EMPLOYER AND EMPLOYEE RIGHTS IN NURSING

EMPLOYER AND EMPLOYEE RIGHTS IN NURSING

by Ricky Ocampo RN

            The constitution places rights that every person is entitled to so that there can be a peaceful coexistence where every person is allowed to thrive. The rights ensure that the law protects people from any form of harm or injustice from other people, governments, and companies. The nurses have various rights that protect their role and their scope as well as their employment (Milstead, 2016). The bill of rights outlines seven rights that every nurse in the country should have. They include the right to practice in a manner that realizes their obligations to those who receive nursing care and the whole society. Nurses need to be fully committed to the society and ensure their profession is to the benefit of the community. Nurses also have the right to practice in environments that permit them to act by legally authorized scopes of practice and professional standards. They also have the right to a work environment that facilitates and supports the ethical practice. The employers need to provide the nurses a suitable environment where nurses can fulfill their roles while meeting various rules of ethics and professional guides (Fitzpatrick et al. 2013).

The bill of rights also gives the nurses the right to openly and freely advocate for their patients and themselves without fear. It also gives the nurses the right to a work environment that is safe for their patients and themselves. The nurses also have the right to negotiate the conditions of their employment either collectively or as individuals (Fitzpatrick et al. 2013). The employers also have rights that protect them such as the right to discipline or terminate the contract of the employee who operates in contrast to the rules agreed on the contract. The employer also has the right to report the nurse involved in misconduct to the relevant licensing board. Understanding the rights of the employer and employee is important since it ensures that the advanced practice nurse does not get into a contract where his or her rights are violated. It also ensures that the advanced practice nurse knows the rights to demand for better employment terms or the improvement of the work environment. The topic is also important since the advanced practice nurse can avoid infringing the rights of the employer (Kangasniemi et al. 2013).

References

Fitzpatrick, T., Anen, T., & Martinez Soto, E. (2013). Nurse Staffing: The Illinois Experience. Nursing Economic$, 31(5), 221-259.

Kangasniemi, M., Stievano, A., & Pietilä, A. (2013). Nurses’ perceptions of their   professional rights. Nursing Ethics, 20(4), 459-469. doi:10.1177/0969733012466001

Milstead, J. (2016). Health Policy and Politics-A Nurse's Guide (Milstead, Health Policy and         Politics)(5th ed.). Burlington, Massachusetts: Jones & Bartlett Learning.

Nickitas, D., Middaugh, D., & Aries, N. (2014). Policy and Politics for Nurses and Other Health Professionals (2nd ed.). Burlington, Massachusetts: Jones & Bartlett Learning.

Knowing Medicare Options

Knowing Medicare Options

by Ricky Ocampo RN

            It appears the nation's woe for affordable healthcare has led the federal government to take action in educating the country on its options and ensuring accessibility to government enforced and regulated plans, but for skeptics of government competence, no songs of praises will be sung until an extensive assessment of how resourceful, affordable, accessible, and generally effective the options are has been conducted. Medicare.gov is the web-based one-stop information center for all topics and dynamics associated with both signing up for and accessing Medicare services (Medicare, 2015). Instant usability consideration is found in URL address of the website alone; Medicare is all that's needed to be remembered, and aside from this, the .gov domain provides users with confidence that the site is an official government one. The process of shopping for health insurance can be very complex and frustrating if one isn't completely sure of which option one wants beforehand, and it's nearly impossible to be sure of such factor without being aware of what options are available. Luckily Medicare.gov has all of the necessary information collected on site. Admittedly, the many links, pages, and texts available on the website can make the website appear intimidating to some users; it's likely that information of such scale can make healthcare appear more complex than it actually is. On the home page for instance, even something as simple as placing the mouse cursor over the 'Sign Up/Change Plans' tab reveals a scripted display of more links and options. The positive side of the amount of information available on the site is that it would only be more frustration if—at the end of it all—one isn't able to find answers to questions one might have, but this is very unlikely to happen.

            One thing to naturally expect is that the process will consist of filling out a lot of forms and completing various assessments and surveys. Initially, one has to first determine eligibility. Right away upon entering one's age, the criteria are simple. As the site blatantly warns, “Medicare is for people age 65 and older and those who have special condition or disability” (Medicare, 2015); anyone short of meeting this requirement will not be able to move on the next step. Medicare plans are generally divided into two main options: Part A and Part B. Part A is explained to cover hospital care, skilled nursing facility care, hospice, nursing home care, and home health services. It's explained that “Medicare Part A (Hospital Insurance) covers hospital services, including semi-private rooms, meals, general nursing, drugs as part of your inpatient treatment, and other hospital services and supplies”, elaborating that “this includes the care you get in acute care hospitals, critical access hospitals, inpatient rehabilitation facilities, long-term care hospitals, inpatient care as part of a qualifying clinical research study, and mental health care” (Medicare, 2015). Things like private duty nursing, unneeded private rooms, television/phone in the patients' room, and personal care items like slippers and socks aren't covered. For skilled nursing facility coverage, Part A covers the typical provisions like a semi-private room, meals, skilled nursing care, physical and occupational therapy, speech-language pathology services, medical social services, medications, ambulatory services, dietary counseling, and more (Medicare, 2015). Part A also covers long-term care hospital (LTCH). The website explains that “generally, you won't pay more for care in a long-term care hospital than in an acute care hospital. Under Medicare, you're only responsible for one deductible for any benefit period. This applies whether you're in an acute care hospital or a long-term care hospital (LTCH)” (Medicare, 2015). Part A also covers hospice care and home health services. Generally, Part A is likely to cover all that an elderly patient would need, unless such patient has multiple illnesses that require very specific and exclusive attention and treatment. Upon assessing the coverage of Part A, it's perhaps a bit more practical to press on towards viewing the provisions of Part B, as opposed to just settling for Part A.

            Part B of Medicare is immediately explained to cover medically necessary services and preventive services. Clinical research, ambulance services, durable medical equipment, mental health, inpatient, outpatient, partial hospitalization, obtaining a second opinion prior to surgery, and more, are all listed as services covered under Part B. Part B covers and Part A cover clinical research, “which help doctors and researchers see if a new treatment works and it's safe” (Medicare, 2015). The ambulance service coverage is rather extensive, as it includes aircraft transportation, given the condition that the patient's location can't be easily reached by land vehicles, and/or the patient's condition is too critical to and obstacles found in land travel—heavy traffic and distance—can take away from crucial time the patient might not have. A third option is Part C, which is also referred to as Medicare Advantage (MA), includes both Part A and Part B, and is covered by private insurance companies that have been approved by Medicare. Most programs require the use of doctors provided by MA, otherwise one would have to pay some or all of the costs out of pocket. Most people pay 104$—the Plan B premium—a month for MA but usually pay additional monthly premiums to get MA. Medicare also warns that one may “pay a copayment or coinsurance for covered services. Costs, extra coverage, and rules vary by plan” (Medicare, 2015). MA plans costs would appear worthwhile due to the factor that—as Medicare boldly declares—they cover all Medicare services. Lastly, Part D simply covers medical prescription drug costs. Admittedly the Part D appears a bit more complex than what just drug costs coverage would initially appear to involve. For instance, prior authorization might be required, meaning—as Medicare explains—that one's prescriber must contact the drug plan before you can fill certain prescriptions, as the prescriber “may need to show that the drug is medically necessary for the plan to cover it” (Medicare, 2015). There are also limits on how much medication a patient can get at a time, and for sleep therapy, the patient must try a similar drug of lower costs before the plan will cover any further prescriptions. After having learned the provisions and limits of each option, one central factor that might be an important part of the decision making process is that of costs. A Part A cost is set at a monthly premium of $407, and Part B is $104.90/month for most people. Part D costs are a bit more complex as they're codependent on the amount of annual income the customer makes. People who make under $85K get the Part D coverage as part of their regular coverage (Part A or B), and people who make over $85K pay a $12.30/month premium, in addition to the costs of their regular coverage; people who earn between $107K pay $31.80 in addition to their regular Medicare premium, people between $160K and $214K pay $51.30 in addition to their regular premium. Lastly, people who earn above $214K pay $70.80.

           

            Upon a close assessment of the costs/coverage of each option, it would appear that Part B is perhaps the most practical option. Part A, while being adequate for covering a basic patient with no chronic illness, it doesn't appear to be ideal for patients who are likely to fall ill; such patients can be hung out dry upon realizing the treatment needed by their sudden illness isn't fully covered by Part A. Part B, on the other hand, appears to provide nearly as much coverage as Plan C, but leaves room for incidences where the patient isn't ill enough to need all of the coverage provided by Plan C, where he/she would have to pay a higher premium and be possibly left to cover part of the overall costs. Part D is obviously not ideally meant for being the only form of coverage any patient would have. Part D should generally be ignored as it's not needed if one has any of the other three options.  From all of the information provided, Plan B is perhaps the best way to go, for the preceding premises established.

           

            To conclude, generally, the decision making process isn't necessarily complex, but is rather intimidating, as all of the content on the website can be seen as overwhelming to people shopping for coverage. The contexts within the site are made for people over the age of 65, but it's very likely that people of such age would need the assistance of a younger professional to guide them through the process. In the long run, it's all there—everything that needs to be known. The website takes on a simple and clean presentation focused solely on providing clear and direct information, in contrast of flash and attention retention. Medicare can perhaps benefit from simplifying and/or reducing the amount of links and sub links and texts available on each page, so older adults who are less computer-savvy won't find the site to be confusing and not resourceful.

References

Medicare. (2015, January 1). Medicare.gov. Retrieved March 5, 2015, from            http://www.medicare.gov/

Substance Abuse

Substance Abuse

by Ricky Ocampo

            A strong factor that attracts extra criticism and scrutiny to nurses associated with drug abuse, dependence, and addiction is that naturally, within the premises of the occupation, they're expected to know better, as they're expected to know the consequences of such actions (Sullivan, 1994). Generally, my standpoint towards such cases is that I try to be objective without being indifferent, and what I mean by that is that I acknowledge that such behavior shouldn't be condoned, but generally, my disapproval isn't of the person participating in the action, but of the action itself. I think a nursing professional is expected to, and should, have the ability to hold his/herself accountable and to take responsibility and control of his/her own personal issues. In order to remain objective, it's not my place to judge how someone chooses to address their problems, but in order to not be indifferent, I do acknowledge and appreciate that nursing—and any medical job in general—is a stressful and troublesome position, and there are plenty of room for people who aren't careful to realize they're taking on more than they can handle. I'm uninterested in sticking up a snobby nose and pointing judgmental fingers and pretending to be saintly.

            The relationships between drugs and users typically vary based on several factors such as extents, how important they are to the user, why they're used, and more, and this leads to the need for having different labels and definitions to differentiate these factors from one another, as the difference are certainly important. Drug use is simply the regular use of prescribed or over-the-counter drugs for the usage they were designed and intended to be used for. Drug abuse is the  usage of excessive dosage of a drug, or the usage of a drug for enhancement of one's physical or psychological—and perhaps neurological—state, or usage towards effects other than what the drug was manufactured and sold for. Dependence occurs after a drug has been used for its purpose to the extent that the body has practically shifted to needing the drug to perform a specific function it should naturally be able to perform independently (Stanhope & Lancaster, 2013), and lastly, addiction occurs when the body is unable to carry out practically all of its natural, psychology and/or neurological functions without having consumed a drug (O'Brien, 2005); addiction is typically the worst extent and consequence of substance abuse.

Reference

Sullivan, E. J. "Impaired nursing practice: ethical, legal and policy perspectives." Bioethics             forum. Vol. 10. No. 1. 1994.

O’Brien, Charles P. "Benzodiazepine use, abuse, and dependence." J Clin Psychiatry 66.Suppl 2 (2005): 28-33.

Stanhope, Marcia, and Jeanette Lancaster. Public Health Nursing-Revised Reprint: Population-     Centered Health Care in the Community. Elsevier Health Sciences, 2013.

Assessing Mental Health of Geriatric Patient

Assessing Mental Health of Geriatric Patient

by Ricky Ocampo RN

Geriatric patients undergo a distinct change by the way they interpret things. Old age means weakened immune systems and lower cognitive responses (Cockrell & Folstein, 2002). As a result, it is important to treat geriatric patients with another means of examination. The discussing point would be to use the Mini-Mental State Examination or MMSE to test five areas of an elderly patient’s cognitive responses. Interpretations of the test would be utilized to understand the cognitive condition of the patient. Interventions would then be derived from these interpretations to enhance the treatment process of the geriatric patient. Additionally, an important discussing point would be the cognitive impairment presence in the patient, which will be analyzed after the results of the interview and examination are presented.

Geriatric Patient Information

The patient, whose identity is to remain confidential as per request, is a 68-year-old male, of Caucasian descent, and who has been recovering from depression. His wife died 15 years ago and he has recently recovered from his depression because of medication and family support. He has three children who are all professionals now, and he remarked on how happy he was to see that they were doing well. He used to work at the police force, so his cognitive abilities are above average. He has been a chain smoker until well into his 40s where bronchitis prompted him to stop. He did not drink much, only on occasions. The patient, with old age, has experienced his motor skills waning, but he could cope because of his police training. He feels that his body is not the same, but he is able to manage because of the fact that he jogs every day to keep up his energy levels and to promote metabolism. 

Upon the administration of the MMSE to the patient, the following points had been attained: he received 4 on Orientation to Time, 5 on Orientation to Place, 2 on Registration, 4 on Attention and Calculation, 3 on Recall, 2 on Language, 1 on Repetition, and 4 on Complex Commands. The possible points for each score had been based on the MMSE guidelines by Cockrell and Folstein (2002) as: 5 for Orientation to Time, 5 for Orientation to Place, 3 for Registration, 5 for Attention and Calculation, 3 for Recall, 2 for Language, 1 for Repetition, and 6 for Complex Commands. The total possible score would be 30.

MMSE Interpretation

Based on the results of the patient, he got a score of 25, which is slightly lower than the mean score of 27 as stated in Muir, Gopaul, and Odasso (2012). He manages to score high on specific portions such as Orientation to Place, Recall, Language, and Repetition due to his line of work as a police officer. He scored lowest on Complex Commands due to his degraded level of cognitive motor skills. 

Upon assessment, Orientation to Time had been the element of how a person perceives the arbitrary elements of past, present, and future. Cockrell and Folstein (2002) studied that the correlation effectiveness decreases as a person ages. The patient scored 4, which is only a subtle decrease.

Orientation to Place via deductive testing is presented by data from the broadest perspectives such as nations to the narrowest such as streets (Cockrell & Folstein, 2002). The patient scored a 5, the perfect score. It is very evident that the geographic element of being a police officer has strengthened his resolve to memorize and retain information on locations.

For Registration, the patient scored a 2. Registration is the repetition of prompts (Cockrell, & Folstein, 2002). The patient may have had a subtle decrease of registration due to the abundance of prompts he had to listen to throughout the years as a police officer. 

For Attention and Calculation, he scored a 4. Attention and Calculation would entail the ability to maintain a keen detail on a set of words or prompts (Cockrell & Folstein, 2002). One of the merits of police work is investigative work, so the patient has engraved such experience to memory.

Recall is the repetitive assessment of Registration, which the patient received a score of 3, which is the perfect score for this category. He also received perfect scores of 2 and 1 on Language and Repetition, respectively. The patient’s justification of the result is due to his experience as police officer in procedural analysis, which requires recall.

Lastly, the patient received a 4 out of 6 for Complex Commands. Because of cognitive performance decrease due to old age, the patient was not able to easily comprehend and execute the complex commands presented.

Having that interpretation, the patient receiving a score of 25 is just below the benchmark of 27 as normal cognition. Cockrell and Folstein (2002) stated that anything below 24 is mild cognitive impairment. So, the patient functions at normal cognition levels.

Cognitive Impairment Analysis and Conclusion

If the patient were to have cognitive impairment, the results of the MMSE would be very different. For instance, he would score low on Orientation to Time and Orientation to Place since these require a deep understanding of correlation. Moreover, he would also fail in Registration, Recall, Repetition, and Complex Commands, which require high cognitive abilities as well. According to Muir, Gopaul, and Odasso (2012), the MMSE is a good indicator of the cognitive levels of a patient. Cognitive impairment will produce a very different result because the patient would not be able to manage the tasks as easily as intended. As a result, the patient would have different treatment goals, especially those focused on intervention and cognitive stabilization.

References

Cockrell, J. R., & Folstein, M. F. (2002). Mini-mental state examination. Principles and practice of geriatric psychiatry, 140-141.

Muir, S. W., Gopaul, K., & Odasso, M. M. M. (2012). The role of cognitive impairment in fall risk among older adults: a systematic review and meta-analysis. Age and ageing, 41(3), 299-308.

IMPLEMENTATION OF A HEALTHCARE SYSTEM PRACTICE GUIDELINE

IMPLEMENTATION OF A HEALTHCARE SYSTEM PRACTICE GUIDELINE

by Ricky Ocampo

Introduction

            The healthcare system involves various professions who have the same goal of ensuring a healthy population. They include physicians, nurses, pharmacists, administrators, and many other workers. The professional diversity is brought about by the need for different approaches to treatment and prevention of diseases. It is also necessitated by the wide range of information about human anatomy, which leads to people specializing in a particular field. Healthcare involves much research, which leads to the discovery of different ways that can improve the practice. Implementation of new guidelines found from research can be efficiently through the collaboration of various disciplines (Melnyk&Fineout-Overholt 2011). The guidelines adopted in the hospital affect different professions, and they need thorough research to define them.

Healthcare System Practice Guideline

In my current job at Kaiser Permanente, there are various employees who work together to ensure patients are fully healthy and out of danger. As a critical care nurse, I have to work hand in hand with workers of different disciplines. Patients in need of critical care are delicate, and caution and professionalism need to be exercised at every given moment to avoid fatal mistakes. Various guidelines are used to provide a framework for patient care and intervention. The guidelines have to be adhered to by all workers in the ICU to ensure proper coordination of care and intervention procedures (Reardon et al. 2013).

One such guideline is the management of delirium, agitation, and pain in adult patients in the intensive care unit. It offers practical approaches to handling patients in ICU who is waiting for, or has undergone a surgical procedure, or for any patient with a severe medical condition. The guideline’s target population is adult patients over 18 years old. The instruction was made to propose best practices for preventing, treating, and assessing pain, agitation, and delirium (PAD) to in adult patients (ICU)(Barr et al. 2013).

The guideline recommends strategies for managing delirium, agitation, and pain to improve ICU outcomes. This can be done with an interdisciplinary ICU team approach that includes provider education, preprinted and/or computerized protocols, and order forms. ICU rounds checklists to monitor the use of pain, agitation, and delirium management guidelines or protocols in adult ICUscan also be used.Promoting sleep in adult ICU patients by using strategies to control noise and light, decreasing stimuli at night, clustering patient care activities, and to protect patients' sleep cycles is also recommended by the guideline. A target light level of sedation or daily sedation interruption to be routinely used in mechanically ventilated adult ICU patients is also part of the recommendations. The guideline also mentions that in mechanically ventilated adult ICU patients analgesia-first sedation should be used. Using specific modes of mechanical ventilation to enhance sleep in mechanically ventilated ICU patients is not advised since there is insufficient evidence to prove the efficacy of these interventions (Barr et al. 2013).

How Different Professions in the Healthcare System are Held to the Guideline

            The various jobs in the system that have to follow the guideline are nurses, pharmacists, physicians, and respiratory care practitioners. The nurses in the ICU handle care of the critical patients, which include administering fluids, and drugs that are prescribed by the physician. They are also in responsible for cleaning the patient, conducting, and recording various tests on the patient such as blood test and blood pressure and temperature (Shorter &Stayt 2010). The guideline offers recommendations on patient care in the ICU therefore binding the critical care nurses. The directive mentions various ways of ensuring patient avoids pain such as by ensuring there is mobility, which falls directly on the work of the nurses. There are also recommendations on drug administration of drugs, monitoring, and recording the patient’s delirium, agitation, and pain levels to ensure that appropriate intervention strategies are utilized which are also roles of the critical care nurse (Warlan & Howland, 2015).There is also a framework for the education of the recommendations and monitoring progress among other staff, which also falls the duty of the nurse. The guideline also provides a way of cooperation between workers of different disciplines in the ICU including nurses (Hsiang-Ling & Yun-Fang 2010).

            The physicians in the ICU are also impacted by the guideline since they assess the patients and prescribe treatment methods. A framework on measuring, treating, and preventing the pain, agitation and delirium is provided which affects the work of the physician.  There also recommendations on the monitoring of the status of the patient in the ICU, which can also be done by the doctors. The doctors can also participate in education and decision making on various recommended issues (Luetz et al. 2014). The guideline also affects the respiratory care practitioners since they are in charge of establishing and maintaining airway during intensive care (Norman, 2010). They also work with life support and mechanical ventilation machines where there are various recommendations on the use of this equipment on the guideline (Luetz et al. 2014). 

            The pharmacists handle medicine in the hospital, which includes processing medication orders, expediting the arrival of medication, and monitoring the drug administration and effects. The guideline mentions drugs that should be offered to patients experiencing delirium, agitation, and pain in the ICU, which falls in the line of work of the pharmacists. There are also recommendations on the titration of some medication, which is part of the work of the pharmacist. The pharmacists are also represented in the multidisciplinary team that is also responsible for education and deliberating on crucial decisions on the implementation of the recommendations (Hsiang-Ling & Yun-Fang 2010). The professions in the system ensure that they follow the guideline clearly. An interdisciplinary team is charged with educating and monitoring the implementation of the directive.

Evidence used to define the Guideline

      Research was done to support the implementation of the directive was done using various online libraries, which included CINAHL, PubMed, and EBSCOhost. The primary evidence utilized in the directive is the 2013 American College of Critical Care Medicine/Society of Critical Care Medicine clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit.This guideline is contained in the National Guideline Clearinghouse (NGC). These guidelines were put to replace “Clinical Practice Guidelines for the Sustained Use of Sedatives and Analgesics in the Critically Ill Adult” published in Critical Care Medicine in 2002(Barr et al. 2013).

These guidelines were formed by the American College of Critical Care Medicine where a multi-institutional and multidisciplinary task force of 20 people divided into four subcommittees with expertise in guideline development, delirium, agitation and sedation, and pain management and associated outcomes in adult critically ill patients. The task force collaborated over six years in person via electronic communication and teleconferences. The subcommittees developed relevant clinical questions, reviewed, evaluated, and summarized the literature to develop clinical recommendations and statements (Barr et al. 2013).

The methods used to collect evidence for the guideline is by a search through electronic databases which include the International Pharmaceutical Abstracts, PubMed, ISI Web of Science, Scopus, CINAHL, Cochrane Database of Systematic Reviews and MEDLINE. The researchers developed an extensive list of related keywords and a professional librarian organized and expanded this key word list. The librarian also created a corresponding medical subject heading (MeSH) terms, searched relevant databases, and with RefWorks software he created a Web-based database. The search parameters included published English-only manuscripts on adult humans from December 1999 to December 2010. Letters to the editor, case reports, editorials, studies with less than 30 patients as well as narrative reviews were excluded (Barr et al. 2013).

The references of the 2002 guideline were also included in the database. Ultimately, over 19,000 references were listed in the RefWorks database. The methods used to assess the quality of evidence for the study include weighting according to a rating scheme and expert consensus method. The evidence was analyzed through systematic review with evidence table; review of published meta-analysis and by meta-analysis. The methods used to formulate recommendations were expert consensus (Delphi) and expert consensus (nominal group technique) (Barr et al. 2013).

The guideline was validated by internal and external peer review. The guideline was also reviewed and endorsed by the New Zealand Intensive Care Society, American Association for Respiratory Care and the American College of Chest Physicians. The benefits of implementing the guideline are that it provides suitable methods of management of critically ill adults in the ICU with delirium, agitation, and pain. The potential harms of the implementation are the side effects from the medication used to manage delirium, agitation, and pain (Barr et al. 2013).

The assessment methods that were reviewed by the guideline are detecting and monitoring delirium, assessment of delirium risk factors, assessment of quality and depth of sedation, and pain assessment. The treatment and management methods that were examined were treatment of pain with Thoracic epidural anesthesia/analgesia, Enterally administered gabapentin, Intravenous (IV) opioids, Nonopioid analgesics to decrease opioid use and side effects and Preemptive analgesia and/or non-pharmacologic interventions (e.g., relaxation).The treatment of agitation and sedation include sedation strategies using nonbenzodiazepine sedatives, Electroencephalogram monitoring (EEG), Objective measures of brain function, Monitoring depth of sedation and brain function (Barr et al. 2013).

The treatment of delirium studied in the guidelines is through IV dexmedetomidine, if sedation is required, routine monitoring of delirium, consideration of delirium risk factors and early mobilization of adult intensive care unit (ICU) patients. The strategies for managing delirium, agitation and pain that were examined include interdisciplinary ICU team approach where they provide education, preprinted computerized and/or preprinted protocols and order forms, and quality ICU rounds checklists. Another management method studied is promoting sleep in ICU patients by controlling noise and light and by decreasing stimuli at night (Barr et al. 2013).

Pain management methods reviewed by the guideline include analgesia-first sedation and a target light level of sedation in mechanically ventilated adult ICU patients or a routine daily sedation interruption or the prevention methods examined include prevention of delirium that includes restart baseline psychiatric medications, if needed, sleep promotion and by identifying delirium risk factors.Prevention of agitation was also studied. Methods reviewed include EEG monitoring for patients at risk for seizures, early mobility, and exercise when at goal sedation level and daily spontaneous breathing trials (SBT). Pain prevention methods studied include treatment of pain before sedation and non-pharmacologic interventions and or pre-procedure analgesia (Barr et al. 2013).

The second evidence document that was used to support the implementation of the guideline is Pain, Agitation, and Delirium Guidelines: Nurses' Involvement in Development and Implementation. Which was authored by Judy Davidson, Chris Winkelman, Celine Gélinas, and Anna Dermenchyan. The article includes the experiences of nurses that served in the guideline-making panel for the 2013 American College of Critical Care Medicine/Society of Critical Care Medicine clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit.This study explores the main responsibilities that nurses have during generation and execution of new practice guidelines (Davidson et al. 2015).

The study also describes the influence of the guidelines to the nursing profession. The nurses in the guideline-writing panel were given equal treatment with other professions represented. According to this article, there are various roles that nurses can have in the implementation of guidelines such as the nurse leader. These are the people charged with the responsibility of translating the recommendation of the new guidelines into practice. The nurse leaders may be staff nurses serving as project leaders, educators, nurse practitioners, clinical nurse specialists, directors, managers, supervisors, and charge nurses. The nurse leader should be involved in an inter-professional committee where various decisions are made on areas where the guidelines recommended two or more methods such as the selection of assessment tools of delirium, agitation,and pain(Davidson et al. 2015).

The nurse leaders are also instrumental in implementing mobility in the ICU since immobility has been noted as one of the chief causes of complication during critical illness. Complications caused include skeletal muscle weakness and wasting, contractures, thrombotic events and pressure ulcer formation. The nurse leader should also measure the impact of change on implementing the guidelines using selected quality metrics. The nurse leader can ensure that change is achieved by making frequent rounds and by educating, coaching, and communicating with the nursing staff ( Davidson et al. 2015).

Nurse informaticist is also a role that the nurses can have in the implementation of guidelines. Nurses in this role use their clinical knowledge to create the documentation in the electronic medical record (EMR) for use by clinicians. Nurse informaticists ensure that professional and regulatory standards are registered in the EMR. They are a critical part of the implementation of guidelines since the hospital might need to change the contents of the EMR to meet the new recommendations. Another role that nurses can play is a staff nurse as a change leader and personnel nurse as change recipient (Davidson et al. 2015).

Conclusion

            The healthcare system consists of a collaboration of various people of different disciplines. In my career as a critical care nurse at the Kaiser Permanente,  I have to work hand in hand with various people. A guideline that affects different workers at my employment place is the management of delirium, agitation, and pain in adult patients in the intensive care unit. The guidance offers practical approaches to handling patients in ICU, who is waiting for, or has undergone a surgical procedure, or for any patient with a severe medical condition. The different medical care disciplines that have to follow the guideline are nurses, physicians, pharmacists, and respiratory care practitioners. The evidence used in the research and implementation of the guideline includes is the 2013 American College of Critical Care Medicine/Society of Critical Care Medicine clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Pain, Agitation, and Delirium Guidelines: Nurses' Involvement in Development and Implementation was also examined for the implementation of the guideline.

References

Barr, J., Fraser, G. L., Puntillo, K., Ely, E. W., Gélinas, C., Dasta, J. F., & ... Skrobik, Y.   (2013). Clinical practice guidelines for the management of pain, agitation, and           delirium in adult patients in the intensive care unit: Executive summary. American           Journal of Health-System Pharmacy, 70(1), 53-58.

Davidson, J. E., Winkelman, C., Gélinas, C., &Dermenchyan, A. (2015).Pain, Agitation,   and      Delirium Guidelines: Nurses' Involvement in Development and          Implementation. Critical Care Nurse, 35(3), 17-32. doi:10.4037/ccn2015824

Hsiang-Ling, W., & Yun-Fang, T. (2010).Nurses' knowledge and barriers regarding pain   management in intensive care units.Journal Of Clinical Nursing, 19(21/22), 3188-       3196. doi:10.1111/j.1365-2702.2010.03226.x

Luetz, A., Balzer, F., Radtke, F. M., Jones, C., Citerio, G., Walder, B., & ... Spies, C. (2014).       Delirium, Sedation and Analgesia in the Intensive Care Unit: A Multinational, Two-     Part Survey among Intensivists. Plos ONE, 9(11), 1-6.         doi:10.1371/journal.pone.0110935

Melnyk, B., &Fineout-Overholt, E. (2011).Evidence-Based Practice in Nursing and           Healthcare (2nd ed.). Philadelphia, Pennsylvania: Wolters Kluwer Health/Lippincott        Williams & Wilkins.

Norman, M. A. (2010). Ventilator Management in the Surgical Intensive Care Unit. Texas            Heart Institute Journal, 37(6), 681-682.

Reardon, D. P., Anger, K. E., Adams, C. D., & Szumita, P. M. (2013). Role of      dexmedetomidine in adults in the intensive care unit: An update. American Journal of Health-System Pharmacy, 70(9), 767-777. doi:10.2146/ajhp120211

THE SCREENING OF PROSTATE CANCER

THE SCREENING OF PROSTATE CANCER

by Ricky Ocampo RN

            Many people across the globe or the world die to various diseases. In many cases, the conditions that they suffer from can be contained or treated with proper and early diagnosis (Amin, Lin, Gore, Srigley, Samaratunga, Egevad, & Berney, 2014). One of the diseases that can be controlled if detected early is cancer. Cancer is a disease involving abnormal cell growth that can spread to other body parts. In 2012, this ailment led to 14.6% of total world deaths, which translated to about 8.2 million people (Amin et Al. 2014). Various treatment methods can be used to control the disease. However, their effectiveness is determined by the stage of advancement that the illness has reached (Amin et Al. 2014). Consequently, an early diagnosis of the disease is crucial or necessary. In this case, I will identify and evaluate a screening methodology for prostate cancer, which is relevant to the National Clearinghouse Guidelines. I will proceed to apply the technique to a specific population.

            Prostate cancer is a type of cancer that affects the man’s prostate gland. This particular type of cancer may spread to other parts of the body such as lymph nodes and bones. This disease may not have any symptoms at the initial phase but in later stages, it may cause pain in the back and the pelvis while urinating, and traces of blood in the urine. The disease is most common in elderly people since many of the people suffering from it are above 45yrs old. A person who has a first-degree relative with the disease is also 2 to 3 times more likely to catch the ailment. In America, the disease is more prevalent in African Americans than persons from the other racial groups (Amin et Al. 2014).

My chosen methodology for screening a patient is the Prostate-Specific Antigen (PSA) method. This screening technique measures the level of PSA in a man’s blood.  The prostate glands produce PSA, which is protein in nature. The persons suffering from prostate cancer have a higher level of PSA than ordinary people do. The Food and Drug Agency (FDA) approved the use of the PSA test in 1986 to monitor the progress of prostate cancer in individuals who had already been diagnosed with it (Hayes & Barry, 2014). I have chosen the method of PSA screening since it helps detect prostate cancer in its embryonic stages.  

            PSA, levels of over 4.0 mg/ml are considered high and doctors recommend a prostate biopsy for patients with those levels to check the presence of prostate cancer (Hayes & Barry, 2014). There are other complications that may cause high PSA levels and they include urinary tract infection or prostatitis (Ubel, 2015). PSA screening also has limitations such as cases where early detection of prostate cancer may not reduce the chances of a patient dying of prostate cancer in a process called overdiagnosis. This happens since tumors found through the test may be harmless or may grow at a very slow rate, which cannot affect the man.  Treatment of these tumors is called overtreatment since the patient may be exposed to side effects associated with the remedy such as erectile dysfunction, urinary incontinence while being exposed to numerous infections (Hayes & Barry, 2014).

            Another limitation of the test is that it may give false-negative or false-positive results. False-positive results occur when the person has high levels of PSA yet he does not have prostate cancer while false-negative results occur when a man has low PSA levels yet he has prostate cancer. The use of the PSA method is also helpful while monitoring a treated patient. This is done where tests will confirm rising PSA levels in those patients that will mean the prostate cancer is recurring (Amin et Al. 2014). The population that this screening method can be applied to is those that are at a higher risk of prostate cancer, which are older men above 50 years. This is because the test may be harmful and administering it to people at low risks of cancer may expose them to various undesirable effects.

Various studies have been advanced to find out and to dismiss the PSA test for screening prostate cancer in men. The National Clearing House guidelines contain various directives that have an in-depth analysis of the method where they evaluate if the benefits outweigh the harm. A guideline that offers an insight into the cancer screening method is titled; The Early Detection of Prostate Cancer: AUA Guideline. The objective of the guideline is to offer recommendations for the detection of prostate cancer that are analysis-based (Hayes & Barry, 2014).

            Another objective is to provide a principle to help address prostate cancer’s early detection, which will reduce the mortality rates resulting from the ailment. The guideline recommends shared decision-making in PSA screening of men in the ages between 55 and 69. For this age group, it also recommends that screening intervals should be in two years or more against annual screening.  The guideline does not recommend PSA tests to men under the age of 40 or routine screening of men in the ages between 40 to 54 years. The guideline also does not recommend the PSA screening of men above 70 years old or the ones who have between 5 to 10years to live (Hayes & Barry, 2014).

            In conclusion, early detection of disease is essential for ensuring that the treatment is effective. Cancer is a disease where early detection can reduce the number of deaths reported. Prostate cancer is a type of cancer that affects the prostate area in a man. Screening of this type of cancer can be done by PSA tests. This is a test that is conducted to check the levels of PSA in the blood. Other diseases such as urinary tract infection or prostatitis may cause high PSA levels. There are various limitations to the PSA screening method that include overdiagnosis whereby it may give a false-negative or false-positive result. The target population for this screening strategy is men above 50 years of age.

References

Amin, M. B., Lin, D. W., Gore, J. L., Srigley, J. R., Samaratunga, H., Egevad, L., & Berney, D.                  (2014). The Critical Role of the Pathologist in Determining Eligibility for Active Surveillance as        a Management Option in Patients with Prostate Cancer. Archives of Pathology & Laboratory              Medicine, 138(10), 1387-1405. doi:10.5858/arpa.2014-0219-SA

Edelman, C., Kudzma, E., & Mandle, C. (2013). Health Promotion Throughout the Lifespan                       (8th edition ed.). Philadelphia, Pennsylvania: Elsevier.

Hayes, J. H., & Barry, M. J. (2014). Screening for Prostate Cancer with the Prostate-Specific                      Antigen Test. JAMA: Journal of the American Medical Association, 311(11), 1143-  1149.                  doi:10.1001/jama.2014.2085

Ubel, P. A. (2015). Medical Facts versus Value Judgments -- Toward Preference-Sensitive                          Guidelines. New England Journal of Medicine, 372(26), 2475-2477.                                                      doi:10.1056/NEJMp1504245

Electronic Health Records: Availability and Portability Vs. Privacy

Electronic Health Records: Availability and Portability Vs. Privacy

by Ricky Ocampo RN

Today's technological advances are out-pacing what we're able to expect or comprehend, and there are several aspects of today’s life and society that benefit greatly from this factor. However, there are several thinkers who stand against some of the consequences—or benefits (subject to perception)—that such technological advances provide. The Internet, for instance, is the pedestal for most of today's technology, and judging by how dependent the world has become  on its provisions, it's very likely that businesses, companies, and the world's industrial sector in general will be the one that has to bend and adapt, and not the other way around. The spread of information is one of such vital benefits the Internet provides, but such spread of information is sometimes at the costs of both private and government secrets and information, thus not all thinkers are on-board with this aspect of online information storage. Inevitably, the heavy shift from conventional file storage to online or “cloud” storage is a step also being taken by many medical institutions, but this step also comes with the risks of leaked or stolen information that could compromise the privacy of patients. In contrast of such risks and consequences, adapting such method of information storage can make patient identification, diagnostics, and information transfer considerably more efficient that the conventional method will ever be able to, thus it becomes very difficult to ignore these advantageous factors. This doesn't stop several thinkers from arguing the controversy, providing several standpoints and perceptions within their own premises. Generally, as already established, the risks and potential hazards/consequences aren't strong enough premises to not adapt the method and miss out on several advantages.

The Case for Availability and Portability

            Availability and portability would appear as mere, unimportant factors until one considers the fact that physical newspapers are practically dragging to a slow death, and being replaced by mobile devices and Internet-provided news and information (Greenslade, 2014). Generally, people arguing for the use of electronic health records (EHR) will find that they have an easier time finding premises to support their claims than those who argue against them. In Electronic Medical Records System it's expressed that “the availability of electronic data permits instant, sophisticated analysis of patient data. Moreover, the EMR system enables enhanced analysis of patient data by providing access to reference databases for diagnosis, procedures and medication” (Evans, 1999). Furthermore, Arthur and medical researcher, Linda Thede, expressed in Informatics: Electronic Health Records: A Boon or Privacy Nightmare that “there have been cases where paper medical records, especially parts of them, have disappeared” (Thede, 2010), a scenario nearly impossible and very abnormal to find in EHRs.

The Case for Privacy

            Researcher and author Lauren Bair Jacques, in Electronic Health Records and Respect for Patient Privacy: A Prescription for Compatibility expressed that “EHRs and patient privacy are compatible and may peacefully coexist” (Jacques, 2010), and he provides several premises to back his claim. For one, he mentions that presidential administrations such as President Clinton or President George W. Bush endorsed the idea of EHRs because the resource appear to fall in line with their overall goal which is to improve and strengthen the American healthcare system (goal). He also mentions that the establishment of government agencies and government-regulated acts such as the Health Insurance Portability and Accountability Act (HIPAA), which was instated as means for “improving portability and continuity of health insurance coverage in the group and individual markets; combating waste, fraud, and abuse in health insurance and health care delivery; promoting the use of medical savings accounts; improving access to long-term care services and coverage; and simplifying the administration of health insurance” (place). But HIPAA also contains several aspects that protect patients' information both from doctors and other institutions. According to the US Health and Human Services (HHS), the HIPAA Privacy Rule “establishes national standards to protect individuals' medical records and other personal health information and applies to health plans, health care clearinghouses, and those health care providers that conduct certain health care transactions electronically” (Jacques, 2010). Generally, one can easily conclude that several safety precautions have been taken to protect patients' information and ensure fairness, thus the arguments based solely on the factor of privacy don't have very solid grounds to stand on.

The Writer's Opinion

            Contrary to the premises and concerns of thinkers arguing against the use of EMRs, the benefits of using EMRs appear nearly endless. For one, supporting a method that heavily involves the use of papers and other resources that are very costly to the environment and overall health of nature and life is a somewhat ironic argument for any health or medical expert to make.   The conventional information storage system involves typically frustrating goose chases of information about patients—information that aren't usually available in hand, meaning that a doctor would have to call the previous doctors or medical facilities of his/her patients to request for specific information. Authors Marcia Stanhope and Jeannette Lancaster, in Public Health Nursing Population-Centered Health Care in the Community, mention that “an innovative use of the electronic health record to meet the needs of the public health workforce is the ability to embed reminders or guidelines within the EHR” (Stanhope & Lancaster, 2013); such a resource would make tracking down vital details and information much easier. Privacy generally appears to be the only concern of most, but with government regulations and insurance measures, it can hardly be said to be a solid factor.

Conclusion

            In conclusion, as Linda Thede provides, “although Americans are concerned about the privacy of medical records, survey data shows that despite this concern, the majority of Americans are aware of the benefits of electronic records and believe that they outweigh privacy concerns” (Stanhope & Lancaster, 2013); one would really have to search for solid premises as to why EHRs aren't a resourceful approach, and one would really have to nitpick at unsubstantial details to gather any attention. Inevitably, such search will drag to a frustrating end as one is forced to acknowledge that EHRs are only going to become more integrated into healthcare as the world continues to advance technologically.

References

Greenslade, R. (2014, July 11). Latest ABCs show newspaper market decline running at 8% a      year. Retrieved October 22, 2015, from         http://www.theguardian.com/media/greenslade/2014/jul/11/abcs-national-newspapers

Evans, J. A. (1999). U.S. Patent No. 5,924,074. Washington, DC: U.S. Patent and Trademark       Office.

Thede, L. (2010). Informatics: Electronic Health Records: A Boon or Privacy Nightmare? OJIN: The Online Journal of Issues in Nursing, 15(2).

Jacques, L. B. (2010). Electronic health records and respect for patient privacy: A prescription      for compatibility. Vand. J. Ent. & Tech. L., 13, 441.

Stanhope, M., & Lancaster, J. (2013). Public Health Nursing-Revised Reprint: Population-            Centered Health Care in the Community. Elsevier Health Sciences.

IMPORTANCE OF PATIENT’S INPUT DURING CRITICAL CARE

IMPORTANCE OF PATIENT’S INPUT DURING CRITICAL CARE
by Ricky Ocampo RN

            The work of nurses is to act as caregivers for patients. Their job involves the application of skills and knowledge that has been acquired from school and experience. However over the years there has been various researches conducted that expect the nurses to seek patient participation as they deal with them. This situation is quite difficult since the patients do not possess the training or experience needed in conducting a nursing job (Dankwa-Mullan, 2015). Through Evidenced Based Approach (EBP), I have researched widely on the topic where I sought to find out if patient’s input can improve the quality of health care.  I have formulated a research question and utilized the PICOT method in carrying out the study.

            The research question that I have chosen for this analysis is: does the patient’s input in clinical remedies quicken healing in critical care? This research question has been widely influenced by my job as a critical care nurse at the Kaiser Permanente’s Northern California division. During my profession, I have worked with many patients with many different needs that warranted different approaches. The different methods can be aided by the patient’s participation since the patients are the ones that feel the illness or pain. Some of the patients might have gone through similar treatments and may possess crucial information about their experience that may be helpful in the present scenario.

With the use of the PICOT format of evidenced based research, I have analyzed the question in this topic. PICOT stands for Population/Patient, Intervention, Comparison, Outcome, and the Timeframe (Boswell, 2012). On the Population/Patient, I used a middle-aged man of Asian origin who is in critical care after undergoing a successful craniotomy surgery. As a critical care nurse, I am responsible for taking care of the patient during his recovery period. This gives me the opportunity to engage the patient through asking for and listening to his views regarding the care he receives. I can also observe firsthand on the importance of incorporating the patient’s opinion in the recovery process.

            In this case, the intervention includes integrating clinical solutions coupled with the man’s input about care and what he prefers. After a proper relationship has been established with the patient, he can share his personal goals in regards to his recovery such as the time he expects to get back to his normal work routine. With his personal goals in mind, I offer the patient advice and suggestion on the clinical solutions. The patient offers feedback, which is used in providing clinical solutions. The clinical solutions include administration of painkillers to the patient. With the patient’s input, the painkillers administered will be regulated by the patient’s pain level at the given time. This will ensure that the patient gets enough painkillers when he needs which will reduce his pain levels. Patient input can also be important while observing his body’s reaction to some medicine. The patient can express freely how the medication makes him feel which will subsequently lead to the prescription of more comfortable medication (Dankwa-Mullan, 2015).

            In this case, the comparison is between a case where the patient's input is not taken into consideration and when the patient’s views are listened and used in his care. The alternative is that the nurse does not take the patient’s opinion and instead caters for the patient with his experience and knowledge alone. The lack of consideration of the ill person’s patient view makes the patient feel dehumanized. The patient may also feel abandoned since nobody is interested in his well-being. The patient who was not involved in the decision-making feels ignored and let down. The patient can also feel that the nurse is trying to incorrectly exert authority by ignoring the patient (Dankwa-Mullan, 2015). All these feelings will make the patient doubt the care that is given to him, which can in turn derail his ability to heal. On the other hand, proper communication with the patient will make the patient feel acknowledged and make him more informed. This will make the patient have a positive attitude and be more willing to follow advice and suggestions from the nursing personnel (Pender et al. 2014).  

            The outcome, in this case, is a full recovery to the patient that had undergone craniotomy surgery. The recovery process should be satisfactory to me where I will ensure that it is going the way it should based on my nursing knowledge and experience. The recuperation process should also be suitable for the patient where he will have met his personal goals, and he would have felt respected throughout the whole period. This outcome is to be achieved through proper communication with the patient where the patient is briefed on every important thing about his recovery. The abundance of information from the nurse and the patient makes the job easier for both of them. Various researchers have found that patients that had a good communication with nurses had a more positive outcome to their treatment than those who had a poor exchange (Peile & Fulford, 2015). The ones that experienced poor communication felt that if the nurses had listened to their opinions, then the recuperation  would have been faster and with less pain or devoid of complications.

            The timeframe that is intended to be used to achieve the outcome is six months. It begins with the first interaction with the patient where I establish a rapport, and I brief the patient on everything that he needs to know regarding his treatment. The timeframe ends when the patient is fully recovered and is satisfied with the care given to him during the recovery process.  The time frame is important since it will quantify the results that are obtained. Achieving full recovery at the minimum possible time is imperative to the concerned patient (Peile & Fulford, 2015). The satisfactory level of persons is very high when they recover quickly since they get to move on with their daily routines. This includes work that will enable the patient to earn a living as opposed to when he is bedridden. The patient can also participate in leisure activities that require much physical energy such as sports. The patient will also be free from the many side effects experienced while using medicine such as nausea.

            Nurses are trained caregivers, and they get much experience while dealing with patients. It is, however, important that the nurse involves the patients in everything that they do as they take care of them. This topic is important to me due to my occupation as a critical care nurse at Kaiser Permanente. With the help of the PICOT method, an analysis of this topic is made easy. The population, in this case, is a middle-aged man of Asian origin who is in critical care after a successful craniotomy surgery. The intervention shows the incorporation of clinical solutions coupled with the input from the man concerning his preferences. The comparison shows the alternative where care was given with no regards to the man’s input. The outcome shows the expectations of a quick recovery from incorporating patient’s opinion. The timeframe is the time that is expected to be used to achieve the desired outcome. In this case, it is six months.

  

References

Boswell, C. (2012). Introduction to Nursing Research: Incorporating Evidence-Based        Practice (3rd ed.). Burlington: Jones & Bartlett Learning.

Dankwa-Mullan, I. (2015). Precision Medicine and Health Disparities: Advancing the       Science of Individualizing Patient Care.American Journal of Public Health, 105S368. Doi:10.2105/AJPH.2015.302755

Peile, E., & Fulford, B. M. (2015, July). Values-based practice: Translating values and       evidence into good clinical care. International Journal of Therapy & Rehabilitation.       pp. 306-307.

Pender, N., Mardaugh, C., & Parsons, M. (2014). Health Promotion in Nursing Practice    (Pender) (7th ed.). Upper Saddle River, N.J.: Prentice Hall.