdf,\\uc0\\u8221{} n.d.)","plainCitation":"(“2015_Helber_DNP_Document.pdf,” n.d.)","noteIndex":0},"citationItems":[{"id":368,"uris":["http://zotero.org/users/local/rVaVAHaF/items/4K6Z5KK9"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/4K6Z5KK9"],"itemData":{"id":368,"type":"article","title":"2015_Helber_DNP_Document.pdf","URL":"https://kb.osu.edu/bitstream/handle/1811/68662/1/2015_Helber_DNP_Document.pdf","accessed":{"date-parts":[["2019",3,24]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (“2015_Helber_DNP_Document.pdf,” n.d.). Results indicate that through proper training not only CAUTI infection reduced up to 66%, but the duration of catheter insertion was also reduced to 16.3% days. It implies that by empowering the nursing staff, CAUTI can be controlled rapidly.

In the article "Culturing practices and the care of the urinary catheter in reducing NHSN-defined catheter-associated urinary tract infections," researcher Bardossy and fellows compared the interventions to control CAUTI in a more effective and faster way. Researchers argue that the main factor behind the infection in the hospital practices. Therefore it is necessary to apply interventions and tools to the hospital which can control CAUTI. To find out which intervention is more effective the research was made. For the purpose, researchers approached two teaching hospitals. The researcher made a weekly audit on indication and compliance of a urinary catheter with processes. The methodology that the researchers used was based on the training program. Proper guidance and training were given to the staff of both the hospitals ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"BVWegzus","properties":{"formattedCitation":"(Bardossy et al., 2018)","plainCitation":"(Bardossy et al., 2018)","noteIndex":0},"citationItems":[{"id":371,"uris":["http://zotero.org/users/local/rVaVAHaF/items/NKHFVYKN"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/NKHFVYKN"],"itemData":{"id":371,"type":"article-journal","title":"Culturing practices and the care of the urinary catheter in reducing NHSN-defined catheter-associated urinary tract infections: The tale of two teaching hospitals","container-title":"Infection Control & Hospital Epidemiology","page":"1494-1496","volume":"39","issue":"12","source":"Crossref","DOI":"10.1017/ice.2018.251","ISSN":"0899-823X, 1559-6834","shortTitle":"Culturing practices and the care of the urinary catheter in reducing NHSN-defined catheter-associated urinary tract infections","language":"en","author":[{"family":"Bardossy","given":"Ana Cecilia"},{"family":"Williams","given":"Takiah"},{"family":"Jones","given":"Karen"},{"family":"Szpunar","given":"Susan"},{"family":"Zervos","given":"Marcus"},{"family":"Alangaden","given":"George"},{"family":"Reyes","given":"Katherine"},{"family":"Fakih","given":"Mohamad G."}],"issued":{"date-parts":[["2018",12]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Bardossy et al., 2018). Also, identical training was provided to physicians about the efficient use of devices and laboratory equipment. The data were analyzed by using SPSS and Pearson test. Results indicate that the hospital identified 84.5% patient who had CAUTI infection. The identification of infection on time was due to the daily assessment and compliance with proper maintenance. Hospital successfully secured the patient and CAUTI rate was reduced as compared to the year 2014 and 2015. Hence research concluded that catheter protocol practice has great impact over the prevention of the CAUTI. It not only identifies the infection but also helps to secure the patient from it.

In this article," Implementing an evidence-based practice protocol for prevention of catheterized associated urinary tract infections in a progressive care unit," Revella and Gallo made research over the positive impact of evidence-based practice and a new protocol for the prevention of CAUTI. CAUTI rate is one of the scales for measuring the nursing quality for any hospital. Therefore research was made to observe the role and practices of the nurses in the hospital. For the purpose, the researcher selected four hospitals for data collection. Initially, data identified 00/1000 and 0.6/1000 urinary catheter days in surgical and medical ICU respectively. Researchers provide evidence-based practice training to the selected teams of the hospitals. Data was collected for 7 days from 41 patients. Data was based on information about the patient's name, age, admission date, catheter insertion date, removal date, and antibiotic coverage ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Mce6mBMX","properties":{"formattedCitation":"(Revello & Gallo, 2013)","plainCitation":"(Revello & Gallo, 2013)","noteIndex":0},"citationItems":[{"id":370,"uris":["http://zotero.org/users/local/rVaVAHaF/items/52QCW5EM"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/52QCW5EM"],"itemData":{"id":370,"type":"article-journal","title":"Implementing an evidence-based practice protocol for prevention of catheterized associated urinary tract infections in a progressive care unit","container-title":"Journal of Nursing Education and Practice","volume":"3","issue":"1","source":"Crossref","URL":"http://www.sciedu.ca/journal/index.php/jnep/article/view/1074","DOI":"10.5430/jnep.v3n1p99","ISSN":"1925-4059, 1925-4040","language":"en","author":[{"family":"Revello","given":"Kathleen"},{"family":"Gallo","given":"Ana-Maria"}],"issued":{"date-parts":[["2013",1,1]]},"accessed":{"date-parts":[["2019",3,24]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Revello & Gallo, 2013). A power point presentation was given to a hospital team who supported as a volunteer in research. The result from data analysis indicates that after applying evidence-based practice infection and device days reduced to 0.7/1000 and 0.3/ device & patient days respectively. Therefore, it was concluded that five months after the implementation CAUTI rate decreased rapidly than before which means evidence-based practice is an effective tool for the prevention of CAUTI.

In the article “A qualitative study exploring the value of a catheter passport.” researchers highlighted the problem of communication gap between nurses and patients. Researchers argued that nurses do not provide sufficient guidance to the patients when they get discharge which results in CAUTI ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"n90Ygz44","properties":{"formattedCitation":"(Jaeger, Fox, Cooney, & Robinson, 2017)","plainCitation":"(Jaeger, Fox, Cooney, & Robinson, 2017)","noteIndex":0},"citationItems":[{"id":379,"uris":["http://zotero.org/users/local/rVaVAHaF/items/6TDBLKQD"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/6TDBLKQD"],"itemData":{"id":379,"type":"article-journal","title":"A qualitative study exploring the value of a catheter passport","container-title":"British Journal of Nursing","page":"857-866","volume":"26","issue":"15","source":"Crossref","DOI":"10.12968/bjon.2017.26.15.857","ISSN":"0966-0461, 2052-2819","language":"en","author":[{"family":"Jaeger","given":"Melanie De"},{"family":"Fox","given":"Fiona"},{"family":"Cooney","given":"Geraldine"},{"family":"Robinson","given":"Jacqueline"}],"issued":{"date-parts":[["2017",8,10]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Jaeger, Fox, Cooney, & Robinson, 2017). The data collection based on two methods, i.e. questionnaire and survey. Nurses and recently discharged patients provided the information. Data were analyzed with the help of thematic analysis. The result shows that hospitals are responsible for the communication gap between the nurses and patient. Nurses provide catheter passport without provided information about CAUTI and self-care. Result also highlighted the fact that the patent who knows about the infection can help them from CAUTI prevention. Therefore it is necessary to train the nurses to provide the patients with sufficient knowledge and information regarding infection so they can do self-care after being discharged.

In a study author indicates that the hospital does not take proper precautions to prevent the infection like CAUTI. Therefore, CAUTI surveillance is performed. It began in 2011. It includes the efforts and programs for the prevention of CAUTI. CAUTI rate is indicated in the number of infection per thousands of urinary catheter days. The programs and implementation that are using by the National Healthcare Safety Network includes improving urine sample, minimum use of the catheter, procedure for urine cultures, and programs to sustain evidence-based practices for prevention and maintenance ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"embMa9MA","properties":{"formattedCitation":"(Gunaseelan, n.d.)","plainCitation":"(Gunaseelan, n.d.)","noteIndex":0},"citationItems":[{"id":386,"uris":["http://zotero.org/users/local/rVaVAHaF/items/2P86XWE6"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/2P86XWE6"],"itemData":{"id":386,"type":"webpage","title":"Catheter-Associated Urinary Tract Infections","URL":"https://www.hopkinsmedicine.org/heic/infection_surveillance/cauti.html","language":"en","author":[{"family":"Gunaseelan","given":"Vidhya"}],"accessed":{"date-parts":[["2019",3,24]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Gunaseelan, n.d.). The author discussed that evidence-based practice like educational training t the nurses can be useful to prevent the CAUTI. Also, the CAUTI guideline not only for nurses but also for the patient is playing an important role and reducing the CAUTI rate.

Another study implies that through proper evaluation of hospitals infection can be helpful for the prevention of CAUTI. The survey indicated that besides devices usage, multi-drug resistant organism, and surgery mostly hospitals had prevention policies for the infection. Also, practices to reduce the risk were not the same in all hospitals. Surgeon-specific rates were evaluated and identified with the surgeons in 75% of hospitals. It was a tool that can be helpful for surgeons to prioritize infection prevention. The conclusion of the survey indicated that evaluation of the hospitals from their policies and current practices could be effective for improvement in CAUTI rate. Some hospitals practices are not sufficient, and some have effective practices like evidence-based practice which is efficient for CAUTI prevention. In other words, evaluation should be made to provide the most effective programs and procedure to reduce the problem of CAUTI ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ayjGE4sm","properties":{"formattedCitation":"(\\uc0\\u8220{}Evaluation Of Hospital Infection Prevention Policies Can Identify Opportunities For Improvement: Study,\\uc0\\u8221{} n.d.)","plainCitation":"(“Evaluation Of Hospital Infection Prevention Policies Can Identify Opportunities For Improvement: Study,” n.d.)","noteIndex":0},"citationItems":[{"id":383,"uris":["http://zotero.org/users/local/rVaVAHaF/items/8WJHV529"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/8WJHV529"],"itemData":{"id":383,"type":"webpage","title":"Evaluation Of Hospital Infection Prevention Policies Can Identify Opportunities For Improvement: Study","URL":"https://www.elsevier.com/about/press-releases/research-and-journals/evaluation-of-hospital-infection-prevention-policies-can-identify-opportunities-for-improvement-study","accessed":{"date-parts":[["2019",3,24]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (“Evaluation Of Hospital Infection Prevention Policies Can Identify Opportunities For Improvement: Study,” n.d.).

B1. Discussion:

CAUTI is a serious problem. It is a preventable infection, but due to the lack of awareness, policies, and practices, it is becoming a severe problem. Nurses are the main factor which can help in reducing CAUTI rate. Also, inefficient nursing can also lead to an increase in the problem. The study indicates that the evaluation of hospital is necessary ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ayjGE4sm","properties":{"formattedCitation":"(\\uc0\\u8220{}Evaluation Of Hospital Infection Prevention Policies Can Identify Opportunities For Improvement: Study,\\uc0\\u8221{} n.d.)","plainCitation":"(“Evaluation Of Hospital Infection Prevention Policies Can Identify Opportunities For Improvement: Study,” n.d.)","noteIndex":0},"citationItems":[{"id":383,"uris":["http://zotero.org/users/local/rVaVAHaF/items/8WJHV529"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/8WJHV529"],"itemData":{"id":383,"type":"webpage","title":"Evaluation Of Hospital Infection Prevention Policies Can Identify Opportunities For Improvement: Study","URL":"https://www.elsevier.com/about/press-releases/research-and-journals/evaluation-of-hospital-infection-prevention-policies-can-identify-opportunities-for-improvement-study","accessed":{"date-parts":[["2019",3,24]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (“Evaluation Of Hospital Infection Prevention Policies Can Identify Opportunities For Improvement: Study,” n.d.). CAUTI is mostly acquired from the hospital; therefore, the hospital should adopt all possible strategies and implementation to control the CAUTI rate. It is necessary to evaluate the current practices, and if any hospital is not having advance and efficient practices, then it should seriously take into account. Another study indicates that National Healthcare Safety Network is helping in promoting programs and implementation for the problem. Different safety measure including patient's assessment ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"embMa9MA","properties":{"formattedCitation":"(Gunaseelan, n.d.)","plainCitation":"(Gunaseelan, n.d.)","noteIndex":0},"citationItems":[{"id":386,"uris":["http://zotero.org/users/local/rVaVAHaF/items/2P86XWE6"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/2P86XWE6"],"itemData":{"id":386,"type":"webpage","title":"Catheter-Associated Urinary Tract Infections","URL":"https://www.hopkinsmedicine.org/heic/infection_surveillance/cauti.html","language":"en","author":[{"family":"Gunaseelan","given":"Vidhya"}],"accessed":{"date-parts":[["2019",3,24]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Gunaseelan, n.d.), minimum use of a catheter, and proper guidance to both patients and nurses is significant for the cause. Also, a training problem like catheter protocol practices for nurses can make nurses more skilled and professional for the prevention of infection.

The research on reducing CAUTI rate with the help of catheter protocol practice indicates those surgical units and well-trained nurses' leads to the improvement in CAUTI rate ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"enFRLVWc","properties":{"formattedCitation":"(Hamilton, n.d.)","plainCitation":"(Hamilton, n.d.)","noteIndex":0},"citationItems":[{"id":378,"uris":["http://zotero.org/users/local/rVaVAHaF/items/S94R5PGP"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/S94R5PGP"],"itemData":{"id":378,"type":"article-journal","title":"Nurse-Driven Protocol to Reduce Catheter Associated Urinary Tract Infections","page":"78","source":"Zotero","language":"en","author":[{"family":"Hamilton","given":"Elva"}]}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Hamilton, n.d.). Proper training given to the nurses made them able to identify infection through daily assessment. Due to the identification of infection, it becomes easy to provide the necessary healthcare to the patient by removing the catheter and providing medication. Another qualitative research again discussed the gap between patients and nurses which mean nurses are the main elements that should be used for the prevention of CAUTI ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"n90Ygz44","properties":{"formattedCitation":"(Jaeger, Fox, Cooney, & Robinson, 2017)","plainCitation":"(Jaeger, Fox, Cooney, & Robinson, 2017)","noteIndex":0},"citationItems":[{"id":379,"uris":["http://zotero.org/users/local/rVaVAHaF/items/6TDBLKQD"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/6TDBLKQD"],"itemData":{"id":379,"type":"article-journal","title":"A qualitative study exploring the value of a catheter passport","container-title":"British Journal of Nursing","page":"857-866","volume":"26","issue":"15","source":"Crossref","DOI":"10.12968/bjon.2017.26.15.857","ISSN":"0966-0461, 2052-2819","language":"en","author":[{"family":"Jaeger","given":"Melanie De"},{"family":"Fox","given":"Fiona"},{"family":"Cooney","given":"Geraldine"},{"family":"Robinson","given":"Jacqueline"}],"issued":{"date-parts":[["2017",8,10]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Jaeger, Fox, Cooney, & Robinson, 2017). It is possible only by providing them knowledge and training regarding the method they should use during medication and also regarding the helpful communication relationship with the patients to make them well aware regarding the problem.

PICO Question:

By identifying the problem of CAUTI, PICO question can be developed. In PICO question "P" representing the population that is nurses, "I" representing the intervention which is an evidence-based protocol or the program which provide the sufficient knowledge to the nurses' regarding prevention of CAUTI. "C" in PICO is a comparison of nurses working efficiency before and after the catheter protocol practice, and "O" indicating the outcome which means the efficiency of nurses increased through educational program and trading regarding the practices for CAUTI prevention.

PICO QUESTION

P

Population

Nurses on a medical-surgical floor of a well-established hospital.

I

Intervention

Programs or knowledge for nurses regarding urinary catheter removal protocol.

C

comparative

Knowledge of nurses before providing training.

O

outcome

Change in nurses efficiency and CAUTI rate.

Evidence Matrix:

Below is the complete evidence matrix indicating the useful information regarding the evidence used for the project.

Evidence Matrix

Authors

Journal Name

Year of Publication

Research Design

Sample Size

Outcome Variables Measured

Quality (A, B, C)

Results/Author’s Suggested Conclusions

Hamilton

Nova Southeastern University

2018

Quantitative

28 nurses

Practice process

B

Programs that provide nurses staffs and surgical units proper training to acknowledge the patient about the issue and also the assessment tool can be helpful for CAUTI prevention

Helber, Betty

The Ohio State University

2015

Mixed

147 eligible patients

Future action/ directions implementation

A

Through proper training not only CAUTI infection reduced up to 66% but the duration of catheter insertion was also reduced to 16.3% days. It implies that by empowering the nursing staff, CAUTI can be controlled rapidly.

Bardossy, A. C., Williams, T., Jones, K., Szpunar, S., Zervos, M., Alangaden, G., … Fakih, M. G.

Infection Control & Hospital Epidemiology

2018

Quantitative

2 hospitals

Identification of effective CAUTI prevention technique

C

The culturing practice has great impact over the prevention of the CAUTI. It not only identifies the infection but also helps to secure the patient from it

Revello, K., & Gallo, A.-M.

Journal of Nursing Education and Practice

2013

Quantitative

41 patients,

1 group of hospital staff

The effectiveness of evidence-based practice

B

CAUTI rate decreased rapidly than before applying practice which means evidence-based practice is an effective tool for the prevention of CAUTI.

Jaeger, M. D., Fox, F., Cooney, G., & Robinson, J.

British Journal of Nursing

2017

Qualitative

9 patients,

11 nurses

The communication gap between nurses and patients

A

it is necessary to train the nurses to provide the patient with sufficient knowledge and information regarding infection so they can do self-care after being discharged

Recommended Practice Change

Limited Use of Catheter:

Through the literature review, the most important aspect for the prevention of CAUTI is the limited use of the catheter. Before any other intervention, nurses should be guided about the sufficient use of the catheter. Study ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"enFRLVWc","properties":{"formattedCitation":"(Hamilton, n.d.)","plainCitation":"(Hamilton, n.d.)","noteIndex":0},"citationItems":[{"id":378,"uris":["http://zotero.org/users/local/rVaVAHaF/items/S94R5PGP"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/S94R5PGP"],"itemData":{"id":378,"type":"article-journal","title":"Nurse-Driven Protocol to Reduce Catheter Associated Urinary Tract Infections","page":"78","source":"Zotero","language":"en","author":[{"family":"Hamilton","given":"Elva"}]}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Hamilton, n.d.) indicates that education regarding the assessment tool can be helpful, ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ybr5VU7S","properties":{"formattedCitation":"(\\uc0\\u8220{}2015_Helber_DNP_Document.pdf,\\uc0\\u8221{} n.d.)","plainCitation":"(“2015_Helber_DNP_Document.pdf,” n.d.)","noteIndex":0},"citationItems":[{"id":368,"uris":["http://zotero.org/users/local/rVaVAHaF/items/4K6Z5KK9"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/4K6Z5KK9"],"itemData":{"id":368,"type":"article","title":"2015_Helber_DNP_Document.pdf","URL":"https://kb.osu.edu/bitstream/handle/1811/68662/1/2015_Helber_DNP_Document.pdf","accessed":{"date-parts":[["2019",3,24]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (“2015_Helber_DNP_Document.pdf,” n.d.) also highlighted the fact with the catheter protocol nurses can efficiently use the catheter and excessive use of catheter intervention can be eliminated. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"BVWegzus","properties":{"formattedCitation":"(Bardossy et al., 2018)","plainCitation":"(Bardossy et al., 2018)","noteIndex":0},"citationItems":[{"id":371,"uris":["http://zotero.org/users/local/rVaVAHaF/items/NKHFVYKN"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/NKHFVYKN"],"itemData":{"id":371,"type":"article-journal","title":"Culturing practices and the care of the urinary catheter in reducing NHSN-defined catheter-associated urinary tract infections: The tale of two teaching hospitals","container-title":"Infection Control & Hospital Epidemiology","page":"1494-1496","volume":"39","issue":"12","source":"Crossref","DOI":"10.1017/ice.2018.251","ISSN":"0899-823X, 1559-6834","shortTitle":"Culturing practices and the care of the urinary catheter in reducing NHSN-defined catheter-associated urinary tract infections","language":"en","author":[{"family":"Bardossy","given":"Ana Cecilia"},{"family":"Williams","given":"Takiah"},{"family":"Jones","given":"Karen"},{"family":"Szpunar","given":"Susan"},{"family":"Zervos","given":"Marcus"},{"family":"Alangaden","given":"George"},{"family":"Reyes","given":"Katherine"},{"family":"Fakih","given":"Mohamad G."}],"issued":{"date-parts":[["2018",12]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Bardossy et al., 2018) reveals that through catheter protocol, nurses get able to identify the patients with CAUTI infection and catheter can be immediately removed which means through proper reporting nurses can use catheter sufficiently and excessive use can be prevented. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Mce6mBMX","properties":{"formattedCitation":"(Revello & Gallo, 2013)","plainCitation":"(Revello & Gallo, 2013)","noteIndex":0},"citationItems":[{"id":370,"uris":["http://zotero.org/users/local/rVaVAHaF/items/52QCW5EM"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/52QCW5EM"],"itemData":{"id":370,"type":"article-journal","title":"Implementing an evidence-based practice protocol for prevention of catheterized associated urinary tract infections in a progressive care unit","container-title":"Journal of Nursing Education and Practice","volume":"3","issue":"1","source":"Crossref","URL":"http://www.sciedu.ca/journal/index.php/jnep/article/view/1074","DOI":"10.5430/jnep.v3n1p99","ISSN":"1925-4059, 1925-4040","language":"en","author":[{"family":"Revello","given":"Kathleen"},{"family":"Gallo","given":"Ana-Maria"}],"issued":{"date-parts":[["2013",1,1]]},"accessed":{"date-parts":[["2019",3,24]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Revello & Gallo, 2013) indicates that when communication gap will be reduced between the nurses and patient, the patient can share their problem regarding catheter, and therefore use of catheter can be minimized ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"n90Ygz44","properties":{"formattedCitation":"(Jaeger, Fox, Cooney, & Robinson, 2017)","plainCitation":"(Jaeger, Fox, Cooney, & Robinson, 2017)","noteIndex":0},"citationItems":[{"id":379,"uris":["http://zotero.org/users/local/rVaVAHaF/items/6TDBLKQD"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/6TDBLKQD"],"itemData":{"id":379,"type":"article-journal","title":"A qualitative study exploring the value of a catheter passport","container-title":"British Journal of Nursing","page":"857-866","volume":"26","issue":"15","source":"Crossref","DOI":"10.12968/bjon.2017.26.15.857","ISSN":"0966-0461, 2052-2819","language":"en","author":[{"family":"Jaeger","given":"Melanie De"},{"family":"Fox","given":"Fiona"},{"family":"Cooney","given":"Geraldine"},{"family":"Robinson","given":"Jacqueline"}],"issued":{"date-parts":[["2017",8,10]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Jaeger, Fox, Cooney, & Robinson, 2017).

The study supports the fact that the assessment should be made before and after the intervention of the catheter. This is because through proper assessment catheter can be rapidly removed as soon it is not required anymore. Also if any patient has got CAUTI infection, it can be identified on time which can help to apply medication for the cure.

Catheter protocol Practice:

Nurses are involved directly with the patients before and after the insertion of the catheter. Nurses are therefore responsible for providing sufficient healthcare to the patients. The limited interaction or lack of communication between patients and nurses can make difficulties to control the CAUTI. Study ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"enFRLVWc","properties":{"formattedCitation":"(Hamilton, n.d.)","plainCitation":"(Hamilton, n.d.)","noteIndex":0},"citationItems":[{"id":378,"uris":["http://zotero.org/users/local/rVaVAHaF/items/S94R5PGP"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/S94R5PGP"],"itemData":{"id":378,"type":"article-journal","title":"Nurse-Driven Protocol to Reduce Catheter Associated Urinary Tract Infections","page":"78","source":"Zotero","language":"en","author":[{"family":"Hamilton","given":"Elva"}]}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Hamilton, n.d.) indicates that proper education and guidance should be provided to the nurses’ staff of the hospitals. So they can identify when catheter insertion is needed and when it should be removed. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ybr5VU7S","properties":{"formattedCitation":"(\\uc0\\u8220{}2015_Helber_DNP_Document.pdf,\\uc0\\u8221{} n.d.)","plainCitation":"(“2015_Helber_DNP_Document.pdf,” n.d.)","noteIndex":0},"citationItems":[{"id":368,"uris":["http://zotero.org/users/local/rVaVAHaF/items/4K6Z5KK9"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/4K6Z5KK9"],"itemData":{"id":368,"type":"article","title":"2015_Helber_DNP_Document.pdf","URL":"https://kb.osu.edu/bitstream/handle/1811/68662/1/2015_Helber_DNP_Document.pdf","accessed":{"date-parts":[["2019",3,24]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (“2015_Helber_DNP_Document.pdf,” n.d.) highlighted the fact that when nurses get advanced training for CAUTI prevention, they become able to handle the situation efficiently. Their role becomes more effective for not only to identify the infection but after saving the patients by giving proper care, and assessment. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"BVWegzus","properties":{"formattedCitation":"(Bardossy et al., 2018)","plainCitation":"(Bardossy et al., 2018)","noteIndex":0},"citationItems":[{"id":371,"uris":["http://zotero.org/users/local/rVaVAHaF/items/NKHFVYKN"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/NKHFVYKN"],"itemData":{"id":371,"type":"article-journal","title":"Culturing practices and the care of the urinary catheter in reducing NHSN-defined catheter-associated urinary tract infections: The tale of two teaching hospitals","container-title":"Infection Control & Hospital Epidemiology","page":"1494-1496","volume":"39","issue":"12","source":"Crossref","DOI":"10.1017/ice.2018.251","ISSN":"0899-823X, 1559-6834","shortTitle":"Culturing practices and the care of the urinary catheter in reducing NHSN-defined catheter-associated urinary tract infections","language":"en","author":[{"family":"Bardossy","given":"Ana Cecilia"},{"family":"Williams","given":"Takiah"},{"family":"Jones","given":"Karen"},{"family":"Szpunar","given":"Susan"},{"family":"Zervos","given":"Marcus"},{"family":"Alangaden","given":"George"},{"family":"Reyes","given":"Katherine"},{"family":"Fakih","given":"Mohamad G."}],"issued":{"date-parts":[["2018",12]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Bardossy et al., 2018) justifies the fact that through proper education regarding CAUTI prevention reduced the CAUTI rate also the patient who acquire the infection can be identified at early stages. Therefore, it becomes preventable. Comparison between two hospitals through education session provided to the hospital’s staff especially nurses justifies the need for training programs like catheter protocol practice to reduce the CAUTI rate ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Mce6mBMX","properties":{"formattedCitation":"(Revello & Gallo, 2013)","plainCitation":"(Revello & Gallo, 2013)","noteIndex":0},"citationItems":[{"id":370,"uris":["http://zotero.org/users/local/rVaVAHaF/items/52QCW5EM"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/52QCW5EM"],"itemData":{"id":370,"type":"article-journal","title":"Implementing an evidence-based practice protocol for prevention of catheterized associated urinary tract infections in a progressive care unit","container-title":"Journal of Nursing Education and Practice","volume":"3","issue":"1","source":"Crossref","URL":"http://www.sciedu.ca/journal/index.php/jnep/article/view/1074","DOI":"10.5430/jnep.v3n1p99","ISSN":"1925-4059, 1925-4040","language":"en","author":[{"family":"Revello","given":"Kathleen"},{"family":"Gallo","given":"Ana-Maria"}],"issued":{"date-parts":[["2013",1,1]]},"accessed":{"date-parts":[["2019",3,24]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Revello & Gallo, 2013). Qualitative data results highly recommended the implementation of catheter protocol practice to control CAUTI in no time ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"n90Ygz44","properties":{"formattedCitation":"(Jaeger, Fox, Cooney, & Robinson, 2017)","plainCitation":"(Jaeger, Fox, Cooney, & Robinson, 2017)","noteIndex":0},"citationItems":[{"id":379,"uris":["http://zotero.org/users/local/rVaVAHaF/items/6TDBLKQD"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/6TDBLKQD"],"itemData":{"id":379,"type":"article-journal","title":"A qualitative study exploring the value of a catheter passport","container-title":"British Journal of Nursing","page":"857-866","volume":"26","issue":"15","source":"Crossref","DOI":"10.12968/bjon.2017.26.15.857","ISSN":"0966-0461, 2052-2819","language":"en","author":[{"family":"Jaeger","given":"Melanie De"},{"family":"Fox","given":"Fiona"},{"family":"Cooney","given":"Geraldine"},{"family":"Robinson","given":"Jacqueline"}],"issued":{"date-parts":[["2017",8,10]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Jaeger, Fox, Cooney, & Robinson, 2017). All studies show that nurses can be significant to control CAUTI. Proper education and training are required to do so. The catheter protocol practice should be implemented in the hospital to get a positive result.

Patient Guidance:

The study indicates that most of the patients do not know about the consequences of CAUTI. Therefore, it becomes difficult to control infection. The patient should be well aware of the problem. The study ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"enFRLVWc","properties":{"formattedCitation":"(Hamilton, n.d.)","plainCitation":"(Hamilton, n.d.)","noteIndex":0},"citationItems":[{"id":378,"uris":["http://zotero.org/users/local/rVaVAHaF/items/S94R5PGP"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/S94R5PGP"],"itemData":{"id":378,"type":"article-journal","title":"Nurse-Driven Protocol to Reduce Catheter Associated Urinary Tract Infections","page":"78","source":"Zotero","language":"en","author":[{"family":"Hamilton","given":"Elva"}]}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Hamilton, n.d.) indicates the evidence where lac of patient died because of CAUTI it is not because of the hospital. It also happened because the patient did not know about the infection and its prevention. Study ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ybr5VU7S","properties":{"formattedCitation":"(\\uc0\\u8220{}2015_Helber_DNP_Document.pdf,\\uc0\\u8221{} n.d.)","plainCitation":"(“2015_Helber_DNP_Document.pdf,” n.d.)","noteIndex":0},"citationItems":[{"id":368,"uris":["http://zotero.org/users/local/rVaVAHaF/items/4K6Z5KK9"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/4K6Z5KK9"],"itemData":{"id":368,"type":"article","title":"2015_Helber_DNP_Document.pdf","URL":"https://kb.osu.edu/bitstream/handle/1811/68662/1/2015_Helber_DNP_Document.pdf","accessed":{"date-parts":[["2019",3,24]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (“2015_Helber_DNP_Document.pdf,” n.d.) also highlighted the fact that chronic critically ill population is found infection acquired from the catheter which is identified by other medication not by the nurses after the catheter or patients. Both Studies ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"BVWegzus","properties":{"formattedCitation":"(Bardossy et al., 2018)","plainCitation":"(Bardossy et al., 2018)","noteIndex":0},"citationItems":[{"id":371,"uris":["http://zotero.org/users/local/rVaVAHaF/items/NKHFVYKN"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/NKHFVYKN"],"itemData":{"id":371,"type":"article-journal","title":"Culturing practices and the care of the urinary catheter in reducing NHSN-defined catheter-associated urinary tract infections: The tale of two teaching hospitals","container-title":"Infection Control & Hospital Epidemiology","page":"1494-1496","volume":"39","issue":"12","source":"Crossref","DOI":"10.1017/ice.2018.251","ISSN":"0899-823X, 1559-6834","shortTitle":"Culturing practices and the care of the urinary catheter in reducing NHSN-defined catheter-associated urinary tract infections","language":"en","author":[{"family":"Bardossy","given":"Ana Cecilia"},{"family":"Williams","given":"Takiah"},{"family":"Jones","given":"Karen"},{"family":"Szpunar","given":"Susan"},{"family":"Zervos","given":"Marcus"},{"family":"Alangaden","given":"George"},{"family":"Reyes","given":"Katherine"},{"family":"Fakih","given":"Mohamad G."}],"issued":{"date-parts":[["2018",12]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Bardossy et al., 2018), ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Mce6mBMX","properties":{"formattedCitation":"(Revello & Gallo, 2013)","plainCitation":"(Revello & Gallo, 2013)","noteIndex":0},"citationItems":[{"id":370,"uris":["http://zotero.org/users/local/rVaVAHaF/items/52QCW5EM"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/52QCW5EM"],"itemData":{"id":370,"type":"article-journal","title":"Implementing an evidence-based practice protocol for prevention of catheterized associated urinary tract infections in a progressive care unit","container-title":"Journal of Nursing Education and Practice","volume":"3","issue":"1","source":"Crossref","URL":"http://www.sciedu.ca/journal/index.php/jnep/article/view/1074","DOI":"10.5430/jnep.v3n1p99","ISSN":"1925-4059, 1925-4040","language":"en","author":[{"family":"Revello","given":"Kathleen"},{"family":"Gallo","given":"Ana-Maria"}],"issued":{"date-parts":[["2013",1,1]]},"accessed":{"date-parts":[["2019",3,24]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Revello & Gallo, 2013) highlighted that with the help of trained nurses, patients also get aware about the problem which helps them for self-care. Study ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"n90Ygz44","properties":{"formattedCitation":"(Jaeger, Fox, Cooney, & Robinson, 2017)","plainCitation":"(Jaeger, Fox, Cooney, & Robinson, 2017)","noteIndex":0},"citationItems":[{"id":379,"uris":["http://zotero.org/users/local/rVaVAHaF/items/6TDBLKQD"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/6TDBLKQD"],"itemData":{"id":379,"type":"article-journal","title":"A qualitative study exploring the value of a catheter passport","container-title":"British Journal of Nursing","page":"857-866","volume":"26","issue":"15","source":"Crossref","DOI":"10.12968/bjon.2017.26.15.857","ISSN":"0966-0461, 2052-2819","language":"en","author":[{"family":"Jaeger","given":"Melanie De"},{"family":"Fox","given":"Fiona"},{"family":"Cooney","given":"Geraldine"},{"family":"Robinson","given":"Jacqueline"}],"issued":{"date-parts":[["2017",8,10]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Jaeger, Fox, Cooney, & Robinson, 2017) indicated that the patient had no guidance provided by the nurses while getting discharge and catheter removal. Which shows that the patient did not know the sufficient information to keep themselves safe from the infection.

All studies indicated that training for nurses is important not only to increase their work efficiency but also to reduce the communication gap between nurses and patient. They should provide information to the patient so they can take care to prevent the CAUTI.

Implementation Process

Stakeholders:

The main stakeholders are those who get directly affected by education. For instance, hospital leadership is the stakeholder because CAUTI is the hospital-acquired infection. If CAUTI reduces it will increase the efficiency and reputation of the hospital. The second stakeholder is the nurses. With the help of catheter protocol practice nurses not only help in preventing CAUTI but it will also increases their skills, and it will be useful for their progressive profession. The third stakeholder is the patients. Nobody wants to get ill because of unknown reason. Through study, the patients will be able to get sufficient knowledge regarding CAUTI.

Barrier:

The two main barriers to the implementation of the given recommendations can be time management and staff interest. Time management can be a barrier as hospitals have limited staff for the patient’s care. Therefore it becomes difficult to manage the regular duties along with extra time for training. The second barrier is related to the staff. They sometimes do not cooperate in additional duties or practice. It is difficult to bring the whole staff on the same platform because staff often avoids extra workload. In other words, without realizing the common interest, most of the time staff focus on their comfort zone and self-interest.

Strategies:

To avoid the barriers some useful strategies should be used. For instance, to balance the time management, staff can be divided into two groups which means training would have two sessions. In this way, training and regular duties can be performed without any problem. The second barrier that is staff interest can be developed through the number of strategies. For instance, a certificate or compensation can be announced. Also, the higher authority can make training official by making it mandatory for the whole staff so no one can avoid it.

Indicator:

Audit team of the hospital can measure the outcome. Report on the identification of CAUTI rate and prevention before and after the training can be developed systematically. Through the report, it will be easy to identify the effectiveness of nurses before and after the catheter protocol practice. Also, the rate of CAUTI can indicates how efficiently the hospital is working for the infection prevention.

References

ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY 2015_Helber_DNP_Document.pdf. (n.d.). Retrieved from https://kb.osu.edu/bitstream/handle/1811/68662/1/2015_Helber_DNP_Document.pdf

Bardossy, A. C., Williams, T., Jones, K., Szpunar, S., Zervos, M., Alangaden, G., … Fakih, M. G. (2018). Culturing practices and the care of the urinary catheter in reducing NHSN-defined catheter-associated urinary tract infections: The tale of two teaching hospitals. Infection Control & Hospital Epidemiology, 39(12), 1494–1496. https://doi.org/10.1017/ice.2018.251

Hamilton, E. (2018). Nurse-Driven Protocol to Reduce Catheter Associated Urinary Tract Infections, 78.https://nsuworks.nova.edu/cgi/viewcontent.cgi?article=1045&context=hpd_con_stuetd

Jaeger, M. D., Fox, F., Cooney, G., & Robinson, J. (2017). A qualitative study exploring the value of a catheter passport. British Journal of Nursing, 26(15), 857–866. https://doi.org/10.12968/bjon.2017.26.15.857

Revello, K., & Gallo, A.-M. (2013). Implementing an evidence-based practice protocol for prevention of catheterized associated urinary tract infections in a progressive care unit. Journal of Nursing Education and Practice, 3(1). https://doi.org/10.5430/jnep.v3n1p99

Evaluation Of Hospital Infection Prevention Policies Can Identify Opportunities For Improvement: Study. (n.d.). Retrieved March 24, 2019, from https://www.elsevier.com/about/press-releases/research-and-journals/evaluation-of-hospital-infection-prevention-policies-can-identify-opportunities-for-improvement-study

Gunaseelan, V. (n.d.). Catheter-Associated Urinary Tract Infections. Retrieved March 24, 2019, from https://www.hopkinsmedicine.org/heic/infection_surveillance/cauti.html

Subject: Healthcare and Nursing

Pages: 3 Words: 900

Xap Task 2 CAUTI

xap task 2 CAUTI

[Name of the Writer]

[Name of the Institution]

xap task 2 CAUTI

Introduction:

CAUTI a Healthcare Problem:

A urinary tract infection is reported as the most common infection associated with healthcare known as Catheter-associated urinary tract infection (CAUTI). Seventy-five percent of urinary tract infection cases are associated with the urinary catheter. Infection can be involved in various body organs include kidney, urinary bladder, urethra, and ureters. The urinary catheter is a tube that is inserted through the urethra into the bladder to drain urine. Lack of proper care during and after the catheter removal can cause CAUTI. Therefore, there is a need for the proper indication for using catheter, and it should be removed as soon as it is no longer required. The main element related to the CAUTI is nurses. Nurses are associated with both stages, i.e. during the insertion of catheter and removal of the catheter. Therefore, they can play a vital role to control the infection. The existence of CAUTI as a common infection also indicates the lack of proper intervention by the nurses for the cause. Hence, there is a need to study the current healthcare practice performed by the nurses. The problems which result in CAUTI should be understood for the reduction of infection as fifty percent of the infection cases are preventable.

The significance of the Problem:

Catheter use sometimes becomes necessary in the hospital. This is why it is the most common infection associated with the hospital. Therefore it is significant to identify the causes for infection prevention. From the collection bag, bacteria can travel up the tube. Hence, CAUTI is an infection that can be a threat to the safety of the patient. CAUTI can occurs one day after the catheter is removed and two days after the insertion. It can cause infections like sepsis, cystitis, prostatitis, meningitis, and arthritis. Therefore it is significant to identify the problem. Through problem identification, a proper plan, recommendations, and implementations can be developing to increase the safety measure of the CAUTI’s patent. The significance of the problem is related to three people, i.e. patient, nurses, and hospital management. Through proper training of nurses, CAUTI can be controlled and therefore can result in the patient's good health, standardized hospital, and empowered nurses.

Current Healthcare Practice:

Various healthcare practices are being used by the hospitals to reduce the infection. CAUTI prevention initiatives are taken by The Hospital Research and Education Trust. The main goal of the organization is to develop learning collaborative for hospitals. Activities and incentives are introducing to enhance the safety of the patents. The model is applied known as the Comprehensive Unit-based Safety Program (CUSP) to disseminate the tools and knowledge to the hospitals. Also, the hospitals are promoting daily urinary catheter assessment tool. It helps to acquire the condition of the patient so the catheter can be removed when no longer required.

CAUTI Affects:

CAUTI affects not only the patients but hospitals as well. CAUTI is a hospital-acquired infection. Which means hospital reputation and efficiency can be questioned if the infection increases. Hospitals are required to make sure about fulfilling all the measures of cleanliness to fight with the bacteria. Hospital's preference is also linked to the performance and satisfaction of the patients. Health behavior of the patient due to the CAUTI indicates the inefficiency of the organization and it cannot only harmful for human life but also the organization economically.

The patients who got catheters are assessed so that the catheter can be removed as soon as it no more required. Patients remain unaware of the problem when they get discharged, and therefore the risk of infection increases. Infection lowers health behavior as it not only affects the patient physically, but its psychological impact is also severe. Patient's preference is to acquire a good and healthy life which is possible only by taking the CAUTI issue seriously.

Literature Review:

In the article "Nurse-Driven Protocol to Reduce Catheter-Associated Urinary Tract Infections" researcher Hamilton discussed the issue of CAUTI and its preventions. Hamilton argued that infection is preventable ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"enFRLVWc","properties":{"formattedCitation":"(Hamilton, n.d.)","plainCitation":"(Hamilton, n.d.)","noteIndex":0},"citationItems":[{"id":378,"uris":["http://zotero.org/users/local/rVaVAHaF/items/S94R5PGP"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/S94R5PGP"],"itemData":{"id":378,"type":"article-journal","title":"Nurse-Driven Protocol to Reduce Catheter Associated Urinary Tract Infections","page":"78","source":"Zotero","language":"en","author":[{"family":"Hamilton","given":"Elva"}]}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Hamilton, n.d.), and it can be reduced by improving the quality of hospital through advance and well-trained nursing staffs and surgical units. For his argument, he presented evidence of medical error in America. Due to the error lac of people died because of CAUTI which was preventable. Evidence from the Institute for healthcare improvement is used which tells that about eighty percent of UTIs are linked with indwelling urinary catheters. Hamilton used quantitative data for analysis. Data was collected 28 nurses from a South Florida Hospital. A demographic survey was taken which was analyzed with the help of t-test and descriptive statistics. Results indicate that CAUTI is preventable if it gets identified on time. Evidence-based prevention can be essential for the problem. Programs that provide nurses staffs and surgical units proper training to acknowledge the patients about the issue and also the assessment tool can be helpful for CAUTI prevention.

In the article "The Impact of an Evidence-Based Practice Protocol on Catheter-Associated Urinary Tract Infections and Urinary Catheter Days," Herber discussed the chronic critically ill population. These patients are mostly diagnosing with CAUTI. The main purpose of the study is to identifies the significance of evidence-based urinary catheter protocol. Researcher claims that catheter protocol is the most effective tool to reduce the CAUTI. For the purpose, two methods used to collect data. Firstly, online education was to the hospital team, and secondly, assessments of the patients using catheter were collected. By focusing on the evidence that chronic critically ill get CAUTI due to various factors like aging, the trajectory of recovery and care, and laden with social burdens, the researcher analyzed the data collected from three month of online education and patient's assessment ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ybr5VU7S","properties":{"formattedCitation":"(\\uc0\\u8220{}2015_Helber_DNP_Document.pdf,\\uc0\\u8221{} n.d.)","plainCitation":"(“2015_Helber_DNP_Document.pdf,” n.d.)","noteIndex":0},"citationItems":[{"id":368,"uris":["http://zotero.org/users/local/rVaVAHaF/items/4K6Z5KK9"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/4K6Z5KK9"],"itemData":{"id":368,"type":"article","title":"2015_Helber_DNP_Document.pdf","URL":"https://kb.osu.edu/bitstream/handle/1811/68662/1/2015_Helber_DNP_Document.pdf","accessed":{"date-parts":[["2019",3,24]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (“2015_Helber_DNP_Document.pdf,” n.d.). Results indicate that through proper training not only CAUTI infection reduced up to 66%, but the duration of catheter insertion was also reduced to 16.3% days. It implies that by empowering the nursing staff, CAUTI can be controlled rapidly.

In the article "Culturing practices and the care of the urinary catheter in reducing NHSN-defined catheter-associated urinary tract infections," researcher Bardossy and fellows compared the interventions to control CAUTI in a more effective and faster way. Researchers argue that the main factor behind the infection in the hospital practices. Therefore it is necessary to apply interventions and tools to the hospital which can control CAUTI. To find out which intervention is more effective the research was made. For the purpose, researchers approached two teaching hospitals. The researcher made a weekly audit on indication and compliance of a urinary catheter with processes. The methodology that the researchers used was based on the training program. Proper guidance and training were given to the staff of both the hospitals ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"BVWegzus","properties":{"formattedCitation":"(Bardossy et al., 2018)","plainCitation":"(Bardossy et al., 2018)","noteIndex":0},"citationItems":[{"id":371,"uris":["http://zotero.org/users/local/rVaVAHaF/items/NKHFVYKN"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/NKHFVYKN"],"itemData":{"id":371,"type":"article-journal","title":"Culturing practices and the care of the urinary catheter in reducing NHSN-defined catheter-associated urinary tract infections: The tale of two teaching hospitals","container-title":"Infection Control & Hospital Epidemiology","page":"1494-1496","volume":"39","issue":"12","source":"Crossref","DOI":"10.1017/ice.2018.251","ISSN":"0899-823X, 1559-6834","shortTitle":"Culturing practices and the care of the urinary catheter in reducing NHSN-defined catheter-associated urinary tract infections","language":"en","author":[{"family":"Bardossy","given":"Ana Cecilia"},{"family":"Williams","given":"Takiah"},{"family":"Jones","given":"Karen"},{"family":"Szpunar","given":"Susan"},{"family":"Zervos","given":"Marcus"},{"family":"Alangaden","given":"George"},{"family":"Reyes","given":"Katherine"},{"family":"Fakih","given":"Mohamad G."}],"issued":{"date-parts":[["2018",12]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Bardossy et al., 2018). Also, identical training was provided to physicians about the efficient use of devices and laboratory equipment. The data were analyzed by using SPSS and Pearson test. Results indicate that the hospital identified 84.5% patient who had CAUTI infection. The identification of infection on time was due to the daily assessment and compliance with proper maintenance. Hospital successfully secured the patient and CAUTI rate was reduced as compared to the year 2014 and 2015. Hence research concluded that catheter protocol practice has great impact over the prevention of the CAUTI. It not only identifies the infection but also helps to secure the patient from it.

In this article," Implementing an evidence-based practice protocol for prevention of catheterized associated urinary tract infections in a progressive care unit," Revella and Gallo made research over the positive impact of evidence-based practice and a new protocol for the prevention of CAUTI. CAUTI rate is one of the scales for measuring the nursing quality for any hospital. Therefore research was made to observe the role and practices of the nurses in the hospital. For the purpose, the researcher selected four hospitals for data collection. Initially, data identified 00/1000 and 0.6/1000 urinary catheter days in surgical and medical ICU respectively. Researchers provide evidence-based practice training to the selected teams of the hospitals. Data was collected for 7 days from 41 patients. Data was based on information about the patient's name, age, admission date, catheter insertion date, removal date, and antibiotic coverage ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Mce6mBMX","properties":{"formattedCitation":"(Revello & Gallo, 2013)","plainCitation":"(Revello & Gallo, 2013)","noteIndex":0},"citationItems":[{"id":370,"uris":["http://zotero.org/users/local/rVaVAHaF/items/52QCW5EM"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/52QCW5EM"],"itemData":{"id":370,"type":"article-journal","title":"Implementing an evidence-based practice protocol for prevention of catheterized associated urinary tract infections in a progressive care unit","container-title":"Journal of Nursing Education and Practice","volume":"3","issue":"1","source":"Crossref","URL":"http://www.sciedu.ca/journal/index.php/jnep/article/view/1074","DOI":"10.5430/jnep.v3n1p99","ISSN":"1925-4059, 1925-4040","language":"en","author":[{"family":"Revello","given":"Kathleen"},{"family":"Gallo","given":"Ana-Maria"}],"issued":{"date-parts":[["2013",1,1]]},"accessed":{"date-parts":[["2019",3,24]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Revello & Gallo, 2013). A power point presentation was given to a hospital team who supported as a volunteer in research. The result from data analysis indicates that after applying evidence-based practice infection and device days reduced to 0.7/1000 and 0.3/ device & patient days respectively. Therefore, it was concluded that five months after the implementation CAUTI rate decreased rapidly than before which means evidence-based practice is an effective tool for the prevention of CAUTI.

In the article “A qualitative study exploring the value of a catheter passport.” researchers highlighted the problem of communication gap between nurses and patients. Researchers argued that nurses do not provide sufficient guidance to the patients when they get discharge which results in CAUTI ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"n90Ygz44","properties":{"formattedCitation":"(Jaeger, Fox, Cooney, & Robinson, 2017)","plainCitation":"(Jaeger, Fox, Cooney, & Robinson, 2017)","noteIndex":0},"citationItems":[{"id":379,"uris":["http://zotero.org/users/local/rVaVAHaF/items/6TDBLKQD"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/6TDBLKQD"],"itemData":{"id":379,"type":"article-journal","title":"A qualitative study exploring the value of a catheter passport","container-title":"British Journal of Nursing","page":"857-866","volume":"26","issue":"15","source":"Crossref","DOI":"10.12968/bjon.2017.26.15.857","ISSN":"0966-0461, 2052-2819","language":"en","author":[{"family":"Jaeger","given":"Melanie De"},{"family":"Fox","given":"Fiona"},{"family":"Cooney","given":"Geraldine"},{"family":"Robinson","given":"Jacqueline"}],"issued":{"date-parts":[["2017",8,10]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Jaeger, Fox, Cooney, & Robinson, 2017). The data collection based on two methods, i.e. questionnaire and survey. Nurses and recently discharged patients provided the information. Data were analyzed with the help of thematic analysis. The result shows that hospitals are responsible for the communication gap between the nurses and patient. Nurses provide catheter passport without provided information about CAUTI and self-care. Result also highlighted the fact that the patent who knows about the infection can help them from CAUTI prevention. Therefore it is necessary to train the nurses to provide the patients with sufficient knowledge and information regarding infection so they can do self-care after being discharged.

In a study author indicates that the hospital does not take proper precautions to prevent the infection like CAUTI. Therefore, CAUTI surveillance is performed. It began in 2011. It includes the efforts and programs for the prevention of CAUTI. CAUTI rate is indicated in the number of infection per thousands of urinary catheter days. The programs and implementation that are using by the National Healthcare Safety Network includes improving urine sample, minimum use of the catheter, procedure for urine cultures, and programs to sustain evidence-based practices for prevention and maintenance ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"embMa9MA","properties":{"formattedCitation":"(Gunaseelan, n.d.)","plainCitation":"(Gunaseelan, n.d.)","noteIndex":0},"citationItems":[{"id":386,"uris":["http://zotero.org/users/local/rVaVAHaF/items/2P86XWE6"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/2P86XWE6"],"itemData":{"id":386,"type":"webpage","title":"Catheter-Associated Urinary Tract Infections","URL":"https://www.hopkinsmedicine.org/heic/infection_surveillance/cauti.html","language":"en","author":[{"family":"Gunaseelan","given":"Vidhya"}],"accessed":{"date-parts":[["2019",3,24]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Gunaseelan, n.d.). The author discussed that evidence-based practice like educational training t the nurses can be useful to prevent the CAUTI. Also, the CAUTI guideline not only for nurses but also for the patient is playing an important role and reducing the CAUTI rate.

Another study implies that through proper evaluation of hospitals infection can be helpful for the prevention of CAUTI. The survey indicated that besides devices usage, multi-drug resistant organism, and surgery mostly hospitals had prevention policies for the infection. Also, practices to reduce the risk were not the same in all hospitals. Surgeon-specific rates were evaluated and identified with the surgeons in 75% of hospitals. It was a tool that can be helpful for surgeons to prioritize infection prevention. The conclusion of the survey indicated that evaluation of the hospitals from their policies and current practices could be effective for improvement in CAUTI rate. Some hospitals practices are not sufficient, and some have effective practices like evidence-based practice which is efficient for CAUTI prevention. In other words, evaluation should be made to provide the most effective programs and procedure to reduce the problem of CAUTI ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ayjGE4sm","properties":{"formattedCitation":"(\\uc0\\u8220{}Evaluation Of Hospital Infection Prevention Policies Can Identify Opportunities For Improvement: Study,\\uc0\\u8221{} n.d.)","plainCitation":"(“Evaluation Of Hospital Infection Prevention Policies Can Identify Opportunities For Improvement: Study,” n.d.)","noteIndex":0},"citationItems":[{"id":383,"uris":["http://zotero.org/users/local/rVaVAHaF/items/8WJHV529"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/8WJHV529"],"itemData":{"id":383,"type":"webpage","title":"Evaluation Of Hospital Infection Prevention Policies Can Identify Opportunities For Improvement: Study","URL":"https://www.elsevier.com/about/press-releases/research-and-journals/evaluation-of-hospital-infection-prevention-policies-can-identify-opportunities-for-improvement-study","accessed":{"date-parts":[["2019",3,24]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (“Evaluation Of Hospital Infection Prevention Policies Can Identify Opportunities For Improvement: Study,” n.d.).

B1. Discussion:

CAUTI is a serious problem. It is a preventable infection, but due to the lack of awareness, policies, and practices, it is becoming a severe problem. Nurses are the main factor which can help in reducing CAUTI rate. Also, inefficient nursing can also lead to an increase in the problem. The study indicates that the evaluation of hospital is necessary ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ayjGE4sm","properties":{"formattedCitation":"(\\uc0\\u8220{}Evaluation Of Hospital Infection Prevention Policies Can Identify Opportunities For Improvement: Study,\\uc0\\u8221{} n.d.)","plainCitation":"(“Evaluation Of Hospital Infection Prevention Policies Can Identify Opportunities For Improvement: Study,” n.d.)","noteIndex":0},"citationItems":[{"id":383,"uris":["http://zotero.org/users/local/rVaVAHaF/items/8WJHV529"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/8WJHV529"],"itemData":{"id":383,"type":"webpage","title":"Evaluation Of Hospital Infection Prevention Policies Can Identify Opportunities For Improvement: Study","URL":"https://www.elsevier.com/about/press-releases/research-and-journals/evaluation-of-hospital-infection-prevention-policies-can-identify-opportunities-for-improvement-study","accessed":{"date-parts":[["2019",3,24]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (“Evaluation Of Hospital Infection Prevention Policies Can Identify Opportunities For Improvement: Study,” n.d.). CAUTI is mostly acquired from the hospital; therefore, the hospital should adopt all possible strategies and implementation to control the CAUTI rate. It is necessary to evaluate the current practices, and if any hospital is not having advance and efficient practices, then it should seriously take into account. Another study indicates that National Healthcare Safety Network is helping in promoting programs and implementation for the problem. Different safety measure including patient's assessment ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"embMa9MA","properties":{"formattedCitation":"(Gunaseelan, n.d.)","plainCitation":"(Gunaseelan, n.d.)","noteIndex":0},"citationItems":[{"id":386,"uris":["http://zotero.org/users/local/rVaVAHaF/items/2P86XWE6"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/2P86XWE6"],"itemData":{"id":386,"type":"webpage","title":"Catheter-Associated Urinary Tract Infections","URL":"https://www.hopkinsmedicine.org/heic/infection_surveillance/cauti.html","language":"en","author":[{"family":"Gunaseelan","given":"Vidhya"}],"accessed":{"date-parts":[["2019",3,24]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Gunaseelan, n.d.), minimum use of a catheter, and proper guidance to both patients and nurses is significant for the cause. Also, a training problem like catheter protocol practices for nurses can make nurses more skilled and professional for the prevention of infection.

The research on reducing CAUTI rate with the help of catheter protocol practice indicates those surgical units and well-trained nurses' leads to the improvement in CAUTI rate ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"enFRLVWc","properties":{"formattedCitation":"(Hamilton, n.d.)","plainCitation":"(Hamilton, n.d.)","noteIndex":0},"citationItems":[{"id":378,"uris":["http://zotero.org/users/local/rVaVAHaF/items/S94R5PGP"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/S94R5PGP"],"itemData":{"id":378,"type":"article-journal","title":"Nurse-Driven Protocol to Reduce Catheter Associated Urinary Tract Infections","page":"78","source":"Zotero","language":"en","author":[{"family":"Hamilton","given":"Elva"}]}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Hamilton, n.d.). Proper training given to the nurses made them able to identify infection through daily assessment. Due to the identification of infection, it becomes easy to provide the necessary healthcare to the patient by removing the catheter and providing medication. Another qualitative research again discussed the gap between patients and nurses which mean nurses are the main elements that should be used for the prevention of CAUTI ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"n90Ygz44","properties":{"formattedCitation":"(Jaeger, Fox, Cooney, & Robinson, 2017)","plainCitation":"(Jaeger, Fox, Cooney, & Robinson, 2017)","noteIndex":0},"citationItems":[{"id":379,"uris":["http://zotero.org/users/local/rVaVAHaF/items/6TDBLKQD"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/6TDBLKQD"],"itemData":{"id":379,"type":"article-journal","title":"A qualitative study exploring the value of a catheter passport","container-title":"British Journal of Nursing","page":"857-866","volume":"26","issue":"15","source":"Crossref","DOI":"10.12968/bjon.2017.26.15.857","ISSN":"0966-0461, 2052-2819","language":"en","author":[{"family":"Jaeger","given":"Melanie De"},{"family":"Fox","given":"Fiona"},{"family":"Cooney","given":"Geraldine"},{"family":"Robinson","given":"Jacqueline"}],"issued":{"date-parts":[["2017",8,10]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Jaeger, Fox, Cooney, & Robinson, 2017). It is possible only by providing them knowledge and training regarding the method they should use during medication and also regarding the helpful communication relationship with the patients to make them well aware regarding the problem.

PICO Question:

By identifying the problem of CAUTI, PICO question can be developed. In PICO question "P" representing the population that is nurses, "I" representing the intervention which is an evidence-based protocol or the program which provide the sufficient knowledge to the nurses' regarding prevention of CAUTI. "C" in PICO is a comparison of nurses working efficiency before and after the catheter protocol practice, and "O" indicating the outcome which means the efficiency of nurses increased through educational program and trading regarding the practices for CAUTI prevention.

PICO QUESTION

P

Population

Nurses on a medical-surgical floor of a well-established hospital.

I

Intervention

Programs or knowledge for nurses regarding urinary catheter removal protocol.

C

comparative

Knowledge of nurses before providing training.

O

outcome

Change in nurses efficiency and CAUTI rate.

Evidence Matrix:

Below is the complete evidence matrix indicating the useful information regarding the evidence used for the project.

Evidence Matrix

Authors

Journal Name

Year of Publication

Research Design

Sample Size

Outcome Variables Measured

Quality (A, B, C)

Results/Author’s Suggested Conclusions

Hamilton

Nova Southeastern University

2018

Quantitative

28 nurses

Practice process

B

Programs that provide nurses staffs and surgical units proper training to acknowledge the patient about the issue and also the assessment tool can be helpful for CAUTI prevention

Helber, Betty

The Ohio State University

2015

Mixed

147 eligible patients

Future action/ directions implementation

A

Through proper training not only CAUTI infection reduced up to 66% but the duration of catheter insertion was also reduced to 16.3% days. It implies that by empowering the nursing staff, CAUTI can be controlled rapidly.

Bardossy, A. C., Williams, T., Jones, K., Szpunar, S., Zervos, M., Alangaden, G., … Fakih, M. G.

Infection Control & Hospital Epidemiology

2018

Quantitative

2 hospitals

Identification of effective CAUTI prevention technique

C

The culturing practice has great impact over the prevention of the CAUTI. It not only identifies the infection but also helps to secure the patient from it

Revello, K., & Gallo, A.-M.

Journal of Nursing Education and Practice

2013

Quantitative

41 patients,

1 group of hospital staff

The effectiveness of evidence-based practice

B

CAUTI rate decreased rapidly than before applying practice which means evidence-based practice is an effective tool for the prevention of CAUTI.

Jaeger, M. D., Fox, F., Cooney, G., & Robinson, J.

British Journal of Nursing

2017

Qualitative

9 patients,

11 nurses

The communication gap between nurses and patients

A

it is necessary to train the nurses to provide the patient with sufficient knowledge and information regarding infection so they can do self-care after being discharged

Recommended Practice Change

Limited Use of Catheter:

Through the literature review, the most important aspect for the prevention of CAUTI is the limited use of the catheter. Before any other intervention, nurses should be guided about the sufficient use of the catheter. Study ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"enFRLVWc","properties":{"formattedCitation":"(Hamilton, n.d.)","plainCitation":"(Hamilton, n.d.)","noteIndex":0},"citationItems":[{"id":378,"uris":["http://zotero.org/users/local/rVaVAHaF/items/S94R5PGP"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/S94R5PGP"],"itemData":{"id":378,"type":"article-journal","title":"Nurse-Driven Protocol to Reduce Catheter Associated Urinary Tract Infections","page":"78","source":"Zotero","language":"en","author":[{"family":"Hamilton","given":"Elva"}]}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Hamilton, n.d.) indicates that education regarding the assessment tool can be helpful, ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ybr5VU7S","properties":{"formattedCitation":"(\\uc0\\u8220{}2015_Helber_DNP_Document.pdf,\\uc0\\u8221{} n.d.)","plainCitation":"(“2015_Helber_DNP_Document.pdf,” n.d.)","noteIndex":0},"citationItems":[{"id":368,"uris":["http://zotero.org/users/local/rVaVAHaF/items/4K6Z5KK9"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/4K6Z5KK9"],"itemData":{"id":368,"type":"article","title":"2015_Helber_DNP_Document.pdf","URL":"https://kb.osu.edu/bitstream/handle/1811/68662/1/2015_Helber_DNP_Document.pdf","accessed":{"date-parts":[["2019",3,24]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (“2015_Helber_DNP_Document.pdf,” n.d.) also highlighted the fact with the catheter protocol nurses can efficiently use the catheter and excessive use of catheter intervention can be eliminated. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"BVWegzus","properties":{"formattedCitation":"(Bardossy et al., 2018)","plainCitation":"(Bardossy et al., 2018)","noteIndex":0},"citationItems":[{"id":371,"uris":["http://zotero.org/users/local/rVaVAHaF/items/NKHFVYKN"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/NKHFVYKN"],"itemData":{"id":371,"type":"article-journal","title":"Culturing practices and the care of the urinary catheter in reducing NHSN-defined catheter-associated urinary tract infections: The tale of two teaching hospitals","container-title":"Infection Control & Hospital Epidemiology","page":"1494-1496","volume":"39","issue":"12","source":"Crossref","DOI":"10.1017/ice.2018.251","ISSN":"0899-823X, 1559-6834","shortTitle":"Culturing practices and the care of the urinary catheter in reducing NHSN-defined catheter-associated urinary tract infections","language":"en","author":[{"family":"Bardossy","given":"Ana Cecilia"},{"family":"Williams","given":"Takiah"},{"family":"Jones","given":"Karen"},{"family":"Szpunar","given":"Susan"},{"family":"Zervos","given":"Marcus"},{"family":"Alangaden","given":"George"},{"family":"Reyes","given":"Katherine"},{"family":"Fakih","given":"Mohamad G."}],"issued":{"date-parts":[["2018",12]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Bardossy et al., 2018) reveals that through catheter protocol, nurses get able to identify the patients with CAUTI infection and catheter can be immediately removed which means through proper reporting nurses can use catheter sufficiently and excessive use can be prevented. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Mce6mBMX","properties":{"formattedCitation":"(Revello & Gallo, 2013)","plainCitation":"(Revello & Gallo, 2013)","noteIndex":0},"citationItems":[{"id":370,"uris":["http://zotero.org/users/local/rVaVAHaF/items/52QCW5EM"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/52QCW5EM"],"itemData":{"id":370,"type":"article-journal","title":"Implementing an evidence-based practice protocol for prevention of catheterized associated urinary tract infections in a progressive care unit","container-title":"Journal of Nursing Education and Practice","volume":"3","issue":"1","source":"Crossref","URL":"http://www.sciedu.ca/journal/index.php/jnep/article/view/1074","DOI":"10.5430/jnep.v3n1p99","ISSN":"1925-4059, 1925-4040","language":"en","author":[{"family":"Revello","given":"Kathleen"},{"family":"Gallo","given":"Ana-Maria"}],"issued":{"date-parts":[["2013",1,1]]},"accessed":{"date-parts":[["2019",3,24]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Revello & Gallo, 2013) indicates that when communication gap will be reduced between the nurses and patient, the patient can share their problem regarding catheter, and therefore use of catheter can be minimized ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"n90Ygz44","properties":{"formattedCitation":"(Jaeger, Fox, Cooney, & Robinson, 2017)","plainCitation":"(Jaeger, Fox, Cooney, & Robinson, 2017)","noteIndex":0},"citationItems":[{"id":379,"uris":["http://zotero.org/users/local/rVaVAHaF/items/6TDBLKQD"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/6TDBLKQD"],"itemData":{"id":379,"type":"article-journal","title":"A qualitative study exploring the value of a catheter passport","container-title":"British Journal of Nursing","page":"857-866","volume":"26","issue":"15","source":"Crossref","DOI":"10.12968/bjon.2017.26.15.857","ISSN":"0966-0461, 2052-2819","language":"en","author":[{"family":"Jaeger","given":"Melanie De"},{"family":"Fox","given":"Fiona"},{"family":"Cooney","given":"Geraldine"},{"family":"Robinson","given":"Jacqueline"}],"issued":{"date-parts":[["2017",8,10]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Jaeger, Fox, Cooney, & Robinson, 2017).

The study supports the fact that the assessment should be made before and after the intervention of the catheter. This is because through proper assessment catheter can be rapidly removed as soon it is not required anymore. Also if any patient has got CAUTI infection, it can be identified on time which can help to apply medication for the cure.

Catheter protocol Practice:

Nurses are involved directly with the patients before and after the insertion of the catheter. Nurses are therefore responsible for providing sufficient healthcare to the patients. The limited interaction or lack of communication between patients and nurses can make difficulties to control the CAUTI. Study ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"enFRLVWc","properties":{"formattedCitation":"(Hamilton, n.d.)","plainCitation":"(Hamilton, n.d.)","noteIndex":0},"citationItems":[{"id":378,"uris":["http://zotero.org/users/local/rVaVAHaF/items/S94R5PGP"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/S94R5PGP"],"itemData":{"id":378,"type":"article-journal","title":"Nurse-Driven Protocol to Reduce Catheter Associated Urinary Tract Infections","page":"78","source":"Zotero","language":"en","author":[{"family":"Hamilton","given":"Elva"}]}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Hamilton, n.d.) indicates that proper education and guidance should be provided to the nurses’ staff of the hospitals. So they can identify when catheter insertion is needed and when it should be removed. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ybr5VU7S","properties":{"formattedCitation":"(\\uc0\\u8220{}2015_Helber_DNP_Document.pdf,\\uc0\\u8221{} n.d.)","plainCitation":"(“2015_Helber_DNP_Document.pdf,” n.d.)","noteIndex":0},"citationItems":[{"id":368,"uris":["http://zotero.org/users/local/rVaVAHaF/items/4K6Z5KK9"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/4K6Z5KK9"],"itemData":{"id":368,"type":"article","title":"2015_Helber_DNP_Document.pdf","URL":"https://kb.osu.edu/bitstream/handle/1811/68662/1/2015_Helber_DNP_Document.pdf","accessed":{"date-parts":[["2019",3,24]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (“2015_Helber_DNP_Document.pdf,” n.d.) highlighted the fact that when nurses get advanced training for CAUTI prevention, they become able to handle the situation efficiently. Their role becomes more effective for not only to identify the infection but after saving the patients by giving proper care, and assessment. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"BVWegzus","properties":{"formattedCitation":"(Bardossy et al., 2018)","plainCitation":"(Bardossy et al., 2018)","noteIndex":0},"citationItems":[{"id":371,"uris":["http://zotero.org/users/local/rVaVAHaF/items/NKHFVYKN"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/NKHFVYKN"],"itemData":{"id":371,"type":"article-journal","title":"Culturing practices and the care of the urinary catheter in reducing NHSN-defined catheter-associated urinary tract infections: The tale of two teaching hospitals","container-title":"Infection Control & Hospital Epidemiology","page":"1494-1496","volume":"39","issue":"12","source":"Crossref","DOI":"10.1017/ice.2018.251","ISSN":"0899-823X, 1559-6834","shortTitle":"Culturing practices and the care of the urinary catheter in reducing NHSN-defined catheter-associated urinary tract infections","language":"en","author":[{"family":"Bardossy","given":"Ana Cecilia"},{"family":"Williams","given":"Takiah"},{"family":"Jones","given":"Karen"},{"family":"Szpunar","given":"Susan"},{"family":"Zervos","given":"Marcus"},{"family":"Alangaden","given":"George"},{"family":"Reyes","given":"Katherine"},{"family":"Fakih","given":"Mohamad G."}],"issued":{"date-parts":[["2018",12]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Bardossy et al., 2018) justifies the fact that through proper education regarding CAUTI prevention reduced the CAUTI rate also the patient who acquire the infection can be identified at early stages. Therefore, it becomes preventable. Comparison between two hospitals through education session provided to the hospital’s staff especially nurses justifies the need for training programs like catheter protocol practice to reduce the CAUTI rate ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Mce6mBMX","properties":{"formattedCitation":"(Revello & Gallo, 2013)","plainCitation":"(Revello & Gallo, 2013)","noteIndex":0},"citationItems":[{"id":370,"uris":["http://zotero.org/users/local/rVaVAHaF/items/52QCW5EM"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/52QCW5EM"],"itemData":{"id":370,"type":"article-journal","title":"Implementing an evidence-based practice protocol for prevention of catheterized associated urinary tract infections in a progressive care unit","container-title":"Journal of Nursing Education and Practice","volume":"3","issue":"1","source":"Crossref","URL":"http://www.sciedu.ca/journal/index.php/jnep/article/view/1074","DOI":"10.5430/jnep.v3n1p99","ISSN":"1925-4059, 1925-4040","language":"en","author":[{"family":"Revello","given":"Kathleen"},{"family":"Gallo","given":"Ana-Maria"}],"issued":{"date-parts":[["2013",1,1]]},"accessed":{"date-parts":[["2019",3,24]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Revello & Gallo, 2013). Qualitative data results highly recommended the implementation of catheter protocol practice to control CAUTI in no time ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"n90Ygz44","properties":{"formattedCitation":"(Jaeger, Fox, Cooney, & Robinson, 2017)","plainCitation":"(Jaeger, Fox, Cooney, & Robinson, 2017)","noteIndex":0},"citationItems":[{"id":379,"uris":["http://zotero.org/users/local/rVaVAHaF/items/6TDBLKQD"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/6TDBLKQD"],"itemData":{"id":379,"type":"article-journal","title":"A qualitative study exploring the value of a catheter passport","container-title":"British Journal of Nursing","page":"857-866","volume":"26","issue":"15","source":"Crossref","DOI":"10.12968/bjon.2017.26.15.857","ISSN":"0966-0461, 2052-2819","language":"en","author":[{"family":"Jaeger","given":"Melanie De"},{"family":"Fox","given":"Fiona"},{"family":"Cooney","given":"Geraldine"},{"family":"Robinson","given":"Jacqueline"}],"issued":{"date-parts":[["2017",8,10]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Jaeger, Fox, Cooney, & Robinson, 2017). All studies show that nurses can be significant to control CAUTI. Proper education and training are required to do so. The catheter protocol practice should be implemented in the hospital to get a positive result.

Patient Guidance:

The study indicates that most of the patients do not know about the consequences of CAUTI. Therefore, it becomes difficult to control infection. The patient should be well aware of the problem. The study ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"enFRLVWc","properties":{"formattedCitation":"(Hamilton, n.d.)","plainCitation":"(Hamilton, n.d.)","noteIndex":0},"citationItems":[{"id":378,"uris":["http://zotero.org/users/local/rVaVAHaF/items/S94R5PGP"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/S94R5PGP"],"itemData":{"id":378,"type":"article-journal","title":"Nurse-Driven Protocol to Reduce Catheter Associated Urinary Tract Infections","page":"78","source":"Zotero","language":"en","author":[{"family":"Hamilton","given":"Elva"}]}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Hamilton, n.d.) indicates the evidence where lac of patient died because of CAUTI it is not because of the hospital. It also happened because the patient did not know about the infection and its prevention. Study ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ybr5VU7S","properties":{"formattedCitation":"(\\uc0\\u8220{}2015_Helber_DNP_Document.pdf,\\uc0\\u8221{} n.d.)","plainCitation":"(“2015_Helber_DNP_Document.pdf,” n.d.)","noteIndex":0},"citationItems":[{"id":368,"uris":["http://zotero.org/users/local/rVaVAHaF/items/4K6Z5KK9"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/4K6Z5KK9"],"itemData":{"id":368,"type":"article","title":"2015_Helber_DNP_Document.pdf","URL":"https://kb.osu.edu/bitstream/handle/1811/68662/1/2015_Helber_DNP_Document.pdf","accessed":{"date-parts":[["2019",3,24]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (“2015_Helber_DNP_Document.pdf,” n.d.) also highlighted the fact that chronic critically ill population is found infection acquired from the catheter which is identified by other medication not by the nurses after the catheter or patients. Both Studies ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"BVWegzus","properties":{"formattedCitation":"(Bardossy et al., 2018)","plainCitation":"(Bardossy et al., 2018)","noteIndex":0},"citationItems":[{"id":371,"uris":["http://zotero.org/users/local/rVaVAHaF/items/NKHFVYKN"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/NKHFVYKN"],"itemData":{"id":371,"type":"article-journal","title":"Culturing practices and the care of the urinary catheter in reducing NHSN-defined catheter-associated urinary tract infections: The tale of two teaching hospitals","container-title":"Infection Control & Hospital Epidemiology","page":"1494-1496","volume":"39","issue":"12","source":"Crossref","DOI":"10.1017/ice.2018.251","ISSN":"0899-823X, 1559-6834","shortTitle":"Culturing practices and the care of the urinary catheter in reducing NHSN-defined catheter-associated urinary tract infections","language":"en","author":[{"family":"Bardossy","given":"Ana Cecilia"},{"family":"Williams","given":"Takiah"},{"family":"Jones","given":"Karen"},{"family":"Szpunar","given":"Susan"},{"family":"Zervos","given":"Marcus"},{"family":"Alangaden","given":"George"},{"family":"Reyes","given":"Katherine"},{"family":"Fakih","given":"Mohamad G."}],"issued":{"date-parts":[["2018",12]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Bardossy et al., 2018), ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Mce6mBMX","properties":{"formattedCitation":"(Revello & Gallo, 2013)","plainCitation":"(Revello & Gallo, 2013)","noteIndex":0},"citationItems":[{"id":370,"uris":["http://zotero.org/users/local/rVaVAHaF/items/52QCW5EM"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/52QCW5EM"],"itemData":{"id":370,"type":"article-journal","title":"Implementing an evidence-based practice protocol for prevention of catheterized associated urinary tract infections in a progressive care unit","container-title":"Journal of Nursing Education and Practice","volume":"3","issue":"1","source":"Crossref","URL":"http://www.sciedu.ca/journal/index.php/jnep/article/view/1074","DOI":"10.5430/jnep.v3n1p99","ISSN":"1925-4059, 1925-4040","language":"en","author":[{"family":"Revello","given":"Kathleen"},{"family":"Gallo","given":"Ana-Maria"}],"issued":{"date-parts":[["2013",1,1]]},"accessed":{"date-parts":[["2019",3,24]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Revello & Gallo, 2013) highlighted that with the help of trained nurses, patients also get aware about the problem which helps them for self-care. Study ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"n90Ygz44","properties":{"formattedCitation":"(Jaeger, Fox, Cooney, & Robinson, 2017)","plainCitation":"(Jaeger, Fox, Cooney, & Robinson, 2017)","noteIndex":0},"citationItems":[{"id":379,"uris":["http://zotero.org/users/local/rVaVAHaF/items/6TDBLKQD"],"uri":["http://zotero.org/users/local/rVaVAHaF/items/6TDBLKQD"],"itemData":{"id":379,"type":"article-journal","title":"A qualitative study exploring the value of a catheter passport","container-title":"British Journal of Nursing","page":"857-866","volume":"26","issue":"15","source":"Crossref","DOI":"10.12968/bjon.2017.26.15.857","ISSN":"0966-0461, 2052-2819","language":"en","author":[{"family":"Jaeger","given":"Melanie De"},{"family":"Fox","given":"Fiona"},{"family":"Cooney","given":"Geraldine"},{"family":"Robinson","given":"Jacqueline"}],"issued":{"date-parts":[["2017",8,10]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Jaeger, Fox, Cooney, & Robinson, 2017) indicated that the patient had no guidance provided by the nurses while getting discharge and catheter removal. Which shows that the patient did not know the sufficient information to keep themselves safe from the infection.

All studies indicated that training for nurses is important not only to increase their work efficiency but also to reduce the communication gap between nurses and patient. They should provide information to the patient so they can take care to prevent the CAUTI.

Implementation Process

Stakeholders:

The main stakeholders are those who get directly affected by education. For instance, hospital leadership is the stakeholder because CAUTI is the hospital-acquired infection. If CAUTI reduces it will increase the efficiency and reputation of the hospital. The second stakeholder is the nurses. With the help of catheter protocol practice nurses not only help in preventing CAUTI but it will also increases their skills, and it will be useful for their progressive profession. The third stakeholder is the patients. Nobody wants to get ill because of unknown reason. Through study, the patients will be able to get sufficient knowledge regarding CAUTI.

Barrier:

The two main barriers to the implementation of the given recommendations can be time management and staff interest. Time management can be a barrier as hospitals have limited staff for the patient’s care. Therefore it becomes difficult to manage the regular duties along with extra time for training. The second barrier is related to the staff. They sometimes do not cooperate in additional duties or practice. It is difficult to bring the whole staff on the same platform because staff often avoids extra workload. In other words, without realizing the common interest, most of the time staff focus on their comfort zone and self-interest.

Strategies:

To avoid the barriers some useful strategies should be used. For instance, to balance the time management, staff can be divided into two groups which means training would have two sessions. In this way, training and regular duties can be performed without any problem. The second barrier that is staff interest can be developed through the number of strategies. For instance, a certificate or compensation can be announced. Also, the higher authority can make training official by making it mandatory for the whole staff so no one can avoid it.

Indicator:

Audit team of the hospital can measure the outcome. Report on the identification of CAUTI rate and prevention before and after the training can be developed systematically. Through the report, it will be easy to identify the effectiveness of nurses before and after the catheter protocol practice. Also, the rate of CAUTI can indicates how efficiently the hospital is working for the infection prevention.

References

ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY 2015_Helber_DNP_Document.pdf. (n.d.). Retrieved from https://kb.osu.edu/bitstream/handle/1811/68662/1/2015_Helber_DNP_Document.pdf

Bardossy, A. C., Williams, T., Jones, K., Szpunar, S., Zervos, M., Alangaden, G., … Fakih, M. G. (2018). Culturing practices and the care of the urinary catheter in reducing NHSN-defined catheter-associated urinary tract infections: The tale of two teaching hospitals. Infection Control & Hospital Epidemiology, 39(12), 1494–1496. https://doi.org/10.1017/ice.2018.251

Hamilton, E. (2018). Nurse-Driven Protocol to Reduce Catheter Associated Urinary Tract Infections, 78.https://nsuworks.nova.edu/cgi/viewcontent.cgi?article=1045&context=hpd_con_stuetd

Jaeger, M. D., Fox, F., Cooney, G., & Robinson, J. (2017). A qualitative study exploring the value of a catheter passport. British Journal of Nursing, 26(15), 857–866. https://doi.org/10.12968/bjon.2017.26.15.857

Revello, K., & Gallo, A.-M. (2013). Implementing an evidence-based practice protocol for prevention of catheterized associated urinary tract infections in a progressive care unit. Journal of Nursing Education and Practice, 3(1). https://doi.org/10.5430/jnep.v3n1p99

Evaluation Of Hospital Infection Prevention Policies Can Identify Opportunities For Improvement: Study. (n.d.). Retrieved March 24, 2019, from https://www.elsevier.com/about/press-releases/research-and-journals/evaluation-of-hospital-infection-prevention-policies-can-identify-opportunities-for-improvement-study

Gunaseelan, V. (n.d.). Catheter-Associated Urinary Tract Infections. Retrieved March 24, 2019, from https://www.hopkinsmedicine.org/heic/infection_surveillance/cauti.html

Subject: Healthcare and Nursing

Pages: 9 Words: 2700

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