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NURS 4211 Assignment Role of the Nurse Leader in Population Health Essay Paper
NURS 4211 Assignment Role of the Nurse Leader in Population Health Essay Paper NURS 4211 Assignment Role of the Nurse Leader in Population Health Essay Paper Nurses play an important role in promoting public health. Traditionally, the focus of health promotion by nurses has been on disease prevention and changing the behaviour of individuals with respect to their health. However, their role as promoters of health is more complex, since they have multi-disciplinary knowledge and experience of health promotion in their nursing practice. This paper presents an integrative review aimed at examining the findings of existing research studies (1998-2011) of health promotion practice by nurses. Systematic computer searches were conducted of the Cochrane databases, Cinahl, PubMed, Web of Science, PsycINFO and Scopus databases, covering the period January 1998 to December 2011. Data were analysed and the results are presented using the concept map method of Novak and Gowin. The review found information on the theoretical basis of health promotion practice by nurses, the range of their expertise, health promotion competencies and the organizational culture associated with health promotion practice. Nurses consider health promotion important but a number of obstacles associated with organizational culture prevent effective delivery. Permalink: https://nursingpaperessays.com/ nurs-4211-assign alth-essay-paper / ? What does it mean, really? How does someone promote health? Im going to address the concept of health promotion from my perspective as a Registered Nurse in Ontario. Nurses play a huge role in illness prevention and health promotion. We, as nurses assume the role of ambassadors of wellness. Yes, I do believe that nurses play just as an important role in caring for the well as they do in caring for the sick. Perhaps caring for the well is the more important role. In this day and age of budget cuts, cost reduction and staffing shortages, health promotion makes sense. If we can preserve wellness, we reduce the number of times a person needs to enter the health-care system, thus reducing costs. The World Health Organization (WHO) defines health promotion as a process of enabling people to increase control over and to improve their health (WHO, 1986). To facilitate that process, we must provide people with appropriate information. Nurses have a key role in providing that information in the form of health teaching. Nurses are highly educated, experienced health professionals who are accessible through many settings. Telehealth Ontario is a great example of how anyone can access the expertise of a nurse. Anyone can call in with a question, concern or health issue and gain information while being advised of a plan of action right over the phone. Of course, without being able to use hands-on assessment skills, this can be limiting when it comes to dealing with an acute scenario. Telehealth is not for resolving situations that require immediate attention. Nurses can direct people to local resources and give out health and wellness information. Telehealth would be useful when parents seek well-baby/well child information, information on vaccines, smoking cessation, addiction counseling, adolescent mental health resources, nutrition information etc. These are examples of situations where access to accurate health information can assist people in staying healthy. There are an increasing number of web pages with good health information available to the general public such as the Healthy Ontario website which is run by the Ontario government and has links to various health related resources. We must be aware that internet searching poses the threat of inaccurate, outdated information. Part of the role of a nurse is to assist clients to decide which websites and what information is indeed suitable. Nurses can use the internet resources to expand their knowledge about specific conditions or treatments, retrieve materials to integrate into teaching or to help patients use the internet to self-educate. When nurses are working within a health promotion model, every interaction with a client can be an educational intervention (Rankin 2005). For example, while changing the dressing of a diabetic foot ulcer, there is the opportunity to discuss blood sugar testing and diabetic control. When in a clinic or doctors office, if a patient comes in with a cut, its the perfect time to check the chart for the last tetanus booster. During a home visit to discuss newborn care, it is the perfect opportunity for the nurse to discuss the childhood vaccine schedule, recommended vitamin supplements or even the developmental milestones of an older sibling. Nurses are practicing health promotion strategies constantly. Recognition of these subtle yet effective interactions is important in giving credit to the significance of nurses as health promoters. Everyone will interact with a nurse at some point in their lives. I challenge you to make the most of the expertise of a nurse. Nurses are high level thinkers with exceptional skills and considerable ability to communicate, negotiate, coordinate, and collaborate in order to deliver care (Sullivan, 2004). I am proud to be a part of such a dynamic, caring profession. The next time you are in the presence of a nurse, read a health-care article or are part of a health related discussion, think about nursing and the impact the occupation has on the health and wellness of our society. Ask a nurse a question about his or her career, daily tasks, and routines and ask questions about how he/she can assist you to achieve your goals for health and wellness. As life expectancy in the United States is declining and the number of people struggling with chronic conditions continues to rise, nurses are everywhere: in our hospitals, schools, businesses, homes, and communities. There are many social, political, and economic influences shaping healthcare delivery today that are expanding the scope of responsibility for the executive nurse leader. The focal point of change is the passing of the Patient Protection and Affordability Care Act (ACA), where there is a clear strategic shift to provide patient care in the right setting with the formation of Accountable Care Organizations (ACOs). Financial reimbursement strategies are being aligned to facilitate these changes. Executive nurse leaders are trying to navigate through these healthcare changes by developing cost-effective care delivery models, supporting the role of the professional and advanced practice nurse, and advocating for the patient. In healthcare reform, this translates to healthcare being delivered in community venues and the executive nurse leader being the advocate for the healthcare needs of the population in the community. Consistently named as the most trusted health profession, nurses are trained to see each person they care for in the context of his or her life. Regardless of their specific backgrounds or assignments, nurses have a responsibility and obligation to promote public and population health no matter where or how they practice. To truly achieve the best possible health and well-being for everyone in our nation, it is increasingly essential for nurses to play an expanded role. Stemming from a range of Robert Wood Johnson Foundation (RWJF) programs focused on the nursing profession, this collection includes analysis and perspectives how to more fully leverage nurses in addressing critical public health issues across our nation, and incorporate a stronger population health focus into nursing education and practice. Public health nursing (PHN) involves working with communities and populations as equal partners, and focusing on primary prevention and health promotion (ANA, 2007). These and other distinguishing characteristics of PHN evolved in the context of historical and philosophical perspectives on health, preventive health care, and the professionalization of nursing. Specifically, these are roles that involve collaboration and partnerships with communities and populations to address health and social conditions and problems. The focus of this course is on application of theories and concepts from nursing and public health sciences in assessing health status, preventing and controlling disease, and promoting a healthier population by working with families, aggregates, communities, and healthcare systems. Students apply system thinking by using epidemiological and community assessment techniques to examine at-risk populations, health promotion, and levels of prevention with special emphasis on ethnically diverse and vulnerable populations. Major local, state, and national health issues are considered including, communicable disease, chronic illness, environmental and occupational health, bioterrorism, emergency and disaster preparedness and response. Practice experiences provide learning experiences in population-based health promotion by collaborating with interdisciplinary public health partners in a local community. Public health nursing developed as a distinct nursing specialty during a time when expanding scientific knowledge and public objection to squalid urban living conditions gave rise to population-oriented, preventive health care. Public health nurses were seen as having a vital role to achieve improvements in the health and social conditions of the most vulnerable populations. Early leaders of PHN also saw themselves as advocates for these groups. In the 21st century, public health nurses practice in diverse settings including, but not limited to, community nursing centers; home health agencies; housing developments; local and state health departments; neighborhood centers; parishes; school health programs; and worksites and occupational health programs. High-risk, vulnerable populations are often the focus of care and may include the frail elderly, homeless individuals, sedentary individuals, smokers, teen mothers, and those at risk for a specific disease. Contemporary PHN practice, like the practice of early PHN leaders, is often provided in collaboration with several agencies and focused on population characteristics that cross institutional boundaries (Association of Community Health Nursing Education [ACHNE], 2003). PHN practice and roles are defined from, the perspective, knowledge base, and the focus of care, rather than by the site in which these nurses practice. Even though they are frequently employed by agencies in which direct care is provided to individuals and families, these nurses view individual and family care from the perspective of the community and/or the population as a whole (ACHNE, 2003, p. 10). PHN knowledge and competencies prepare nurses to take a leadership role to assess assets and needs of communities and populations At an advanced level, PHN knowledge and competencies prepare nurses to take a leadership role to assess assets and needs of communities and populations and to propose solutions in partnership. Community- or population-focused solutions can have widespread influence on health and illness patterns of multiple levels of clients including individuals, families, groups, neighborhoods, communities, and the broader population (ACHNE, 2003). The purpose of this article is to describe evolving roles in the specialty of public health nursing. A brief history of PHN provides a historical and philosophical background for current practice. A model for community participation with ethnographic orientation, and an exemplar of its use in a rural youth substance use prevention project, illustrates current advanced PHN practice. The article concludes with a discussion of essential PHN competencies, evidence that supports evolving PHN roles, and implications for contemporary public health nursing roles. Brief Background and History of PHN Role: NURS 4211 Assignment Role of the Nurse Leader in Population Health Essay Paper Prevention and curative care have been distinct concepts since ancient times. In Greek mythology, Hygeia was the goddess of preventive health, and her sister Panacea was the goddess of healing (Lundy & Bender, 2001). The notion of health care as healing, or treating those already sick, maintained dominance over preventive care for many centuries. During the mid-19th century however, new scientific understanding of transmission of disease enabled successful sanitation interventions that prevented disease on a large scale. To carry preventive care forward, district nursing evolved as the first role for public health nurses, and Florence Nightingale concurrently professionalized nursing as an occupation (Brainard, 1922, 1985). Evolving PHN practice required an understanding of how culture, economics, politics, psychosocial problems, and sanitation influenced health and illness and the lives of patients and families (Fitzpatrick, 1975). Public health nursing in the United States (U.S.), England, and other countries quickly grew to include working with vulnerable populations in diverse settings including communities, homes, schools, neighborhoods, and worksites. The new public health nursing role struggled, and continues to struggle, with appropriate interventions that would achieve quick results, but also leave lasting improvements in the population. With the advent of preventive health care, a moral tension arose between giving resources to the needy, and teaching them how to meet their own needs. Nursing of the acutely ill fits more easily into a model of one-way flow of resources from nurse to patient (Buhler-Wilkerson, 1989). The new public health nursing role struggled, and continues to struggle, with appropriate interventions that would achieve quick results, but also leave lasting improvements in the population. The Christian principle of helping those who help themselves guided this tension, but could not easily resolve it (Brainard, 1922, 1985). Public health nurses were urged to balance wisdom and kindness (Buhler-Wilkerson, 1989, p.32). Giving free services or free supplies to the poor was seen as creating dependency and upsetting the natural social fabric of communities. Public health nurses have addressed this moral tension over many years with innovative solutions that seek positive health outcomes, as well as advocate for vulnerable populations. CLICK HERE TO ORDER YOUR NURS 4211 ASSIGNMENTS By the early 1900s, public health nursing roles extended beyond the care of the sick to encompass advocacy, community organizing, health education, and political reform (American Nurses Association [ANA], 2007). Several examples of exceptional PHN initiatives show how these roles improved the health of communities and populations. The visionary work of Lillian Walds Henry Street Settlement, started in New York City in 1906, evolved from finding and caring for the sick poor, to advocating and educating about the poor to other organizations. Wald expanded this mission to advocating for new federal agencies and a host of local improvements (Stanhope & Lancaster, 2011). In the 1920s in Mississippi, Mary Osborne formed a collaborative between public health nurses and African-American (AA) lay midwives to improve perinatal mortality of AA women and babies (Lundy & Bender, 2001). In the 1960s in Detroit, Nancy Milio integrated community organizing, community decision-making, and PHN to develop a maternal-child health center that was highly accepted and even protected by the AA neighborhood during the Detroit riots (Milio, 1970). Public health nurses and other community professionals have continued to recognize the advantages of community participatory methods, including the potential for more effective intervention outcomes and capacity-building for long term benefit to the community (Savage et al., 2006). Community Participatory Health Promotion Model: NURS 4211 Assignment Role of the Nurse Leader in Population Health Essay Paper The community participation and ethnographic model (see Figure 1) is an innovative framework that demonstrates evolving public health nursing practice. It was developed, based on the work of Aronson, Wallis, OCampo, Whitehead, and Schafer (2007a), by an inter-professional research team from the University of Virginia (UVA), Virginia Polytechnic Institute and State University (Virginia Tech [VT]), and Carilion Clinic (CC) (Kulbok, Meszaros, Bond, Botchwey, & Hinton, 2009) to address youth substance use prevention in a rural tobacco-growing county of Virginia. The community participation and ethnographic model builds on assumptions underlying community-based participatory research (CBPR) and encourages engagement of community members and trusted community leaders in processes from problem identification to project evaluation and dissemination. The CBPR approach is philosophically based in critical and social action theory; it builds partnerships with community members across social-economic status and focuses on community assets and resources rather than on deficits (Israel, Eng, Schulz, & Parker, 2005; Kretzmann & McKnight, 1997: NURS 4211 Assignment Role of the Nurse Leader in Population Health Essay Paper). CBPR seeks balance between community members and practitioners or researchers through shared leadership, co-teaching, and co-learning opportunities; it benefits from the expertise of both community members and practitioners or researchers (Anderson, Calvillo, & Fongwa, 2007; Isreal et al., 2005: NURS 4211 Assignment Role of the Nurse Leader in Population Health Essay Paper). Hospitals are taking a stance on patients lifestyles since non-medical factors such as social, behavioral and environmental issues have a substantial impact on patient health.Public health nursing (PHN) practice is population-focused and requires unique knowledge, competencies, and skills. Early public health nursing roles extended beyond sick care to encompass advocacy, community organizing, health education, and political and social reform. Likewise, contemporary public health nurses practice in collaboration with agencies and community members. The purpose of this article is to examine evolving PHN roles that address complex, multi-causal, community problems. A brief background and history of this role introduces an explanation of the community participation health promotion model. A community-based participatory research project, Youth Substance Use Prevention in a Rural County provides an exemplar for description of evolving PHN roles focused on community health promotion and prevention. Also included is discussion about specific competencies for PHNs in community participatory health promoting rolesand the contemporary PHN role. A standard definition of population health emerged from a 2003 report published in the American Journal of Public Health entitled, What is Population Health? In the report, authors David Kindig and Greg Stoddart defined population health as: Health outcomes of a group of individuals, including the distribution of such outcomes within the group.Nurses are trained to think holistically, to consider the context of a patients life and how that impacts his or her health, says Paul Kuehnert, DNP, RN, FAAN, assistant vice president for RWJF Program staff, who commissioned the study. Whole care also means assessments of the patients healthcare environment, which can include acute, ambulatory, home, behavioral health and community interventions. Because of the nature of their roles, nurses often spend more face-to-face time with patients, which allows them to gain insight into the community and societal factors that impact patients lives and health. Armed with this insight, nurses can work with primary care physicians to help connect patients to resources within the community that can improve their overall well-being. This was the definition used by the NACNEP in its 2016 report, Preparing Nurses for New Roles in Population Health Management. While it has become the accepted definition of the term, the concept continues to evolve as the role of healthcare professionals is refined. In 2015, the online publication Healthcare IT Newssought clarity by asking 37 healthcare leaders to offer their personal definitions of population health. The definitions varied, but a consensus emerged around opportunities for health systems, agencies and organizations to work together for better health outcomes in their respective communities. And that is where the idea of population health begins to be revealed as a practical concept for understanding and meeting the needs of patient communities throughout the nation. Tech companies have also been stepping into the population health ring. In March 2018, Uber announced Uber Health: a way to partner with healthcare organizations to provide reliable, comfortable transportation for patients. The announcement mentioned that over 100 U.S. healthcare organizations, are already using Uber Health to encourage patients to be more proactive in their care. As more organizations focus on population health initiatives, healthcare workers adjust their practice to fit those needs. The role of the bedside nurse continues to shift beyond acute care. Promoting wellness and disease prevention is not new to nurses at the bedside. However, since the Affordable Care Act in 2010, more reimbursement programs are encouraging hospitals to be catalysts in community health engagement. Many U.S. facilities require nurses to be patient health advocates in helping people stay healthy and avoid chronic diseases. In 2016, the National Advisory Council on Nurse Education and Practice (NACNEP) called for changes in nursing education to better align with a new emphasis away from acute care and toward population health management. Population health management programs are geared toward closing the gap of health disparities across demographics because of social determinants of health. Social determinants of health are conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks, according to Healthy People 2020. Nurses who desire to succeed in health promotion take an active role in educating families and communities to improve their health status. Ordinarily, health promotion activities involve the assessment of individuals, or families and whole communities to plan, implement and evaluate intervention programs. The best form of health promotion goes beyond education on healthy living to include disease prevention. Nurses use a robust advocacy approach to promoting health by identifying health risk factors in every persons life. These are the factors that prevent underserved groups of the population from engaging in the health promoting activities. Some of the risk factors are: Poverty Unemployment Homelessness Illiteracy Socio-political factors Health promotion thrives when people access professional advice from someone who enables them to have more control of their health and improve their wellness. Nurses facilitate the process by providing appropriate information. Many patients get help promotion from nurses as they are the health personnel that they interact with frequently. Nurses are also easy to reach. They trust nurses because they are well educated, experienced and accessible in many settings. For example, some people rely on telehealth service to call in with questions, concerns or discuss a health issue. Nurses use their experience to offer advice on their phone. For acute cases that require immediate attention, nurses providing telehealth help direct callers to local resources or facilities that can solve their health issues. When nurses work in the traditional health promotion model, they interact with all sorts of individuals. Those who want to promote health can do it at every interaction. For instance, a nurse who is changing the dressing on a wound can use the opportunity to inform the patient about the importance of taking a blood sugar test or determine the last tetanus booster from the chart. A home visit to a new mother is a chance to pass information about childhood vaccines, best vitamin supplements and healthy feeding methods for older siblings. Nurses consistently provide health promotion strategies hence are significant promoters. Nurses play a dynamic and crucial role in healthcare. A nurse is usually the first person a patient interacts with. Nurses are responsible for assessing patients needs and diagnosing illnesses. As such, nurses are an integral part of the comprehensive standards of care and health promotion. The World Health Organization (WHO) defines health promotion as the process of enabling people to increase control over the determinants of health and thereby improving their health. Before we can examine the role of nurses in health promotion, we must first assess the guiding principles of health promotion. The three main tenets of health promotion are advocate, enable and mediate. Nurses advocate on behalf of their patients and the community at large by supporting causes that help optimize health, such as nonprofit organizations and educational campaigns. Nurses enable or empower their patients by striving for equal access to healthcare services. Race, gender and ethnicity are important factors to consider. Finally, to promote health for all citizens, nurses play the role of mediator between healthcare providers, governments, businesses and the media. A collaboration between various institutions is the only way to ensure the health of a population. A comprehensive health education the use of different learning approaches to help improve health through knowledge and experience is essential to effective health promotion. Thus, health promotion underpins a nurses role within a healthcare setting. Nurses are able to improve their capacity for promoting health in an online RN to BSN program that incorporates health promotion strategies into the curriculum and learning environment. In 2016, the Centers for Medicare and Medicaid Services announced a 5-year, $157 million test of a payment model called Accountable Health Communities to accelerate the development of a scalable delivery model for addressing upstream determinants of health. Hospitals in lower-income areas have more pressure from Medicaid to enact population health management initiatives. The impact of population health programs is much greater in lower-income urban communities than in suburban counterparts. Through the practice of health promotion, nurses provide patients the information they need to manage and ultimately improve their health. A nurses work environment makes it easy to take advantage of a routine interaction with a patient and use it as an opportunity to educate. For example, a nurse can educate new parents at their babys wellness visit on their childs upcoming vaccines. Or a nurse can use the time treating a patients diabetes-related foot ulcer to review tips and tricks regarding how to best control blood sugar levels. Equipping patients with accurate information, while also advocating for a healthy lifestyle, can help them gain better control of their health. It can also have a big effect on healthcare costs. With an industry-wide focus on cost reduction and staffing shortages in healthcare facilities, effective health promotion can reduce the frequency with which an individual must seek out treatment. The Journal of Professional Nursing acknowledged health promotion has become a popular buzzword, and concluded health promotion is aimed at mitigating the determinants of health through community action, action by health professionals and group action. Health promotion focuses on holistically addressing health issues, as opposed to lecturing individuals concerning habits that are negatively affecting their health. Often, individuals may be aware of health practices they should make habits (exercise) or stop (smoking). However, health promotion is more about ensuring access to the resources needed to improve healthy behavior. On a much higher level, nurses might also be able to advocate for societal changes to reduce resource scarcity that may impede health promotion. There are a number of conceptual models that attempt to organize the main elements that affect health. Some models list five elements, some six. In general, though, there are six main dimensions of health that comprise most models: Biophysical: Physical risk factors for disease, including age, genetics and any anatomical abnormalities Psychological and emotional: Coping mechanisms, ability to adapt, level of cognition, and inclination and drive to adapt healthy behaviors Behavioral: Lifestyle choices that impact health, whether beneficial, like an exercise regimen or detrimental, like a smoking habit Social-cultural: Individual-level attributes like socioeconomic status and support systems, as well as broader social influences including beliefs, practices and values influenced by culture Physical environment: Anything in a patients environment that may impact health, including water and air quality Health systems: A patients ability to access healthcare systems, both because of the individuals willingness to do so and his or her ability to pay for and access appropriate care As technology continues to develop, educating patients through the practice of health promotion will become easier. Nurses no longer must be face-to-face with their patients in to share information. Medical technology improvements such as telehealth have expanded patient access to nurses, which allows patients to contact a healthcare professional via phone or a video chat. When one thinks of health care, notions of treatment and management for existing medical conditions come to mind. A major component of health care, however, also involves the prevention of illness. Known as preventative health care, a number of strategies fall under this banner. A United Healthcare fact sheet details that procedures performed in a doctors office, such as physical examinations, drawing blood for testing, immunizations and screenings for certain illnesses can be considered preventative health care measures. This classification is used because the procedures are performed in order to uncover illness in its early stages or to look for signs that may indicate elevated risk for certain conditions. NURS 4211 Assignment Role of the Nurse Leader in Population Health Essay Paper A health care professional will screen for certain kinds of cancers colon and breast cancer as these diseases are typically far easier to treat if they are discovered in their earliest stages, before the onset of symptoms. A primary care provider also may test a patients blood sample for evidence of problems that could lead to disease further down the road: High cholesterol and high blood pressure can foreshadow the development of heart disease, for example. As noted in the United Healthcare article, preventative measures such as screenings, physical examinations and immunizations often are implemented in accordance with demographic factors like age, gender and family history. A fact sheet from the U.S. Centers for Disease Control and Prevention (CDC) detailed one such example, being colorectal cancer, which is widely screened for but only in adults over the age of 50. The CDC suggests the age threshold of 50 because adults younger than this are statistically at a much lower risk for exhibiting with disease. Texture Health combines deep healthcare and technical expertise to create integrated, advanced and highly-configurable, cloud-based and mobile technology solutions that help providers, health plans, patients and the people who care for them connect, communicate, and collaborate like never before. We help ACOs, Integrated Delivery Networks, Behavioral Health Collaboratives, Hospitals and Health Systems, Health Plans and MCOs improve patient health and achieve their value-based initiatives, by caring for more patients, in less time, with less resources. The Interprofessional Student Hotspotting Learning Collaborative is an annual program that trains interdisciplinary teams of professional students from schools around the country to learn to work with complex medical and social needs using a patient-centered approach. Student Hotspotting is part of the Camden Coalition of Healthcare Providers effort to educate and provide mentorship for the next generation of health care professionals and is run through the National Center for Comple
Death Euthanasia Research Paper
Death Euthanasia Research Paper Death Euthanasia Research Paper The Netherlands and Belgium permit euthanasia performed by a doctor, and define it as the act, undertaken by a third party, which intentionally ends a persons life at his or her request. Doctor?assisted suicide is legal in The Netherlands, Belgium and Oregon. Assisted suicide, with or without the involvement of a doctor, is legal in Switzerland. In Australia, the Northern Territory approved euthanasia in 1995, but in 1997 this bill was overturned by parliament.Death Euthanasia Research Paper In the UK, the issue of euthanasia has been widely debated since the 1870s,1 and many argue that the question of the right to die has become one of the most important in contemporary ethics.2 A House of Lords select committee recently produced a report on Joel Joffes Assisted Dying for the Terminally Ill Bill, and recommended that, in future, assisted suicide and voluntary euthanasia be debated separately, allowing the possibility of a change in the law for one but not the other.3 Lord Joffe has since redrafted his bill, which had its formal first reading in November 2005. Permalink: https://nursingpaperessays.com/ death-euthanasia-research-paper / The aim of human medicine is to save lives at all cost. Great suffering and excruciating physical pain are justified if they are necessary to save a life. Euthanasia is not permitted, even in the most extreme cases. Conversely, killing is very much a part of veterinary medicine. It is often recommended to avoid prolonged suffering and pain, even when animals are in no immediate danger of dying. This basic difference between the two medicines is profound. Each type of medicine necessitates its own, fundamentally different moral and philosophical approach. But this fundamental difference has not yet been comprehended. The methods and attitudes of human medicine color those of veterinary medicine. Veterinarians still put animals to death using injections, which are both painful and frightening to the animals, causing them to have an ugly, unpleasant death rather than a tranquil, peaceful one.Death Euthanasia Research Paper Reasons for Euthanasia Unbearable pain Right to commit suicide People should not be forced to stay alive 1. Unbearable pain as the reason for euthanasia Probably the major argument in favor of euthanasia is that the person involved is in great pain. Today, advances are constantly being made in the treatment of pain and, as they advance, the case for euthanasia/assisted-suicide is proportionally weakened. Euthanasia advocates stress the cases of unbearable pain as reasons for euthanasia, but then they soon include a drugged state. I guess that is in case virtually no uncontrolled pain cases can be found then they can say those people are drugged into a no-pain state but they need to be euthanasiaed from such a state because it is not dignified. See the opening for the slippery slope? How do you measure dignity? No it will be euthanasia on demand. The pro-euthanasia folks have already started down the slope. They are even now not stoping with unbearable pain they are alrady including this drugged state and other circumstances.Death Euthanasia Research Paper Nearly all pain can be eliminated and in those rare cases where it cant be eliminated it can still be reduced significantly if proper treatment is provided. It is a national and international scandal that so many people do not get adequate pain control. But killing is not the answer to that scandal. The solution is to mandate better education of health care professionals on these crucial issues, to expand access to health care, and to inform patients about their rights as consumers. Everyone whether it be a person with a life-threatening illness or a chronic condition has the right to pain relief. With modern advances in pain control, no patient should ever be in excruciating pain. However, most doctors have never had a course in pain management so theyre unaware of what to do. If a patient who is under a doctors care is in excruciating pain, theres definitely a need to find a different doctor. But that doctor should be one who will control the pain, not one who will kill the patient. There are board certified specialists in pain management who will not only help alleviate physical pain but are skilled in providing necessary support to deal with emotional suffering and depression that often accompanies physical pain. 2. Demanding a right to commit suicide Probably the second most common point pro-euthanasia people bring up is this so-called right. But what we are talking about is not giving a right to the person who is killed, but to the person who does the killing. In other words, euthanasia is not about the right to die. Its about the right to kill. Euthanasia is not about giving rights to the person who dies but, instead, is about changing the law and public policy so that doctors, relatives and others can directly and intentionally end another persons life. People do have the power to commit suicide. Suicide and attempted suicide are not criminalized. Suicide is a tragic, individual act. Euthanasia is not about a private act. Its about letting one person facilitate the death of another. That is a matter of very public concern since it can lead to tremendous abuse, exploitation and erosion of care for the most vulnerable people among us.Death Euthanasia Research Paper 3. Should people be forced to stay alive? No. And neither the law nor medical ethics requires that everything be done to keep a person alive. Insistence, against the patients wishes, that death be postponed by every means available is contrary to law and practice. It would also be cruel and inhumane. There comes a time when continued attempts to cure are not compassionate, wise, or medically sound. Thats where hospice, including in-home hospice care, can be of such help. That is the time when all efforts should be placed on making the patients remaining time comfortable. Then, all interventions should be directed to alleviating pain and other symptoms as well as to the provision of emotional and spiritual support for both the patient and the patients loved ones. Ethical problems of euthanasia Does an individual who has no hope of recovery have the right to decide how and when to end their life? Why euthanasia should be allowed Those in favour of euthanasia argue that a civilised society should allow people to die in dignity and without pain, and should allow others to help them do so if they cannot manage it on their own. They say that our bodies are our own, and we should be allowed to do what we want with them. So its wrong to make anyone live longer than they want. In fact making people go on living when they dont want to violates their personal freedom and human rights.Its immoral, they say to force people to continue living in suffering and pain. They add that as suicide is not a crime, euthanasia should not be a crime.Death Euthanasia Research Paper Why euthanasia should be forbidden Religious opponents of euthanasia believe that life is given by God, and only God should decide when to end it. Other opponents fear that if euthanasia was made legal, the laws regulating it would be abused, and people would be killed who didnt really want to die. The legal position Euthanasia is illegal in most countries, although doctors do sometimes carry out euthanasia even where it is illegal. Euthanasia is illegal in Britain. To kill another person deliberately is murder or manslaughter, even if the other person asks you to kill them. Anyone doing so could potentially face 14 years in prison. Under the 1961 Suicide Act, it is also a criminal offence in Britain, punishable by 14 years imprisonment, to assist, aid or counsel somebody in relation to taking their own life. Nevertheless, the authorities may decide not to prosecute in cases of euthanasia after taking into account the circumstances of the death. In September 2009 the Director of Public Prosecutions was forced by an appeal to the House of Lords to make public the criteria that influence whether a person is prosecuted. The factors put a large emphasis on the suspect knowing the person who died and on the death being a one-off occurrence in order to avoid a prosecution.Death Euthanasia Research Paper (Legal position stated at September 2009) Changing attitudes The Times (24 January 2007) reported that, according to the 2007 British Social Attitudes survey, 80% of the public said they wanted the law changed to give terminally ill patients the right to die with a doctors help. In the same survey, 45% supported giving patients with non-terminal illnesses the option of euthanasia. A majority was opposed to relatives being involved in a patients death. What Happens During Euthanasia? by Paige Garnett When a pet owner has made the very difficult decision to help his or her pet die, many questions arise regarding the actual process of euthanasia. What exactly occurs when a pet is euthanatized? Is the animal aware of what is happening? Is he in pain during the euthanasia process? What does the veterinarian use to help the pet die? The term euthanasia is derived from the Greek terms eu meaning good and thanatos meaning death. A good death would be one that occurs without pain or distress. Euthanasia is the act of producing a humane death in an animal. In order to produce a humane death, the techniques employed should result in rapid unconsciousness followed by cardiac or respiratory arrest. Also, the technique should minimize any stress and anxiety experienced by the animal prior to unconsciousness. If the animal appears anxious or distressed when presented for euthanasia, most veterinarians will administer a tranquilizer or sedative prior to the actual euthanasia injection. This ensures that the animal is restful and peaceful prior to the euthanasia. The tranquilizer may be given with a needle under the skin or in the muscle, or with pills which are taken orally. Generally it takes approximately 15 minutes for a tranquilizer to help the pet relax. Most veterinarians use an injectable drug, most commonly pentobarbital, which is given in a vein. This barbiturate depresses the central nervous system beginning with the cerebral cortex, the part of the brain that determines awareness. The pet will lapse into unconsciousness, and then progress to anesthesia (the absence of pain). With an overdose of pentobarbital, deep anesthesia is followed by the stopping of breathing and then by cardiac arrest.Death Euthanasia Research Paper The advantages of using a barbiturate are the speed of action and the very minimal discomfort to the animal (the only pain being associated with the needle puncture). To inject the euthanasia solution, a vein is first prepared by painlessly clipping away the hair. A needle may be inserted directly into the vein and the euthanasia solution slowly injected, or a catheter (a small plastic tube) may be inserted in the vein and the injection given through it. Most animals die quickly, within ten seconds. Their eyes remain open and some animals urinate and defecate following death. Some animals gasp after they have died and may even twitch. These normal, mechanical responses can be very disconcerting to pet owners who stay with their pets during euthanasia if the owners are not prepared in advance. The decision for euthanasia is a difficult one, but the actual process is painless and very quick, granting our beloved pets a peaceful ending to their lives. Pet owners should feel free to discuss all questions concerning the euthanasia process with their veterinarians, so that they may be as comfortable as possible with their decisions. There are many different beliefs about the nature and meaning of death. But, regardless of belief, most people will agree that death should occur in as calm, relaxed, peaceful, and even exquisite a manner as possible. Unfortunately that is not the way death usually occurs when animals are killed with the customary method, lethal injection.Death Euthanasia Research Paper The main problem with lethal injection does not seem to be the drugs, since they work very quickly and apparently painlessly. The problem is the pain and fright caused by the injection itself. In the standard procedure, the cat is brought into the room where it is to be euthanized. Then, because the injection is expected to hurt the animal and cause it to struggle or even break off the needle, an assistant holds it very tightly, while the vet gives it the injection. The strange room is already unsettling for any sensitive animal, especially the typical home-owned pet. But being forcibly held, as well as the sight of the needle, frightens it. The pain of the injection then makes a bad situation even worse and the drug works so quickly that the animal has no time to calm down and become tranquil. It dies in a state of fear and trepidation. Humans may take painful injections for granted, but they frighten animals out of their wits. Our institutes own experience provides insight into the dilemma. Since they have the most sensitive hearing of all tested animals, The Anstendig Institute has been keeping cats for research purposes. But we had the misfortune of having an outbreak of FIP (Feline Infectious Peritonitis) and four cats had to be put to sleep.Death Euthanasia Research Paper The first, an exquisite blue-eyed, color-point Cornish Rex kitten, had been in intensive care before we were advised by the veterinary clinic at U.C. Davis that nothing more could be done for her. When it came time to put her to sleep, the catheters from the intravenous feedings were still attached and the fluid could be painlessly injected into the catheter. She did not have to be forcibly held still or pierced with a needle. I was able to hold her in tender communion and she had an exquisite, painless death experiencing all the love she had grown used to in her short life. In fact, it happened so gently, quietly, and quickly that the doctor had to tell me it was over. The only complaint was that the substance worked too quickly. But the next victim, a rare Sphynx kitten had no such luck: he was not as wasted as the girl when he was diagnosed, but the vet recommended euthanasia because there is no known cure for the disease.1 At my request, the veterinarian gave the little boy a tranquilizing shot before the lethal injection. But, to my surprise, the final injection still caused the baby a great deal of fright and pain and I was just barely able to calm him down before he died in my arms. If I had not used certain yoga disciplines that allowed me to use my own breath to calm his, the poor little boy would have died in a panic of fear, agitation, and pain.Death Euthanasia Research Paper In the late twentieth century superbly complicated miracles of medicine are taken for granted. Dentists and doctors can, after an initial application of analgesic, make painless even the most excruciating procedures. It is unacceptable that the final lethal injection caused that baby any pain whatsoever. His spirit should have been able to depart his body as peacefully and exquisitely as that of the other kitten. Veterinary medicine has not yet understood the need to work out an elegant, painless, peaceful method of killing and the important question is why? We were saved many hours of pondering this question by an incident that happened at U.C. Davis: when the doctor informed us that the girl would have to be put to sleep, I acquiesced, but requested that I be present so that she could die in my arms. U.C. Davis is a veterinary school and the doctors students were in the examining room learning from his methods in handling real-life cases. When I said I wanted to be present when my kitten was put to sleep, the doctor launched into what obviously was meant to demonstrate the accepted method of handling such a request. He tried to discourage me, for my own sake, from being present, pointing out that many people find the experience different from, and much more unsettling than they expected. But I answered that we have a special, sensitive communication with our cats at our institute; that this kitten was used to a lot of love and that we wanted it to have that love when it departed this world. That apparently simple statement had a surprising effect on those in the room. The doctor and his students stopped dead in their tracks. For a good minute there was absolute silence and stillness. Everyone was frozen in deep thought. No one moved. Finally the doctor relaxed and took a deep breath, at which time, one of the students blurted out We never thought of it that way. We never thought of it from the cats point of view. It then came out that, because veterinarians always have to deal with the owners, who are usually more difficult to deal with than the patients, they had come to view everything, even euthanasia, from the owners point of view and not from the point of view of what would be most humane and beautiful for the animal.Death Euthanasia Research Paper This is, by no means, an indictment of veterinarians. Vets do have to deal with the owners, as well as the pets. And it often takes a great deal of effort to convince the owners to give the animals the treatment they deserve, with the resulting emphasis on dealing with the owners and not the pets. But that is not the only reason veterinary medicine has not yet established a humane, painless method of euthanizing pets. The dominance of human medicine in our thinking has made pain, especially the pain accompanying injections, an accepted part of our lives. Because we all have to undergo this pain rather often, we are oriented towards putting it out of our minds. Everyone develops his/her own grin and bear it and be a man form of coping with injections, as well as other painful forms of treatment. We tend to put out of our minds the fact that they do hurt. Of course, a poor animal does not have this power to rationalize and resign itself to pain. It is simply scared by the syringe and the strange environment and shocked by the pain. It dies a fearful, agitated, unhappy death, no matter how swiftly and painlessly the solution does its work. Richard Wagner once remarked how he had no sympathy for the plight of man because man has, after all, the power of resignation. But he had great sympathy for animals because they do not have this power of resignation. When traditional euthanasia by injection is recommended by a vet for a beloved pet, the owners are given the impression that it is a painless way of saving their animal much suffering and providing the animal with a quick beautiful death, attended by loving hospital personnel. But, even with the best-intentioned veterinarians, this is just not the case. Veterinary medicine has to rethink its approach to euthanasia. It must realize that, unlike human medicine, in which no pain and suffering is too great to inflict on the patient if it will save a life, animal medicine needs a different approach. A method must be found to put animals to sleep gently and peacefully in a loving and caring manner. And that method really should be standard procedure for all hospitals.Death Euthanasia Research Paper If such a method of euthanasia should prove too expensive or impractical for hospitals like the SPCA that euthanize thousands of strays at their own cost, it should at least be available for pets, whose owners want to pay for it. We were ready to pay any necessary costs. But a suitable method had never been worked out. We had this experience with three doctors, all of whom had to improvise. Except for the girl with the catheters, we were unable to get any doctors to perform euthanasia in a truly painless manner in a suitably calm environment. Some of the surroundings were hectic and the injections into the artery invariably caused great pain. Even if the substances used in lethal injection are the most painless and efficient method, a way must still be found to both gently tranquilize the animal and numb the area to receive the injection beforehand, so that the final injection does not cause any pain or upset whatsoever. After the initial tranquilization, time must be left for the animal to relax and calm down before giving it the final (painless) injection. The surroundings should be quiet and peaceful and the animal should be treated with love and affection. Such an approach may take more time, but a well organized animal hospital should be able to devise an elegantly rational arrangement that allows the necessary procedures with little extra demands on the doctors time. One of us (JDB) was recently attending on a clinical service where a situation arose that prompted a discussion concerning assisted suicide. It revealed a surprising lack of consensus among physicians regarding the difference between assisted suicide and euthanasia, as well as an appalling level of confusion about basic facts. Such a situation is disconcerting, given that good ethical decision-making requires getting the facts straight as an essential first step. It may be understandable that personal perspectives will vary on matters such as physician-assisted suicide (PAS) and euthanasia, particularly in our pluralistic societies. However, it is unacceptable that conversations of a professional nature would proceed in the absence of agreement on relevant first principles and without a shared knowledge base. It would be akin to a cadre of interventional cardiologists, equipped with a shaky grasp of the vascular anatomy of the myocardium, debating the merits of an innovative approach to intracoronary stenting.Death Euthanasia Research Paper This article addresses such lacunae in relation to euthanasia and PAS. (We will use the word euthanasia to include PAS except where we state otherwise or it is clear we are dealing with the issues separately). We define euthanasia and assisted suicide, reveal common misconceptions in this regard, and expose euphemisms that, regrettably, often serve to confuse and deceive. We review the main arguments advanced by proponents and opponents of legalizing euthanasia. The philosophical assumptions guiding our perspectives are laid out. We consider the effect of legalization on patients and their families, physicians (as individuals and a collectivity), hospitals, the law, and society at large. Our goal is to provide a vade mecum useful in end-of-life care and ethical decision-making in that context. Definitions Euthanasia Euthanasia is an emotionally charged word, and definitional confusion has been fermented by characterizations such as passive versus active euthanasia. Some have suggested avoiding using the word altogether.1,2 We believe it would be a mistake to abandon the word, but we need to clarify it. The words etymology is straightforward: eu means good and Thanatos means death. Originally, euthanasia meant the condition of a good, gentle, and easy death. Later, it took on aspects of performativity; that is, helping someone die gently. An 1826 Latin manuscript referred to medical euthanasia as the skillful alleviation of suffering, in which the physician was expected to provide conditions that would facilitate a gentle death but least of all should he be permitted, prompted either by other peoples request or his own sense of mercy, to end the patients pitiful condition by purposefully and deliberately hastening death.3 This understanding of euthanasia is closely mirrored in the philosophy and practice of contemporary palliative care. Its practitioners have strongly rejected euthanasia.4 Recently, the noun has morphed into the transitive verb to euthanize. The sense in which physicians encounter it today, as a request for the active and intentional hastening of a patients demise, is a modern phenomenon; the first sample sentence given by the Oxford English Dictionary to illustrate the use of the verb is dated 1975.5 The notion of inducing, causing, or delivering a (good) death, so thoroughly ensconced in our contemporary, so-called progressive values cultural ethos, is a new reality. That fact should raise the question: Why now? The causes go well beyond responding to the suffering person who seeks euthanasia, are broad and varied, and result from major institutional and societal changes.Death Euthanasia Research Paper Physicians need a clear definition of euthanasia. We recommend the one used by the Canadian Senate in its 1995 report: The deliberate act undertaken by one person with the intention of ending the life of another person in order to relieve that persons suffering.7 Terms such as active and passive euthanasia should be banished from our vocabulary. An action either is or is not euthanasia, and these qualifying adjectives only serve to confuse. When a patient has given informed consent to a lethal injection, the term voluntary euthanasia is often used; when they have not done so, it is characterized as involuntary euthanasia. As our discussion of slippery slopes later explains, jurisdictions that start by restricting legalized euthanasia to its voluntary form find that it expands into the involuntary procedure, whether through legalizing the latter or because of abuse of the permitted procedure. In the Netherlands, Belgium, and Lichtenstein, physicians are legally authorized, subject to certain conditions, to administer euthanasia. For the sake of clarity, we note here that outside those jurisdictions, for a physician to administer euthanasia would be first-degree murder, whether or not the patient had consented to it. Assisted suicide Assisted suicide has the same goal as euthanasia: causing the death of a person. The distinction resides in how that end is achieved. In PAS, a physician, at the request of a competent patient, prescribes a lethal quantity of medication, intending that the patient will use the chemicals to commit suicide. In short, in assisted suicide, the person takes the death-inducing product; in euthanasia, another individual administers it. Both are self-willed deaths. The former is self-willed and self-inflicted; the latter is self-willed and other-inflicted. Although the means vary, the intention to cause death is present in both cases.Death Euthanasia Research Paper Some will argue that agency is different in assisted suicide and euthanasia; in the former, the physician is somewhat removed from the actual act. To further this goal, two ethicists from Harvard Medical School in Boston, Massachusetts, USA, have proposed strategies for limiting physician involvement in an active death-causing role.8 It is, indeed, the case that patients provided with the necessary medication have ultimate control over if, when, and how to proceed to use it; they may change their mind and never resort to employing it. However, in prescribing the means to commit suicide, the physicians complicity in causing death is still present. There are, however, some limits on that complicity, even in the jurisdictions where it has been legalized. For instance, even supporters of PAS in those jurisdictions agree it is unethical for physicians to raise the topic with individuals, as that might constitute subtle coercion or undue influence, whether or not intended. PAS has been decriminalized in Oregon, Washington State, Montana, and Vermont, and absent a selfish motive, assisted suicide is not a crime in Switzerland.9 Even in these jurisdictions, however, one cannot legitimately speak of a right to suicide because no person has the obligation to assist in the suicide. Rather, assisting suicide has been decriminalized for physicians in the American states listed and for any person in Switzerland; that is, it is not a criminal offence for those who comply with the applicable laws and regulations. Terminal sedation and palliative sedation A lethal injection can be classified as fast euthanasia. Deeply sedating the patient and withholding food and fluids, with the primary intention of causing death, is slow euthanasia. The use of deep sedation at the end of life has become a more common practice in the last decade and has been the focus of controversy and conflict, especially because of its probable abuse.Death Euthanasia Research Paper Certain terminology, such as palliative terminal sedation, creates confusion between sedation that is not euthanasia and sedation that is euthanasia. It was used, for example, by the Quebec Legislative Assembly in drafting a bill to legalize euthanasia.10 We note that creating such confusion might constitute an intentional strategy to promote the legalization of euthanasia. In the amended bill, the term palliative terminal sedation was replaced by continuous palliative sedation, which the patient must be told is irreversible, clearly indicating the legislatures intention to authorize slow euthanasia, although many people might not understand that is what it means. The bill died on the order paper when a provincial election was called before it was passed. Immediately after the election the bill was reintroduced at third reading stage by unanimous consent of all parties and passed by a large majority. This new law allowing euthanasia in Quebec, the only jurisdiction in North America to do so, remains the focus of intense disagreement and is now being challenged as ultra vires the constitutional jurisdiction of Quebec. Palliative sedation, which is relatively rarely indicated as an appropriate medical treatment for dying people, is used when it is the only reasonable way to control pain and suffering and is given with that intention. It is not euthanasia. Terminal sedation refers to a situation in which the patients death is not imminent and the patient is sedated with the primary intention of precipitating their death. This is euthanasia. The terms palliative terminal sedation and continuous palliative sedation confound these two ethically and legally different situations.Death Euthanasia Research Paper Euthanasia advocates have been arguing that we cannot distinguish the intention with which these interventions are undertaken, and therefore, this distinction is unworkable. But the circumstances in which such an intervention is used and its precise nature allow us to do so. For instance, if a patients symptoms can be controlled without sedation, yet they are sedated, and especially if the patient is not otherwise dying and food and fluids are withheld with the intention of causing death, this is clearly euthanasia. Needing to discern the intention with which an act is carried out is not unusual. For instance, because intention is central to determining culpability in criminal law, judges must do so on a daily basis. We note, also, that intention is often central in determining the ethical and moral acceptability of conduct, in general. Within the realm of decision-making in a medical context, withdrawal of artificial hydration and nutrition has continued to be a very contentious issue in situations in which persons are not competent to decide for themselves about continuing or withdrawing this treatment. The questions raised include: When does its withdrawal constitute allowing a person to die as the natural outcome of their disease (when it is not euthanasia)? And when does its withdrawal constitute starving and dehydrating a person to death (when it is euthanasia) Angels of Death, which reports on Magnussons study of the euthanasia underground within the HIV/AIDS communities principally in Sydney, Melbourne, and San Francisco, is, in many respects, a unique work. It is written by a legal scholar but is quite deliberately non-legalistic; indeed, Magnusson makes clear his intention is not to create another manifesto but to inject new perspectives into the euthanasia debate. The books underlying methodology also sets it apart. It is based on the authors own extensive empirical research, drawing on data gathered over three years in the course of indepth, face to face interviews with healthcare workers in Australia and the USA who have been involved in caring for people with AIDS. This kind of empirical research is not often undertaken by lawyers, and while a number of studies into attitudes and practices of healthcare professionals in relation to euthanasia have been carried out by researchers from other disciplines, very few have involved interview based research, relying instead predominantly on surveys.1 By any measure, Magnussons research has been undertaken with meticulous care. He i
NR501 Entire Course Work Latest
NR501 Entire Course Work Latest NR501 Entire Course Work Latest NR 501 Week 1 Discussion Latest Importance of Theory in Nursing (graded) Class, you may begin posting in this TD on October 23, 2016 for credit. The outcome for week 1 is as follows: Permalink: https://nursingpaperessays.com/ nr501-entire-course-work-latest / Analyze theories from nursing and relevant fields with respect to their components, relationships among the components, logic of the propositions, comprehensiveness, and utility to advanced nursing. (PO#1) It is essential to understand why the nursing profession has a theoretical framework. The existence of a theoretical framework is one attribute that makes nursing a profession. Nursing theory is designed to define and construct the framework for nursing practice. Nursing theory may be used to provide structure and organization when collecting data and explaining nursing practice (McEwen & Willis, 2014). Nursing theory is also used to advance nursing practice. As you read through the assigned chapters, carefully examine the theory that best fits your nursing practice. When reviewing the theories that best fits your nursing practice, consider how your personal values that you hold are reflected in the nursing theories. Reflect on the following questions. Why is nursing theory important to the nursing profession? What theoretical concepts do you believe are most significant to your nursing practice? Identify the nursing theory that has been implemented in your current clinical setting. McEwen, M., & Wills, E. (2014). Theoretical basis for nursing. (4th ed.). Philadelphia, PA: Lippincott Williams and Wilkins. Dr. Kari Luoma For many students enrolled in NR 501, this is an initial course for nursing theory. So, lets have a debate!!! Is nursing theory important to the nursing profession? If you believe that it is important, explain why it is useful. If you do not believe that it is useful, explain why nursing theory is not necessary to the profession? Be sure to provide an example that demonstrates your opinion and a scholarly reference (not using the required textbook or lesson) which supports your opinion. NR501 Entire Course Work Latest NR 501 Week 2 Discussion Latest Significance of Nursing Paradigms within the Profession (graded) This week you will be discussing the Metaparadigm concepts and how each of these impacts your practice. Metaparadigms that are included for the profession of nursing includes; health, person, environment, and nursing. The structure of the Metaparadigm provides a meaningful and logical way to clarify ones beliefs concerning each of the components. This allows you to see how these beliefs come together as a whole and shape your professional nursing practice. For the first question this week, you will demonstrate an understanding of the term metaparadigm. The traditional metaparadigms are person, health, environment, and nursing, by your discussion may expand to more non-traditional metaparadigms including: social system; role; interpersonal relations; caring; and cultural context. There are many clinical issues in which the connection to one component will be more pronounced, but the other three will still have some role. Think of the Metaparadigm as a structure to demonstrate the holistic nature of nursing. As you begin, take a moment and reflect on the following course/program outcome: Analyze theories from nursing and relevant fields with respect to their components, relationships among the components, logic of the propositions, comprehensiveness, and utility to advanced nursing. (PO #1) This lesson presents the four paradigms of the nursing professionperson, environment, health and nursing profession. Select an area of the nursing profession (i.e. education, executive, and informatics, healthcare policy, advanced clinical practice) and apply EACH of the paradigms to the selected area. Be sure to apply EACH of the paradigms and include an example that demonstrates the application to the practice area. Dont forget to support your initial posting with scholarly references. NR 501 Week 3 Discussion Latest Steps of Concept Analysis (graded) As you begin, take a moment and reflect on the following course/program outcome: Demonstrate logical and creative thinking in the analysis and application of a theory to nursing practice. (PO #4) In order to begin this discussion, it is important to first reflect on the steps involved in concept analysis. Wills & McEwen (2014) include a table identifying the steps of concept analysis (derived from Walker & Avant, 2005). The steps include the following: 1) select a Concept; 2) determine the aims or purpose of the analysis; 3) identify all the uses of the concept possible; 4) determine the defining attributes 5. Identify model case; 6) Identify borderline, related, contrary, and illegitimate cases; 7) Identify antecedents and consequences; and 8) Define empirical referents. (p. 58). See Box 3-1. See you in the threaded discussions. In your response to this question, I want you refer back to the steps of concept analysis that are explored in the chapter. Identify a concept and show how you would apply the concepts in your current practice. Take this response as far as you can go in terms of a basic concept analysis. Please make an attempt to reflect a clear and diligent attempt of applying the steps. I look forward to seeing you in the threaded discussions. NR501 Entire Course Work Latest Reference Wills, E. & McEwen, M. (2014). Concept development: Clarifying meaning of terms. In M. McEwan & E.M. Wills (Eds.), Theoretical basis for nursing (4th. ed.; pp. 49-71). Philadelphia, PA: Lippincott, Williams, & Wilkins. Dr. Kari Luoma At the end of Week 4 your concept analysis is due. This threaded discussion provides an opportunity to start this assignment. Select a nursing concept (be sure to use a nursing theory) and then provide a response to each one of the steps included in a concept analysis regarding your selected concept. This information does not have to be comprehensive but provides a foundation to the upcoming assignment. Be sure to include a scholarly reference. NR 501 Week 4 Discussion Latest Connection Between Theory and Advanced Clinical Practice (graded) As you begin this week, please reflect on the following relevant course/program outcomes: Analyze theories from nursing and relevant fields with respect to their components, relationships among the components, logic of the propositions, comprehensiveness, and utility to advanced nursing. (PO #1) Examine instances where theory is used to guide the development of new knowledge and implementation of evidence-based practice. (PO #6) As you prepare your response, there are some items for you to consider. You will select a grand nursing theory. When you do so, you need to be prepared not only to identify a grand theory that will guide you in sharing what characteristics your selected theory has that substantiate the fact that it is a grand theory. Please provide specific examples. Once you have accomplished this, you will then share a specific example that includes your chosen grand theory and how it can or cannot be readily applied in clinical practice. I look forward to the threaded discussion. Dr. Kari Luoma Some nurses say that theory has no role in advance clinical practice. How would you use nursing theory to improve advanced clinical practice? Be sure to include an example that demonstrates your thoughts. Dont forget to include a scholarly reference! NR501 Entire Course Work Latest NR 501 Week 5 Discussion Latest Borrowed (non-nursing) Theories Applied to the Nursing Profession (graded) Week 5 Threaded Discussion 2 course outcome is as follows: Analyze theories from nursing and relevant fields with respect to their components, relationships among the components, logic of the propositions, comprehensiveness, and utility to advanced nursing. (PO #1) This weeks question focuses on the debate concerning the use of or avoidance of borrowed theories in nursing education, research, as well as other practice areas. Thinking of theories from non-nursing disciplines may become a dynamic discussion concerning whether nursing is a unique profession and whether it demonstrates all of the characteristics of a profession. In the initial development and application of nursing theories, many nurses tried to apply non-nursing theories to the profession with varying degrees of success. Especially in the areas of leadership/administration and education, non-nursing theories are frequently used. For example, adult learning theory is frequently applied to nursing education. In this threaded discussion, select a non-nursing theory and apply it to the profession. Dont forget to include an example of its application. Please answer the following: While the focus of this course is nursing theory, frequently the use of non-nursing or borrowed theories occurs. Select a nursing practice area (i.e. education, executive, advance clinical practice, informatics, and health care policy); then identify a non-nursing (borrowed) theory; and apply it to the area you have selected. Be sure to provide an example of how the non-nursing theory can be used to enhance the selected practice area. Dont forget to include scholarly reference(s) to support your information. NR 501 Week 6 Discussion Latest Impact of Nursing Theory Upon Healthcare Organization (graded) Below are a few examples of items you may want to discuss. You may want to initiate the discussion by identifying a specific situation (i.e. early discharge of a patient before sufficient education about ostomy care has been completed) and ask for interventions (based from a specific theory) that could have been beneficial in preventing the identified situation. Expand discussion of theory and management away from institutionalized healthcare to community settings including Third World countries. Expand discussion by applying a middle range nursing theory to this situation. Course Outcome 2. Propose strategies for use of relevant theories that nurse leaders can employ in selected healthcare or educational organizations considering legal and ethical principles. (PO #2, 6) Course Outcome 3. Communicate the analysis of and proposed strategies for the use of a theory in nursing practice. (PO #3) See you in the threaded discussions. Please answer the following question: Discuss how a specific middle-range nursing theory has been or could be applied by nurse leaders or nurse managers to effectively deal with an administrative issue (i.e., staffing, use of supplies, staff performance issues). Include an example from the literature or your own experience to illustrate your points. NR501 Entire Course Work Latest NR 501 Week 7 Discussion Latest Nursing Theory Applied to Research or Education (graded) This week, we will discuss the extent a nursing theory drive or provide a framework for your undergraduate education. We will discuss which theory was used and you will provide a brief description of the theory and explain the effectiveness of the theory in relation to your undergraduate education. The majority of the state boards of nursing require an organizing framework be identified for undergraduate nursing programs. Also, the national accrediting agencies of the National League for Nursing (NLN) and American Association of Colleges of Nursing (AACN) have noted in their accreditation standards the need for an organizing framework. There is a complementary relationship between theory and research. Research conducted with either philosophical theory to clarify, modify, and/or extend a nursing theory. This week, we will look at research studies that does not describe or name a theory or conceptual framework. We will discuss what consequences, if any, is there from the absence of a guiding framework or theory? This weeks course outcomes are directly related to this weeks discussions: 2). Propose strategies for use of relevant theories that nurse leaders can employ in selected healthcare or educational organizations considering legal and ethical principles. (PO #2, 6) 5). Recommend strategies for the use of theory as the basis for actions of advanced nursing practice in leadership and education. (PO #5) Please answer the following question: The content for this week focused on applying nursing theory to research and education. Select one area (either research or education), select a nursing theory and then apply the selected nursing theory to the area. For example, how could theory be used to select a research topic? How nursing theory would be used within the classroom or clinical setting? Be sure to provide an example that demonstrates the application to either research or education. Dont forget to include a scholarly reference. NR501 Entire Course Work Latest NR 501 Week 8 Discussion Latest Course Reflection and Future Application (graded) In this last week of class, we ask you to reflect on all you have learned these past weeks. Describe how you as an advanced nurse will interpret and apply theory in your practical environment (i.e., leadership or education) compared to when you first started this course. When did the paradigm shift in your thinking occur? Describe your shift in thinking with details and examples. Describe your relevant actions, thoughts, and feelings, as well as the situations specific circumstances and features. Relate how you did or would in a similar situation in the future apply what you have learned in this course. We can meet the course objectives by reflecting on the theories that nurse leaders can employ in your own work environment. This week, we will discuss all you have learned in these past weeks. Relate how you did or would in a similar situation in the future apply what you have learned in this course. The course outcomes for this week are directly related to this weeks discussions: 2) Propose strategies for use of relevant theories that nurse leaders can employ in selected healthcare or educational organizations, considering legal and ethical principles. (PO #2, 6) Throughout the discussions occurring within NR 501, a common element has been application of theory. In this our last discussion regarding theory, it is time to focus on you and your capstone experience (yes, it is never too early consider this major project!). While it is too early to identify your project, lets consider on your future practice area as this is the setting your project will occur in. Based upon your self-reflection and use of nursing theory within the discussions and assignments, select ONE nursing theory that you prefer and answer the following questions: 1. Why do you prefer the nursing theory you selected? 2. How can this theory be used in your current practice area (education, executive, advanced clinical practice, informatics, or healthcare policy)? 3. How can this theory be used in your future practice area (education, executive advanced clinical practice, informatics or healthcare policy)? Dr. Luoma NR501 Entire Course Work Latest NR 501 Week 2 Importance of Theory Latest PURPOSE The purpose of this assignment is to a) identify a nursing theory, b) analyze the importance of the selected theory to the nursing profession, c) summarize key concepts and relationships among the concepts of the selected nursing theory, d) present views of the selected theory on areas of specialization, and e) communicate ideas in a clear, succinct, and scholarly manner. COURSE OUTCOMES Through this assignment, the student will demonstrate the ability to: (CO#1) Analyze theories from nursing and relevant fields with respect to their components, relationships among the components, logic of the propositions, comprehensiveness, and utility to advanced nursing. (PO1) (CO#3) Communicate the analysis of and proposed strategies for the use of a theory in nursing practice. (PO3, 7, 10) (CO#4) Demonstrate logical and creative thinking in the analysis and application of a theory to nursing practice. (PO4, 7). NR501 Entire Course Work Latest DUE DATE Sunday 11:59 PM MT at the end of Week 2 TOTAL POINTS POSSIBLE: 100 REQUIREMENTS Description of the Assignment This assignment focuses on the importance of nursing theory within the profession. Selecting one nursing theory (non-nursing theories are not allowed), the nursing theory will be presented by identifying the key concepts present within the theory. The selected nursing theory will then be applied to ONE of the following professional nursing practice areas: Education (e.g. undergraduate, staff development, etc.) Leadership (e.g. nurse executive, manager, leader, etc.) Informatics (e.g. data management, etc.) Healthcare policy (e.g. application to local, state, national, or global healthcare concerns, etc.) Nurse practitioner Criteria for Content 1. Introduction: The introduction requires the following information. Statements about nursing theory in general Identification of the ONE nursing theory (non-nursing theories are not allowed) selected by the student to be used within this assignment. The specific selected nursing theory may be from any of the three categories of nursing theory (i.e. grand, middle-range, or practice), but must be a specific nursing theory (i.e. Orem, Roy, Benner, etc.); a category may not be used. Identification of the sections of the paper. References from nursing literature are required. 2. Importance of Nursing Theory: This section requires the following information. Present an analysis of the importance of nursing theory, in general, to the nursing profession. Each of the following questions are to be answered. o Why should the study of nursing theory be included in a masters program? o How is nursing theory useful to the nursing profession? o How can nursing theory be used to separate the nursing profession from other healthcare professions? o What would be ONE concern regarding the use of nursing theory within the profession? References from nursing literature are required. 3. Summary of Selected Nursing Theory: This section requires the following information. Present the name and author of the selected nursing theory (bibliographic and historical information about the theory or theorist is NOT included). Identify when the nursing theory was initially published and the latest edition of the selected nursing theory. Provide a summary of the key concepts contained within the selected nursing theory. Provide a detailed description of how this nursing theory addresses each of the metaparadigms/ concepts (person, health, environment, and nursing profession) associated with nursing. Identify why this nursing theory selected and its potential use within the students selected Masters track (i.e. education, leadership, informatics, healthcare policy, or nurse practitioner) References from nursing literature are required. 4. Application of Specific Nursing Theory to Selected Professional Nursing Practice area: This section includes the following elements: Present a discussion of how the selected nursing theory defines and explains one of the following professional nursing practice areas: o Education (e.g. undergraduate, staff development, etc.) o Leadership (e.g. nurse executive, manager, leader, etc.) o Informatics (e.g. data management, etc.) o Healthcare policy (e.g. application to local, state, national, or global healthcare concerns, etc.) o Nurse practitioner Present 2 (two) examples illustrating the above information. Professional examples come from a students own practice experiences or from the scholarly literature. If the example is from the students experience, identify this as the source by using the first person in describing the example. Keep each example succinct (about 1 3 paragraphs). References from nursing literature are required. 5. Conclusion: This section includes the following elements: Summarizes presented information regarding theory in general and its use within the nursing profession Summarizes the selected nursing theory. Presents self-reflection regarding what was learned from writing this assignment. Criteria for Format and Special Instructions 1. A nursing theory was used. 2. This assignment must be submitted to TurnItIn, as required by the TurnItIn policy. A Similarity Index of blue or green must be obtained. A score in the blue or green range indicates a similarity of less than 24% which is the benchmark for CCN graduate nursing students. Any other level of similarity index level requires the student to revise the assignment before the due date and time. To allow sufficient time for revision, early submission of the assignment to TurnItIn is highly encouraged. The final submission will be graded by faculty. If a Turnitin report indicates that plagiarism has occurred, the Academic Integrity policy will be followed. NR501 Entire Course Work Latest 3. A minimum of 4 (four) scholarly references must be used. A dictionary, required textbooks for this course, and Chamberlain College of Nursing lesson information may NOT be used as scholarly references for this assignment. References are current within a 5-year time frame unless a valid rationale is provided and the instructor has approved them. For additional information regarding scholarly resources, please see What is a scholarly source? located in the Course Resource tab. Information from .com websites may be incorrect. 4. Title page, running head, body of paper, and reference page must follow APA guidelines as found in the 6th edition of the manual. This includes the use of headings for each section of the paper except for the introduction where no heading is used. 5. The paper (excluding the title page and reference page) should be at least 5, but no more than 7 pages. Points will be lost for not meeting these length requirements. 6. Ideas and information that come from scholarly sources must be cited and referenced correctly. 7. Rules of grammar, spelling, word usage, and punctuation are followed and consistent with formal, scientific writing. 8. PLEASE note: Do not rely on .com sites to identify the nursing theory as they do not provide accurate information in all cases. PREPARING THE ASSIGNMENT Criteria for Format and Special Instructions 9. This assignment must be submitted to TurnItIn, as required by the TurnItIn policy. A Similarity Index of blue or green must be obtained. A score in the blue or green range indicates a similarity of less than 24% which is the benchmark for CCN graduate nursing students. Any other level of similarity index level requires the student to revise the assignment before the due date and time. To allow sufficient time for revision, early submission of the assignment to TurnItIn is highly encouraged. The final submission will be graded by faculty. If a Turnitin report indicates that plagiarism has occurred, the Academic Integrity policy will be followed. 10. A minimum of 4 (four) scholarly references must be used. A dictionary, required textbooks for this course, and Chamberlain College of Nursing lesson information may NOT be used as scholarly references for this assignment. References are current within a 5-year time frame unless a valid rationale is provided and the instructor has approved them. 11. Title page, running head, body of paper, and reference page must follow APA guidelines as found in the 6th edition of the manual. This includes the use of headings for each section of the paper except for the introduction where no heading is used. NR501 Entire Course Work Latest 12. The paper (excluding the title page and reference page) should be at least 5, but no more than 7 pages. Points will be lost for not meeting these length requirements. 13. Ideas and information that come from scholarly sources must be cited and referenced correctly. 14. Rules of grammar, spelling, word usage, and punctuation are followed and consistent with formal, scientific writing. 15. PLEASE note: Do not rely on .com sites to identify the nursing theory as they do not provide accurate information in all cases. NR 501 Week 4 Concept Analysis Latest Purpose This assignment provides the opportunity for the student to complete a concept analysis of a concept found in a nursing theory using an identified process. The assignment fosters analytical thinking related to the selected concept as well as application within the profession. Course Outcomes Through this assignment, the student will demonstrate the ability to: · (CO#1) Analyze theories from nursing and relevant fields with respect to their components, relationships among the components, logic of the propositions, comprehensiveness, and utility to advanced nursing. (PO1) · (CO#3) communicate the analysis of and proposed strategies for the use of a theory in nursing practice. (PO3, 7, 10) · (CO#4) · Demonstrate logical and creative thinking in the analysis and application of a theory to nursing practice. (PO4. 7) Due Date Sunday 11:59 PM MT at the end of Week 4 Total Points Possible: 250 Points Requirements Description of the Assignment This assignment presents a modified method for conducting a concept analysis of ONE concept found in a nursing theory. The source of the concept for this assignment must be a published nursing theory. The selected concept is identified and then the elements of the analysis process are applied in order to synthesize knowledge for application within the model and alternative cases. Non-nursing theories may NOT be used. The paper concludes with a synthesis of the students new knowledge about the concept. The scholarly literature is incorporated throughout the analysis. Only the elements identified in this assignment should be used for this concept analysis. Criteria for Content 1. Introduction The introduction substantively presents all following 4 (four) elements: · Identifies the role of concept analysis within theory development, · Identifies the selected nursing concept, · Identifies the nursing theory from which the selected concept was obtained, and · Names the sections of the paper. 2. Definition/Explanation of the selected nursing concept This section includes: · Defines/explains the concept using scholarly literature (a dictionary maybe used for this section ONLY, and additional scholarly nursing references are required), and · Information about the concept as discussed by the theorist from the selected nursing theory is substantively presented. A substantive discussion of this section with support from nursing literature is required. 3. Literature review This section requires: · A substantive discussion of at least 6 (six) scholarly nursing literature sources on the selected concept. · Themes, ideas, and/or facts about the concept found in the reviewed sources are presented in an organized fashion. Support from nursing literature is required. Please Note: Primary research articles about the selected nursing concept are the most useful resource for the literature review. 4. Defining attributes For this section: · A minimum of THREE (3) attributes are required. A substantive discussion of this section with support from nursing literature is required. Explanation: An attribute identifies characteristics of a concept. For this situation, the characteristics of the selected nursing concept are identified and discussed. 5. Antecedent and Consequence This section requires the identification of: · 1 antecedentof the selected nursing concept, and · 1 consequenceof the selected nursing concept. A substantive discussion of the element with support from nursing literature is required. Explanation: An antecedent is an identifiable occurrence that precedes an event. In this situation, an antecedent precedes a selected nursing concept. A consequence follows or is the result of an event. In this situation a consequence follows or is the result of the selected nursing concept. 6. Empirical Referents This section requires the identification of: · 2 (two) empirical referents of the selected nursing concept. A substantive discussion of the element with support from nursing literature is required. Explanation: An empirical referent is an objective ways to measure or determine the presence of the selected nursing concept. 7. Model Cases 1 model case is created by the student and discussed substantively by demonstrating within the case each of the following areas: · Definition, · All identified attributes, · Antecedent, · Consequence, and · Empirical referent or Measurement Information from selected nursing theory is applied to the created model case. A substantive discussion of the element with support from nursing literature is required. Explanation: A model case is an example of the hypothetical individual who demonstrates all of the attributes, antecedents, consequences, and referents noted previously in this assignment. NR501 Entire Course Work Latest 8. Alternative Cases This section requires: · The identification of 2(two) alternative cases correctly created and presented. The two required alternative cases are: · Borderline (absence of one or two of previously identified attributes of the selected nursing concept. · Contrary (demonstrates the complete opposite of selected nursing concept) Applies information from selected nursing theory. Explanation: Alternative cases represent the opposite of the model case. For this assignment, two alternative cases are required. These are: · Borderline case which is a created case where one or two of the previously identified attributes are missing. · Contrary case which is a created case that demonstrate the complete opposite of the selected nursing concept. 9. Conclusion This section requires: · Summarization of key information regarding: o Selected nursing concept, o Selected nursing theory, and o Application of concept analysis findings to advanced nursing practice. · The concluding statements include self-reflection on the new knowledge gained from conducting a concept analysis. NR501 Entire Course Work Latest Preparing the Assignment Criteria for Format and Special Instructions 1. The paper (excluding the title page and reference page) should be at least 8, but no more than 10 pages. Points will be lost for not meeting these length requirements. 2. Title page, running head, body of paper, and reference page must follow APA guidelines as found in the 6thedition of the manual. This includes the use of headings for each section of the paper except for the introduction where no heading is used. 3. The source of the concept for this assignment must be a published nursing theory. Non-nursing theories may NOT be used. 4. A minimum of 6(six) scholarly references must be used. Required textbooks for this course, and Chamberlain College of Nursing lesson information may NOT be used as scholarly references for this assignment. A dictionary maybe used as a reference for the section titled Definition/Explanation of the selected nursing concept, but it is NOT counted as one of the 6 required scholarly nursing references. For additional assistance regarding scholarly nursing references, please see What is a scholarly source located in the Course Resources tab. Be aware that information from .com websites may be incorrect and should be avoided. References are current within a 5-year time frame unless a valid rationale is provided and the instructor has approved them. 5. Ideas and information from scholarly, peer reviewed, nursing sources must be cited and referenced correctly. 6. Rules of grammar, spelling, word usage, and punctuation are followed and consistent with formal, scientific writing. 7. PLEASE note: Do not rely on .com sites to identify the nursing theory as they do not provide accurate information in all cases. NR501 Entire Course Work Latest Possible Concepts: The following concepts are not required; students may select one of these concepts or find another concept. Each selected concept must be associated with a nursing theory; the use of non-nursing theories is NOT allowed. If you have any questions regarding your concept or the nursing theory, please consult with your faculty member for assistance. · Behavioral system · Adaptation · Boundary lines · Comfort · Caring · Compassion · Empowerment · Engagement · Homeostasis · Leadership · Noise · Meaningfulness · Open system · Modeling · Palliative care · Pain · Resources · Pat
Emergency Plan For The Older Adult Essay Paper
Emergency Plan For The Older Adult Essay Paper Emergency Plan For The Older Adult Essay Paper Natural disasters, such as hurricanes, tornadoes, and blizzards, may force you to evacuate your home or shelter-in-place at short notice. It is important to know what to do in case of an emergency well before disaster strikes. If you are an older adult living in the community, you may face some challenges during an emergency. For example, you may have mobility problems, or chronic health conditions, or you may not have any family or friends nearby to support you. Support services that are usually available, such as help from caregivers or in-home health care and meal delivery services, may be unavailable for a period of time. In addition, older adults may experience challenges that come with advanced age, such as hearing or vision problems or cognitive impairment, which may make it difficult to access, understand, and respond to emergency instructions.Emergency Plan For The Older Adult Essay Paper You or the person you care for can be prepared for emergency situations by creating a plan, reviewing or practicing it regularly, and keeping an emergency supply kit. Permalink: https://nursingpaperessays.com/ emergency-plan-f dult-essay-paper / Emergency planning is important for older adults. The first step in preparing for an emergency is creating a plan. Work with your friends, family, and neighbors to develop a plan that will fit your needs. Choose a contact person who will check on you during a disaster, and decide how you will communicate with each other (for instance, by telephone, knocking on doors). Consider speaking with your neighbors about developing a check-in system together. Create a list of contact information for family members and friends. Leave a copy by your phone(s) and include one in your Emergency Supply Kit. Plan how you will leave and where you will go during an evacuation. If you are living in a retirement or assisted living community, learn what procedures are in place in case of emergencies. Keep a copy of exit routes and meeting places in an easy-to-reach place.Emergency Plan For The Older Adult Essay Paper Create a care plan and keep a copy in your Emergency Supply Kit. Try out CDCs easy-to-use care plan template Cdc-pdf . If you have medical, transportation, or other access needs during an emergency, consider signing up for SMART911, Code Red, or your local county registry, depending upon which service your area uses to helps first responders identify people who may need assistance right away. After an emergency, you may not have access to clean water or electricity. Make sure you are prepared with your own supply of food, water, and other items to last for at least 72 hours. Visit Ready.gov External for a list of basic items to gather for your Disaster Supply Kit. Medical-Related Items: A 3-day supply of medicine, at a minimum. If medications need to be kept cold, have a cooler and ice packs available. ID band (full name, contact number for family member/caregiver, and allergies) Hearing aids and extra batteries Glasses and/or contacts and contact solution Medical supplies like syringes or extra batteries Information about medical devices such as wheelchairs, walkers, and oxygen including model numbers and vender. Documents (Keep physical copies in a waterproof bag and take photos of each document for backup): Your Care Plan Cdc-pdf Contact information for family members, doctors, pharmacies and/or caregivers List of all medications, including the exact name of the medicine and the dosage, and contact information for pharmacy and doctor who prescribed medicine List of allergies to food or medicines Copies of medical insurance cards Copies of a photo ID Durable power of attorney and/or medical power of attorney documents, as appropriate.Emergency Plan For The Older Adult Essay Paper The elderly in America have many needs that can range from transportation, a little more money, and even just a little companionship but one of their major needs is advocacy. They need someone to stand up and fight with them for what the need. The elderly of today did so much for this country such things as fight both world wars and the Korean Conflict, they fought for equality, and the escalated this country to the greatness we have today. So what is an advocate? Advocate is a person or group that represents a common interest and goes to great lengths to see that their cause is not neglected. So why does our elderly need advocates? Our elderly need advocates for various reasons. Another service offered is protection against abuse and neglect. Many people such as family, friends, neighbors, and strangers who are scam artist, robbers, and murders can abuse the elderly. They also can be neglect by the same people but there is one more person on this list that is themselves. An older person can often neglect themselves because they dont have the money to pay for extra bills and proper healthcare or they may even feel that those things are just a part of aging. The Office for the Aging receive many calls from concerned family members and friends of elderly that they feel that that person is being neglected or abused. The office then will investigate and review the situation and decide the proper course of action.Emergency Plan For The Older Adult Essay Paper They also provide financial counseling on things like taxes, bills, balancing a checkbook, and budgeting. Financial counselors will sit down with an older person either in their office or at the home of the elderly person discuss the best option and how to go about following through with the plan. The Office for the aging also can assist in finding proper care centers when an older person either cannot or decide they do not want is in the community anymore. Depression is one of the most recurrently investigated psychological disorders within the area of medical R&D (Montorio & Izal, 1996). A number of exhaustive researches have been carried out to study its symptoms and impacts on different patients belonging to different personal and professional attributes and most of these researchers depicted that depression in the elderly people is very frequent and in spite of number of researches in this context, it is often undiagnosed or untreated. To add to this jeopardy, it has also been estimated that only 10% out of the total depressed elderly individuals receive proper diagnosis and treatment (Holroyd et al, 2000). Population: Adults, age 65 and older. Score: The inventory provides a Total Score and five Primary Dimensions: Negative Mood, Interpersonal Problems, Ineffectiveness, Anhedonia, and Negative Self Esteem. Time: 35 minutes Description: The DIE has been designed to measure depressive symptoms for elderly individuals. The self-administered inventory consists of 90 items related to such depressive symptoms as depressed mood, withdrawal, feelings of guilt and worthlessness, difficultly making decisions, vegetative functions, selfevaluation and interpersonal behaviors. Norms: The normative sample included 1266 retired individuals residing in Florida age 65 to 91. There were 350 men between the ages of 65 and 85, and 750 women ages 65 to 91. The population was mostly middle to upper class retirees.Emergency Plan For The Older Adult Essay Paper Scoring: The inventory uses a 5-point scale of distress (04), ranging from not at all (0) to extremely (4). The DIE yields raw scores and T scores for the Total Score and Primary Dimension scores. Results are hand scored. T scores above 65 on the Total Score and the Primary Dimensions are considered in the clinical range. Reliability: Internal consistency reliability has been found to be range from .71 to .89 with an assortment of The Practicality of the Elderly in Contemporary Society After reading Henry David Thoreaus Walden, I was mesmerized by a certain paragraph on page five. In said paragraph, Thoreau states how worthless the elderly actually are. He writes about them having no advice worth listening to and how any valuable experience he has gained throughout his life was not taught to him by his seniors. More specifically, he says I have lived some thirty years on this planet, and I have yet to hear the first syllable of valuable or even earnest advice from my seniors. This stance is magnanimously contradictory, as most of the world would be opposed to such ridicule. Ponder on the topic and ask if there truly is any usefulness of old people. I feel that there is some truth behind the Thoreaus diction. The elderly can grant no largess of economical gifts, however they do provide a strong basis for moral and ethical enlightenment. This essay will be divided into two main sections. The first section has four subdivisions while the second section has three. In section one, I will dive into the economic burdens old people place on the world. The first subdivision in this section will prove that old folks are economic burdens, followed by subdivision two where I tell of the simple change needed to fix that problem.Emergency Plan For The Older Adult Essay Paper As one ages, the body accumulates a myriad of multidimensional changes in the realms of physical, biological, psychological, and social alterations. These changes can manifest from a deficiency in one area or an abundance in another. According to the student nurse, these changes can be functional, potentially dysfunctional, or dysfunctional based on Gordons Functional Health Patterns. The student nurse conducts a similar interview and assessment process with each patient to gather subjective and objective data related to the health and wellness of the individual. The function of the student nurses interview process using Gordons Functional Health Patterns reflects the purpose of the interviewing an elderly individual This health pattern is dysfunctional with a nursing diagnosis of risk for falls related to difficulty with gait. This is the second priority mainly because of her history with two falls within the last year. The objective data supports this as the second priority due to an unsteady, hunched gait when ambulating and a scar on her head. When E.K. walks her face is looking down and her upper torso is hunched forward. The subjective data which supports this nursing diagnosis includes her admitting that she had two falls which resulted in minor injury within the past year. The scar on her head is from the most recent fall which resulted in several staples. Even though there are no stairs in her home, she accredited that both falls were due to losing her balance and not being able to prevent herself from falling to the ground. The accumulation of the objective and subjective data support this health pattern as dysfunctional and the second priority nursing diagnosis. The third priority nursing diagnosis is under the elimination health pattern.Emergency Plan For The Older Adult Essay Paper the Finnish parliaments future commission has listed challenges in elderly peoples lives that could be overcome using new technology. The two most important inhibiting factors affecting the quality of life of elderly people were identified as solitude and immobility (O Kuusi, 2001). The purpose of this research is to identify everyday motivational needs concerning communication and mobility of elderly people and present a show more content Technological solutions should contribute in travelling outside home and daily activities at home and near home. The commission has stated that solitude and immobility are the most important shortcomings that technology should attempt to alleviate (O Kuusi, 2001). Here are examples to show that researchers have started to see the importance of social and mobility needs. The importance of elderly peoples social, emotional and environmental factor needs have been found in recent researches (J abascal, 2001; KZ Haigh, J Phelps and CW Geib, 2002; T Hirsch et al., 2000 and JA Jore, 2001). They argued that designing eldercare technologies to address all these factors lowers social barriers. Nokia Mobile Phones and Work Science Laboratory in Oulu, Finland found out that the most beneficial services for elderly in the future are those by which they can maintain their social relationships, health and ability to live at home.Emergency Plan For The Older Adult Essay Paper Pain and Anxiety Associated with Falls in the Elderly The risk of falling dramatically increases as one ages. According to Menant et al, a fall is defined as an unexpected event in which the person comes to the ground, floor, or lower level. In this study conducted by Menant et al, the authors desired to distinguish certain factors that may contribute to falls associated with the elderly. Dizziness is a complaint that tends to increase as a person ages, which can also be said about the incidence of falling. According to Menant et al, dizziness symptoms can affect the activities of daily living in many elderly people. Many studies have found that dizziness can be a result from both medical and psychological factors. This study was conducted on 526 elderly individuals who were randomly selected to a dizzy and non-dizzy group from a previous cohort study in eastern Sydney, Australia. Each participant had to meet certain criteria and sign informed consent prior to partaking in this study. Participants were assessed through questionnaires & assessments. The questionnaires and assessments focused on aspects of dizziness, exercise levels, overall health, falls follow-up procedures, balance assessment, and cardiovascular, psychological, and neuromuscular function.Emergency Plan For The Older Adult Essay Paper This study uses interview data collected from public health departments and aging-in-place effortsspecifically, from coordinators of age-friendly communities and village executive directorsto explore how current aging-in-place efforts can be harnessed to strengthen the disaster resilience of older adults and which existing programs or new collaborations among public health departments and these organizations show promise for improving disaster resilience for older populations. Interviews with stakeholders revealed that most age-friendly communities and senior villages did not place a high priority on promoting disaster preparedness. While most public health departments conducted or took the lead on disaster preparedness and resilience activities, they were not necessarily tailored to older adults. Aligning and extending public health departments current preparedness activities to include aging-in-place efforts and greater tailoring of existing preparedness activities to the needs of older adults could significantly improve their disaster preparedness and resilience. For jurisdictions that do not have an existing aging-in-place effort, public health departments can help initiate those efforts and work to incorporate preparedness activities at the outset of newly developing aging-in-place efforts.Emergency Plan For The Older Adult Essay Paper The increasing frequency and intensity of weather-related and other disaster events combined with the growing proportions of older adults present a new environment in which public health programs and policies must actively promote the resilience of older adults. Preparedness programs conducted by public health departments are designed to reduce mortality and morbidity and, consequently, will become even more critical, given the increasing proportion of older adults in the United States, largely due to aging baby boomers. Interviews with stakeholders revealed that most age-friendly communities (AFCs) and senior villages did not place a high priority on promoting disaster preparedness. While most public health departments we interviewed did engage in disaster preparedness and resilience activities, they were not necessarily tailored to older adults. AFCs and senior village interviewees cited older adults challenges with communication and low prioritization of the need to plan for disasters. These organizations also acknowledged their limited awareness of disaster preparedness and lack of demand from their constituents to provide services to help their communities be better prepared. Current aging-in-place efforts can be harnessed to strengthen the disaster resilience of older adults. Existing programs and new collaborations between public health departments and these organizations show promise for improving disaster resilience for older populations.Emergency Plan For The Older Adult Essay Paper The work of public health departments and aging-in-place efforts is complementary. Improving the everyday engagement of older adults with family, friends, neighbors, and trusted institutions supports other organizations and agencies preparedness work by strengthening informal ties and building information networks. Likewise, the work of helping older adults become more resilient to disasters provides an opportunity for older adults to engage with others and learn skills needed to remain safely living at home as they age. Aligning and extending public health departments current preparedness activities to include aging-in-place efforts and greater tailoring of existing preparedness activities to the needs of older adults could significantly improve their disaster preparedness and resilience. For jurisdictions that do not have an existing aging-in-place effort, public health departments can help initiate those efforts and work to incorporate preparedness activities at the outset of newly developing aging-in-place efforts.Emergency Plan For The Older Adult Essay Paper Older adults, defined for this study as adults age 65 or older, are especially vulnerable during and after disasters (Bei et al., 2013; Malik et al., 2017; Weisler, Barbee, and Townsend, 2006). For example, half of the deaths from Hurricane Katrina were adults age 75 and older (Brunkard, Namulanda, and Ratard, 2008), and 63 percent of the deaths after the 1995 heat wave in Chicago were adults age 65 or older (Whitman et al., 1997). Older adults are more likely than others in a community to be socially isolated and have multiple chronic conditions, limitations in daily activities, declining vision and hearing, and physical and cognitive disabilities that hamper their ability to communicate about, prepare for, and respond to a natural disaster (Levac, Toal-Sullivan, and OSullivan, 2012; Aldrich and Benson, 2008). A sizable number of adults age 65 or older (about one-third of Medicare enrollees, or approximately 16 million nationally) live alone (Komisar, Feder, and Kasper, 2005). Disasters can also disrupt essential services that allow older adults to live in the community, such as assistance from family caregivers and social services like home-delivered meals, chore services, and personal care (Benson and Aldrich, 2007). A 2012 survey found that 15 percent of U.S. adults age 50 or older would not be able to evacuate their homes without help, and half of this group would need help from someone outside the household (National Association of Area Agencies on Aging, National Council on Aging, and UnitedHealthcare, 2012). A 2014 survey of adults age 50 or older found that 15 percent of the sample used medical devices requiring externally supplied electricity (Al-Rousan, Rubenstein, and Wallace, 2014). Thus, power interruptions could pose adverse health effects for this group.Emergency Plan For The Older Adult Essay Paper Older adults can also contribute important assets to disaster response. A 2017 qualitative study of 17 focus groups with at-risk individuals found that adults age 65 or older contribute their experience, resources, and relationship-building capacity to prepare themselves and to support others during an emergency (Howard, Blakemore, and Bevis, 2017). Specifically, older adults both generate and mobilize social capital at the local level during a disaster. Yet there are critical gaps in disaster preparedness for this group. Although preparedness guidelines and resources exist for older adults, the 2014 survey mentioned earlier found that two-thirds of adults age 50 or older had no emergency plan, had never participated in any disaster preparedness educational program, and were not aware of the availability of relevant resources (Al-Rousan, Rubenstein, and Wallace, 2014). More than a third of respondents lacked a basic supply of food, water, or medical supplies in case of emergency (Al-Rousan, Rubenstein, and Wallace, 2014). Adults age 65 and older will make up nearly 25 percent of the U.S. population by 2060 (U.S. Census Bureau, 2017). As the U.S. population ages and weather events become more severe, the need to address the vulnerability and leverage the strengths of older Americans in disasters will grow.Emergency Plan For The Older Adult Essay Paper Public health and prevention planning and programs are needed to identify older adults at elevated risk in the event of disasters, address their needs, and leverage their strengths (Al-Rousan, Rubenstein, and Wallace, 2014). Public health departments are the government entity primarily responsible for disaster-related public health and safety. However, public health departments are often focused on the entire community, and even their tailored programs may be limited to individuals with functional limitations and may not necessarily meet the needs of all older adults. One set of resources for improving the disaster resilience of older adults may already exist in communities: current efforts to promote aging in place. The Centers for Disease Control and Prevention (Centers for Disease Control and Prevention, 2009) define aging in place as the ability to live in ones own home and community safely, independently, and comfortably, regardless of age, income, or ability level. A 2015 survey found that 75 percent of respondents age 60 or older intended to continue living in their current home for the remainder of their lives, in large part driven by their desire to be near family and friends (National Association of Area Agencies on Aging, National Council on Aging, and UnitedHealthcare, 2015). There are two primary types of nationwide organizations that promote aging in place in the United States (Greenfield, 2012): Age-friendly communities (AFCs) are typically collaborations or partnerships between organizations (which may include local government agencies and community groups) that promote the social connectedness of older adults across a municipal or regional area (e.g., cities and counties) and facilitate their inclusion in community life. The World Health Organization oversees the Global Network for Age-Friendly Cities and Communities. AARP oversees a network of U.S. Age-Friendly Cities.Emergency Plan For The Older Adult Essay Paper Villages are membership-driven grassroots nonprofit organizations that seek to help older adults age in place successfully through a number of programs and services, such as health education, social gatherings, access to a list of service vendors who have been vetted, transportation, and bookkeeping. Villages generally cover a neighborhood or a city but in some cases can cover multiple adjacent counties in more rural areas. Villages differ based on their size, governance structure, membership characteristics, and regional coverage. The Village to Village Network is a national nonprofit organization that provides expert guidance, resources, and support to help communities establish and maintain villages. Like resilience, successful aging in place emphasizes connectedness. For older adults in particular, this means engagement with community life and needed services. The following list summarizes the rationale for focusing on older adults preparedness and our hypothesis that aging-in-place efforts may serve as resources to public health departments to bolster the disaster resilience of older adults (Keim, 2008):Emergency Plan For The Older Adult Essay Paper The U.S. population is aging rapidly, in part because of the aging baby boomer cohorts. Intense storms and other emergencies have become more frequent and severe over time, and older adults tend to live in areas more prone to disasters. The majority of older adults in the United States are unprepared for an emergency, and many are socially isolated or are not able to receive or respond to messages typically employed by public health departments. Older adults are vulnerable and have specific needs in the face of an emergency that are not fully covered by most public health departments preparedness activities.Emergency Plan For The Older Adult Essay Paper Emergency preparedness programs are designed to reduce mortality and morbidity, which will become even more critical, given the aging U.S. population.The Department of Elder Affairs (DOEA) maintains this Resource Directory as an informational service to help elders, their families, caregivers, and others interested in elder issues learn about available resources and organizations in their respective areas. The appearance of an individual or organization on this site is not intended as an endorsement of that individual or organization or any products or services identified on their external websites. DOEA disclaims any and all warranties, including accuracy, completeness, or validity of the data, and assumes no liability or responsibility for any errors or omissions in the information contained on this Resource Directory. DOEA does not warrant either expressly or by implication any individual, organization, product, or service appearing on this site or that is electronically linked to this site. This Resource Directory is not intended to be used as a tool for verifying the credentials, qualifications, or abilities of any professional, organization, product, or service. DOEA strongly urges all users of this Resource Directory to conduct their own research of any individual, organization, product, or service appearing on this site or that is electronically linked to this site. DOEA also recommends that users exercise independent judgment and request references when considering a resource associated with diagnosis, treatment, or the provision of any service.Emergency Plan For The Older Adult Essay Paper The outcome of these disasters is dependent on the healthcare systems ability to respond and treat the injured or ill. The increased risk of a disaster occurring requires that communities nationwide have a well-prepared public health and healthcare disaster system. To mitigate the consequences of disasters, all communities need to have processes in place to treat the ill/injured and protect the healthy (Toner, 2017). A medical emergency kit can mean the difference between life and death. When emergency responders arrive on the scene, they must have fast access to the information that can help them provide swift and correct care to the senior in need.All seniors should prepare a medical emergency kit and keep it in plain sight in their main living area or kitchen for first responders to notice. Here is a list of items that belong in a seniors medical emergency kit to ensure their medical care is precise and efficient.Emergency Plan For The Older Adult Essay Paper 1. A List of Medications Print out a detailed list of all current medications along with the correct dosages. This information can help medical responders better understand and track the patients health. They can make quick judgments as to possible causes of the emergency and narrow down the ideal treatment option swiftly. 2. Copies of Medical History Keep a current copy of your entire medical history as well. This may include updates on doctor visits, primary doctor contact information and insurance coverage details. It is also helpful for patients with Alzheimers or dementia to keep records of their most recent behavioral patterns to help medical professionals understand the full extent of the individuals health history, even if they cannot personally recall the details. 3. Family Member Contact Information Always keep detailed records of your main emergency contacts home, cell and office phone numbers as well as their home and work address. In a serious medical emergency, the treatment team will want to notify loved ones as soon as possible for guidance on making decisions regarding the individuals health. Seniors should also keep this contact information in their purse or wallet in case an emergency occurs outside the home.Emergency Plan For The Older Adult Essay Paper 4. Replacement Supplies Even if you are not experiencing a medical crisis, a medical emergency kit can still help provide backup support. If possible, obtain a backup medical prescription in case your current prescription runs out and you are not able to reach the pharmacy in time. Keep batteries in the kit to replace rundown sets in hearing aids and other medical equipment. You could also keep a spare set of prescription glasses in the medical emergency kit in case your current pair is suddenly lost or broken. Contact My Senior Health Plan for assistance in ensuring your current insurance coverage meets your present needs and any other challenges that may arise in the event of a medical emergency. There are various preparedness programs already in place; however, funding for many of these programs has been drastically decreased over the years (Toner, 2017). In 2016, the Centers for Medicare and Medicaid Services (CMS) preparedness rule was finalized and established emergency preparedness requirements for facilities participating in Medicare and Medicaid and coordinates efforts with the federal, state, and local emergency preparedness systems (Toner, 2017).Emergency Plan For The Older Adult Essay Paper In 2014 the Association of Public Health Nurses updated their position paper The Role of the Public Health Nurse in Disaster Preparedness, Response and Recovery. This paper supplies guidance for the public health nurses role throughout the disaster cycle (Association of Public Health Nurses (APHN), 2014). Nurses may be allowed by federal and/or state law or declarations to cross state boards to assist in disaster relief; however, it is important that the nurse knows and understands these laws prior to joining the disaster effort. Be sure to clarify the expectations for licensure with the organization you are volunteering with. Currently, there are no comprehensive, national legal protections for healthcare workers participating in the disaster cycle (Courtney, Priest, & Roost, 2012). Public health nursing is the practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences (American Public Health Association, Public Health Nursing Section, 2013, p.1). Currently there are an estimated 34,521 public health nurses (PHN) working across the U.S. This number represents a significant, nationwide shortage of PHN.Emergency Plan For The Older Adult Essay Paper Public health nurses bring critical expertise to each phase of the disaster cycle: preparedness (prevention, protection, and mitigation), response and recovery. They have a unique skill set and an ability to link systems that are vital to the disaster continuum to include, but not limited to disease surveillance, disease and health investigation, case finding, rapid needs assessment, public health triage, mass prophylaxis and treatment, collaboration, health teaching and provider education, community organizing, outreach and referral, population advocacy and policy development (APHN, 2014, p. 6). To understand the role of the public health nurse and the nursing process during a disaster, review the APHN Position Statement at http://nacchopreparedness.org/wp-content/uploads/2014/01/APHN_Role-of-PHN-in-Disaster-PRR_FINALJan14.pdf. Specifically table 1 on page 7. Disaster preparedness, response, and recovery are critical components of public safety. Public health nurses who understand the population-based nature of a disaster response and possess the knowledge and skills to respond in a timely and appropriate manner to any type of disaster are a vital component to this process (APHN, 2014). Aging-in-place efforts may be a national resource to support disaster resilience of older adults.Emergency Plan For The Older Adult Essay Paper Disasters can be particularly disruptive to the daily living of older adults and their caregivers. Chronic conditions that exist prior to an emergency can be exacerbated,
NURS 6051 Transforming Nursing and Healthcare Through Technology Assignment
NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper Nursing Informatics and Patient Safety In 2011, Mason General Hospital was named by Hospitals & Health Networks magazine as one of the Most Wired hospitals in the United States. What makes this particularly significant is that Mason General is a small, 25-bed, rural hospital in the state of Washington. It credits its success to nurse Eileen Ransomer, director of clinical informatics. Under her leadership, the hospital adopted such innovations as visual smart boards where real-time patient information is always available.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper According to the magazine, those hospitals designated as Most Wired show better outcomes in patient satisfaction, risk-adjusted mortality rates, and other key quality measures through the use of information technology (IT) (Mason General Hospital and Family of Clinics, 2012). Permalink: https://nursingpaperessays.com/ nurs-6051-transf gy-essay-paper / ? Developments in information technology have enabled patients and health care providers to collaborate for quality improvement at an unprecedented level, and nurses have consistently been at the forefront of these efforts. This week you focus on the IOM report To Err Is Human and consider how health information technology has helped to address the issues of patient safety and quality health care. Clinical transformation: Blending people, process, and technology Together with all of the healthcare reform efforts being considered, the massive adoption of electronic health records (EHRs) nationwide is expanding the focus on reducing costs and improving quality. Many healthcare organizations are embracing the concept of clinical transformation to achieve these goals, but they still require the tools and capabilities to make data available in real time and reduce the burden on scarce resources. These are among the key findings from the HIMSS 2011 Clinical Transformation Survey.1 This is the HIMSS organizations first industry survey to measure clinical transformation. To ensure respondents had a level foundation for their responses, the following definition was developed: NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper Clinical Transformation: This involves assessing and continually improving the way patient care is delivered at all levels in a care delivery organization. It occurs when an organization rejects existing practice patterns that deliver inefficient or less effective results and embraces a common goal of patient safety, clinical outcomes and quality care through process redesign and IT implementation. By effectively blending people, processes and technology, clinical transformation occurs across facilities, departments and clinical fields of expertise. Approximately 175 respondents assessed the degree of clinical transformation within their organizations in terms of measurement, governance and leadership, organizational behavior and data access. Among the key findings: NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper * Clinical priorities: Nearly half of respondents indicated that their organization was presently focused on ensuring that a fully operational EHR is in place. * Key drivers for addressing quality metrics: While meaningful use/ARRA is the influence driving which quality metrics to address, the choices made by healthcare organizations are also driven by other federal efforts, The Joint Commission, and other quality initiatives. * Improved outcomes: Organizations arent only using the analysis of clinical and financial data to improve quality and efficiency of care, but to control costs and improve revenue, as well.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper * Barriers: Respondents identified the fact that data arent captured in discrete fields or defined consistently as key barriers to the capture and use of clinical data for quality metrics. * Clinical transformation teams: While nurses and physicians are well represented on clinical transformation teams, one-third of respondents noted that these teams were lead by a member of the executive office. * Organizational changes: As organizations are evaluating how to use IT to effectively implement clinical and quality improvement efforts, more than 80% are evaluating clinical workflow and process. * Addressing change management: Three-quarters of respondents rely on education and training to address change management issues. NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper According to the survey findings, there are numerous improvements that organizations can make to enhance their ability to use clinical and financial data to improve patient outcomes. For instance, data isnt always available in a way that facilitates easy access and reporting. Only 35% of respondents presently import data into a data warehouse, and nearly half of respondents noted that they rely on interfaces to assist with integration. Since not all data is available in an electronic fashion with discrete data elements, reviewing charts by hand is still a key means for measuring clinical quality. Having the correct resources in place to improve reporting capability is also an issue. Nearly two-thirds of respondents noted that their organization needs additional resources in order to report appropriately on quality measures.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper Although theres organizational support for clinical transformation, there are gaps and barriers to being able to accomplish goals and objectives in this area. Specifically, nearly three-quarters of respondents noted that they needed additional IT resources to report on quality measures. This was closely followed by additional staff (61%) and more money (58%). Only 4% of respondents indicated that they dont need additional resources. In addition, two-thirds of respondents directly noted that while they had staff qualified to report on quality measures, the staff simply didnt have the time needed to create reports. Other respondents (43%) noted that their organizations priorities were focused elsewhere. NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper The role of clinical informatics, including nurse informatics, continues to be a much valued and necessary position in todays healthcare organization because these experts are essential to the success of quality initiatives, participating in the executive clinical team that analyzes clinical data. Survey results indicate that these human resources are necessary to ensure that clinical transformation efforts benefit from appropriate access to clinical data that is derived from the EHR. NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper The recently published IOM report on The Future of Nursing asserts the U.S. healthcare system has the opportunity to transform itself, and envisions nurses as active leaders in this transformation.2 Nurses have already taken a leadership role in embracing technology as a necessary tool to innovate the delivery of healthcare. The report recommends that nurses take on leadership roles to improve safety and efficiency, bring evidence for decision making to the point of care, and empower patients to be involved partners. NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper Also recognizing the vital leadership role of nurses in providing quality patient care, the HIMSS Board of Directors approved a position statement this summer describing how to transform nursing practice through technology and informatics.3 Leaders from the HIMSS Nursing Informatics Community, representing over 2,900 members who not only serve the nursing profession, but also, the broader healthcare industry and HIMSS membership at large, developed the following position statement. Position Statement: Nurses are key leaders in developing the infrastructure for effective and efficient health information technology that transforms the delivery of care. Nurse informatics play a crucial role in advocating both for patients and fellow nurses who are often the key stakeholders and recipients of these evolving solutions. Nursing informatics professionals are the liaisons to successful interactions with technology in healthcare. As clinicians who focus on transforming information into knowledge, nurse informatics cultivate a new time and place of care through their facilitation efforts to integrate technology with patient care. Technology will continue to be a fundamental enabler of future care delivery models and nursing informatics leaders will be essential to transforming nursing practice through technology. NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper In addition to the need for knowledgeable and available leaders, nearly all survey respondents (87%) indicated that their organization leverages technology to standardize and automate practices, such as the format of a discharge summary, to enable additional focus on new quality initiatives. Survey respondents were also asked if they were leveraging data from diverse information sources to measure quality. Approximately half of respondents (53%) noted that theyve created interfaces to support integration. A third (35%) noted that their organization imports all data into a repository-warehouse. Only 12% reported that the tools they use are fully integrated into their EHR. 55% reported that these tools are partially integrated, and 13% reported that these tools arent automated with organizational EHRs. NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper One organizational leader in this area, Catholic Health East (CHE), has launched a massive, multi-year initiative to move forward with the development and implementation of a system-wide evidence-based care/clinical transformation initiative.4 This new delivery model, the ACT (Advancing Clinical Transformation) initiative, was developed in 2008 and introduced throughout CHE in early 2009. The initiative is focused on ensuring excellence in quality and patient safety outcomes-every person, every place, every time. Evidence-based care has been established throughout CHE using core measures, technology assessments, standardized documentation, order sets and computerized provider order entry. CHE will also leverage existing information systems and introduce new system capabilities and industry standard clinical terminology to provide patients with their personal health information and exchange key clinical information with authorized entities and public health agencies.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper New Nursing Technologies and Trends Nursing technology has transformed the way nurses work and continues to evolve, along with the roles that nurses play in todays health care arena. According to various studies and surveys, technology in the nursing world has increased patient satisfaction and overall outcomes, reduced clinical errors and decreased the amount of paperwork that nurses were once required to perform. The outlook for new technology in nursing remains robust, as new devices, computers and robots aim to transform the future of health care. The following technologies are just a few that have made headlines recently as they ease and streamline each nurses workload to help them focus on what matters mosttheir patients.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper Point-of-Care Technology Accessing patient records, X-rays, medication information and even obtaining a second opinion from another health care professional, can all be done directly from the bedside thanks to new advances in point-of-care technology. Utilizing a wireless network and computer, nurses in many hospitals can now access and receive a wide array of information right from the patients room. Computer and software companies are working to further advance point-of-care technology to include wireless and mobile applications that will enable nurses to have the information they need directly at their fingertips.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper Electronic Health Records Electronic Health Records (EHR) have been a hot topic lately as policymakers work towards establishing a Nationwide Healthcare Information Network (NHIN) that would standardize EHRs. Although paperless health records have been utilized for years, a new Harvard research study showed that fewer than 1 in 5 nurses are using EHRs, although computerized documentation was linked to nursing excellence and better patient outcomes. As more hospitals began to implement EHRs, experts predict that there will likely be fewer medical errors, an increase in quality care and satisfaction, and an overall increase in accuracy.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper Electronic Lift Systems, Smart Beds and Computerized Staff Schedules Many of the health care technologies we see today have been put in place to make a nurses everyday routine safer and more efficient. Electronic lift systems operated by remote control and other wireless technologies have greatly reduced injury and stress for both patients and nurses. Smart beds and computerized staff scheduling systems have also improved general nursing efficiency. Smart beds, such as those developed by Hill-Rom, work in conjunction with other point-of-care technology to obtain and analyze patient information such as weight, temperature and head and neck elevation. New staff scheduling systems improve efficiency by enabling nurses to set up coverage and even schedule their shifts remotely.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper Patient and Staff Identification Systems Patient and staff identifiers in the hospital setting have become increasingly important in light of patient mix-ups and unauthorized people entering a facility or accessing patient records. Bar codes, wristbands and radio frequency identification (RFID), all work to track and identify patients in an effort to reduce errors while also keeping the hospital population safe. New palm vein technology, eye scans and microchips have also been introduced as a way to identify both patients and healthcare professionals, and to cut down on unauthorized access to patient files. As new technologies continue to emerge, nurses roles will continue to evolve, with each advance, bringing a safer and healthier future for both nurses and the patients in their care.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper Technology in Nursing The technology involved in nursing today would likely surprise even the most devoted gadget freak. Nurses must increasingly master a host of complex technologies, from smart medical devices to tablet PCs. Theres no way to get around it, says Carol Bickford, PhD, RN, BC, a senior policy fellow in the department of nursing practice and policy at the American Nurses Association. You need to know the tools, and new ones are coming in right and left. Nursing Tech Types The technology nurses encounter on the job falls into two broad categories clinical and other information systems, and smart medical devices, often with integrated computer chips and screens. Specific technologies include:NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper Clinical Information Systems: These systems bring together an organizations patient records, lab results, pharmaceutical data, medical research resources and other information, providing nurses and other caregivers with integrated, PC-based tools to help them input and retrieve information. Electronic Health Records: Patient records in this format provide instant access to a patients medical history, improve communication between caregivers and offer flags and alerts to prevent conflicts over prescriptions and tests. Drug Retrieval-and-Delivery Systems: These utilize several technologies, including bar codes and automated dispensing machines, to ensure patients receive the correct medications and dosages. Tablet Computers, Wall-Mounted PCs and Mobile Carts: These computer-based tools allow nurses to enter and retrieve information housed in a facilitys information system without leaving the bedside. The systems can operate wireless and connect to databases containing care guidelines and other clinical resources.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper Medical Devices: Devices such as infusion delivery systems and ventilators often have brains built into them, says Joyce Ramsey-Coleman, vice president of nursing and patient-care services at Childrens Healthcare of Atlanta. These electronic brains assist nurses by flagging problems and helping to avoid errors. Personal Digital Assistants: PDAs with add-on software can help nurses research conditions and check medication doses. Furthermore, wireless tech integrates information from disparate sources and delivers data faster, so nurses dont need to be tied to a specific workstation to get the necessary information. Boon and Burden While nurses acknowledge the advantages of using technology, they also say training is sometimes inadequate, IT systems occasionally force them to rethink how they do their jobs, and technological snafus can impede their work.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper But without a doubt, the introduction of new technologies may bring considerable changes to nurses day-to-day work. Consider the experience of Texass Baylor Medical Center at Achievable after touch-screen computers were installed in the emergency department. The system has helped improve efficiency and patient care in a number of ways, says Mike Beaning, RN, the emergency departments day supervisor. With the system in place: Nurses dont have to find a doctor to get a patients chart. Charts are easier to read, minimizing potential errors. Lab results are available in real time. Various departments communicate better. Because of the time that is saved by using this system, it gives the nurses more time for more personalized care, Behning says. But new technologies dont always result in more time for patients. Bar-code scanning, Bickford notes, can serve as part of a check-and-balance system for catching errors, but the bar-code systems arent always convenient and can take up nurses time. The same goes for automated medication systems, which may be designed more for the convenience of the pharmacy than for use during nurses daily duties, she says. Many times the technologies are imposed on nurses, Bickford explains. There has not been thoughtful consideration about the work processes or the business processes.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper Bickford expresses concern about losing the sounds and touch of nursing when dealing with screens and nursing equipment. While technology can improve patient care, she acknowledges that sometimes its burdensome. TECHNOLOGIES THAT CHANGED NURSING FOREVER Anyone who has been in the nursing field for an extended period of time will tell you that a lot has changed. In fact, the twentieth century brought literally a technological invasion to nursing. According to Kaplan Nursing, from small advances, like digital thermometers, to sophisticated strides, like laser surgery, health care as a whole has been on quite a roller coaster and nurses have been along for the ride.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper Medical advancements and information technologies of the twentieth century have not only changed the face of the nursing they have become part of the intricate fabric of the field. But what are the technologies responsible for this monumental transformation? One nursing professional and author of a site called The Nurse Lady- offers these 19 technologies that changed nursing forever. 1. Electronic IV monitors There was a time when IVs had to be administered with a nurses constant attention to ensure a steady flow. Manual IVs were highly sensitive to a patients movement and the flow of the IV could be sped up or slowed to a crawl by a subtle movement. To prevent this, nurses had to directly administer an IV from beginning to start. With the advent of IV pump infusion and electronic monitoring, nurses are freed up to initiate an IV and allow a machine to monitor and regulate the process. If there is an error, the system tries to correct it, and otherwise contacts the nurse via remote monitoring.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper 2. The Sphygmomanometer The sphygmomanometer is simply a fancy term for electronic blood pressure cuffs that also measure heart beat rate automatically. Gone are the days when a nurse had to measure blood pressure manually. According to one nurse, this is the technological change that makes the biggest daily difference. 3. Information management As computer technologies become the primary means of managing patient information, nurses have had to adapt their record-keeping practices and increase their computer skills. Nursing informatics is a specialty that has emerged, combining IT skills and nursing science.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper 4. The portable defibrillator Manual CPR can only do so much and for the longest time this was the only method available to many nurses for reviving someones heart. Now, even school nurses stand a fighting chance to save the life of a person whose heart has failed. The few minutes after heart failure are critical, and the portable defibrillator allows for immediate resuscitation action. Sturdy, portable IT devices Tablet computers and mobile wireless computer stations are now a standard part of the day-to-day methods of delivering care to patients. Charts are updated continuously, in real time, providing nurses with immediate access to essential patient information. 6. Readily accessible base of information Wireless Internet connections quickly make reference materials available. This can prove very helpful for diagnosis, especially when using a resource like Web MD.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper 7. The sonogram/ultrasound Ultrasound devices provide nurses working with pregnant patients the ability to see inside the womb. Ultrasound has been nothing short of revolutionary in the field of Womens Health and pregnancy, allowing nurses and doctors to noninvasive identify the health of the baby throughout pregnancy. Now, with the advent of 4-D ultrasound, unprecedented detail is available for diagnosing fetal well-being. In addition to pregnancy monitoring, sonogram technology also offers many other new diagnostic advances such as the ability to easily identify cancer tumors in the bladder, and to tell whether the liver is enlarged. 8. Local wireless telephone networks These systems significantly reduce communication delays. Not only is this type of communication technology being utilized between nursing staff, but also between patients and staff, changing the dynamics of the relationship between patients and their nurses. 9. Hands-free communication devices Hands-free devices such as Voceras Call Badge provide the ultimate in communication while a nurse is engaged in active patient care or associated tasks.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper 10. Communications options It is not uncommon for patients and nurses (and doctors) to communicate via e-mail or even web cam; a practice that is becoming common for parents of children in neo-natal intensive care units. 11. Patient remote monitoring In addition to high-tech and ultra-sensitive vital signs monitoring equipment, web cams and other technologies make the close monitoring of multiple patients much easier, changing how environments are staffed and operated. 12. RFID technologies RFID-enabled devices make monitoring hospital assets easier, ranging from drugs and equipment to records and patients. They also enhance safety and security with less effort and lower long-term cost. NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper 13. Compact, portable medical devices Combined with portable IT and communication equipment, these small, high-tech types of devices allow well-equipped nurses to take their skills on the road. They can travel to patients homes and treat conditions that once had to be treated on an in-patient basis. Neo-natal nursing advancements New, more affordable portable devices for the care of tinier and more health-compromised babies. 15. Drug management technologies High-tech systems of medication retrieval and delivery, such as bar coding and verification, have greatly reduced the potential for dangerous error. Infusion equipment advances have made the delivery of slow-administer drugs much easier, with computerized machines able to control dosages and rates. 16. Configurable nursing environments Configurable work spaces increases efficiency and safety, reduces stress, and prevents accidents and injuries. 17. Learning technologies The availability of individual and off-site learning opportunities and degree programs, via specialized software and online classes, allows for more rapid career advancement.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper 18. Video conferencing The ability to interact with nursing professionals throughout the world, through such means as video conferencing, offers advantages and opportunities like never before, both in terms of the further development of the nursing profession and the continued improvement in patient care outcomes. 19. The blogosphere Medical technologies have brought changes to the process of life and death and the role of the nurse. The Internet allows nurses to share their experiences and feelings. As technology transforms the profession, nurses adapt and change as well. The big question is: What will the rest of the twenty-first century bring? What Technology Do Registered Nurses Use? Modern nursing care has been called a mixture of high tech and high touch, a way to describe the traditional nurturing and compassion of a nurse in combination with the advanced health care technology of the 21st century. Technology, such as computers and monitoring equipment, is used in nearly every aspect of nursing. Many of the applications nurses use are wireless.Todays nurses must not only know how to care for patients, but how to use technology safely and appropriately in their day-to-day work.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper Computers Computer technology is one of the most common applications used in nursing. Nurses use computers to schedule staff, for timekeeping, to order medications or supplies, and for research and email. In some organizations, nurses use computers for all patient care documentation, using systems called electronic health records or electronic medical records EHRs and EMRs. A nurse who uses an EMR may document medication dosages, administration, dressing changes and other treatments in the computer, rather than on paper. Monitors Monitoring systems are technological devices that allow a nurse to obtain patient information. These devices include fetal monitors, which can show the heart rate of a baby still in the uterus; heart monitors that display the electrical rhythm and pattern of a patients heart; and vital sign machines that automatically take the patients blood pressure, pulse and respiration. Other monitoring systems measure pressure inside the heart or brain or the amount of oxygen in a patients blood. Systems built into the hospital bed report a patients weight or movement during sleep.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper Intravenous Devices Hospital patients often have intravenous lines that are threaded through technological devices that control the flow and sound an alarm if the line becomes kinked or plugged. Other alarms warn the nurse if the IV bag or bottle is getting empty. Some machines can even switch back and forth from a a primary IV solution to a separate IV antibiotic solution without human intervention. A patient in an intensive care unit may be attached to several IV monitors at once. Medication Administration Safety in medication administration dictates the use of bar-coding and scanners in many hospitals. In the past, human vigilance was the only protection against medication errors. Now medications come prepackaged with a bar code that the nurse scans prior to administration. Patient armbands are also bar-coded, and the patients band is scanned as well. The system will sound an alert if the patient is allergic to a medication or if the nurse selects the wrong medication or patient.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper Important Technological Advancements for Nurses Looking back over the past few years, many people would have never been able to understand how significantly technology would affect the way we work, live, and play. The healthcare industry has been one area that technology has helped. Patient care has been drastically improved by these advances, as have the nurses and doctors who use new measures. The job of a nurse today looks nothing like it did 10, 20 or even 30 years ago. ORDER HERE RNs and Nurse Practitioners have changed the way they administer patient care. They are able to increase their workflow all while limiting their human errors. In return, it makes their job safer, and it is also less challenging on their bodies. Over the years, there have been seven major enhancements that have changed the nursing field Today, these advancements are being used at top hospitals and health care facilities across the world. These practices have made nursing a better profession to be a part of.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper 1. Enhanced Communication When nurses received pagers back in the 1980-1990s, they were able to increase patient care. Fast forward nearly 20 years and each nurse carries a cell phone with the ability to order a pizza and medicine all at the same time. Most hospitals have advanced communication systems. Use smart phones and apps, nurses can receive text messages and receive alarms from their patients through their phones. Forget those old-fashioned pagers. The entire nursing staff is more in touch with their patients and with each other. Its efficiency at its finest and the nursing staff of today wouldnt know how to do it any other way. 2. Electronic Records Piles of endless paperwork consumed the nursing staff for decades. Physical paper charts and faxing medical records is pretty much a thing of the past. Hospitals and medical care centers have switched to electronic records. This allows everyone in the hospital to access the patients information with the touch of a button. A nurse can quickly see what medications the patient is taking and which ones they are allergic too. They can look up test results and see all sorts of other data. Doctors can put notes that the nurse needs to see about the patients needs. Even things like religious preference can be recorded. Its one way that nurses are connecting with their patients without hours of paperwork.NURS 6051 Transforming Nursing and Healthcare Through Technology Essay Paper 3. GPS tracking Hospital efficiency has been increased through GPS tracking. Tagging and tracking medical equipment is much easier than it was before. Radio frequency identifications tags help nurses find the nearest blood pressure machine or another piece of equipment. It sounds like a simple matter, but being able to centrally monitor equipment has increased bed management and patient care incredibly. 4. Enhanced Diagnostic Devices Most of the technological advancements are to help doctors, nurses, and the patients. Take for instance diagnostic exams. These can now b
Drug administration and Delivery Systems Sample Essay
Drug administration and Delivery Systems Sample Essay Drug administration and Delivery Systems Sample Essay The oral route of drug administration is the most important method of administering drugs for systemic effects. The parentral route is not routinely used or not possible to self-administration of medication. Drug administration and Delivery Systems Sample EssayThe topical route of administration has only recently been employed to deliver drugs to the body for systemic effects. It is probable that at least 90 % of all drugs used to produce systemic effects are administered by the oral route. When a new drug is discovered, one of the first questions a pharmaceutical company asks is whether or not the drug can be effectively administered for its intended effect by the oral route. If it cannot, the drug is primarily relegated to administration in a hospital setting or physicians office. Of drugs that are administered orally, solid oral dosage forms represent the preferred class of product. The reasons for this preference are well known1.Drug administration and Delivery Systems Sample Essay Permalink: https://nursingpaperessays.com/ drug-administrat ems-sample-essay / ? 1.1 Novel Drug Delivery System: Today, a pharmaceutical scientist is well versed with the fact that the overall action of a drug molecule is not merely dependent on its inherent therapeutic activity, rather on the efficiency of its delivery at the site of action. An increasing appreciation of the latter has led to the evolution and development of several drug delivery systems (DDS) aimed at performance enhancement of the potential drug molecules.Drug administration and Delivery Systems Sample Essay A review of the literature has revealed the recent several technical advancements have led to the development of various Novel Drug Delivery Systems (NDDS) that could revolutionize method of drug delivery and hence could provide definite therapeutic benefits 2. Till date, remedies have been found for most of the diseases; but still research is going on inorder to improve the existing therapy. To bring a new drug molecule in the market, it involves a lot more than investment of time and money. In the pre GATT era the patents of drug molecules/formulations are expiring. The new way of patenting the drug is to use.Drug administration and Delivery Systems Sample Essay Novel Drug Delivery Systems i.e. NDDS with improved bioavailability (BA). To formulate a drug or to re-formulate it in a form of NDDS is not a Herculean task if one goes methodically and skillfully. This is where the formulation development studies play an important role.Drug administration and Delivery Systems Sample Essay 1.2 Oral Controlled Drug Delivery: Drug absorption at the desired rate means, first to reach the effective plasma level within an acceptable short time period; second, to avoid an overshoot in the case of rapidly absorbed drugs and third to maintain effective plasma levels over the desired time period. Although the intensity of pharmacological effect is related to the drug concentration at the site of action, which is in turn, related to the plasma drug concentration, an ideal situation is obtained when the concentration is continuously maintained between minimum effective and maximum safe levels (Therapeutic Index). Invariably, conventional drug dosage forms do not maintain the drug. Blood levels within the therapeutic range for an extended period of time. Drug administration and Delivery Systems Sample EssayTo achieve the same, a drug may be administered repetitively using a fixed dosing interval. This causes several potential problems as like saw tooth kinetics characterized by large peaks and troughs in the drug concentration-time curve (Fig.1), frequent dosing for drugs with short elimination half-life, and above all the patient noncompliance. Controlled release drug delievery systems(CRDDS) attempt to sustain drug blood concentration at relatively constant and effective levels in the body by spatial placement or temporal delivery. Thus CRDDS offer various advantages viz. reduce blood level fluctuations, minimize drug accumulation, employ less total drug, improve patient compliance, and minimize local and systemic side effects3-7.Drug administration and Delivery Systems Sample Essay Fig 1.1: Plasma level profiles following conventional and controlled release dosing Modified release DDS, in general, can broadly divided into four categories: Delayed release Site specific release Receptor release Sustained release a) Controlled release b) Prolonged release For the oral controlled administration of drug, several research and development activities have shown encouraging signs of progress in the development of programmable controlled release dosage forms as well as in the search for new approaches to overcome the potential problems associated with oral drug administration8. Drugs that are easily absorbed from the gastrointestinal tract (GIT) and having a short half-life are eliminated quickly from the blood circulation. Drug administration and Delivery Systems Sample EssayTo avoid this problem, the oral controlled release (CR) formulations have been developed as these will release the drug slowly into the GIT and maintain a constant drug concentration in the serum for a longer period of time1. Oral controlled release dosage forms (CRDFs) are being developed for the past three decades due to their advantages. The design of oral controlled drug delivery systems (CDDS) should primarily be aimed at achieving more predictable and increased bioavailability of drugs. Orally administered controlled release dosage forms suffer from mainly two adversities: 1.3 Gastroretentive drug delivery system (GRDDS) : Recent scientific and patent literature shows increased interest in academics and industrial research groups regarding the novel dosage forms that can be retained in the stomach for a prolonged and predictable period of time. One of the most feasible approaches for achieving a prolonged and predictable drug delivery profile in the GI tract is to control the gastric residence time (GRT), using gastroretentive drug delivery system (GRDDS) that will provide us with new and important therapeutic options8. A major constraint in oral controlled drug delivery is that not all drug candidates are absorbed uniformly throughout the GIT. Some drugs are absorbed in a particular portion of the GIT only or are absorbed to a different extent in various segments of the GIT. Such drugs are said to have an absorption window, which identifies the drugs primary region of absorption in the GIT 11 Figure1. 2: (a) Conventional drug delivery system (b) GRDDS An absorption window exists because of physiological, physicochemical, or biochemical factors. Drugs having site-specific absorption are difficult to design as oral CRDDS because only the drug released in the region preceding and in close vicinity to the absorption window is available for absorption. After crossing the absorption window, the released drug goes waste with negligible or no absorption (Fig.2a). This phenomenon drastically decreases the time available for drug absorption after its release and jeopardize the success of the delivery system. The GRDDS can improve the controlled delivery of the drugs which exhibit an absorption window by continuously releasing the drug for a prolonged period before it reaches its absorption site, thus ensuring its optimal bioavailability (Fig.2b) 12.Drug administration and Delivery Systems Sample Essay Pharmaceutical aspects of gastroretentive drug delivery system (GRDDS) : In designing GRDDS, the following characteristics should be sought: convenient intake, retention in the stomach according to clinical demand; ability to load substantial amount of drugs with different physicochemical properties and release them in controlled manner; complete degradation, preferable in the stomach13 .Gastric retention will provide advantages such as the delivery of drug with narrow absorption window in the small intestinal region. Also longer residence time in the stomach could be advantages for local action in the upper part of small intestine; e. g. in the treatment of peptic ulcer disease, further more improved bioavailability is expected for drug that absorbed readily upon release in the GI tract. 1.4 Physiology of Stomach:Drug administration and Delivery Systems Sample Essay The shape of the normal stomach is generally like letter J. Sometimes the long axis may be slanting from left to right or it may be even horizontal. The junction of the esophageal mucosa with that of the stomach is abrupt. The oesophago-cardiac line of junction is irregular or zigzag and is often referred as the Z or ZZ line. At the pylorus, the mucous membrane of the stomach makes junction with that of duodenum. The capacity of the average stomach is about 1.12-1.7 lts. The stomach can be subdivided into three parts- the fundus, the body and the pylorus.Drug administration and Delivery Systems Sample Essay Figure 1.3: Stomach anatomy Each of these contains a particular type of gland. The cardiac area is the zone,1 to 4 cm wide that guards the esophageal orifice, also known as cardiac Fundus Body Pylorus sphincter. The fundic area is the largest area of stomach accounting for 60-80 % of total mucosal surface, interposed between the cardiac and the pyloric areas. The lower part of the fundic area is separated from the pylorus by a sharp angle on the lesser curvature called the incisura angularis. The junction of the pyloric and fundic area is not sharply demarcated and is frequently known as transitional zone. The pylorus is limited on the left by the incisura and on the right by the pyloric sphincter. The circular fibres of pyloric sphincter guards against back flow of small intestinal contents into the stomach. The pyloric area is about 15 % of the total gastric mucosal area. It is subdivided into two parts: (a) the pyloric antrum which is short, comparatively wider, proximal chamber and (b) the pyloric canal which is narrow tubular passage about 3 cm long, ending in the pyloric sphincter (Fig.3).Drug administration and Delivery Systems Sample Essay Histologically, stomach consists of the same four layers but with characteristic differences. The outer serous coat consists of peritoneum. The muscular coat consists of three layers: the outer longitudinal, the middle circular and the inner oblique layer. Next comes the submucous coat, and then come the layer of muscular is mucosae and a supporting stroma of connective tissue. This layer of muscle also contains of an outer longitudinal and an inner circular layer. Finally comes mucous membrane which is thrown out into the large folds called rugae when the stomach is empty and these folds tend to disappear when distended14.Drug administration and Delivery Systems Sample Essay 1.5 Gastric Emptying: The GIT is always in a state of continuous motility. The process of gastric emptying occurs both during fasting and fed states; however, the pattern of motility differs markedly in the two states. In the fasted state, it is characterized by an interdigestive series of electrical events which cycle both through the stomach and small intestine every 2-3 h. This activity is called the interdigestive myoelectric circle or migrating myoelectric complex (MMC), which is often divided into four consecutive phases13.Drug administration and Delivery Systems Sample Essay Figure1.4: Typical motility patterns in fasting state12 A complete cycle of these 4 phases, as illustrated in Fig. 4, has an average duration of 90-120 minutes. Any CRDDS designed to stay during the fasted state should be capable of resisting the house-keeping action of phase III, if one intends to prolong the GI retention time. The bioadhesive properties added to the GI drug delivery system must be capable of adhering to the mucosal membrane strongly enough to withstand the shear forces produced in this phase15.Drug administration and Delivery Systems Sample Essay The gastroretentive technology of solid dosage forms is thus mainly dependent on the coincidence between dosing time and phase III MMC occurrence. Dosage forms such as tablets, capsules and particles have demonstrated a transit pattern similar to that of nutrients. These forms taken orally in the fasted state empty within 90 min. In fed state, these will have to await the MMC activity occurring at the end of digestion to be cleared from stomach in association with the Phase III cleansing contractions. It is thus the pylorus, and, more particularly, the small diameter of the gastric lumen at the gastroduodenal junction, that has remarkable function of performing the selective retention of the solid particles, depending on their size16.Drug administration and Delivery Systems Sample Essay 1.5.1. Factors Affecting Gastric Retention 10, 12: Gastric residence time of an oral dosage form is affected by several factors. The pH of the stomach in fasting state is ~1.5 to 2.0 and in fed state is 2.0 to 4.0. A large volume of water administered with an oral dosage form raises the pH of stomach contents from 6.0 to 9.0. Stomach doesnt get time to produce sufficient acid when the liquid empties the stomach; hence generally basic drugs have a better chance of dissolving in fed state than in a fasting state. To pass through the pyloric valve into the small intestine the particle size should be in the range of 1 to 2 mm.. In the case of elderly persons gastric emptying is slowed down. Generally females have slower gastric emptying rates than males. Stress increases gastric emptying rates while depression slows it down. Studies have revealed that gastric emptying of a dosage form in the fed state can also be influenced by its size. Small-size tablets leave the stomach during the digestive phase while the large-size tablets are emptied during the housekeeping waves. The effect of size of floating and nonfloating dosage forms on gastric emptying and concluded that the floating units remained buoyant on gastric fluids12. These are less likely to be expelled from the stomach compared with the nonfloating units, which lie in the antrum region and are propelled by the peristaltic waves.Drug administration and Delivery Systems Sample Essay It has been demonstrated using radiolabeled technique that there is a difference between gastric emptying times of a liquid, digestible solid, and indigestible solid. It was suggested that the emptying of large (91 mm) indigestible objects from stomach was dependent upon interdigestive migrating myoelectric complex. Indigestible solids larger than the pyloric opening are propelled back and several phases of myoelectric activity take place when the pyloric opening increases in size during the housekeeping wave and allows the sweeping of the indigestible solids. Size and shape of dosage unit also affect the gastric emptying. Garg and Sharma15 reported that tetrahedron- and ring-shaped devices have a better gastric residence time as compared with other shapes. The diameter of the dosage unit is also equally important as a formulation parameter. Dosage forms having a diameter of more than 7.5 mm show a better gastric residence time compared with one having 9.9 mm.Drug administration and Delivery Systems Sample Essay Floating units away from the gastroduodenal junction are protected from the peristaltic waves during digestive phase while the nonfloating forms which stay close to the pylorus and are subjected to propelling and retropelling waves of the digestive phase. It is also observed that of the floating and nonfloating units, the floating units had a longer gastric residence time for small and medium units while no significant difference was seen between the 2 types of large unit dosage forms. When subjects are kept in the supine position it was observed that the floating forms could only prolong their stay because of their size; otherwise the buoyancy remained no longer an advantage for gastric retention. A comparison was made to study the affect of fed and non-fed stages on gastric emptying. For this study all subjects remaining in an upright position were given a light breakfast and another similar group was fed with a succession of meals given at normal time intervals. It was concluded that as meals were given at the time when the previous digestive phase had not completed, the floating form buoyant in the stomach could retain its position for another digestive phase as it was carried by the peristaltic waves in the upper part of the stomach10.Drug administration and Delivery Systems Sample Essay 1.6 Gastroretentive technologies (GRT) : A number of systems have been used to increase the GRT of dosage forms by employing a variety of concepts. These systems have been classified according to the basic principles of gastric retention (Fig.5). Figure 1.5: Classification of gastroretentive drug delivery system 1. Floating DDS (FDDS), with low density providing sufficient buoyancy to float over the gastric contents. 2. Bioadhesive systems, the localized retention of the system in the stomach. 3. Swelling and expanding systems, preventing transit from the gastric sphincter. 4. High density systems, remaining in the stomach for longer period of time, by sedimenting to the folds of stomach. Fig.5 illustrates the mechanistics of these systems in stomach.Drug administration and Delivery Systems Sample Essay A number of other methods like use of passage-delaying agents and modified shape systems have also been used for gastroretention purpose. 1.6.1 Floating Drug Delivery System (FDDS) : Floating dosage form is also known as hydrodynamically balanced system (HBS). FDDS have a bulk density less than gastric fluids and so remain buoyant in the stomach without affecting the gastric emptying rate for a prolonged period of time while the system is floating on the gastric contents, the drug is released slowly at the desired rate. After release of drug, the residual system is emptied from the stomach. It is formulation of a drug (capsule or tablet) and gel forming hydrocolloids meant to remain buoyant on stomach contents. Drug administration and Delivery Systems Sample EssayThis not only prolongs GI residence time but also does so in an area of the GI tract that would maximize drug reaching its absorption site in solution and hence ready for absorption. Drug dissolution and release from the capsule retained in stomach fluids occur at the stomach, under fairly controlled condition. The retentive characteristics of the dosage form in gastric content are most significant for drugs which are insoluble in intestinal fluid, that acts locally and that exhibits sitespecific absorption16, 17. Classification of FDDS: Based on the mechanism of buoyancy, floating systems can be classified into two distinct categories viz. non-effervescent and effervescent systems.Drug administration and Delivery Systems Sample Essay A. Non-Effervescent systems: 1. Colloidal gel barrier systems: Hydrodynamically balanced system (HBS) of this type contains drug with gel forming or swellable cellulose type hydrocolloids, polysaccharides and matrix forming polymers. They help prolonging the GI residence time and maximize drug reaching its absorption site in the solution form ready for absorption. These systems incorporate high levels (20 to 75 % w/w) of one or more gel forming highly swellable cellulose type hydrocolloids e.g. hydroxyethyl cellulose (HEC), hydroxypropyl cellulose (HPC) hydroxypropyl methyl cellulose (HPMC), sodium carboxy methyl cellulose (NaCMC) incorporated either in tablets or capsules. When such a system comes in contact with the gastric fluid, the hydrochloride in the system hydrates and forms a colloidal gel barrier around its surface (Fig.6).Drug administration and Delivery Systems Sample Essay Figure1. 6: Hydrodynamically Based System (HBS) 18 The HBS must comply with following three major criteria 1. It must have sufficient structure to form cohesive gel barrier. 2. It must maintain an overall specific density lower than that of gastric contents. 3. It should dissolve slowly enough to serve as reservoir for the delivery system. Figure 1.7: Intragastric Floating Tablet Intragastric floating tablet that were hydrodynamically balanced in the stomach for an extebded period of time until all the drug- loading dose was released. Tablets were comprised of an active ingredient, 0-80 % by weight of inert material, and 20-75 % by weight of one or more hydrocolloids such as methylcellulose, hpc, hydroxypropylmethylcellulose, and sodium caboxymethylcellulose, which upon contact with gastric fluid provided a water impermeable colloid gel barrier on the surface of tablets. (as shown in fig 7) Figure 1.8: Bilayer Intra-Gastric Floating Tablet A bilayer tablet can also be prepared to contain one immediate release and other sustained release layer. (Fig.8) Immediate release layer delivers the initial dose whereas sustained release layer absorbs gastric fluid and forms a colloidal gel barrier on its surface. This results in system with bulk density lesser than that of gastric fluid and allows it to remain buoyant in the stomach for an extended period of time19. A multi-layer, flexible, sheath-like device buoyant in gastric juice showing sustained release characteristics have also been developed. The device consists of at least one dry self-supporting carrier film made up of water insoluble polymer matrix having a drug dispersed/dissolved therein, and a barrier film overlaying the carrier film.Drug administration and Delivery Systems Sample Essay 2. Micro- porous compartment system: This technology is comprised of encapsulation of a drug reservoir inside a micro porous compartment with pores along its top and bottom surfaces. The peripheral walls of the drug reservoir compartment are completely sealed to prevent any direct contact of gastric mucosal surface with undissolved drug. In stomach, the floatation chamber containing entrapped air causes the delivery system to float over the gastric contents. Gastric fluid enters through the pores, dissolves the drug and carries the dissolved drug for continuous transport across the intestine for absorption. The micro porous compartment system is shown in (Fig.9).Drug administration and Delivery Systems Sample Essay Figure 1.9: Floating drug delivery device with microporous membrane and floatation chamber Micro porous intra-gastric floating drug delivery device 19: Intra-gastric floating and sustained release granules of Diclofenac sodium were developed using hydroxypropyl cellulose, ethyl cellulose and calcium silicate as floating carriers which had a characteristically porous structure with numerous pores and a large individual pore volume. The coated granules acquired floating ability from the air trapped in the pores of calcium silicate when they were coated with a polymer.Drug administration and Delivery Systems Sample Essay 3. Alginate beads: Multiple unit floating dosage forms have been developed from freeze-dried calcium alginate. Spherical beads of approximately 2.5 mm in diameter were prepared by dropping a sodium alginate solution into aqueous solution of calcium chloride, causing a precipitation of calcium alginate. These beads were then separated; snap frozen in liquid nitrogen and freeze-dried at 40C for 24 hrs. leading to formation of porous system that maintained floating force for over 12 hrs. They were compared with non-floating solid beads of same material. The latter gave a short residence time of 1 hr., while floating beads gave a prolonged residence time of more than 5.5 hrs10. 4. Hollow Microspheres: Hollow microspheres (microballoons), loaded with ibuprofen in their outer polymer shells were prepared by novel emulsion solvent diffusion method. The ethanol: dichloromethane solution of the drug and an enteric acrylic polymer were poured into an agitated aqueous solution of PVA that was thermally controlled at 40oC. The gas phase was generated in dispersed polymer droplet by evaporation of dichloromethane and formed an internal cavity in microsphere of polymer with drug (Fig.10).Drug administration and Delivery Systems Sample Essay Figure1. 10: Mechanism of microballoon formation by emulsion-solvent diffusion method. Figure 1.11: Microballoon These microballoons floated continuously over surface of acidic solution media that contained surfactant, for greater than 12 hrs. in vitro. The drug release was high in pH 7.2 than in pH 6.8. B. Effervescent systems: A drug delivery system can be made to float in the stomach by incorporating a floating chamber, which may be filled with vacuum, air or inert gas. The gas in floating chamber can be introduced either by volatilization of an organic solvent or by effervescent reaction between organic acids and bicarbonate salts.Drug administration and Delivery Systems Sample Essay 1. Volatile liquid containing systems: These devices are osmotically controlled floating systems containing a hollow deformable unit that can be converted from a collapsed to an expanded position and returned to collapse position after an extended period.Drug administration and Delivery Systems Sample Essay Figure1. 12: Gastro inflatable drug delivery device16. A deformable system consists of two chambers separated by an impermeable, pressure responsive, movable bladder. The first chamber contains the drug and the second chamber contains volatile liquid. Drug administration and Delivery Systems Sample EssayThe device inflates and the drug is continuously released from the reservoir into the gastric fluid. The device may also consist of bioerodible plug made up of PVA, polyethylene, etc. that gradually dissolves causing the inflatable chamber to release gas and collapse after a predetermined time to permit the spontaneous ejection of the inflatable system from the stomach (Fig.12). Intra-gastric, osmotically controlled drug delivery system consists of an osmotic pressure controlled drug delivery device and an inflatable floating support in bioerodible capsule.Drug administration and Delivery Systems Sample Essay Figure 1.13: Intragastric osmotic controlled drug delivery system16. 2. Gas generating systems: These buoyant delivery systems utilize effervescent reaction between carbonate/bicarbonate salts and citric/tartaric acid to liberate CO2 which gets entrapped in the jellified hydrochloride layer of the system, thus decreasing its specific gravity and making it float over chyme.Drug administration and Delivery Systems Sample Essay These tablets may be either single layered wherein the CO2 generating components are intimately mixed within the tablet matrix or they may be bilayer in which the gas generating components are compressed in one hydrocolloid containing layer, and the drug in outer layer for sustained release effect. Multiple unit type of floating pills (Fig.1.14) that generates CO2, have also been developed. These kinds of systems float completely within 10 minutes and remain floating over an extended period of 5-6 hrs. Figure-1.14: The multiple units floating drug delivery system using gas generation technique 1.6.1.1. Advantages of floating drug delivery system19: An FDDS offers numerous advantages over conventional DDS: 1. The gastroretensive systems are advantageous for drugs absorbed through the stomach. E.g. Ferrous salts, antacids. 2. Acidic substances like aspirin cause irritation on the stomach wall when come in contact with it. Hence HBS formulation may be useful for the administration of aspirin and other similar drugs. 3. Administration of prolongs release floating dosage forms, tablet or capsules, will result in dissolution of the drug in the gastric fluid. They H2O e) Drug d) dissolve in the gastric fluid would be available for absorption in the small intestine after emptying of the stomach contents. It is therefore expected that a drug will be fully absorbed from floating dosage forms if it remains in the solution form even at the alkaline pH of the intestine.Drug administration and Delivery Systems Sample Essay 4. The gastroretensive systems are advantageous for drugs meant for local action in the stomach. e.g. antacids. 5. When there is a vigorous intestinal movement and a short transit time a might occur in certain type of diarrhea, poor absorption is expected. Under such circumstances it may be advantageous to keep the drug in floating condition in stomach to get a relatively better response.Drug administration and Delivery Systems Sample Essay 6. Sustained Drug Delivery: HBS systems can remain in the stomach for long periods and hence can release the drug over a prolonged period of time. The problem of short gastric residence time encountered with an oral CR formulation hence can be overcome with these systems. These systems have a bulk density of 100 , swell to equilibrium size within a minute, due to rapid water uptake by capillary wetting through numerous interconnected open pores. Moreover, they swell to a large size (swelling ratio of approx. 100 or more) and are intended to have sufficient mechanical strength to withstand pressure by gastric contraction.Drug administration and Delivery Systems Sample Essay Figure 1.17: High Density System 1.6.5. Superporous hydrogel: Although these are swellable systems, they differ sufficiently from the conventional types to warrant separate classification. With pore size ranging between 10 nm and 100 nm, absorption of water by conventional hydrogel is a very slow process and several hours may be needed to reach an equilibrium state during which premature evacuation of the dosage form may occur. Superporous hydrogels, average pore size >100 , swell to equilibrium size within a minute, due to rapid water uptake by capillary wetting through numerous interconnected open pores. Moreover, they swell to a large size (swelling ratio of approx. 100 or more) and are intended to have sufficient mechanical strength to withstand pressure by gastric contraction.Drug administration and Delivery Systems Sample Essay 1.6.6. Incorporation of passage delaying food agents: The food excipients like fatty acids, e.g. salts of myristic acid change and modify the pattern of the stomach to a fed state, thereby decreasing gastric emptying rate and permitting considerable prolongation of release. The delay in the gastric emptying after meals rich in fats is largely caused by saturated fatty acids with chain length of C10-C1416, 18.Drug administration and Delivery Systems Sample Essay 1.6.7. Modified- shape systems: These are non-disintegrating geometric shapes molded from silastic elastomer or extruded from polyethylene blends which extend the GRT depending on size, shape and flexural modulus of the drug delivery system23. Figure 1.18: Modified shape systems24 1.7 Criteria for selection of drug candidate for GRDF: Drugs that are easily absorbed from the gastrointestinal tract (GIT) and having a short half-life are eliminated quickly from the blood circulation.Drug administration and Delivery Systems Sample Essay Absorption from upper GIT: Drugs have a particular site for maximum absorption, e.g. Ciprofloxacin, whose maximum absorption is in the stomach only. The absorption of Metformin HCL is confined to the small intestine only and the conventional sustained release dosage forms may be poorly BA since absorption appears to diminish when the dosage form pass into large intestine. Drugs insoluble in intestinal fluids (acid soluble basic drugs):e.g. Chlordiazepoxide, chlorpheniramine, cinnarizine, diltiazem. Local action is seen in the treatment of Helicobacter pylori by Amoxicillin24. The BA of drugs that get degraded in alkaline pH can be increased by formulating gastro-retentive dosage forms, e.g. Doxifluridine, which degrades in small intestine. Drug that are erratically absorbed due to variable gastric emptying time.Drug administration and Delivery Systems Sample Essay Drug which get metabolized in the colon or having high first pass metabolism. 1.8 Floating microspheres: Floating microspheres are gastro-retentive drug delivery systems based on non-effervescent approach. Hollow microspheres are in strict sense, spherical empty particles without core. These microspheres are characteristically free flowing powders consisting of proteins or synthetic polymers, ideally having a size less than 200 micrometer. Drug administration and Delivery Systems Sample EssaySolid biodegradable microspheres incorporating a drug dispersed or dissolved throughout particle matrix have the potential for controlled release of drugs 25. As the exter
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