Nursing Care » Nursing Care

Evaluation of Health Service

Rose — Tue, 08 Mar 2011 22:29:20 +0000

Over the last 20-25 years there been major changes to the UK health system. These changes have been driven by the desire to improve the quality and efficiency of services. In the 1970s there was considerable clinical autonomy and the quality of health care was the responsibility of the clinicians. Following on from then there has been a number of key developments:

Principles of general management introduced following the Griffith Report in 1983. Now every NHS trust has a chief executive and a chairperson.
Fund holding for general practices introduced in 1990. This was the introduction of purchaser-provider split where general practices could negotiate and purchase services on behalf of their patients. The ‘market place’ ensured patients. The ‘market place’ ensured patients received quality care.
Following the NHS White Paper the News NHS; Modern and Dependable in 1997 there was the introduction of the quality framework for health care. Standards of care made explicit and a complex system of monitoring was introduced to ensure these standards were being applied.

Primary care trust (PCTs) has a responsibility to purchase services. Each PCT has a finite financial allocation. Because the perceived needs and demands for health care always tend to outstrip resources they have to have clear aims to help them prioritize the services they purchase. Some health needs will be identified but cannot be met either because the treatments are not available or because they are judged to be too expensive in relation to the expected benefit (e.g. some newer drugs for the treatments are ineffective or unnecessary they are not provided. This is often thought of as a ‘want’ rather than a health need. Cosmetic surgery or alternative therapies are sometimes placed in this category. It must be remembered that the physical needs of patients are not the only responsibility of the health service; psychological and social needs should also be taken into account. Thus, there ca be needs for support, rehabilitation or social services to help maintain and improve health. When thinking about the provision of health services planners will try and balance the health services planners will try and balance the health needs with the demands from patients and the supply available in term of money, staff and resources.

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Control of Infectious Diseases

Rose — Fri, 04 Mar 2011 22:30:39 +0000

An infectious or communicable disease is an illness caused by the transmission of a specific microbial agent (or its toxic product) to a susceptible host. The agents can be bacteria, viruses or parasites. The majority of microbes are harmless to humans. Some, although not universally pathogenic, are potentially dangerous and my cause disease in unusual circumstances. Caution is needed not to attribute a disease to an organism which happens to be present as a commensal or contaminant.

There are many factors that determine whether or not biological agents result in the spread of disease in a population. They can be broadly divided into the presence of reservoirs of infection, the population or its individual members to the organism concerned, and the characteristic of the organism itself.

Reservoirs of Infection

A reservoir of infection is the site or sites in which a disease agent normally lives and reproduces. Reservoirs of infection may be classified as human, other biological or environmental.

Human

The human population is the reservoir of infection in disease such as measles and chickenpox. Were these organisms to be eliminated from humans, the disease the cause would be eradicated in the same way that smallpox has been eradicated? However, due to their high infectivity and ease of transmission, these diseases are difficult to eliminate despite the use of mass vaccination programmers. In addition, some infections may be carried by non-symptomatic individuals who may transmit them to others. Asymptomatic carriers are often difficult to identify.

Human carriers are of three types: healthy, convalescent or chronic.

Healthy carriers are people who are colonized by a potentially pathogenic organism without any detectable illness, for example staphylococcal carriage in the anterior nares or in the axilla, or coliforms in the gut.

Convalescent carriers are people who have recovered from the illness but who continue temporarily to excrete the organism, for example salmonellae in faeces.

Chronic carriers are people who, while remaining clinically well, may carry and excrete organisms continuously or intermittently over a prolonged period, for example typhoid carriers in whom salmonella typhi may remain in the gallbladder for life. Such carriers are a continuing threat to the community long they recover from the disease.

Human immunodeficiency virus (HIV) is of particular interest because the reservoir of infection is human. All carriers are infectious. Infectivity is at its highest around the time of seroconversion often when HIV infection has yet to be diagnosed and again later when HIV disease (the symptomatic phase) occurs.

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Using Third Person to Take Care Your Family

Rose — Fri, 18 Feb 2011 16:44:28 +0000

Sometimes people who have aged or dementia family member feel difficulties to take care of them. Their family member must be paid attention so much. Moreover, they have to work everyday from morning until night. They don’t have any time to care them always. However, they think that they must look for someone who can help them in home because they can’t hold it alone. Is there someone or company that can handle this problem?

Oxley Home Care is a company that can support you caring your family member who must much attention from others. The company provides aged care Sydney that will help you to handle your aged parents or grandparents. The employers have known all the things that you need to handle this problem. Beside that Oxley also provides dementia care Sydney for you. You can use the home care person as third person in your home.

Not only the caring types above, if you just left from hospital and you should be in medical treatment, you can use home nursing Sydney. You will be helped by people from the company to treat you based on medical ways. Now, you don’t need to worry when you take care of your family or yourself. Oxley Home Care will help you to solve your problem with its professional employers.

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Patient Management, Triage and the Triage Nurse Part III

Rose — Fri, 07 May 2010 10:38:47 +0000

Role of the triage nurse
Tine triage nurse’s main role is the accurate prioritisation of patients, and this must be the prime objective. The triage nurse needs to become accomplished at rapid assessment — this involves quick decision making and suitable delegation of tasks. Long conversations with patients should be avoided as should exhaustive history taking. Clinical observations such as temperature/pulse, etc_ need to be delegated if they are not required to establish priority as they are too time consuming.
In small departments the triage nurse will sec all patients corning in the department. In others there may be separate nurses dealing with patients who come walking and on stretchers. The mode of arrival of the patient does not always concur with the seriousness of the illness. (Patients with trivial complaints call the Emergency Services and patients with MI arrive by ear) Therefore there must he close liaison between triage stall in order to place the patients correctly. The triage method outlined in this book should assist this process by standardising triage practice.
Rapid influxes of patients may require the triage nurse to seek assistance from another member of stalk the triage process is integral to the clinical management of most departments, and a variety of additional tasks may be undertaken.

First aid/analgesia
The triage nurse may need to provide or facilitate some first-aid treatment, and recognise the need to provide analgesics if required (see pain). Application of a sling or dressing will immediately improve the patient’s comfort and help Minimise further trauma and bleeding.

Patient information
The triage nurse is the first clinical contact for the patient. and talking the patient through the illness and probable course in the department alleviates much distress and anxiety. Patients appreciate knowing the waiting time, the probable time spent in the department, whether any investigations may be ordered and possible treatment. This information can be provided quite quickly for most common conditions.

Health promotion
The triage nurse (if times allows) can usefully act as a health promoter. The patient is quite receptive to health care advice when an adverse event has occurred. If possible brief advice about relevant topics such as locked cabinets, cycle helmets anti stopping smoking may be appropriate. It is helpful if patient information leaflets are available.

Disposition of patients around the department
The triage nurses will “lieu hive to decide where to place the patients in the department. This will depend on departmental facilities and policies. Patients who are distressed, in pain, bleeding or at extremes of age may be best placed in cubicles away from the general waiting room. Patients who need to be lying down for examination (for example those suffering from knee injuries, back complaints and abdominal pain) should be placed in an area where they can lie down. Ill patients may well walk into the department and may need to be placed in the appropriate area of the department. To achieve this, the triage nurse needs to be continuously aware of the occupancy of the department and the current disposition of patients.

Managing the waiting room
Emil they have been seen by a clinician, the patients’ main contact is the triage nurse. Further advice may be sought by these patients, and criticisms delivered. The triage nurse needs to keep the occupants of the waiting room informed of the current approximate waiting time. Constant observation and reassessment are necessary in order to spot those patients whose condition is changing. Triage is a dynamic process and the patients often need regular reassessment. This might occur after an intervention e.g. the administration of analgesic, or after an appropriate length of time. Patients may be dropped into a lower category after pain relief or brought forward if they deteriorate. No one can anticipate all problems and it is not a ‘failure’ id accurate assessment to change the triage category according to further developments in the patient’s condition, or indeed with further information that may be acquired. The waiting room should be considered to him a clinical area.

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Patient Management, Triage and the Triage Nurse Part II

Rose — Fri, 07 May 2010 10:29:47 +0000

Patients with physical disability or learning difficulties
Apart from the extremes of age, there will be patients who have particular difficulties. These include those with special needs, poor sight, poor hearing, etc. Persons who can cope quite well in the community under controlled circumstances may have great difficulties in the strange environment of the Emergency Department. Communications again become particularly important, and it may be appropriate for such patients to be seen relatively quickly.

Abusive/aggressive patients
There are levy things worse than having a full waiting room, with one or more patients (or more often relatives or friends of patients) constantly demanding attention. Although the guiding principle must be that these patients are not given priority just because they shout louder, the distress they cause to others must be taken into consideration. An initial attempt to communicate departmental policy may be followed by a number of actions. The patient may be placed in an individual cubicle to wait in order to minimise the disruption to the waiting room. Alternatively such patients can be seen, treated and discharged rapidly for the benefit of others. If all else fails the patient (or the patient’s relatives) may be asked to leave, assisted as necessary by security or police.

Patients under the influence of alcohol
These patients are difficult to assess because of the effect of alcohol on conscious level and on pain perception. They need frequent assessment to check that they are not deteriorating or developing a problem not immediately apparent at triage. Disruptive drunk patients should be treated as outlined above.
The regular
Most departments have a number of patients who are frequent attenders. It is undoubtedly tempting to place these patients in the non-urgent category without proper assessment. Beware, even the regulars develop organic pathology, injure themselves or have a serious complication of their disease. These patients (even those with predominantly social problems) are in fact more likely to develop illnesses or sustain injuries than the general population. Each attendance should be treated as a new visit and proper assessment should be undertaken; this avoids underestimation of possible serious causes for attending.

Patients who re-attend
There are occasions when patients return to the department, usually because their original presenting complaint has not resolved or they have developed a complication. Sometimes the patients’ expectations of the natural progress of an injury or illness are unrealistic. The patient may also return having failed to wait for definitive treatment on a prior occasion. The patient should be allocated a triage category according to the symptoms presenting at the time of triage, and not according to the original triage category. Some departments may have polices recommending that such patients are reviewed by a senior doctor if available. It may also be appropriate to offer some tit these patients a review clinic appointment for assessment by a senior doctor it the problem does not seem to need immediate treatment.

Clinic patients
Most Emergency Departments hold review ditties. Some services hold clinics in an area away from the department, and although they may see Emergency Department staff these patients would not impinge on the triage nurse role. If the clinic is held within the Emergency Department then it is usual for these patients to have a different priority and/or route through the department. It is important that the triage nurse explains to the new patients that there are clinic patients who may be called out of turn.

Patients referred by other agencies
Many departments allow their facilities to be used by other teams for assessment of the patients. These patients are usually pre-arranged or accepted patients from primary care physicians. They are often patients who are accepted for possible admission and many have a relatively high clinical priority. These patients must be triaged in the same way as Emergency Department patients. If the patient is triaged as first priority it would be usual for the Emergency Department team to initiate resuscitation, unless the referral team is in the department. The triage nurse should inform the referral team of the triage category of the patients in order to try and ensure that these patients are treated with a similar degree of urgency as Emergency Department patients. It may also be appropriate for the triage nurse m ask departmental clinical staff to provide analgesia or initiate immediate investigations, in order to smooth the patients’ stay in the department.
Some patients may have been brought in by the police (for instance tinder mental health legislation), by social services or by other professional services. Triage practitioners should be aware of the pressures on staff from other agencies and consider this when deciding on the management of such patients.

Departmental factors
Any department that deals with emergencies may at times be overwhelmed by the influx of patients. Sometimes it only takes one seriously ill patient, or an absent member of staff to produce standstill. Each department needs to develop means of coping with this. An accurate triage assessment is an essential first step in good departmental management.
Both the workload and the staffing of the department will vary according to the time of day. Frequently overnight there is reduced clinical staffing. This may cause increased waiting times and difficulties in the waiting room, particularly if there are patient who are aggressive or under the influence of alcohol. It may be appropriate for the clinician to see a few ‘quick’ cases before spending a long time with a patient of a higher triage category. Some departments may wish children to be seen more rapidly late at night.

Fast tracking, streaming and matching resources to demand
Streaming is a term used to describe the splitting of patients into different groups who are then seen by staff dedicated to their particular stream. Once within a particular stream the patient is not affected by pressures elsewhere in the system. This is similar to the concept of ‘fast-tracking’ where particular groups of patients (usually those with relatively minor injuries and illnesses) are identified and seen by dedicated staff to improve the flow. The main difference is that streaming is delivered as a planned intervention rather than as a reactive one.
The Manchester Triage System can be used to facilitate streaming. This is discussed in detail in chapter 8.

The quiet days
Even when the department is quiet it is important to maintain die momentum of work in order to ensure that patients are seen promptly within their triage category, and to stop unnecessary delays.

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Patient Management, Triage and the Triage Nurse Part I

Rose — Fri, 07 May 2010 10:25:48 +0000

There is a difference between absolute clinical priority as defined using the method in this book, anti relative priority within and between triage categories. In overview the process of triage as outlined here is quite simple —patients are assigned to a triage category and then managed in order of priority mid time of attendance. However there are many other factors apart from clinical priority which may from time to time influence how the patient is handled within the Emergency Department. This chapter outlines these factors and discusses their importance. Clinical priority and the findings that determine it are dearly very important, but failure to recognize other factors can be detrimental to both departmental function and quality of care for individual patients.

Type of patient
There are a number of issues about the nature of individual patients that affect their management in addition to their clinical priority. These are summarized below.

Children
Children may need special management, especially in Emergency Departments without special pediatrics facilities. They are always accompanied by someone else (usually a parent but teachers, relatives or social workers may also he present), as well as siblings and friends who, although well, need entertaining. Children have very short attention spans and get bored, frightened and tired very easily. They may get very distressed and agitated because of communication and understanding difficulties, and this makes later handling more difficult.
Children who can be happily entertained by a play leader or in a separate waiting room with play facilities probably do not need any special attention other than frequent reassessment. It is helpful if child friendly food and drink e.g. snacks and drinks in cartons, bottles, etc. are available (provided the carer of any child who may need a general anaesthetic or sedation is aware of the need to keep the child nil by mouth).

It may be worthwhile having a special policy for children who present late in the evening or at night. The child who is very tired may prove impossible to examine and treat, so a relatively early examination may be considered.

Elders
Relative immobility can cause increased discomfort in the waiting room and may cause difficulty in reaching the toilet or going for refreshments. A per- son who is normally able to cope well in familiar surroundings may become quite confused and disorientated in the Emergency Department even it only slightly injured. The elderly are often set in a routine and become anxious if unable to meet their normal time table. There may be carers at home who have responsibilities who would need to be informed about the elderly patients’ attendance. The elderly are very prone to pressure damage to tissues which can develop after only half an hour on a hospital trolley. If they cannot be seen quickly for treatment they need frequent nursing attention. They may have problems with continence which if not anticipated may lead to embarrassment. Memory problems may lead to them providing little information. Practitioners should be aware of these issues and consider the relative needs of this group of patients.

Developing and Refining a Research Question – The Researcher’s Perspective

Rose — Wed, 21 Apr 2010 02:48:55 +0000

A researcher spends a great deal of time refining a research idea into a testable research question. Unfortunately, the evaluator of a research study is not privy to this creative process because it occurs during the study’s conceptualization. Although this section will not teach you how to formulate a research question, it is important to provide a glimpse of what the process of developing are search question may be like for a researcher.

As illustrated in Table 3-1, research questions or topics are not pulled from thin air. Research questions should indicate that practical experience, critical appraisal of the scientific literature, or interest in an untested theory has provided the basis for the generation of a research idea. The research question should reflect a refinement of the researcher’s initial thinking. The evaluator of a research study should be able to discern that the researcher has done the following:

1. Defined a specific question area

2. Reviewed the relevant scientific literature

3. Examined the question’s potential significance to nursing

4. Pragmatically examined the feasibility of studying the research question

Defining the Research Question

Brainstorming with teachers, advisors, or colleagues may provide valuable feedback that helps the researcher focus on a specific research question area. For example, suppose a researcher told a colleague that the area of interest was pain experienced by children with cancer. The colleague may have said, “What is it about the topic that specifically interests you?” Such a conversation may have initiated a chain of thought that resulted in a decision to explore the pain experiences, management strategies, and outcomes of children with cancer (children with leukemia during the first year after diagnosis). Figure 3-1 illustrates how a broad area of interest (pain experiences of children with cancer) was narrowed to a specific research topic (children’s pain experience, pain management strategies, and outcomes during the first year after the diagnosis of leukemia).

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Developing Research Questions and Hypotheses

Rose — Wed, 21 Apr 2010 02:36:58 +0000

When nurses ask questions such as, “Why are things done this way?”, “I wonder what would happen if … ?”, “What characteristics are associated with … ?”, or “What is the effect of … on patient outcomes?”, they are often well on their way to developing a research question or hypothesis.

Formulating the research question or hypothesis is a key preliminary step in the research process. The research question (sometimes called the problem statement) presents the idea that is to be examined in the study and is the foundation of the research study. The hypothesis attempts to answer the research question.

Hypotheses can he considered intelligent hunches, guesses, or predictions that help researchers seek the solution or answer the research question. Hypotheses are a vehicle for testing the validity of the theoretical framework assumptions and provide a bridge between theory and the real world. In the scientific world, researchers derive hypotheses from theories and subject them to empirical testing. A theory’s validity is not directly examined. Instead, it is through the hypotheses that the merit of a theory can be evaluated.

Research consumers often find research questions or hypotheses at the beginning of a research article. However, because of space constraints or stylistic considerations in such publications, they may be embedded in the purpose, aims, goals, or even in the results section of the research report. Nevertheless, it is equally important for both the consumer and the producer of research to understand the importance of research questions and hypotheses as the foundational elements of a research study. This chapter provides a working knowledge of quantitative research questions and hypotheses, as well as the standards for writing them and a set of criteria for evaluating them.

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Community Health Nursing System Development

Rose — Tue, 30 Mar 2010 04:21:24 +0000

CHN agencies have used computers since the late 1960s, when computers were introduced into the healthcare industry. Many of the early systems focused on regulatory compliance, billing applications, and statistical reporting related to community health, which encompasses public health and home health compliance. As healthcare services continued to evolve, community health services grew primarily due to consumer choice, cost control initiatives, and the increase in numbers of healthcare recipients with chronic illnesses.

Concurrently the numbers of hospital beds were decreasing with an increase of services in community health settings (Elfrink and Martin, 1996). The changing healthcare trends have been the impetus for increasingly sophisticated management information systems (MISs), which transformed data into information to measure outcomes, track client progress, exchange healthcare information among physicians, nurses, insurers, managed care companies, regulatory agencies, and public reporting, and analyze financial data. These systems supported clinical care delivery, electronic billing, and had the potential for multiple user access.

Further advancements led to four domains of concentration which directed unique MISs for practice: (1) public health that focused on population interventions and the outcomes related to epidemiologic and/or mortality/ morbidity trends; (2) home health that focused on skilled nursing care for individuals in the home and the outcomes related to care delivery for individuals or aggregated populations; (3) special population community practices (i.e., mental health) that focused on specific diagnostic care and/or treatment needs and the outcomes related to care delivery for individuals, diagnostic groups, and/or aggregated populations; and (4) outpatient care that focused on intermittent, episodic, or preventative care for individuals and the outcomes related to interventions for individuals and/or aggregate groups, inclusive of national health prevention standards. Concurrently, these MISs also offered clinical documentation capabilities at the point of care, provided billing functions, supported submission by computer of data for regulatory compliance, provided statistical reporting, and even developed decision support features.

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Toddler With a High Risk

Rose — Tue, 09 Mar 2010 18:17:43 +0000

By looking at still higher rates of infant mortality and disease, Checking your baby’s health and development must be considered. One factor to consider is the progress to reduce infant toddler with a high risk. Toddler with a high risk, should be more often controlled by physical and laboratory examination and weighing of weight and height. This can maintain our vigilance against a toddler, so not a bad thing happened to the toddler.

Young children with high risk if:
1. Ages zero to three months; gain weight less than 750 grams / month
2. Aged four to seven months; gain weight less than 350 grams / month
3. Age is more than one year; gain weight less than 150 grams / month
4. Number of children more than three people with birth spacing less than two years.
5. There are children in the family who died more than three people.
6. History partus there asfiksia or with pathological partus.
7. Had whooping cough
8. never suffered measles
9. Age under two years had malnutrition (CTF) level II and III
10. Had never been immunized

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nursing interventions for toddlers