Monday, July 13, 2015

Saturday, February 21, 2015

Relay for Life

I know many people that have been affected by cancer. I am supporting the American Cancer Society by participating in the relay for life. I hope someone reading or exploring this blog will find it in your heart to donate to this worthy cause. No matter how small or large it will be greatly appreciated. Click here to go to my page and learn more. Thank you.

Thursday, March 6, 2014

HGT1 Community Health Nursing

My Practicum can be viewed in my other blog Vickie Views

I choose Disaster Preparedness. Living in Florida and working at a coastal hospital for over 20 years as both a LPN and a RN, I volunteered on our team. We had mock disasters from train derailments, chemical spills, hurricanes, and plane crashes. I had fun practicing setting up decontamination tents and putting on the "zoot suit". Thankfully I never had to use what I learned in real life.
I hope this helps demonstrate the format required in the paper.

EBT1 Task 2 Research Integration



EBT1 Task 2 Research Integration
Victoria Hart
Western Governors University



A. Review of the Sources of Evidence
Name of Source Author
A1. Types of Sources of Evidence
A2. Appropriateness of Sources of Evidence

A3. Classification of Sources of Evidence

In text citation
Classify the type of each source of evidence as either a general information resource, a filtered resource, or an unfiltered resource.
Discuss whether each source of evidence is appropriate for this nursing practice situation.
Classify each source of evidence as primary research, evidence summary, evidence-based guideline, or none of these.
("Diagnosis and management," 2004)
This source is a filtered resource as it identifies a question of whether to wait to treat acute otitis media or to initiate antibiotic therapy immediately.
This source is appropriate for this nursing practice situation. It is peer reviewed and received formal approval by partnering organizations. This study is data 2004 therefore a more current source may be of value to support of dispute the recommendations and opinions of this guideline.
This source is an evidenced based guideline.
(Block, 1997)
This is a filtered resource as the author identifies the problem of resistance to antibiotic therapy and provides a summary of the most effective course to therapy.
This source is inappropriate for this nursing practice. It is dated 1997, the research is not current however the results support the trend of the resistance to antibiotics in causative organisms. There is no research on waiting to initiate treatment
This source includes primary research and an evidence summary
(Kelly, Friedman & Johnson, 2007)
This source is general information as it is from a textbook.
This is an appropriate source for the practice as it provides the background information to explain the practice guideline.
This source is an evidence-based guideline
(McCracken, 1998)
This source is a filtered resource as it contains information that can help decide a course of action in response to a problem.
This is an appropriate source for the practice as it provides research data and information to explain the potential evidence practice guideline.
This source is a primary source.
Interviews
Interviews are general information.
Interviews are appropriate as they provide the current beliefs of the parents of the children being treated in the clinic. It is important to evaluate this source to determine how implementation will be achieved.
This source is a primary. It is research conducted by the clinic staff.

B1. Watchful Waiting
Watchful waiting is an appropriate approach for treating children under certain conditions base on the article “Clinical Practice Guideline”. This article gives the evidence-based statement that allowing 48-72 hours before prescribing antibiotics is an option to be considered by clinicians. Included in this study are children up to age 12. The observation option applies to the children greater than age 2, without other chronic illnesses or anatomic abnormalities. The recommendation was based on placebo controlled trails that spanned 30 years. This article includes results the AHRQ evidence-report, the Dutch College of General Practitioners guidelines, and a randomized trial in the United Kingdom as part of the evidence in making the recommending. In conclusion it is imperative to ascertain the history of acute onset, to identify signs of middle ear effusion or inflammation, the child must be within the appropriate age, the severity of the illness must be considered and an assurance of follow-up obtained ("Diagnosis and management," 2004).
C. Application of Findings
The process of applying the findings in “Diagnosis and management of acute otitis media” into practice would include education of the clinical staff. A team to implement the change should be created, a team leader should be appointed to help educate and gain acceptance of the evidenced-based guideline. This includes education of the entire staff and cliental. The physicians must agree to the change. A pilot group should be formed to implement the new guidelines; this will allow for adjustments or added education to be put into place. Collect benchmarks of current success rates and re-occurrences of acute otitis media (AOM) to compare with the EBG once implemented. Rolling out new treatment recommendations in increments will make it easier for the staff and clients to adjust and accept the change; it will also provide the opportunity to make any necessary adjustments. Communicating the change and the rationale to the parents of the children affected by the practice will gain their support and understanding providing compliancy with follow-up evaluation. A policy outlining criteria to be implemented will solidify the change as a standard of practice within the organization. (Titler, M.G., 2008)
D. Ethical Issues
The three main ethical concerns of research studies are autonomy, beneficence, and justice. Autonomy recognizes the participant is capable of giving informed consent. This includes a thorough explanation of the benefits and risks. Beneficence includes protecting the participant’s privacy and confidentiality, providing information that may arise during the course of the study to protect or prevent harm and maintaining the safety of the participant. Justice provides compensation for the participation in the study in the event they were in a group that did not receive the best treatment or in the event that their condition worsened as a result of the study. (Callahan & Hobbs, October)
D1. Issues
Vulnerable populations include various ethnic groups, the elderly, prisoners, handicapped individuals, mentally ill or handicapped, prisoners, women, poverty stricken and children. It is required that information is presented in a language that is understandable to them. Confidentiality must be guaranteed, they have the right to refuse or withdraw from the study at anytime. Any questions that are asked by them must be answered in a manner that they understand. Under no circumstances may they be harmed or exploited. (Gaines, 2006)



Sunday, September 1, 2013

Drug Calculations

http://www.dosagehelp.com/I found this link to be very helpful when studying. I hope it will benefit someone else.

Sunday, April 7, 2013

EBT1 TASK 3 Research Integration and Outcome Evaluation








EBT1 TASK 3 Research Integration and Outcome Evaluation
Victoria Hart
Western Governors University



A1. Procedure
 The preoperative procedure of shaving the operative site with a razor has been proven to be a source of surgery site infections. Studies have shown shaving creates micro abrasions that permit bacteria to penetrate the area and infect the wound. The CDC guidelines recommend not removing the hair unless it will interfere with the procedure, if the hair must be removed clipping immediately prior to the surgery is recommended (Segal, C., 2006).
A2a. Basis for Practice
  The basis for changing the method of removing hair at the operative site was due to the results of much research on surgical site infections (SSI) as well as the recommendations from the Center for Disease Control and Prevention (CDC) and The Joint Commission on Hospital Accreditation (TJC). The Hospital Infection Control Practices Advisory Committee published Guideline for Prevention of Surgical Site Infection in 1999. TJC included reducing the risk of healthcare associated infections as one of the national safety goals in 2008 (Waddington, C., 2008).
At the hospital the Infection Control, Performance Improvement, and Patient Safety committees made the recommendation for the change from shaving the patient with razors to only removing hair with clippers and only if necessary. The service line directors of nursing and surgical surgery were responsible for implementing this change after the approval of the hospital administration.
A2b. Rationale
 Antisepsis was introduced in 1860 and resulted in the transformation of surgery. The CDC National Nosocomial Infections Surveillance (NNIS) began tracking nosocomial infections the 1970s. Based on this data more trends were identified. SSIs are responsible for approximately one third of all nosocomial infections (Mangram, Horan, Pearson, Silver, & Jarvis, 1999).
Several characteristics were identified as causative factors that increase the risk of SSIs. Preoperative shaving was identified as one of those causes. Unlike factors that cannot be modified such as the patient’s age changing the way a patient is prepared for surgery can be altered.
A2c. Explanation
 Originally in the early nineteenth century surgeons removed hair to prevent it from falling into the wound or to allow them to visualize the operative area clearly. Later around 1850’s surgeons removed the hair because they believed it caused infection from the bacteria that inhabited the hair. In 1927, Dr. Walter Hughson recognized the risk of shaving with a razor with his description of the condition of the operative site being worse than if the hair remained present (Altman, 1983). The result of a Nigerian study of third world country surgical practices conducted by Adisa, Lawal, & Adejuyigbe in 2010 concluded that depilatory cream is safer than razors. It was concluded by multiple studies depilatory cream can cause skin irritation; therefore the 1999 CDC guideline excluded this method of hair removal. The current recommendation in the United States is for no hair removal or clipping immediately prior to surgery.
A3a. Reference List
Adisa, A., Lawal, O., & Adejuyigbe, O. (2011). Evaluation of two methods of preoperative hair removal and their relationship to postoperative wound infection. Journal Of Infection In Developing Countries, 5(10), 717-722.
Altman, L. K. (1983, June 21). The doctor's world; shaving area of operation now seems dangerous. The New York Times. Retrieved from http://www.nytimes.com/1983/06/21/science/the-doctor-s-world-shaving-area-of-operation-now-seems-dangerous.html
Mangram, A. J., Horan, T. C., Pearson, M. L., Silver, L. C., & Jarvis, W. R. (1999). Guideline for prevention of surgical site infection. Infection Control Hospital Epidemiology, 20(4), 205-178.
Segal, C. (2006). OR special. Infection control: start with skin. Nursing Management, 37(4), 46-52.
Waddington, C. (2008). Changing behavior: evidence based practice supporting hair removal with clippers. ORL Head Neck Nurs, 26(4), 8-12.
A4. Clinical Implications
Clinical implications of shaving verses clipping may greatly reduce the rate of SSI resulting in improved patient safety, shorter hospital stays and lower costs for care. In each of the studies and literature reviewed the results were significant in the difference between rates of infection with the patients shaved with at razor as opposed to those clipped.
The comfort of the patient with this practice is improved as the risk of micro abrasions are decreased with clippers. The anxiety of the patient is substantially less in cases that require hair removal in vulnerable areas such as the groin with clippers.
The cost to the health care industry will be reduced as the cost of disposable razors is eliminated. The cost of treating infections is reduced as a result of fewer infections. 
Areas of the hospital impacted by this change are significant. The purchasing department must research the cost of clippers; order the correct equipment whether it is reusable or disposable as many patients require preoperative shaving and removal of any kits containing razors. The nursing staff must be educated to the new practice. This includes the operating staff and the surgical care unit staff. Physicians must accept the evidence based recommendation that not all patients have hair removal. Pre-operative printed educational literature for patients must be changed to reflect the new process.
A5. Procedural Changes
By removing the practice of shaving surgical sites with razors infection rates will be decreased. “The infectious rate was significantly higher in the manually shaven than in the electrically clipped patients with an odds ratio of 3.25%” (Ko, Lazenby, Zelano, Isom & Krieger, 1992). By decreasing wound infections, patient discomfort, morbidity and cost of care will decrease significantly (Adisa, Lawal, & Adejuyigbe, 2011). The CDC has recommended hair not be removed unless absolutely necessary (Segal, 2006).
A cited study in the Hospital Infection Control Practice Advisory Committee states SSI rates for hair removal by razor was 5.6% as opposed to 0.6% rate for patients that had hair removed with a depilatory cream or not removed. The timing of hair removal is an important factor in SSI, shaving done greater than 34 hours before surgery increased the rate more than 20%. Additional studies show hair removal by any method increases infection rates. (Mangram, Horan, Pearson, Silver, & Jarvis, 1999)
Based on the research presented, by eliminating preoperative hair removal except when it would interfere with the surgical procedure, we can significantly reduce SSI. This will provide a greater safety to the patient, a cost savings to the organization and increased revenue to the hospital.
A6. Stakeholders
Once administration has approved the evidence based practice recommended change, department managers must be informed and educated to the rationale of changing the procedure. Beginning with the purchasing department, the necessary equipment must be obtained. They must understand the desired practice change to identify the proper equipment and help establish a time line and what education may be necessary. The education department will provide educational in-services to explain the change to the nursing staff. They will need all of the evidence to create the necessary education to the staff. The staff must understand and accept the change. The front line staff is the one educating and helping patients understand their surgical care. The medical staff director will provide education and buy-in from the physicians and surgeons. Infection Control nurses can be influential in providing up to date statistics of our SSIs with easy to read graphs and posters in strategically located places. By showing the trend of lower SSIs acceptance of the change will be increased.
B1. Translation of Research
Shaving the operative site has been a practice in hospitals as far back as the nineteenth century. It has been noted by many great practitioners that bacteria inhabit the hair and has a role in causing infection. This particular practice is clearly understood and the theory has been proven in many medical studies. What may be difficult is explaining to others why the practice of not removing the hair is the best method of infection prevention. A PowerPoint presentation with statistics, photos, and references will be the best method of translating the research to others. Creating a multidisciplinary team to disseminate the information to other departments will assist synthesizing the conclusions and recommendations into our organizational procedure. By creating a team to institute this change the understanding at difference levels and in various departments will be more effective.
B2. Barriers
Possible barriers to instituting this change based on the evidence-based study are physician refusal to accept the change in practice. Shaving the hair from a surgical site has been done for centuries, beginning with a straight razor. Physicians that have a routine may be resistant to change believing it may hinder their outcome or impair their ability to perform the operation. Nursing staff may be hesitant to accept the change due to lack of understanding the research and evidence fearing they may impair their patient’s outcome. Operating room staff may be concerned with delays due to the surgical site possibly needing to be clipped.
In any situation involving change people can be resistive; in the operating room confidence in the accuracy of the research is paramount to accepting new procedures. 
B3. Strategies.
Communication, understanding and education are the key strategies to help institute a change. A gradual transition by providing old and new methods of hair removal and recommendations to avoid hair removal if at all possible will make the change easier to implement. Department champions are able to gain acceptance within departments as they are trusted peers.
B4. Application of Findings
              SSIs are responsible for approximately one third of all nosocomial infections (Mangram, Horan, Pearson, Silver, & Jarvis, 1999). The CDC guidelines recommend not removing the hair unless it will interfere with the procedure, if the hair must be removed clipping immediately prior to the surgery is recommended (Segal, C., 2006). TJC included reducing the risk of healthcare associated infections as one of the national safety goals in 2008 (Waddington, C., 2008). By decreasing wound infections, patient discomfort, morbidity and cost of care will decrease significantly (Adisa, Lawal, & Adejuyigbe, 2011). Based on the evidence presented over the last couple of decades it has been shown the age old practice of shaving hair from the operative site has a direct impact on SSIs. Current practice recommendation guidelines written 1999 from Hospital infection Control Practices Advisory Committee have been implemented by the accreditation committee TJC. “The Center for Medicare and Medicaid Services (CMS) MS will continue to work collaboratively through consensus processes, such as those of the Hospital Quality Alliance(HQA), National Quality Forum (NQF), and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), to coordinate measures and implementation of the Value Based Purchasing (VBP) program” (CMS Hospital Pa y-for-Performance Workgroup , 2007).
References
Adisa, A., Lawal, O., & Adejuyigbe, O. (2011). Evaluation of two methods of preoperative hair removal and their relationship to postoperative wound infection. Journal Of Infection In Developing Countries, 5(10), 717-722.
CMS Hospital Pa y-for-Performance Workgroup U.S. Department of Health and Human Services, Center for Medicare and Medicaid Services. (2007). Medicare hospital value-based purchasing plan development (1st Public Listening Session). Retrieved from website: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/downloads/hospital_VBP_plan_issues_paper.pdf
Freshwater, D. (2003). Understanding and implementing clinical nursing research. Blackwell Publishing, Ltd., Retrieved from http://www.icn.ch/images/stories/documents/networks/Research/48751_4th_proof.pdf
Ko, W., Lazenby, W., Zelano, J., Isom, O., & Krieger, K. (1992). Effects of shaving methods and intraoperative irrigation on suppurative mediastinitis after bypass operations. The Annals Of Thoracic Surgery, 53(2), 301-305.
Mangram, A. J., Horan, T. C., Pearson, M. L., Silver, L. C., & Jarvis, W. R. (1999). Guideline for prevention of surgical site infection. Infection Control Hospital Epidemiology, 20(4), 205-178.
Segal, C. (2006). OR special. Infection control: start with skin. Nursing Management, 37(4), 46-52.
Tanner, J., & Khan, D. (2008). Surgical site infection, preoperative body washing and hair removal. Journal Of Perioperative Practice, 18(6), 232.