A) There are several issues in the case of Mr. J that need to be examined. Using nurse sensitive indicators “reflect patient outcomes that are determined to be nursingsensitive because they depend on the quality or quantity of nursing care” (American
Sentinel University, 2011). Mr. J. was not receiving acceptable care, because his daughter noticed a red, depressed area over Mr. J’s lower spine, similar to a severe sunburn. This skin condition is the first stage of a developing pressure ulcer.
a. Nurses should be aware that a patient with limited mobility is at risk for skin breakdown, and pressure ulcers. Anyone with limited mobility should be assisted to change positions by the care providers on a regular schedule to help
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b. Restraints should be used as a last resort on patients that are at a high risk for hurting either themselves or others. If this particular hospital is found to be overusing their restraints, they should look into why this is happening and where it is happening most often. What is the patient to staff ratio? Are acuities being considered when staffing the unit? If restraints are being overused, maybe a shortage of staff could be to blame. Having an appropriately staffed unit can lower the usage of restraints.
c. Providers should be culturally sensitive to all of their patients, and dietary restrictions according to religion should be honored. The nurses should help create diets for in-patients, and help ensure that religious requests are being honored. The hospital can survey patients, and help collect data to get to the root cause of why diet requests are not being honored.
C) Mr. J was not receiving a kosher meal, and his cultural and religious requests were not being honored by the staff and hospital. The nurse that noticed this did the right thing by informing the supervisor on shift. The supervisor, however, did not address the issue appropriately. Instead of asking the reporting RN to keep it quiet, the supervisor should have thanked her for noticing. After validating the reporting RN, the supervisor
Once the patient is stabilized the nurse can begin to assess the cultural aspects of care for this patient. Noting that the patient is African American the percentage of that ethnicity having adequate health care and education is very low. The last admission may have very well left her without a leg and any means to help care for it. Setting her up for another admission due to infection. She does have a primary healthcare provider but as far as knowing the extent of her home care or education level the patient could have been set up for failure. During the admission, it is the nurses job to educate the patient when appropriate. Clearly, she needs teaching on the importance of knowing her medication, signs and symptoms of infection, and taking proper care of a surgical site. Although since we do not know exactly what her health insurance will and will not pay for it is important for the patient and family to be properly educate before
There are a few ethical issues that in the provided scenario which need addressing from the nursing shift supervisor. The first occurs when the Certified Nursing Assistant (CNA) fails to appropriately address the possibility of a developing pressure ulcer. A wound care team can be consulted about developing an educational program about pressure ulcers for hospital staff. Also, there is the issue of restraints. The ordering physician should be contacted about the necessity of restraint use. Along with the wound care team, data could be collected about the use of restraints and the subsequent development of
Despite these “rights” nurses in the United States and around the world still use restraints stating the main reason is for patient safety.
is very pleased with the quality of care she recived during her stay, after further conversation with her I noticed a couple of things that would have improved the quality of care. there was a dicrepancy in the care she received in two different units. while in delivery unit all the call bells were answered on time and the nurses checked on her frequently, same couldn't be said about the nursing care in the recovery unit. A couple of incidences stood out that could have been handeled in a different manner. First one was that when S.D. received her meal and she wanted to confirm that it was a vegetarian meal. The nurse said that she was sure the meal ddn't have any meat in it because that’s what her chart said. but this response didn't satisfy the ptient and she decided not to eat the meal. Second incident was more of a safety concern compared to the first one. S.D. was advised to call for help before going to the bathroom because of pain and swelling around her stiches. But during one instnace while she rang the bell, a nurse came in and told the patient that because her husband was sleeping in the room he could help her to get to the bathroom. This incidence raises a serious safety concern for the pateint. If an untrained healthcare professional such as her husband helped her get in and out of the bed, he could have pulled on the stiches and caused a potential
Based on Mr. Lucas’s actions, it can be argued that he did not comply with Standard 6.1; “provides comprehensive safe, quality practice to achieve agreed goals and outcomes that are responsive to the nursing needs of people.” (NMBA, 2016). Throughout the periods of abuse and ultimate lack of beneficence, Lucas did not act within a safe and comprehensive manner, leading to further suffering by Hausler, without meeting his individual nursing needs. Lucas also fails to comply with Standard 6.5; “practices in accordance with relevant policies, guidelines, standards, regulations and legislation.” (NMBA,
Islam culture is very different with various cultures especially on what is perceived as respect and modesty. Therefore a nurse or a health care worker who nurses a patient from a Muslim community should be aware of their beliefs and practices. Their respect to modesty and privacy is expected to be respected and some examination can be done over a gown. Their culture forbids Muslims from eating any other food besides halal food, so a nurse should provide halal food to a Muslim patient (Ashiq Kermalli, 2009).
That being stated, if a patient must be placed on restraints, qualified professionals must have a comprehensive understanding of patient outcomes that correspond with the use of restraints. First and foremost, skin integrity is placed at risk if proper placement and management of patient care while in restraints is not implemented as with the case of Mr. J. There is numerous evidence based research studies conducted that correlate the use of restrains with an increase in pressure ulcers (Baumgarten, Margolis, Localio, Kagan, Lowe, Kinosian, Abbuhi & Abbuhi, 2010).
In addition the RN should also review policy and procedure of the place employment. The above areas will great tool in help the RN deal any issues relating to belief that are different their own. There are many different interventions, with supporting rationales, the RN would perform to ensure the delivery of culturally sensitive care. For example, the RN can help the patient set realistic goal and identify personal skill and knowledge. By including the patient in the decision making helps them toward independence can help ensure the delivery of culturally sensitive care. Also, the RN should also assess the influence or cultural belief, norms and values on the patient perceptions of effective coping. The nurse may learn that the patient coping behavior may be based on the cultural perception or normal and abnormal coping behavior. The nurse should also research the patient reason for objecting to the treatment plan. Michael refused of the treatment is based on his religion Christian Scientist. Christian Scientist promotes healing of physical and mental illnesses and disorders through prayer (“religious tolerance,”2008). It safe to say that had he not pass out, he would not be in the hospital, but it seem to me that he was cooperative to the best of his able base on his personal
When the primary nurse reported Mr. J had received and eaten a non-kosher entree to the nursing supervisor, she instructed the nurse to keep it quiet. Reporting errors to the patient and apologizing for errors is an evidence based practice for improving patient satisfaction and maintaining trust. Although Mr. J may not have retained the information due to his dementia, his daughter should have been informed of the error. Keeping the error quiet is unethical nursing practice. Mr. J’s daughter needs to know she can trust the staff to care for her father and respect his patient rights and wishes. This is of particular concern when a family member lives eight hours away and may have limited opportunity to visit. Also, the nurse’s comments to Mr. J’s daughter were unprofessional. Reports from the hospital administrator of other Jewish patients’ feeling their dietary requests were not taken seriously, sends the message that actions have not been taken to correct inexcusable practices and behavior. Patients who have poor experiences most often have poor outcomes. Actions must be taken to review system failure causes such as errors, compromised care, safety infractions, and poor outcomes. Without prompt resolutions, the patients will choose alternative resources for their health care needs ultimately resulting in
After reviewing the Texas Health and Safety Code in regards to restraints in a facility, it is understood that there are many different requirements when attempting to write a policy and procedure. In the policy, the following regulations will be instated, it needs to be known that only trained professionals are allowed to lawfully apply restraints to a person. The restraints used may not hinder the person’s ability to breathe in any aspect or hinder communication. Prior to the use of restraints, first the physician must physically assess the patient before providing an order for the use and thereafter if there is the need to continue the restraints. Once a restraint is applied, a nurse, other than the nurse that applied the restraints, is
The pressure ulcer could have been noticed and addressed if the certified nursing assistant (CNA) had been exposed to the NSI. The process of repositioning the patient on a regular interval would have been followed (Ayello, 2012). The CNA would have known what are signs of a pressure ulcer and how to report them to the registered nurse (RN) who was assigned to this patient. Notification of the RN would have allowed the care plan to adapt and incorporate care for pressure ulcers so as to prevent the progression. Perhaps the NSI would have identified which hospital units were at risk for increased pressure ulcers and would have pointed to additional training
On my unit, we complete a database for every patient admitted. The database covers everything from current living conditions, assistance received or needed, advance directives, willing to receive blood products, belongings at the bedside, and cultural beliefs. We ask all our patients if they have any special diet restrictions, whether personal or medical choices. We also ask the patient if there are any cultural or spiritual beliefs that would impact their healthcare. We offer communion, prayer, and anointment services. We supply our patients with bibles and other spiritual or cultural symbolic properties upon request.
Organizational systems are of great importance companies' success on the market. The most important systems in this organization are represented by the management system, the technical system, the human resources system, the organizational system, and others. Each of these systems has individual objectives, but that are oriented towards the general objectives of the organization. The management system refers to establishing the competence limits within the company, the objectives that each department must have, and the decision making process. In addition to this, the management system also establishes how activities can be delegated within the company.
The uses of physical restraints for medical purposes are valued in the patient safety and ethics by performance of evidence of best practice. According to Craven a singular definition of a restraint “any manual method, physical, or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head freely” (2013). By this definition we can also rule out that orthopedic devices, dressings or bandages, or any other equipment used in the patients physical examinations or tests to protect the patient are not considered restraints (Craven, Hirnle, & Jensen, 2013). The most common circumstances to use medical restraints take place in intensive care units (ICU) where
During the fall of 2001, five or more letters were received in the mail by the offices of two U.S. Senators, and news organizations in New York and Florida. The letters contained a dry, powdered, and especially virulent and airborn form of the anthrax bacteria, as well as a handwritten note (D.O.J., 2010). As a result of these mailings, five people lost their lives, 31 more contracted anthrax but did not die, and ten thousand more received prophylactic antibiotics on the basis of estimated exposure risk (D.O.J., 2010). In August 2008, nearly seven years after the deadly anthrax attacks, the FBI announced that research scientist Bruce Ivins