I NEED A POSITIVE COMMENT BASED IN THIS ARGUMENT..BETWEEN 100-120 WORDS

After discussion with your mentor, name one financial aspect, one quality aspect, and one clinical aspect that need to be taken into account for developing the evidence-based practice project. Explain how your proposal will directly and indirectly impact each of the aspects.

               My EBP has to do with falls and trying to cut back on the falls. At my current hospital and others I have worked at the fall risk assessment is usually only 4-5 questions. That being said the assessment isn’t enough to determine a person’s fall risk. The number one factor in falls is age and once a person gets to 65 the risk of falls triples. The age of a person should be one of the main factors. When I talked to my mentor about this we figured the big issue is probably the financial side of things. It will cost to get this in motion because we have to educate staff and make a new fall risk assessment. But, if we can show them how much they could save by cutting back on falls it will be worth it in the long run. Just one fall with a fracture could cost over $20,000 in surgery and hospital stay cost. The quality aspect that we talked about is the safety of the patients. If we can prevent one fall it would be worth it. Patient safety is the main thing we go to work for so if we can spend 2 more minutes doing a fall risk assessment that could prevent falls in the future then I’ll do it. The main clinical aspect that we discussed was having the other nurses get on board and be willing to spend that extra time to assess the patients. We just have to show them that it might take 2 extra minutes but it can save them hours in the long run in paper work if they do have a fall.

 

Reference:

 

•             de Jong, Lex D.  (09/19/2017). “Feature Article: Exploring falls prevention capabilities, barriers and training needs among patient sitters in a hospital setting: A pilot survey”.  Geriatric nursing (New York) (0197-4572)

Exercise can reduce the risk of various health issues in middle age adults; according to the Centers for Disease Control and Prevention (CDC, 2015), benefits of physical activity include reducing the risk of cardiovascular disease, type two diabetes, and cancers as well as help improving mental health, mood, and ability to perform activities of daily living. According to an article, “Middle-Aged Adults Behind on Prevention,” by the American Society on Aging (ASA, 2013) found that 25,000 to 40,000 deaths per year among Americans younger than age 65 could be prevented if these individuals would quit smoking, lose weight, exercise routinely, eat healthily, and use of recommended clinical preventive services. This article further found that 44% of middle age adults are reported having high blood pressure and 33% were obese, which maintaining a healthy lifestyle and physical activity are critical keys to healthy aging (ASA, 2013).  

Next, according to the World Health Organization (WHO, 2017), physical activity such as walking, dancing, gardening, hiking, swimming, walking, cycling, household chores, or game sports, are benefits in improving cardiorespiratory and muscular fitness and bone health in adults aged 18-64; however, an adjustment is needed for each individual based on their capacity and specific health risks or limitations.  To incorporate exercise and physical health into my clients, I would use the nursing process to assess the client’s understanding about his or her current health, current or chronic illness, and knowledge about health promotion, in order to create and effective individual care plan. Lastly, the approach to use to gain cooperation from my clients would be, for examples, using teach back method to determine the client’s understanding and/or encourage the clients to keep journal of their physical activities and to bring it in at the next follow-up appointment.

References

The American Society on Aging (ASA). October 17, 2013. Middle-aged adults behind on prevention. Retrieved October 24, 2017 from http://www.asaging.org/blog/middle-aged-adults-behind-prevention

Read Chapter 4

1-which of the following behaviors may be (1) ethical but illegal, (2) legal but unethical, (3) illegal and unethical, and (4) legal and ethical. 

A. Working in a clinic that performs abortions 

b. Respecting the wishes of a client suffering from ALS that he be permitted to die with dignity and not placed on “breathing machines”

c. Respecting the health surrogate’s wishes regarding termination of life support of her friend 

d. Observing a coworker take out two tablets of oxycodone as ordered for pain management for his patient but keeping one for himself, administering only one tablet to the patient. 

2-differentiate among the following: deontological theories, utilitarianism, and principlism. 

3-what do you think about health-care professionals disclosing information to clients about a poor prognosis, even though the information may cause severe distress.

4-What do they think about health-care professionals disclosing information to clients against family wishes? 

5. You see a colleague use another nurse’s password to access the medication administration system and take out a narcotic. What would you do? 

6.Your colleague’s child fell and was brought to the emergency department. She comes back up to the unit and tells you that they cleaned and debrided the wound, and she needs to change the dressings twice a day using a wet to dry method. You see her go into the supply system and remove the dressings and saline using a patient’s identification number. What would you do?

7. You are caring for a patient who has a terminal disease. He asks you if he is dying. Would you tell him? If yes, how? If no, what might you say? . 

8-You are administering hydromorphone to a patient. The patient asks you what you are administering. Would you tell the patient about the medication?

 

 I NEED A POSITIVE COMMENT BASEDIN THIS ARGUMENT..BETWEEN 150-200 WORDS

 

I am an RN Transitional Care Manager. My job is to specifically visit and manage our frequently admitting patients and assist with interventions in the community to assist the patient.

I send at least 1-2 patients onto palliative care and or hospice weekly. Sometimes, patients will decline, transfer to ICU and expire.   In previous roles, I have cared for actively dying patients as a CNA and LPN. Personally, I have provided end of life care with my family for my grandmother, and my own mother. For me, being with a person during their last breath is a difficult thing to do, but a priviledge to be with someone during their last moments. I have found my family members, as well as patients, are often ready for suffering to end. I find a person’s preparedness, family, and faith greatly affect the dying person’s approach to death.

Depending on their needs, I assist families and patients find resources to address the root problem. This may be from coordinating care at home, to applying for benefits, or volunteer and community services. Many I have seen over mutliple admissions. For high risk patients with chronic and terminal illness, I specifically incorporate consults with spiritual care, and a strong palliative care/hospice provider.  The palliative care providers I recommend  send  Nurse Practioners bedside to the home every two weeks, or more often as needed (many palliative programs only have “telephonic” support, which is not enough support for many high risk patients). This strong “prescriber” relationship significantly reduces our re-admissions, along with improving education to patient and family about their condition, and the services that palliative care and hospice can provide them. Despite fear, through the interaction with our team regularly supporting  patients during the final “season” of life, families often are relieved of some of their guilt and stress on caregiving burdens. Often, families state they wish they would have known about these services earlier  (Hart, 2014).

From my personal and work related experience, I do not fear death. I have Advance Directives prepared and copied to my family, and we often revisit health topics and our wishes. The more I see at the trauma hospital where I work, I fear more about long term disability and financial resources running out and quality of life deteriorating. I have seen to many people drag out the inevitable, leading poor quality lives and being unhappy. For me, quality is better than quantity. I continue to live modestly, maintain an accessible home, and keep resources available for times of need. When the my time comes, I will not be afraid to reconcile and meet my maker.

References

Hart, J. (2014). Shifting Our View Toward Palliative Care’s Life-Giving Role. Alternative & Complementary Therapies, 20(1), 31-33. doi:10.1089/act.2014.20106

Re:Topic 4 DQ 1

Although the U.S. health care system is advance in comparison to many other countries. The effectiveness of the system falls short when it comes to the delivery, finance, and management of care. The health care delivery system have shown to be bias when it comes to lower socioeconomic status and minority ethnic groups. Frequently these groups tends to receive substandard care or instructions of care for multiple reasons. Attributing to suboptimal care are education level, language and financial barriers. For example, studies showed according to Agency for Health Care Research and Quality (2014) blacks and American Indians received worse care than whites for about 40% of core measures, Asians received worse care than whites for about 20% of core measures, Hispanics received worse care than non-Hispanic whites for about 60% of core measures, and poor people received worse care than high-income people for about 80% of core measures.  The cost of health care has grown astronomical, affecting mostly the people who cannot afford the cost of health care. Most lower socioeconomic and minority ethnic groups are without health insurance due to the outrageous cost. In spite of the cost of health insurance, many insured have to pay out of pocket expenses in order to seek medical care and cover the cost of care or treatments. Many people are electing to be uninsured in order to keep food on their family’s dinner table and roof over their heads. The cost of health care is also affecting the management of care. If the patient is able to gather the finances for a doctor’s visit, the cost of prescription and continued treatment are unaffordable. In some areas, the access to health care is limited making it very difficult to seek or continue with. As a result of these factors the management of care on both the provider and patient part is very difficult. Issues prompting the need for health care reform are the disparities in quality, access and cost of care. Chronic diseases such as diabetes, heart disease and stroke can create financial burden to the patients and ultimately society. Typically, patients with chronic diseases require long term, high quality care that is affordable. The American Heart Association (2016) reported People who lack health insurance experience up to 56% higher risk of death from stroke than those who are insured and 46% of those who had difficulty paying their medical expenses delayed getting the needed care. The rising cost of care have not only proven to be problematic to people of lower socioeconomic status and minority ethnic groups but to society as a whole. It is imperative that all patients regardless of status and finances receive the best care in order to keep the country healthy.

con quest 1 stacy