Childhood obesity has increased at an alarming rate over the last 20 years. Today, nearly one in five children is battling this condition and if patterns predict the future, almost all of America’s children will be living with diabetes, heart disease, and dying younger due to obesity within the next 20 years.Click on the Edit HTML tab. Paste the first two sentences of your old paper over these words, with your name. Leave the following text intact.
Childhood obesity has increased at an alarming rate over the last 20 years. Today, nearly one in five children is battling this condition and if patterns predict the future, almost all of America’s children will be living with diabetes, heart disease, and dying younger due to obesity within the next 20 years. The educated nurse can influence the caregiver’s strategies in promoting healthy lifestyle behaviors for obese children through proper education of prevention, lifestyle changes, and offering treatment options for obesity.
Childhood obesity alone is not the only issue facing children today, although being overly large may inhibit the child from living life to the fullest. However, the co-morbidities relating to childhood obesity are the real killers. Hypertension, type 2 diabetes, respiratory ailments, sleep apnea, and depression are just some of the common problems linked directly to obesity in children (Henry 2005). Others are increased likelihood of having elevated cholesterol, raised systolic blood pressure, experience of early menarche which links with future instances of breast cancer, and increased risk for cardiovascular disease (Ruxton 2004). All of these issues are associated with childhood obesity, and this is a fact that many people do not realize. Steps must be taken to prevent obesity and to promote wellness in children of all ages in order to save America’s children.
First, nurses can influence prevention through sharing information on misunderstood topics. Many people do not know which food choices will keep their children healthy, and these healthy choices should begin at infancy. Numerous women choose not to breastfeed their infants and according to a study done by Mayer-Davis, et al. (2006), breastfeeding can decrease the incidence of overweight/obese children by 13-22%. It is the concern for the children that many mothers say is the reason they do not want to breastfeed, as the mothers are either obese or battling diabetes and don’t want to transfer their health problems into their infant through diet. However, the study conducted proved that regardless of the mother’s weight and diabetic status, the infant equally benefited from the mother’s breast milk (Mayer-Davis 2006). Another piece of information that many people do not realize is the long-term health problems related to childhood obesity. In a separate study done by the American Obesity Association (AOA), over 30% of parents were concerned of their children’s weight, yet only 5.6% of those parents chose “being overweight or obese” as their child’s greatest long-term health risk (Childhood Obesity). These parents need to be told that their children are at risk for poor organ functioning due to large amounts of fat inhibiting normal function, that the excess weight will place unnecessary strains on growing joints and limbs, and that the adipose tissue will have major effects on the metabolic and endocrine systems (Ruxton 2004). Discussing the long-term effects of childhood obesity can play a crucial part in prevention because, as the AOA’s study confirms, people are not aware of the permanent effects this disease can have on a child. Prevention and education are key to battling childhood obesity, but once the knowledge is there, the lifestyle changes must be implemented.
Lifestyle changes will be crucial to reverse childhood obesity if prevention measures are not taken or are unsuccessful. The nurse should teach that lifestyle changes include diet appropriate for the growing child as well as increased amounts of physical activity. Many professionals (i.e. pediatricians, pediatric nurse practitioners, and registered dieticians) are hesitant to put a child on a diet because the child is still growing into his/her body; however, it is appropriate to limit the amount of high fat foods and soft drink consumption while encouraging low-fat dairy products, breakfast each day, and an increase in fruit and vegetable intake (Barlow 2002, Ruxton 2004). Creating a healthy eating environment can help teach kids to make healthier choices; such as assisting with meal preparations, eating slowly to enjoy the family’s time together, and avoiding the use of food as a reward (Childhood Obesity). Along with diet, physical activity is vital to the health of a child. Many children are content to sit in front of a television and play video games for hours at a time. Encouraging physical activity as a family or enrolling the child in a structured activity that he/she enjoys are ways to decrease the amount of TV time, and assigning active chores to every family member is both productive and heart-healthy. Limiting the amount of sedentary time a child is allowed, whether it is computer time, video games, or television time is always a good idea as the child can learn creativity and problem solving outside of the technological world.
Finally, if preventative knowledge and lifestyle changes are not enough, medical-surgical interventions can be implemented. Bariatric surgery for pediatric patients, normally adolescents, has been found to be effective in resolving obesity as well as any obesity-related co-morbidities. This surgery is a last-chance option for these children and should be addressed as so by the informing nurse, as there are many criteria that must be met before a pediatric bariatric surgery will be implemented. For instance, the patient must have a BMI of >/= 40 or be more than 100 lbs. overweight, must have high risk comorbidities, must have a life-threatening cardiopulmonary problem and must have potentially other problems that interfere with lifestyle (Henry 2005). The American Academy of Pediatrics and the American Pediatric Surgical Association have both approved of this method, though they do require additional criteria to be met and they reach the conclusion that bariatric surgery is the answer much more slowly than other organizations. One final point the nurse should make very clear to families discussing this option is that Medicare has recently passed a bill stating that adult obesity is a disease and therefore will be covered by insurance as a disease. However, childhood obesity is not yet labeled as a disease; therefore, families will likely bear the entire cost of this surgical procedure (Henry 2005).
Obesity does not merely inhibit a child from living a normal life, but prevents the child from having a healthy and favorable future. With the rate of childhood obesity increasing like it is, all children will likely become affected in one way or another. The educated nurse must intervene to promote healthy lifestyle behaviors for obese children, as well as educate on prevention, changes in lifestyle and offer treatment options for obesity.
A. Intervention 1: The educated nurse can influence the caregiver’s strategies in promoting healthy lifestyle behaviors for obese children through lifestyle changes.
I. Disadvantage 1: Knowledge Deficit
A parent’s lack of knowledge is a difficult barrier to cross when trying to implement lifestyle changes for an obese child. The skewed thoughts of the parents are often what enable the child to continue with unhealthy lifestyles. In a study done by Myers and Vargas, about 80% of parents understood that obesity led to heart disease and had negative long-term effects; however, only 5% of the parents thought that an increase in physical activity could decrease their child’s weight and only 3.5% understood that decreasing their child’s consumption of soda and Kool-Aid could help their child’s weight loss. Others thought their child was slightly overweight when the child was well beyond the recommended weight for his/her age, but were not concerned with any long-term health risks (Myers, Vargas 2000).
II. Disadvantage 2: Low Socioeconomic Status
Lifestyle changes are also difficult to implement in a family of low socioeconomic class. When there is no money for healthy food choices, which are by far the more expensive foods, families will tend to choose quick, cheap food choices that are higher in fat and calories. Lack of financial means is also related to decreased physical activity. The cause is not certain, but one can assume that many organized activities require some sort of fee and those of low socioeconomic class may not have the funding to participate in those organized physical activities. A study found that there was a direct correlation between low socioeconomic status and sedentary lifestyles with poor dietary choices, though the authors noted that additional longitudinal studies should be done to confirm these findings (Lioret et al 2008).
B. Intervention 2: The educated nurse can influence the caregiver’s strategies in promoting healthy lifestyle behaviors for obese children through offering treatment options for obesity.
I. Disadvantage 1: Lack of Insurance Coverage
Medicare has recently declared adult obesity to be a disease, and therefore covers any interventions needed to change the adult’s obesity status. However, childhood obesity is not considered a “disease” and therefore is not covered by most insurances, since many insurances follow Medicare’s lead on deciding coverage. Though bariatric surgery is considered elective for most children and is a last resort in most situations, some children’s lives depend on losing weight rapidly. Diabetes, heart disease, and organ failure due to increased adipose tissue are among the very serious issues that obese children face, and these factors can be life-threatening and often need to be dealt with immediately. Surgery options should be implemented only if activity levels and lifestyle changes do not affect the child’s obesity status, unfortunately this is not a realistic factor if the insurances do not cover the child’s surgery (Henry 2005).
II. Disadvantage 2: Non-Compliance
Though banding is the most common childhood bariatric surgery, many different methods are used to help a person lose weight. Other methods are: removal of part of the stomach and rerouting the intestines, stapling the stomach, and gastric bypass, all which effectively help a person lose weight but are all a bit riskier than the band. Regardless of which method is used, it can only be successful if the obese person also changes their eating habits and exercise habits. The likelihood of a child changing these habits after surgery is very small, often because the parents are enabling the child to continue with their poor lifestyle choices or the child is not interested in physical activity and continues with their sedentary activities. Unless the child is very mature and responsible enough to make life-changing decisions, compliance is likely to be an issue and needs to be addressed with a psychologist as well as with a dietician, life-counselor and/or exercise physiologist prior to and following the child’s bariatric surgery (Marchione 2006).
REFERENCES:
Barlow, S.E., Trowbridge, F.L., Klish, W.J., & Dietz, W.H. (2002). Treatment of child and adolescent obesity: Reports from pediatricians, pediatric nurse practitioners, and registered dieticians. Pediatrics, (110)1, 229-235. Retrieved January 4, 2007 from Expanded Academic ASAP database.
Childhood Obesity (n.d.). Retrieved February 2, 2007, from
http://www.obesity.org/subs/childhood/prevention.shtml.
Henry, Linda L. (2005). Childhood obesity: What can be done to help today’s youth? Pediatric Nursing, (31)1, 13-16. Retrieved January 4, 2007 from Expanded Academic ASAP database.
Lioret, S., Touvier, M., Lafay, L., Volatier, J.L. & Maire, B. (2008). Dietary and physical activity patterns in French children are related to overweight and socioeconomic status. The Journal of Nutrition (138)1, 101-107. Retrieved February 3, 2008 from Expanded Academic ASAP database.
Marchione, Marilynn. (2006). Weight-loss surgery growing: Doctors, patients debate which kind of procedure is best. Columbian. Retrieved February 3, 2008 from Expanded Academic ASAP database.
Mayer-Davis, E.J., Rifas-Shiman, S.L., Zhou, L., Hu, F.B., Colditz, G.A., & Gillman, M.W. (2006). Breast-feeding and risk for childhood obesity: Does maternal diabetes or obesity status matter? Diabetes Care, (29)10, 2231-2238. Retrieved January 4, 2007 from Expanded Academic ASAP database.
Myers, S. & Vargas, Z.. (2000). Parental perceptions of the preschool obese child. Pediatric Nursing, (26)1, 23-30. Retrieved February 3, 2008 from Expanded Academic ASAP database.
Ruxton, Carrie. (2004). Obesity in children. Nursing Standard, (18)20, 47-55. Retrieved January 4, 2007 from Expanded Academic ASAP database.
Paste the rest of your old paper plus the new part and all the references over these words. Leave the following text intact.
Tuesday, February 5, 2008
Childhood Obesity
Smoking Cessation and the Role of the Nurse
Habitual smoking is a worldwide health crisis that can shorten life expectancies by over 20 years and create fatal illnesses such as lung cancer, emphysema and heart disease (Whyte,2007).Because smoking can lead to chronic and acute illnesses, nurses can have and impact on their clients health by educationg them on the importance of smoking cessation.
Nursing strategies for this are to act as role models by not smoking themselves, promoting smoking cessation in the adult clients, and educating children and adolescents on the dangers of taking up smoking.
The International Council of Nurses believes that nurses can be very helpful in the prevention of smoking and smoking cessation. Nurses can help to reinforce this influence on their client’s by not smoking themselves since they are regarded by the public as important health role models. Just as important, or even more so is to provide a good example for their own children in order to safeguard the nurses health and that of their family. Children of smokers have an increased risk of sudden infant death syndrome, respiratory infections, lung cancer and ear infections (Kellogg, 2002).
Smoking and the willingness to try a smoking cessation program should be assessed with clients. Nurses working in Dr’s offices who see the same clients on a regular basis are in an optimal position to do this. Cost should not be a deterrent since the clients’ employer may offer programs or their insurance benefits may cover the cost of smoking cessation programs. While some clients may not be ready to quit, the nurse may follow an approach called the “transtheorhetical model of change.” This method is a way to help clients move through stages such as: precontemplation, contemplation, preparation, action and maintenance in order to prepare them for smoking cessation. During precontemplation, the client has no intent on quitting smoking in the next six months. The contemplation stage is the time that the client has an intention to quit during the next six months time. Preparation is the stage that the client has planned to quit in the next 30 days and has taken behavioral action toward action. The stage that follows preparation is the action stage which includes clients who have quit for less than six months. Lastly, is the maintenance stage in which the client has remained free of smoking for more than six months.
Another approach for the nurse to use with smoking cessation is the intervention steps known as the five A’s which include: ask, assess, advise, assist and arrange (Whyte, 2007). Asking clients about their smoking is always the first step. For the younger person asking about what their friends do is also important. Assessing includes whether or not the client is ready to make a change within the next 30 days. Advising pertains to providing help and motivation for the smoker to quit. Assisting the client could include many options such as: setting a quit date, recommending smoking cessation pharmacotherapy, removing all tobacco items from the clients’ environment, individual or group therapy, expecting challenges and enlisting help from friends and family. Lastly, arranging follow up contact by either in-person or telephone conversations to keep track of the client and continue with support.
Nurses can also help support their clients by educating them on the available pharmacotherapy treatments for smoking cessation. There are six currently available treatments approved by the Food and Drug Administration (FDA) for smoking cessation: one nonnicotine treatment and five nicotine replacement products that differ based on delivery mechanism (Ford, 2006). The nicotine replacement products include the nicotine inhaler and nasal spray which are available by prescription and the nicotine gum, lozenge and patch which are available over the counter. Clients should be advised to completely stop smoking before using nicotine replacement product to increase their chance of success. Sustained-release bupropion (bupropion SR) is approved by the FDA for smoking cessation, is available by prescription in tablet form and should be started before the client stops smoking. It is believed to ad smoking cessation through the inhibition of various neuro chemicals normally activated in the brain by smoking (Scanlon, 2006). Bupropion SR Bupropion SR and the nicotine patch can be combined for another alternative.
While interventions and pharmacotherapy’s can be effective in smoking cessation with the adult population, smoking prevention among children and adolescents is better than the cure. The younger a person begins to smoke, the greater their risk of smoking-induced diseases such as cancer or heart disease (Whyte, 2002). For this age group, peer lead prevention programs can be very effective. These can include videos or films which highlight the social consequences such as: smelly clothing, bad breath, financial cost and decreased athletic ability. Nurses working in schools can help by promoting smoke-free environments and reinforce the dangers of smoking.
Smoking has many adverse effects on health and contributes greatly to morbidity and mortality. Because smoking can lead to chronic and acute illness, nurses can have an impact on their clients’ health by educating them on the importance of smoking cessation and the avoidance of smoking in children and adolescents. Nurses can also set a healthy example by not smoking themselves. These strategies can help to increase abstinence rates and decrease tobacco-related mortality and morbidity which can help to improve their client’s lives.
Intervention #1- Promoting smoking cessation in adult clients.
Disadvantage #1- The high addictiveness of cigarettes.
Due to the high addictiveness of tobacco, clients participating in smoking cessation treatments do not always respond as readily as many healthcare professionals would like. It is the complex neurobiology of tobacco that is likely to be responsible for the development of tobacco dependence. The nicotine is the principal addictive component of tobacco smoke and shares many of the pharmacological characteristics of a psychostimulant drug such as amphetamine and cocaine.
Balfour, D., (2002). The Neurobiology of Tobacco Dependence: A Commentary. Respiration. 69, (1). 7-11. Retrieved February 4, 2008, from Proquest database (677604631).
Disadvantage #2- The financial costs of smoking cessation treatments.
Smoking cessation medications can range in price from $3.50 to $11.00 per day. Medicare does not cover smoking cessation treatments and private insurers have been reluctant to cover these costs as well. Their lack of coverage comes even as the healthcare savings has been estimated to be $1,623 a year for each person that quits smoking. Fortunately, tobacco cessation treatments are available and effective, and more medications are being developed to treat tobacco dependence. However, the inability of tobacco users to afford these treatments remains a barrier to reducing smoking cessation.
Solberg, L., (2005, June). Impact of insurance coverage on the use and effects of smoking cessation medications. Disease and Management Health Outcomes. (3). 151-58. Retrieved February 5, 2008, from EBSCO database (1173-8790).
Intervention #2-Educating children and adolescents on the dangers of taking up smoking.
Disadvantage #1-Peer pressure and the smoking behavior of their closest friends.
Research findings show that adolescent peer relationships contribute to adolescent cigarette smoking. Youth who are friends with smokers have been found to be more likely to smoke themselves than those with only nonsmokers as friends. Best friends, romantic partners, peer groups and social crowds all have been found to contribute to the smoking or non-smoking behavior of teenagers. Rather than coercive pressures, the decision to smoke has been found to be more about trying to fit in, social approval and popularity.
Castrucci, B.C., Gerlach, K.K., Kaufman, N.J., Orleans, C.T., (2002, September). The association among adolescents’ tobacco use, their beliefs and attitudes, and friends’ and parents’ opinions of smoking. Maternal and Child Health Journal. 6(3). 159-67. Retrieved from EBSCO database February 5, 2008.
Disadvantage #2- Advertising and promotion of smoking that appeal to adolescents.
Despite tobacco industry claims, researchers have consistently implicated cigarette marketing activities as an important catalyst in the initiation of smoking in adolescents. Due to advertising, studies show and increase in smoking rates among population subgroups specifically targeted by marketing campaigns.
Biener, L., (2000, March). Tobacco marketing and adolescent smoking: more support for a casual inference. American Journal of Public Health, 90(3). 407-11. Retrieved February 5, 2008, from EBSCO database (0090-0036).
References
Kellogg, John Harvey, (2002, June). Tobaccoism. American Journal of Public Health, 92 (6). 932-934. Retrieved October 12, 2007, from EBSCO database (0090-0036).
Potts, Lisa A., (2007, August 15). Emerging psychotherapies for smoking cessation. American Journal of Health-System Pharmacy, 64 (16). 1693-1698. Retrieved October 12, 2007 from EBSCO database (1079-2082).
Saarman, L., Daugherty, J, & Riegel, B. (2002, June). Teaching staff cognitive-behavioral intervention. MedSurg Nursing, 11(3). 144-151. Retrieved January 7, 2007, from Expanded Academic ASAP database (A87509029).
Scanlon, A. (2006, November). “Nursing and the 5A’s guideline to smoking cessation interventions”. Australian Nursing Journal, 25(4), 14- . Retrieved January 7, 2007, from Expanded Academic ASAP database (A154562471).
Whyte, F., & Kearney, N. (n.d.). Enhancing the nurse’s role in tobacco control. Retrieved February 4, 2007, from http://www.tobacco-control.org/tcrc_Web_Site/Pages_tcrc/Resources/Factsheets/enhancenursesrole.pdf
The Cultural Diversity of Patients and the Importance of Providing
The 21st century has been an era of multiculturalism and diversity. With this increase in our ethically diverse population, the nurses’ ability to deliver appropriate care for all people is extremely important. Jennifer McBride
The 21st century has been an era of multiculturalism and diversity. With this increase in our ethically diverse population, the nurses’ ability to deliver appropriate care for all people is extremely important. There are a number of barriers that separate people of different backgrounds, but unless those barriers are discovered and overcome the people in this world will never receive the healthcare that they need and deserve. Cultural competence in the nursing field is imperative in providing successful care to clients of different ethnic or cultural backgrounds. Nurses can accomplish this by first evaluating their own personal beliefs, educating themselves and others on skills needed to do cultural assessment, and by collaborating with a multidisciplinary team.
Lacking cultural competence is a huge problem in the health care industry. Cultural competence is knowing how to communicate with people of different backgrounds. It is knowing what biologic variations can present. Cultural competence is knowing about the client’s world view and how they view life, illness, medicine, gender and health care. Without this knowledge it is virtually impossible to provide people with adequate care. Communication is key in providing the healthcare provider with vital information about the client. Cultural competence by no means calls for the nurse to be fluent in all languages, rather to know how to get around these barriers. By not knowing how a client feels about medicine or women, for example, the nurse could very easily offend the client, which could cause the client to have a negative experience. Lacking cultural competence is a problem because of our ever growing diverse country. It is a problem because without it, people will not receive the care nor education that they need.
Becoming culturally competent is an ongoing process and the nurse must bring the willingness and commitment to change. Every person is to an extent, ethnocentric. Dennis and Small (2003) recognized that clarifying one’s own values is one of the most important steps in being culturally competent. Learning how to reduce our ethnocentrism is enhanced by realizing that there are many other cultures out there. Some of these cultures are similar to our own and some are very different. Some have practices that we like or dislike, but having an awareness to this helps us to treat our clients as individuals.
In order to achieve cultural competence the nurse must yearn for the following characteristics: cultural desire, cultural awareness, cultural knowledge, cultural skill and cultural encounters. (Potter and Perry, 2005) Cultural awareness is the examination of one’s own cultural background. This process involves the recognition of one’s biases, prejudices, and assumptions about individuals who are different. Cultural knowledge is the process of seeking and obtaining educational information about diverse cultural and ethnic groups. (Purnell, 2005) Obtaining cultural knowledge about the patient’s health related beliefs and values involves understanding their world view. Understanding the patient’s world view will help the nurse to interpret how the patient views their illness. Nurses can obtain this knowledge by doing research on different cultures on the internet or at the library. Cultural skill involves being able to accurately perform a culturally based, physical assessment. The nurse needs to know about biologic differences in cultural groups, whether that is skin color or metabolic differences. The nurse also needs to be educated on cultural beliefs about medicine, illness and healthcare. This will refine or modify one’s existing beliefs about a cultural group and will prevent stereotyping. Although it may not be an actual skill, cultural desire is the pivotal and key construct of cultural competence, for it is the nurse’s desire that evokes the entire process of cultural competence. Cultural desire includes a genuine passion to be open and flexible with others, to accept differences and build on similarities, and to be willing to learn from others.
During the assessment phase it is very important to take into account things such as variations between groups. Skin color is one of the most easily observable. Many skin conditions manifest differently in light and dark skin; anemia, erythema and jaundice are just a few (Dennis and Small, 2003) Nurses need to take into account the different biologic variations of clients while performing their assessments and developing a plan of care. Because of African American’s dark skin tone it may be difficult to diagnose inflammation, jaundice and cyanosis. Clients of Asian background have a high incidence of lactose intolerance. Some variations are not biological, but are still extremely important to recognize. For instance, Native Americans sometimes wear a ceremonial patch that keeps evil spirits away; these patches should never be removed by a health care professional. Because of their religious beliefs, Muslim men may not want to be touched by a woman, even in a health care setting. Knowing these variations ensures that the nurse will be able to provide the appropriate care and treatment.
Using a formally trained medical interpreter is sometimes necessary to facilitate accurate communication during the nurse-client encounter. The use of untrained interpreters, friends or family members may pose a problem due to their lack of knowledge regarding medical terminology and disease entities. This situation is heightened when children are used as interpreters. (Campinha-Bacote, 2003) Nurses can learn just a few phrases in the most common languages and this will help with being able to communicate with clients. Usually when a health care professional attempts to communicate with a client in their own language it makes them feel more cared for and can lower the communication barriers. Nurses need to have at least a minimal amount of knowledge about the culture and background of the client they are dealing with. Collaborating with multiple health care team members is also sometimes helpful in receiving new ideas and, or receiving help in dealing with clients. Another person may have a different perspective than the nurse, and this can sometimes be a good thing.
According to Servonsky and Gibbons (2005) some assessment strategies that demonstrate how nurses can deliver culturally competent care include knowing what questions to ask and how to ask them in a nonjudgmental way, being able to empower the family and its members and acting as a mentor so that the family is more involved in the health care process. All of these things point to having a therapeutic nurse-client relationship. Working on and implementing these strategies will help the client and family to feel comfortable. Empowering the family will allow them to trust their nurse. Servonsky and Gibbons (2005) define cultural competence as:
An understanding not only of one’s own culture, values, and beliefs, but the awareness and acceptance of cultural differences among groups and the recognition that diverse groups have their own way of communicating, behaving, problem solving and interpreting health and illness. (2)
This country is growing and becoming more culturally diverse every day.
Providing successful care to clients is ensuring that the world not only survives, but advances. Nurses need to have the skills and competence to care for these clients. There will always be barriers that attempt to separate people of different backgrounds, but there are ways to overtake them. By evaluating their own personal beliefs, educating themselves and others on skills needed to do cultural assessment, and by developing collaborating with team members, the nurse can and will be able to provide culturally competent care to clients of different cultural and ethnic background.
A. Evaluating one’s own personal beliefs.
i. Viewing own personal beliefs as superior to all others.
1. Narrative: In order to provide culturally congruent care it is first necessary to examine one’s own personal beliefs. This step is essential in becoming culturally competent due to its ability to allow one to recognize that there are many different cultures with many different views on everything from life, gender, illness and medicine. Although it is a vital step, it can have a harmful outcome. In knowing and understanding one’s own cultural beliefs, it is possible to view only those as right, and all other beliefs as wrong. The attitude that one’s own ethnic group, world view or culture is superior to all others is termed ethnocentrism (Taylor, 1998). This has a harmful affiliation with viewing all other differences as negative.
1. Journal citation: Taylor, Rosemarie. (1998) Check Your Cultural Competence. Nursing Management. 29 (8) 30. Retrieved February 2, 2008 from Proquest Database.
ii. Assumed similarity or stereotyping.
2. Narrative: Another possible fallout of being in touch with one’s own cultural beliefs is believing that all other cultural groups are similar. The assumption that every culture has similar beliefs and values can lead to staff conflict as well as poor outcomes for patients. In the American culture for example, it is common courtesy to have direct eye contact with whomever one is speaking to. To believe that all cultures feel this way can lead to negative client experiences. Some Asian cultures believe direct eye contact with superiors is disrespectful. To become multicultural is to realize that one’s values and beliefs simply reflect a single set of options among many (Taylor, 1998). Stereotyping is another possible outcome. It is possible to make assumptions and perceptions about people based on their ethnicity and cultural background. For example, just because it is known that many Asian cultures use medical practices such as cupping, burning and pinching, it would be inappropriate to assume that your Asian-American client also uses these practices. It is critical to know and understand practices among different cultures, but is wrong to assume that because someone is from a certain ethnic background that these practices are used in everyday life.
3. Taylor, Rosemarie. (1998) Check Your Cultural Competence. Nursing Management. 29 (8) 30. Retrieved February 2, 2008 from Proquest Database.
B. Educating self and others on skills needed to do accurate cultural assessment.
i. Not dedicating self to the process of life-long learning and research for the purpose of assessment findings.
1. Narrative: Knowledge about cultures and its impact on interactions with health care is essential for nurses, whether one is practicing in a clinical setting, education, research or administration. Culturally congruent care can only be achieved through the process of learning cultural competence. Therefore, one must become an empowered, active learner. Cultural competence is an ongoing process in which one is always attempting to become more culturally competent. (Campinha-Bacote, 2003) The problem with this life-long learning process is that many nurses believe that there is not enough time in the day. Yes, one may be exhausted after a twelve hour shift at the hospital; however, this commitment will result in high quality, culturally congruent care.
2. Journal citation: Campinha-Bacote, J. (2003) Many Faces: Addressing Diversity in Health Care. Journal if Issues in Nursing. 8, 1. Retrieved Jan 19,2007 from Proquest Database.
ii. Not providing an assessment individualized to the clients race or culture.
1. Narrative: Providing individualized care to each and every client is dependent on having knowledge about different cultural practices, beliefs and world views. However, providing individualized care also means that every person is unique and that one must take into account their cultural background without assuming that because that client is Muslim, Indian or Asian, that they have certain religious or cultural practices. Nurses sometimes have a tendency to make generalizations about clients based on their background. This goes hand in hand with assuming similarities and stereotyping. There is always a fallout to every good intervention, but knowing that these problems exist is what allows us to acknowledge it and not make the mistake.
References:
Campinha-Bacote, J. (2003) Many Faces: Addressing Diversity in Health Care. Journal if Issues in Nursing. 8, 1. Retrieved Jan 19,2007 from Proquest Database.
Dennis, B.P. & Small, E.B. (2003). Incorporating cultural diversity in nursing care: An action plan. ABNF Journal, 14 (9), 17-26. Retrieved February 8, 2007, from Proquest Database.
Hernandez, C.G., Quinn, A.A., Vitale, S.D., Falkenstern, S.K., & Ellis, T.J. (2004). Making nursing care culturally competent. Journal of Holistic Nursing Practice. 18, 215-218. Retrieved January 19, 2007, from Proquest database.
Potter, P. & Perry, A. (2005). Culture and Ethnicity. In S. Epstein (Ed.), Fundamentals of Nursing (pp. 120-133). St. Louis, Missouri: Mosby
Purnell, L. (2005). The Purnell model for cultural competence. Journal of Multicultural Nursing and Health, 11 (2) 7-15. Retrieved February 4, 2007, from Proquest Database.
Servonsky, J.E. & Gibbons, M.E. (2005). Family nursing: Assessment strategies for implementing culturally competent care. Journal of Multicultural Nursing and Health, 11, 51-56. Retrieved January 19, 2007, from Proquest database.
Nutrition and Elderly
Preventing Malnutrition in the Elderly
CLINT WEBSTER
With the increasing number of baby boomers reaching an older age, malnutrition is a serious problem today. Many of these elderly will end up in nursing homes and up to 85% suffer from malnutrition.
Clint Webster
Preventing Malnutrition in the Elderly
With the increasing number of baby boomers reaching an older age, malnutrition is a serious problem today. Many of these elderly will end up in nursing homes and up to 85% suffer from malnutrition (Crogen, 2006). This is an alarming number of malnourished patients for the Registered Nurse to take on. However, the knowledgeable nurse can aid elderly patients by providing adequate nutrition in a vulnerable population prone to malnutrition, and prevent the resulting problems. Three nursing strategies can include acquiring knowledge on malnutrition risk factors and signs/ symptoms, in order to identify the problem, know how to improve food consumption via different dining atmosphere, and supplement the types of foods the elderly consume by improving taste and nutrient density.
Malnutrition can be managed, but it requires skilled nurses and medical teams. In understanding that elderly malnutrition is a dramatic problem of epic scale today, this issue is not taken lightly by the medical community. Nursing homes are managed by nurses and this is where malnutrition is extremely prevalent. Mortality and morbidity are correlated with malnutrition (Brownie, 2006). Nutrition plays a large role in the severe problem of pressure sores due to protein loss. Adequate nutrition and protein are necessary in helping prevent and heal these pressure ulcers. Malnutrition makes pressure sores more likely and more difficult to heal (Dambach, 2005). The immune system is also hindered by malnutrition and this at risk population is already more susceptible to communicable diseases (Brownie, 2006). Conditions like pneumonia and bronchitis are much more serious in an elderly patient and malnutrition weakens their defenses. Registered Nurses are key in the fight against elderly malnutrition because they give the most direct care to elderly populations, and hence spend the most time with this high risk population. The nurse working with the elderly population should acquire detailed knowledge of malnutrition in order to identify the problem. The Mini Nutritional Assessment (MNA) is one valuable tool at the Registered Nurse’s disposal to judge malnutrition in the elderly. It consists of a survey of the patient’s level of malnutrition. Depending on the extent or score, it will recommend appropriate interventions that the Registered Nurse will implement (Vellas, 2006). Tools like the MNA incorporate many aspects of nutrition in the elderly to objectively identify who is at risk, but nurses still need to understand the process themselves. Knowing that the elderly client has decreased bodily function related to consuming and absorbing nutrients is important. Diminishing taste and smell senses can make food less appetizing than in the past. Dental problems can make consuming foods difficult. Poor fitting dentures can cause difficulty and pain in chewing and swallowing (Crogen, 2006). Factors such as reduced stomach acid and absorption problems can make garnering nutrients from food difficult. These can be exacerbated by the various medications the elderly take (Eliopoulos, 2005). Motor coordination is sometimes affected by medications. Elderly often already have some motor coordination deterioration. Further impairment by medications can hinder them from adequate consumption in limiting their ability to feed themselves (Crogen, 2006). The nurse should be educated on these issues and understand that they influence the clinical manifestations of malnutrition in the elderly. These can include “weight loss greater than five percent in the past month, weight ten percent below or above ideal range, serum albumin level lower than 3.5g/100mL, hemoglobin level below 12g/dL, and hematocrit value below 35 percent” (Eliopoulos, 2005, 202).
With knowledge on aging changes and identifying who is at risk, nurses should implement appropriate strategies to improve nutrient consumption. Elderly clients in nursing homes can be aided by an environment that is suitable for food consumption. The Registered Nurse in these settings can change lighting and table setting contrast to aid elderly nutrition. In one study, researchers found that placing white plates on blue trays laid out on a green table cloth with more evenly distributed light markedly increased nutrient consumption over three days (Brush, 2007). In those patients who eat in their rooms at the hospital or nursing home, it is especially important that unappetizing objects such as urinals and related items are not near or on the dining area. These objects detract from the dining environment (Calverly, 2007). Promoting a proper dining atmosphere is a valuable tool in nursing care of elderly malnutrition.
Improving the atmosphere of the dining experience can help in the nurse’s ability to manage elderly nutrition, but foods the elderly consume are the most important factor in preventing malnutrition. According to Dunn (2007), many foods and strategies for increasing their consumption do not work. Serving smaller more frequent meals does not improve nutrition. Oral supplements are also not very beneficial and often go wasted or conflict with medications. However, fortified foods (foods with added vitamins and minerals) and nutrient dense foods (foods that naturally have large quantities of vitamins and minerals for the amount of calories they contain) have been found to be effective. Fortified foods work best when they taste like their regular counterparts. Nutrient dense foods have been found to be very effective in promoting nutrition (Dunne, 2007). Improving taste is one of the best and simplest ways of improving nutrition. In some cases it is more important that elderly patients simply consume calories. Elderly patients have the same taste preferences as they have had all of their life, and thus low sodium, low fat meals are not always as appetizing as the normal version of a food with naturally high fat and sodium content (Calverley, 2007).
Malnutrition will always be an issue for the ever growing elderly population. It is important that this issue be dealt with correctly in order to prevent pain and suffering, increased healthcare costs, staff burden, and mortality (Brownie, 2006). A knowledgeable nurse can aid elderly patients by providing adequate nutrition in a vulnerable population prone to malnutrition. Nurses should be aware of the risk factors and signs via greater knowledge and insight, implementing strategies to improve food consumption, and offering different food choices to improve the amount of nutrients ingested. These strategies all help to minimize the devastating effects of malnutrition by promoting nutrition.
References
Brownie, S (2006).Why are elderly individuals at risk of nutritional deficiency?. Journal of Nursing Practice. 2, 115.
Brush, J. A., Meehan, R. A., & Calkins, M. P. (2002). Using the environment to improve intake for people with dementia. Alzheimer's Care Quarterly. 4, 330-339. Retrieved January 9, 2007, from Expanded Academic ASAP database.
Calverley, D (2007).The Food Fighters. Nursing Standard. 22, 20-21.
Crogen, N, & Alvine, C (2006). Testing of the Individual Nutrition Rx assessment process among nursing home residents. Applied Nursing Research. 19, 102-104.
Dunne, J.L., & Dahl, W.J. (2007). A novel solution is needed to correct low nutrient intakes in elderly long-term care residents. Nutrition Reviews. 65. Issue 3, 135-139.
Eliopoulos, C (2005). Gerontological Nursing. Philadelphia, PA: Lippincott Williams & Wilkins.
Vellas, B, Villars, H, Abellan, G, Soto, ME, Rolland, Y, & Guigoz, Y (2006). Overview of the MNA--Its history and challenges. Journal of Nutrition, Health, and Aging. 10, 456-463.
Intervention 1: Improving the dining atmosphere to improve nutrient consumption in elderly.
#1) While it is documented that improving the dining atmosphere will increase nutrition in the elderly, there are obstacles to overcome. One issue is that some elderly in nursing homes are very messy eaters for various health related reasons. This can be a distracting and unappetizing occurrence for the rest of the elderly eating there. Even if the lighting and contrast are adjusted for proper atmosphere, the elderly themselves can end up being a distraction. This can be dealt with by having these individuals in a side room (Andreoli, 2007).
#2) The timing of meals is also important. No matter how nicely laid out the dining atmosphere is, if the meal is during a portion of the day when an individual does not have an appetite, then that person will miss out on a meal until the next one comes around (Jhavari, 2006). This system will prevent a proper dining atmosphere from counting for anything because of poor timing.
Andreoli, N.A., Breuer, L, Marbury, D, Williams, S, & Rosenblut, MN (2007). Serving Culture Change At Mealtimes. MN Nursing Homes: Long Term Care Management. 9, 48.
Jhavari, T. (2006) Enhancing the dining experience in senior living. Nursing Home Magazine. October Issue, 58
Intervention 2: Improving nutrient density of foods, implementing fortified foods, and improving taste will help the elderly improve nutrition.
#1) While these techniques and foods have been shown to work, they do not account for the economic status of the elderly. Some may not have the financial means to afford these services and foods (Holman, 2005). The elderly may have someone else doing the shopping for them if they are not in a home, and this can leave their nutritional options in the hands of the person shopping (Holmes, 2006). Similarly, a common problem can be an elderly person who had a spouse or relative do their shopping for them and they are suddenly no longer capable of shopping. In these instances it leaves those elderly to do shopping on their own or not at all, and if they do end up shopping on their own, their nutritional knowledge could be a new problem.
#2) In other instances the elderly may have a host of issues that deter them from adequate consumption of nutrient. Of these, psychosocial issues such as an elderly person losing a loved one and being lonely can make them disinterested in eating (Holmes, 2006). Many other issues may affect a persons desire to eat as well, limiting nutrition.
Holmes, S. (2006) Barriers to effective nutritional care for older adults. Nursing Standard. 3, 51-54
Holman, R.N., Nicol, M. (2005) Promoting adequate nutrition. Nursing Older People. 17, 31-2
References:
Andreoli, N.A., Breuer, L, Marbury, D, Williams, S, & Rosenblut, MN (2007). Serving Culture Change At Mealtimes. MN Nursing Homes: Long Term Care Management. 9, 48.
Holman, R.N., Nicol, M. (2005) Promoting adequate nutrition. Nursing Older People. 17, 31-2
Holmes, S. (2006) Barriers to effective nutritional care for older adults. Nursing Standard. 3, 51-54
Jhavari, T. (2006) Enhancing the dining experience in senior living. Nursing Home Magazine. October Issue, 58
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Spiritual Assessments in Nursing
The nurses’ role in providing holistic care for a patient should include a spiritual assessment upon hospitalization. The question is, are nurses given the proper training on when to use an assessment tool and if so, how to plan care based on the results for a more holistic healing?
Providing spiritual care for patients becomes more complicated for the nurse as the definition of religion and spirituality seems to blend together. Addressing key nursing strategies, such as educating nurses on how to properly use a spiritual assessment tool, identifying what spiritual therapies are provided or available to patients, and what therapies nurses have found to be beneficial during the healing process are essential in allowing nurses to provide a plan of care that is focused on the overall holistic healing of the patient.
Nurses are in an excellent position to provide spiritual care to patients that can positively impact their healing process. Recognizing the patient’s spirituality may also help to enhance the nurse-patient relationship. Spiritual or holistic nursing is an area that has been neglected within nursing education. Concern over conflicting spiritual values between nurse educators, students, and patients may cause educators and students to avoid these difficult areas of care. (Lovanio & Wallace 2007). When approaching a patient about their spirituality, the nurse must be sensitive and cautious. Spiritual assessment and care should be based on a relationship of trust between patient and nurse. It will involve awareness of the person's culture, social and spiritual preferences, as well as a respect for their beliefs and religious practices. Spirituality is a core component of holistic healing as it provides the foundation for hope and faith that life will continue on through their sickness. When spirituality and emotional needs are not addressed, a patient’s hope can quickly turn to depression, their faith to disbelief, and their will to live can fade. Nurses are in an ideal position to provide spiritual care to patients but many are hesitant to because they lack the experience and education to do so.
Educating nurses on how to properly use a spiritual assessment tool to address patient’s needs is a crucial part of the solution. According to Power (2006), one problem nurses run into in America is that spirituality is often linked to religion. With spirituality being such an important part of the health assessment, nurses are struggling with ways to integrate any assessment tool that is acceptable for everyone. There are several different tools used but the most effective tool is simply using general observation and encouraging patients to talk about their spirituality. Power (2006) states that for nurses to be more sensitive to a patient’s culture and religious practices, a nurse might simply ask what a patients’ belief system is and if there is a pressing concern. Nurses might also consider taking a simple spiritual history. This history should address the patient's spiritual attitudes and value system, spiritual development, and sense of meaning and purpose spirituality may play in the patient's life. The biggest problem found in hospitals is nurses admit they need more education in conducting a spiritual assessment and feel they would be better prepared if there was a way to combine an informal assessment with a more specific assessment tool such as a spiritual history (Power 2006). No matter when, how, or what assessment tool is used, nurses agree that by gaining valuable information about the patients spirituality can be vital to their healing.
While educating nurses is important, another key strategy is identifying what spiritual therapies are available to the patient. Since many nurses feel they are undereducated when it comes to spiritually assessing their patients, Grant (2004) says that nurses are equally unaware of the different interventions and therapies available to their patients. Spiritual interventions should not be limited to services provided by a chaplain or priest but should also include more basic human needs. Some simple therapies that could be given to patients include things such as touch, therapeutic conversation, listening, prayer or meditation, or a referral to other resources inside or outside of the hospital.
Many patients do not think to ask nurses for spiritual support. But if nurses provide simple therapies, then patients develop a bond with their nurse that will make it easier to seek the support they need. Other interventions that patients should be made aware of are alternative therapies such a biofeedback and acupuncture. No matter which therapies or interventions patients choose, nurses should make all options available and encourage patients to seek out what fits their needs and beliefs best.
Knowing what therapies are available is important, but also knowing what therapies and interventions other nurses have found beneficial can greatly impact nurse’s ability to make the biggest difference. Dembner (2005) concludes that many people use prayer as an acceptable belief or tool for healing their loved ones. The difference that prayer makes is to the patient’s spirit and the level of hope they have during their healing process. Other nurses say that their patients do not pray but like to meditate or take quiet moments to reflect on the past and future. Adopting a nursing philosophy that routinely includes therapeutic touch, active listening, appropriate humor, referral to a spiritual counselor and understanding can keep hope alive in patients when physical healing is not taking place. Healing of the soul can give the patient the peace they need to deal with the physical stress of the illness.
Educating nurses on how to approach a patient with spiritual needs is crucial if a patient’s hope is going to be kept alive. Holistic healing can only take place if the whole body is healing as one. Recognizing a nurses own limitations and knowing when to make a referral, or utilizing other members of the team is as important for spiritual care as it is for other aspects of care. Implementation of key nursing strategies such as educating nurses on how to properly use a spiritual assessment tool to address the patients needs, identifying what spiritual therapies are available, and what therapies nurses have found to be beneficial during the healing process are essential in allowing nurses to provide a plan of care that is focused on the overall holistic healing of the patient.
a. Intervention 1 – Educating nurses on how to properly use a spiritual assessment tool to address patient’s needs is crucial part of healing
i. disadvantage 1 – Nurses do not receive enough education in school to be able to use the spiritual assessment tool correctly
1. Nurses may lack the confidence to broach spiritual issues with patients and their families owing to limited dialogue on spirituality in education and practice.(Cavendish 2005) Most educational experience is limited in assessments practiced in nursing school or during a school’s clinical setting, with spiritual care inconsistently or infrequently addressed.
2.Cavendish, R., DiJoseph, J. (2005 July/Aug). Expanding the Dialogue on Prayer Relevant to Holistic Care. Holistic Nursing Practice. 19(4), 147-154. Retrieved February 4, 2008 from EBSOC Research Database.
ii. disadvantage 2 –Spirituality is difficult to teach to a wide range of people
1. There may be as many different spiritual values and beliefs as there are individuals. Varying spiritual values may make the range of spiritual interventions difficult
for nurses. The lack of emphasis on spiritual assessments and care in nursing school may be because some educators believe that spirituality cannot be taught, but must be modeled by nurse educators in order for students to learn to address the spiritual needs of patients. Nursing educators often lack spiritual education and are consequently ill-prepared to teach spiritual assessment and interventions to students.(Lovanio (2007) Plus, concern for conflicting spiritual values between nurse educators, students and patients, may cause nurse-educators to avoid these difficult areas.
2. Lovanio, K., & Wallace, M. (2007 Jan/Feb). Promoting Spiritual Knowledge and Attitudes: a student nurse education project. Holistic Nursing Practice, 21(1), 42-48. Retrieved January 3, 2007 from Expanded Academic ASAP database.
b. Intervention 2 –Identifying what spiritual therapies & interventions other nurses have found beneficial can greatly impact nurse’s ability to make the biggest difference
i. disadvantage 1 – Spiritual care is not clearly defined
1. Nurses are often not comfortable providing spiritual care and they may not be able to distinguish spiritual needs from religious needs. Cavendish found that spiritual care activities are not clearly defined in the nursing education, and few spiritual care interventions are outlined in nursing care books to guide nurses with their care. The private nature of spirituality may be another reason that spiritual interventions are not initiated.
2. Cavendish, R., Konecny, L., Mitzeloitis, C., Russo, D. (2003 Oct-Dec). Spiritual Care Activities of Nurses Using Nursing Interventions Classification (NIC) Labels. International Journal of Nursing Terminologies and Classifications. Retrieved February 4, 2008 from http://findarticles.com/p/articles/mi_qa4065/is_200310/ai_n9312174/pg_7
ii. disadvantage 2 – Many time spiritual care and interventions are not notated in the patients charts
1. Spiritual care activities (eg, praying with patients or supporting their prayer activities) are rarely found in nursing notes. If nurses are providing spiritual care, many times it is not being documented correctly. In a 2004 study some nurses claim the reason they do not document the type of spiritual care they provided is because they do not know how to document it. Typically, the only reference to spirituality in acute care settings relates to asking if patients would like to visit with a chaplain.
2. Grant, Don. (2004 Jan/Feb). Spiritual interventions: How, when, and why nurses use them. Holistic Nursing Practice, 18 (1), 36 – 42. Retrieved January 3, 2007 from Expanded Academic ASAP database.
References
Cavendish, R., Konecny, L., Naradovy, L., Kraynyak Luise, B., Como, B.,Okumakpeyi, P., Mitzeliotis, C., & Lanza, M. (2006 Jan/Feb). Patients' perceptions of spirituality and the nurse as a spiritual care provider. Holistic Nursing Practice, 20(1), 41-48. Retrieved January 3, 2007 from Expanded Academic ASAP database.
Cavendish, R., DiJoseph, J. (2005 July/Aug). Expanding the Dialogue on Prayer Relevant to Holistic Care. Holistic Nursing Practice. 19(4), 147-154. Retrieved February 4, 2008 from EBSOC Research Database.
Cavendish, R., Konecny, L., Mitzeloitis, C., Russo, D. (2003 Oct-Dec). Spiritual Care Activities of Nurses Using Nursing Interventions Classification (NIC) Labels. International Journal of Nursing Terminologies and Classifications. Retrieved February 4, 2008 from http://findarticles.com/p/articles/mi_qa4065/is_200310/ai_n9312174/pg_7
Dembner, A. (2005, July 25). A Prayer for health. The Boston Globe, Retrieved March 15, 2007.
Grant, Don. (2004 Jan/Feb). Spiritual interventions: How, when, and why nurses use them. Holistic Nursing Practice, 18 (1), 36 – 42. Retrieved January 3, 2007 from Expanded Academic ASAP database.
Lovanio, K., & Wallace, M. (2007 Jan/Feb). Promoting spiritual knowledge and attitudes: a student nurse education project. Holistic Nursing Practice, 21(1), 42-48. Retrieved January 3, 2007 from Expanded Academic ASAP database
Power, Jeanette. (2006 March). Spiritual assessment: developing an assessment tool. Nursing Older People, 18 (2), 16-21. Retrieved January 3, 2007 from Expanded Academic ASAP database.
Ray, Rebecca. (2004 February). The faith connection. Retrieved February 4, 2007 from http://www.nurseweek.com/news/features/04-02/faith_3.asp
Family Centered Care in the NICU
Jessica Ballard 2/5/08
Roughly 12.5% of all babies born in the United States each year are premature (Archibald, 2006). That is a about half a million children being born before the 37th week of gestation is complete.
While in the hospital, new parents need an advocate. That advocate can be the registered nurse. The role of the RN is that of a care provider for the neonate. However, it is also one of an educator and facilitator of communication for the needs of the family. Too often families are made to feel like visitors in special areas of the hospital like the NICU (neonatal intensive care unit). By implementing the three strategies of incorporating a family centered care plan, unrestricted access to the child and treatment participation, and developing good communication skills with full information sharing, the RN can help the families become contributors, rather than spectators, in the care of their neonate.
When a newborn and parents are separated, the necessary bonding time is greatly diminished. According to Wong (2006), infants begin to develop a sense of trust as they learn the feel, sound, and smell of their parents. When their parents are gone, the neonate must learn to trust the nurses. However, the nurse is also associated with pain as well as comfort. It is important for the parents to be enveloped in the care of their child so that the neonate does not begin to associate pain with their care provider. During this time, the parents also discover the personality of their infant and how to recognize their needs by the behavioral cues displayed. When their time is limited in the NICU, the personalities go undiscovered and these cues go unlearned. When the previously mentioned strategies are put into practice, these developmental tasks can be completed successfully.
The first strategy is to create a family centered care plan (FCC). By incorporating family centered care into the unit, those stresses can be alleviated tremendously. FCC is creating a partnership between the parents and the hospital staff. There are four main concepts to FCC. They are dignity and respect, information sharing, family participation, and family collaboration (Cisneros, 2003). Though implementing family centered care can be difficult, it brings positive outcomes for both the family and the child. There is not a single way that all neonatal units must operate their family centered care. Each location is different depending on the needs of the staff and patients. The facility begins with a vision and a philosophy. It is suggested that the staff in the neonatal unit participate in developing these documents. Sharing of ideas and reviewing all feedback allows for a clear and well developed vision to emerge. Families are also an integral part of developing FCC. Those who have the experience of having a child in the neonatal intensive care unit are a valuable resource to consult when making changes to the program.
The second strategy is finding ways to involve parents in the care of their child. Parents are no longer seen as visitors but as critical components in the care plan of the child. Unlimited access to their baby at any time of the day is essential. It is important for the parents to be able to be there to comfort their child and learn ways to ease their tensions and pain. The nurse is the educator for the parents. He or she provides the information and guidance to help the parents through this difficult time. Two important areas that the nurse needs to help the mother in are kangaroo holding and breastfeeding. Kangaroo holding is skin to skin contact between mother and baby. These things are necessary, not only for the development of the infant, but also as a way for the mother and child to bond. Parents are encouraged to participate in the care of their child while they are in the NICU. Physical contact, especially kangaroo holding, has been shown to help the baby thrive as well as promote bonding between child and parent (Johnson, 2005). They show the parents how to take part in the infants care so that they may spend as much time as they wish with their baby. Many infants in the NICU have feeding problems or are unable to digest properly. The NICU nurse aids the mothers in breast and bottle feeding. The nurse takes time to show the parents how to read monitors, adjust equipment, and explain difficult medical jargon so that they are comfortable and understand clearly. Parents leave the NICU with a bond to the staff that cared for their child. Some even bring the baby back to show that they are thriving. “It’s a great reminder that the NICU isn’t a horrible place. Most babies leave here and grow into happy, healthy kids. You’d never know that they ever had a health problem” (American Baby, 2007).
The third strategy is developing good communication with the families. The largest contribution to family-centered care is the participation of the families. The NICU nurse is not only a caregiver and educator, but he or she must be an excellent communicator. As a result of being informed of every detail, the parents feel a sense of involvement and control in their decision making. By providing explanations and honest answers, the nurse helps the parents to build confidence in their abilities. Being this close allows the parents to make better decisions regarding the care of their baby and gives them the opportunity to become more connected to the child. Daily communication between the nurse, the other hospital staff, and the parents keeps the flow of family centered care moving. If the parents do not feel included in their infants care plan, then family centered care has not been achieved. “To support the philosophy of FCC, attention must be paid to teaching and supporting nurses’ communication skills, and relationship building with self, peers, and families” (Griffin, 2006).
While taking care of the half a million children born prematurely each year, the role of the RN is that of a care provider for the neonate and an educator and facilitator of communication for the needs of the family. The purpose of FCC is to provide the parents with a greater role in the care of their infant. By implementing the three strategies of incorporating a family centered care plan, unrestricted access to the child and treatment participation, and developing good communication skills with full information sharing, the RN can help the families become contributors, rather than spectators, in the care of their neonate.
Archibald, C. (2006, Mar-Apr) Job satisfaction among neonatal nurses.
Pediatric Nursing. Pitman: Vol. 32, Iss. 2, p. 162, 176-179.
Cisneros-Moore, K., Coker, K., DuBuisson, A. & Swett, B. (2003, April) Implementing potentially better practices for improving family-centered care in neonatal intensive care units: success and challenges. Pediatrics 111. Retrieved Apr. 22, 2007 from www.pediatrics.org.
Griffin, T. (2006, Jan-Mar) Family-centered care in the NICU. Journal of Perinatal & Neonatal Nursing 20. Retrieved Jan. 3, 2007 from Expanded Academic ASAP database.
Johnson-Nagorski, A. (2005, Jan-Feb) Kangaroo holding beyond the NICU. (Updates & Kidbits)(neonatal intensive care unit). Pediatric Nursing 31. Retrieved Jan. 3, 2007 from Expanded Academic ASAP database.
Special babies, special care. American Baby. Retrieved April 13th, 2007 from http://www.americanbaby.com.
Wong, D., Perry, S., Hockenberry, M., Lowdermilk, D., Wilson, D. Maternal Child Nursing Care. St. Louis: Mosby, 2006.
ARGUMENTS
a. Intervention 1 –Incorporating a family-centered care plan
i. Disadvantage 1 – The family-centered care plan that the facility has adopted may not fulfill the needs of each individual family.
Unrestricted access to their infant and treatment participation only may not fulfill the emotional and psychiatric needs of the family. It takes more than just family-centered care to assist the parents. Hospitals that offered a combination of formats for support services: group support, one-to-one support, and telephone support were more effective at meeting the needs of the infant’s parents. (Hurst, 2006). The family-centered care ideology is all too often “cookie-cutter” and not adaptable to the individual family needs.
Hurst, Irene (2006). One size does not fit all: parents' evaluations of a support program in a newborn intensive care nursery. Journal of Perinatal & Neonatal Nursing, 3, 252. Retrieved February 3, 2008 from ProQuest database.
ii. Disadvantage 2 – Support groups are more effective than family-centered care.
Parents often become frustrated when they have a child in the NICU. The unknown environment and language can be overwhelming. Though family-centered care tries to alleviate these issues, it has several hang-ups. It does not leave the parents with an outlet for frustrations. Group support offered more opportunities for families to problem-solve communication issues with nursery personnel and provide information that assisted parents' involvement in their babies' care. Parent support programs offer an important mechanism to assess provider approaches to facilitate family-centered care (Hurst, 2006). By having others to talk with who are going through the same experiences, the families can become more connected and have a place to discuss their fears and concerns.
Hurst, Irene (2006). One size does not fit all: parents' evaluations of a support program in a newborn intensive care nursery. Journal of Perinatal & Neonatal Nursing, 3, 252-255. Retrieved February 3, 2008 from ProQuest database.
b. Intervention 2 –NICU nurses need to develop good communication skills and fully share care information with the family.
i. Disadvantage 1 – Years of experience and clinical work setting influenced both perceptions and practices of family-centered care.
A recent study of sixty-two licensed registered nurses looked at the level of implementation of family-centered care. It covered the necessity of family-centered care and current nurse practices. According to Peterson, Cohen, and Parsons, 2004, scores representing current nursing practice of family-centered care were significantly lower than those representing its necessity (p = .000). Nurses with 10 years or fewer of neonatal or pediatric experience scored significantly higher on both the total Necessary Scale (p = .02) and total Current Scale (p = .017) than did those with 11 years or more. Nurses who work in the NICU scored significantly lower on the total Necessary Scale (p = .013) than did nurses who work in pediatrics or PICU. Although nurses agree the identified elements of family-centered care are necessary, they do not consistently apply those elements in their everyday practice.
Peterson, M., Cohen, J., & Parsons, V. (2004). Family-centered care: do we practice what we preach?. Journal of Obstetric, Gynecologic, and Neonatal Nursing : JOGNN., 4, 421-424. Retrieved January 31, 2008 from ProQuest database.
ii. Disadvantage 2 – The fear of the unknown and a lack in trust of the healthcare provider can lead the mother to feel trapped. Heermann, Wilson, and Wilhelm (2005) reported that mothers "struggled to mother" because nursing interactions pushed the mothers to the sidelines and left the mothers feeling unimportant in the life of their child. The power struggles between the mothers and the nurses with each trying to position herself as the 'expert' on the infant. Heermann, Wilson, and Wilhelm (2005) found that mothers attempted to negotiate partnership relationships with professional caregivers but that their actions were frequently misunderstood or unrecognized. Thus, the primary focus in this study was the mother's developing relationship with the infant and ways in which that relationship was affected by interactions with the nurses.
Heermann,J., Wilson,M., Wilhelm, P. (2005). Mothers in the NICU: outsider to partner Pediatric Nursing, 3, 176-183. Retrieved January 31, 2008 from ProQuest database.
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Heart Disease Prevention
Travis Cox 2/5/08
As of 2007, heart disease is the leading cause of death in the United States and it includes a variety of diseases relating to the heart (AHA, 2007). Heart disease is very costly and creates quite a burden for the patients affected as well as their families.
As of 2007, heart disease is the leading cause of death in the United States and it includes a variety of diseases relating to the heart (AHA, 2007). Heart disease is very costly and creates quite a burden for the patients affected as well as their families. With nursing education, heart disease can be reduced. It can also help maintain the health of patients at risk or those who have been diagnosed with heart disease. Nurses have the proper training and are more cost effective than using physicians for educational means. With proper nurse education and intervention through nurse led clinics, clients who either have heart disease or are at risk for heart disease will have significantly better quality of life. Heart disease targets people who are with hypercholesterolemia, have hypertension, hyperglycemia, which are smokers or, TABP (Type A Behavior Patterns) which has been recently added to the list (AHA, 2007). Because these problems are very prominently found in today’s society, heart disease is common and hard to avoid. In 2005, it was estimated that the cost of heart disease in America was $394 billion (CDC, 2005). This ever-increasing problem can be avoided or managed by maintaining basic day to day activities which include: decreasing cholesterol in daily diet, avoiding obesity by regular exercise, avoiding a sedentary lifestyle, smoking cessation, controlling diabetes and having regular check ups and health screenings. (CDC, 2005) As a nurse, strategies such as education, screenings in outpatient clinics and community screening can lead to a decrease in heart disease and better lives for those with heart disease.
There are many techniques that a nurse can utilize when educating people on the importance of preventing heart disease. Diet, exercise and smoking are three main categories that ought to be addressed. The American Heart Association has many pamphlets and brochures that talk about strategies and methods to prevent this disease (AHA, 2007). Education should focus on the methods used to prevent heart disease such as reducing cholesterol, lowering salt intake and avoiding obesity. Avoiding foods high in saturated and trans fat can help reduce cholesterol. One of the biggest obstacles for this issue is educating those in poverty who find it easier and cheaper to eat a ninety-nine cent high fat cheeseburger then to buy fresh fruits and vegetables from the grocery store (Wright, 2007). Preventative diets include ones high in vegetables and fruits as well as avoiding large quantities of red meat and foods high in Omega-3 fatty acids (found in many seafood products). One of the most common preventative diets is the Mediterranean style diet which consists mainly of olive oil, bread, abundant fruit and vegetables, a moderate amount of wine, and animal products such as lamb, sausage and goat cheese (Wright, 2007). Exercising regularly can also help to reduce the risk of heart disease. It is recommended that the average adult get 30 minutes of moderate exercise 5 times a week (AHA, 2007). Nurses should also promote smoking cessation programs or products that can help people to stop smoking such as nicotine gum or patches. There are nearly 135,000 smoking-related cardiovascular disease deaths per year (AHA, 2007). Education on this matter can be the first step to promoting a healthy lifestyle and reducing the occurrence of heart disease.
Along with education, people screened early and screened often have a better chance of avoiding or fighting heart disease. Nurse led clinics have been a proven resource in reducing the number of people with heart disease as well as improving the lifestyle of those with heart disease (CDC, 2005). Studies involving three different styles of outpatient teaching methods and screenings were done and compared in 2001. These studies showed that people responded to and were more apt to attending nurse led clinics. The study compared hospital screening, physician run clinics and nurse led clinics. The results showed that the nurse run clinics had more visitors with a better rate of identifying patients at risk. They also had better follow up care and better education retention with an overall 85% success rate and a 33% better overall experience according to patients (Campbell, 2005). Nurse led clinics also were more cost effective per patient with better success rates according to a 2005 study which showed that nurse led clinics can thrive financially in a community while serving a valuable purpose (Berg, 2007). Clients at these clinics receive advanced screenings based on their predisposition to heart disease. They will receive proper education, screening for blood pressure and cholesterol and monitoring for patients with heart disease to help them get on track (Berg, 2007).
Besides nurse led clinics, nurses can help educate and screen in the community. Mobile operation centers such as school and office screenings can be set up with correspondence to the American Heart Association (AHA, 2007). These mobile screenings can have a significant impact in catching people pre disposed or those who may have early signs of heart disease but have not yet been diagnosed. These early tests (education, cholesterol and blood pressure screening) can save a life as well as start someone down the right path in getting well. These early warning stations can also be a very helpful resource for preventative education.
Strategies such as education and early detection are the absolute key to preventing heart disease. Nurses can be a valuable tool in all these venues. Nurses can help people pre disposed to heart disease to stay healthy and treat people with heart disease so that the quality of life for these people becomes better rather then declining into a state where the disease process takes over and eventually ends in death. Overall nurses can educate, prevent and sustain people’s health regarding heart disease. Nurses are cost effective, properly trained and caring enough to get the job done.
American Heart Association (AHA). (2007). Exercise and Fitness. Retrieved October.17, 2007 from http://www.americanheart.org/presenter.jhtml?identifier=1200013
Berg, S., Hertz, P.. (2007). Outpatient Nursing Clinic for Congenital Heart Disease Patients: Copenhagen Transition Program. Journal of Cardiovascular Nursing, 22, 488-492. Retrieved November. 17, 2007 from http://www.jcnjournal.com.
Campbell, N.C., Murchie, P., Ritchie, L.D., & Thain. J. (2005). Running nurse-led secondary prevention clinics for coronary heart disease in primary clinics: Qualitative study of health professionals’ perspectives. British Journal of General Practice, 55, 522-528. Retrieved April. 12, 2007 from PubMed Central database.
National Center for Chronic Disease Prevention and Health Promotion (CDC). (2005). Preventing Heart Disease and Stroke. Retrieved October. 17, 2007 from http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/cvh.htm
Wright, J. (2007). Nutritional Spices of Life. Journal of Community Nursing, Vol. 21 (10), 10-16. Retrieved November. 21, 2007 from http://www.jcn.co.uk/index.html
INTERVENTION DISADVANTAGES:
A. Mobile operation centers such as school and office screenings can be set up with correspondence to the American Heart Association (AHA, 2007). These mobile screenings can have a significant impact in catching people pre disposed or those who may have early signs of heart disease but have not yet been diagnosed.
I. The cost of running and maintaining these mobile operation centers would be to costly to justify their use.
1. To make this option work well, the city would be required to make an investment to a fleet of vehicles, man power to operate and maintaining those vehicles, man power to work out of those vehicles and screen patients, the cost of supplies, advertising the location of screening clinics and possible paying for temporary housing for the vehicles.
2. According to an article from Children’s Advocate, the cost of running a mobile health center can be over $500,000 in the first year and then $250,000 every year after that to maintain the program. This money would need to come from taxes, fund raisers or private funding which is not practical (Santana, 2005).
II. Pre screening of patients does not determine that those people at risk or currently living with heart disease will have the motivation or means to seek out regular professional medical help.
1. The range of people who would be screened in this system is to vague to guarantee that people would follow up with primary care providers or seek out providers if they currently do not receive care. With our current health care system those uninsured would not benefit from this except by gaining some understanding of a disease that they may have. They do not have the insurance or money to seek out routine care to guarantee their future health. Those with insurance or means to seek out care may not follow up with their doctors. We can not be sure that the costs will not out way the benefits.
2. In a research article published in PHN, who screened 222 people for ongoing visits to the mobile centers and follow up exams 3 in 10 people screened did not seek further medical expertise. 8 in 10 of these people could not afford the cost of medical exams, further treatment or transportation to medical facilities (Betty, 1998).
B. Nurse led clinics have been a proven resource in reducing the number of people with heart disease as well as improving the lifestyle of those with heart disease
I. Nurse led clinics cost more per individual then medical facilities that can meet all of their needs.
1. The cost of running a nurse lead clinic is astronomical, without MD support the services provided are limited and patients still have to be referred to other medical facilities. Although they may be able to screen and educate they can not do numerous treatments needed to help patients. Patients would much rather be seen in an all encompassing site where all there needs can be met.
2. In a study of 19 nurse led clinics that dissected the willingness of patients to pay for the amount of services rendered for heart disease the cost was (on average) $254 higher in the nurse clinics providing intervention then in just assessing and educating. This extra cost per individual would make it very hard for a nurse led clinic to compete with other medical centers (Campbell, 2005).
II. Nurse led clinics do not have the resources to effectively treat and manage people with heart disease.
1. Nurse led clinics lack the resources available to treat heart disease patients. They must be referred to treatment centers and hospitals for continuous care. Although nurse led clinics can help educate and prevent heart disease they still lack this essential tool to treat people with heart disease.
2. In my research for this article I found that a majority of clinics that were nurse led failed because of the feeling that they were not giving adequate care to their patients (Campbell, 2005).
Betty, A., Elnitsky, C. (1998). Rural Mobile Health Units: Outcomes. Public Health Nursing. Vol. 15 (1), 3-11. Retrieved January. 31, 2008 from http://www.blackwell-synergy.com/doi/abs/10.1111/j.1525-1446.1998.tb00314.x?cookieSet=1&journalCode=phn
Santana, J. (2005). Going Out to the Community, Mobile Clinics Bring Health Care to Families. Childrens Advocate, 12, 96 – 100. Retrieved January. 31, 2008 from http://www.mobilehealthclinicsnetwork.org/featured.html
Campbell, N., Murchie, P., Raferty, J. (2005) Cost effectiveness of nurse led secondary prevention clinics for coronary heart disease in primary care: follow up of a randomised controlled trial. BMJ, 707. Retrieved January. 31, 2008 from http://www.bmj.com/cgi/content/full/330/7493/707
Campbell, N.C., Murchie, P., Ritchie, L.D., & Thain. J. (2005). Running nurse-led secondary prevention clinics for coronary heart disease in primary clinics: Qualitative study of health professionals’ perspectives. British Journal of General Practice, 55, 522-528. Retrieved April. 12, 2007 from PubMed Central database.
Ineffective Management of Chronic and Acute Pain, Carl C
Ineffective management of chronic and acute pain by nursing and other medical staff because of inadequate treatment, education and cultural misconceptions, is a continuing barrier to achieving client wellness. This situation is not a recent development and can be mitigated through the implementation of several strategies of which the nursing cohort is the prime driver. These strategies include educating nurses to perform adequate and regular pain assessments. These assessments require that the nurse listen to what the client is saying about their pain levels and experience. In addition, the nurse needs to develop awareness in others of cultural and social constructs that create misconceptions surrounding pain and pain treatment therapies. Lastly, the nurse must have the ability to formulate effective strategies to break down these misconceptions of all the involved parties and ultimately, help the client.
Pain is described as;“ A sensation in which person experiences discomfort, distress or suffering due to the provocation of sensory nerves.” (Thomas, 1973) Taber’s then goes on to describe ninety seven different types of pain, demonstrating that pain is a highly complicated subject matter ranging from the metaphorical to sequlae of a specific medical condition. Regardless of the neurological response generated, pain impacts wellness. Acute pain is generally short in duration but severe, such as the pain generated from a surgical procedure or accident. It is expected to abate or at worst convert to chronic pain. Chronic pain is long term and constant, such as the pain of arthritis or cancer. Pain can impact an individual’s ability to lead a participatory life or a patient’s ability to recover from an illness. Pain can impact mental health, acuity and, pain can result in a lifetime of searching for relief (Fine & MacLow, 2006). In her article Managing Chronic Pain (2002), Michelle Meadows relates the story of a woman’s 30 year search for relief from pain resulting from injuries received in a skiing accident. Her search involved multiple surgeries, some of dubious value, therapies, depression and numerous healthcare workers who offered little help or hope.
One strategy for improving outcomes is educating nurses. A qualitative study conducted in a series of Colorado Long Term Care (LTC) facilities found that 25-33% of the residents experience moderate to severe pain on a daily basis (Clark, Fink, Pennington & Jones 2006). Data from this study indicates that this issue is related to inadequacies of the care staff involving training, basic philosophies and communication among the staff and clients, all correctable factors (Clark, Fink, Pennington & Jones 2006). . Education of the nursing and support staff caring for these individuals is critical to improving this situation. Regular and complete assessments for pain must be completed on all clients under care. There are numerous tools available to make these assessments complete and in a common format that all care providers coming in contact with these clients can understand and use to the client’s benefit. The most common tool in use is the very effective 0-10 scale. This tool needs to be augmented with observations made by the managing nurse and include input from support staff who may very well have more contact with the client. Proper communication of the client’s reaction to the multitude of stimuli encountered is as important as the formal assessments and needs to be part of the treatment plan.
Another strategy involves specific cultural issues surrounding how a client may deal with or express pain. Strategies that resolve these issues need to be understood and incorporated into daily care. A known example of this is individuals from some Asian cultures will readily accept pain relief if they are asked several times. They simply feel it is impolite to accept the offering immediately and expect that it will be offered a second time. In this instance, offering pain relief to this client one time and walking away under the assumption they are able to tolerate their pain is an error in care. An adjunct to this is having this specific knowledge and not communicating it to other care staff. In some ways this is no different than ignoring the client’s pain altogether. Key information such as this needs to be available to all the care givers requiring clear and adequate communication are part of the routine of daily care.
A third strategy involves the clarification of misconceptions surrounding pain in general and treatments for pain. In addition to factors elucidated in the LTC study regarding how social constructs impact how pain is treated another issue involves direct treatments for pain. Often times the most effective therapies for pain often is the use of opioid drugs or narcotics. While their proper use is known and accepted in much of the medical community, societal controls over these substances places blocks to their proper and effective application. Physicians and practitioners wanting to prescribe these materials are faced with regulations governing their use that are so onerous these professionals physicians often use less effective therapies (Berry & Dahl 2007). Patients and family members often question the use of these therapies based on a fear of addiction and place a self imposed stigma on their use, a situation largely derived from their own ignorance (Mercadante 2007).
The technology and techniques to effectively manage pain already exist. Through the implementation of strategies that include educating nursed in proper assessments, secondly improve social and cultural awareness and lastly that address misconceptions that hinder treatment these techniques can be better utilized. In many instances the barriers to their implementation are created by the very professionals meant to administer these therapies (Berry & Dahl 2007). As primary caregivers the ranks of professional nurses are in an ideal position to make these changes across the entire spectrum of healthcare.
Intervention One
Educate professional care giving staff to adequately assess and treat pain
Disadvantage 1
Currently there are multiple tools in use to measure or attempt to quantify pain. This includes the visual analogue scale (VAS), the numeric rating scale (NRS), the verbal rating scale (VRS), the category ratio (CR-10 scale) and McGill pain questionnaire (Ergun et al, 2005). What is to be taught and how is it to be taught. Are the existing tools up to the task of providing a universal description of pain and it’s rating. Are the existing tools up to the task interpreting across the breadth of cultural and educational diversity that the health care professionals are required to address. At this point in time the answers for these questions is not a definitive yes, there are still tools in development that may be more effective. So the question is what is to be taught.
Ergun, U et al, Trial of a New Pain Assessment Tool in Patients With Low Education: The Full Cup Test. International Journal of Clinical Practice 63(3) 2005, Retrieved February 2, 2008 from Medscape Nursing Search. < http://www.medscape.com/viewarticle/565917_1 >
Disadvantage 2
Pain and its assessment is by nature subjective what is tolerable to one person is not to another. Pain is also a symptom of a condition that may be identified or may not be, in this case therapies for pain relief mask the existence of underlying pathology. With these instances in mind, is it even reasonable to assume that effective assessments for pain and the implementation of effective therapies can be adequately taught. A simple 0-10 scale is simply not adequate (Vallerand et al, 2007).
Hazard Vallerand et al, Knowledge of and Barriers to Pain Management in Caregivers of Cancer Patients Receiving Homecare. Cancer Nursing, 2007, 30(1):31-37, Retrieved February 2, 2008 from Medscape Nursing Search. < http://www.medscape.com/viewarticle/552132_1 >
Intervention 2
Removal of barriers to effective pain control
Disadvantage 1
Many of the most effective therapies for pain relief involve the use of opiates, the ability to use these medications more freely would improve pain control. The vast majority of the governments in the world place heavy regulation on the use and distribution of these dangerous chemicals for good reason. Reducing the control mechanisms already in place over these materials would reduce the responsibilities associated with their proscription and dispensing(Mercadante 2007). Given the potential for abuse and danger here facilitating their use is unwise.
Mercadante, S. (2007). Why are our patients still suffering pain? National Clinical Practice Oncology 4(3) pp 138-139. Retrieved April 19, 2007 from Medscape Today Search. < http://www.medscape.com/viewarticle/553554 >
Disadvantage 2
Fear of addiction is a very legitimate fear and a distinct possibility where the regular use of strong pain medications is involved. A patients or their family’s concern over this matter is well placed. In many instances the populations of not only inner city but urban hospitals display drug seeking behaviors (McCaffery et al, 2007). Are these individuals in pain or are they seeking an alternate source to better serve their additions. Is it the job of the medical community and the population of those responsibly insured to support these actions. Can a medical system that is not capable of providing services to the population as a whole need to support addictive behavior (Levine et al, 2007).
McCaffery et al, On the Meaning of "Drug Seeking" Pain Management Nursing 8(3) 2007, Retrieved February 2, 2008 from Medscape Nursing Search. < http://www.medscape.com/viewarticle/519760>
Levine et al, Improving Access to Health Care: A Consensus Ethical Framework to Guide Proposals for Reform. The Hasting Center Report, 2007;37(5):14-19. Retrieved February 2, 2008 from Medscape Nursing Search. <>
Bibliography
Berry, P.; Dahl, J., Advanced Practice Nurse Controlled Substances Prescriptive Authority: A Review of the Regulations and Implications for Effective Pain Management at End-of-Life. Medscape Nurses. Released October 30, 2007. Retreived November 6, 2007 from Medscape Nursing Search.
Clark, L, Fink, R, Pennington, K & Jones, K, (2006) Nurses' reflections on pain management in a nursing home setting. Pain Management Nursing 7(2) pp 71-77, Retrieved April 13, 2007 from Medscape Today Database.
Ergun, U et al, Trial of a New Pain Assessment Tool in Patients With Low Education: The Full Cup Test. International Journal of Clinical Practice 63(3) 2005, Retrieved February 2, 2008 from Medscape Nursing Search. < http://www.medscape.com/viewarticle/565917_1 >
Fine, P. & MacLow, C., (2006). Principles of effective pain management at the end of life. Medscape CME/CE Activity. Released October 5, 2006. Retrieved April 19, 2007 from Medscape Today Search. < http://www.medscape.com/viewprogram/6079 >
Hazard Vallerand et al, Knowledge of and Barriers to Pain Management in Caregivers of Cancer Patients Receiving Homecare. Cancer Nursing, 2007, 30(1):31-37, Retrieved February 2, 2008 from Medscape Nursing Search. < http://www.medscape.com/viewarticle/552132_1 >
Levine et al, Improving Access to Health Care: A Consensus Ethical Framework to Guide Proposals for Reform. The Hasting Center Report, 2007;37(5):14-19. Retrieved February 2, 2008 from Medscape Nursing Search. <>
McCaffery et al, On the Meaning of "Drug Seeking" Pain Management Nursing 8(3) 2007, Retrieved February 2, 2008 from Medscape Nursing Search. < http://www.medscape.com/viewarticle/519760>
Meadows, M. (2004, March-April ). Managing chronic pain. FDA Consumer Magazine. Retrieved April 13, 2007. <>
Mercadante, S. (2007). Why are our patients still suffering pain? National Clinical Practice Oncology 4(3) pp 138-139. Retrieved April 19, 2007 from Medscape Today Search. < http://www.medscape.com/viewarticle/553554 >
Thomas, C. L. (Ed.). (1973). Taber’s cyclopedic medical dictionary (12th ed.) p-4. Philadelphia, PA: Davis.
AIDS and MOTHERHOOD
In the United States, since the beginning of the epidemic, AIDS has been diagnosed foran estimated 8,460 children who were infected perinatally. Of those, an estimated 4,800 (57%)have died. Perinatal HIV transmission is the most common route of HIV infection in childrenand is now the source of almost all AIDS cases in children in the United States (CDC 2007 p.1).Having HIV does not need to end people’s lives, mothers can still have happy, healthy families.Preventing mother-to-child transmission (MTCT) of HIV can be done with antiretroviral
therapy (ART) medications, cesarean section (CS), and bottle feeding instead of breast feeding. These three strategies will greatly reduce the risk of transmission of HIV to the infants. The CDC states, ART administered to the mother during pregnancy, labor and delivery, and then to the newborn, as well as elective CS, can reduce the rate of perinatal HIV transmission to 2% or less (2007 p.1). This paper first will explain the need for antiretroviral medication. Also, it will show the need for cesarean section. Last it explains the need to bottle feed to help reduce the risk of HIV transmission.
Giving antiretroviral therapy medications to mothers before and during pregnancy and to the infant after birth reduces the risks of transmitting HIV. Pregnant mothers, who are HIV-positive, should begin to take ART medication as soon as they find out they are pregnant. Also, they need to have it given intravenously while giving birth, and the infant needs to take ART medication for 6 weeks to help reduce the risk of transmission. ZDV is started orally at 14 to 34 weeks gestation, given intravenously to the mother during labor and administered to the infant for six weeks. In the United States, taking prophylactic medication during pregnancy can dramatically reduce, but not eliminate, the risk of vertical transmission. The reported rates of MTCT of HIV are less than 2% for women who begin treatment early in pregnancy, 12-13% among women who do not initiate treatment until labor, delivery, or after birth (Kirshenbaum 2004 p.106). One common ART medication is Zidovudine (ZDV). Kirshenbaum states, four out of five women pregnant at diagnosis of HIV reported taking ZDV as a vertical transmission risk reduction strategy. Women voiced trust in the medication and seemed to contemplate a wide array of vertical transmission risk reduction strategies (2004 p.110). After 2000, in the United States, when ART became widely used in pregnant women, 1,839 infant infections were averted (Walensky 2006 p.16). One of the major achievements in HIV research was the demonstration that administration of ZDV to the pregnant women and her infant can reduce the risk of perinatal transmission by nearly 70%. In the United States, without ART approximately 25% of pregnant women infected with HIV will transmit the virus to their child (CDC 2007 p.1&2).
Another way to reduce mother to child transmission of HIV is to have an elective cesarean section. Children who are vaginally delivered have a high risk of becoming infected with HIV due to the vaginal secretions and bleeding during delivery. Vaginal delivery is associated with increased risk of MTCT, this increased risk is ascribed to increased exposure to infected genital secretions and micro trauma during birth (Mohlala 2005 p.488-490). The greatest benefit in preventing transmission is associated with cesarean delivery performed before the rupture of membranes or to the onset of labor in conjunction with ART prophylaxis (CDC 2007 p.4). The most potent predictors of perinatal HIV transmission are prolonged rupture of the amniotic membranes, and mode of delivery. Several studies done in South Africa have demonstrated that delivery by CS reduces MTCT significantly. Recruited into the study were 26 HIV-positive pregnant mothers. For 23 of the 26 fetuses, fetal cord blood samples obtained at birth were negative for HIV RNA. Their findings demonstrated that women with healthy pregnancies who underwent elective CS before labor, at 38-40 weeks of gestation, almost all gave birth to HIV free children (2005 p.488).
The last thing to do to prevent mother to child transmission of HIV is to bottle feed and to not breast feed. There is a high risk of transmission of HIV through breast milk. Though it is healthy for mothers to give their child the first milk, which is colostrum, with HIV-positive mothers the risks outweigh the benefits. Since HIV can pass through breast milk, it is safest for HIV-positive mothers not to breast feed (Boston Women’s Health Book Collective 2005 p.304). More than one-third of all MTCT of HIV in breast-feeding population is estimated to occur via breast milk (Rousseau 2004 p.1880). During 1992-1998, a randomized clinical trial was conducted of breast feeding versus formula feeding in infants of HIV-infected mothers in Nairobi, Kenya, and found the frequency of breast milk transmission to be 16%. MTCT of HIV through breast feeding led to 44% of infants being infected (Richardson 2003 p.736). In 1998, United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) revised their guidelines on feeding infants of HIV-positive mothers in developing countries. Previously breast feeding was recommended for all mothers including HIV-positive mothers. Now with more understanding of disease HIV the revised guidelines recommend “avoidance of breast feeding” to prevent MTCT of HIV even in the developing countries (Whitney 2001 p.244).
In the absence of interventions, the rate of mother to child transmission of HIV is 15-25% in Europe and the United States and 25-40% in Africa and Asia. WHO estimated that, in 2002, HIV-infected children accounted for 10% of the infections in developing countries. Perinatal transmission accounts for more than 90% of HIV infections in infants and children, and it is also responsible for almost all new HIV infections in preadolescent children (Mohlala 2005 p.488). MTCT of HIV is a complex process that can occur while the fetus is in utero, duringdelivery of the infant, or through breast feeding (Richardson 2003 p.736). The first thing to do to reduce the risk of mother to child transmission of the disease pregnant mothers should take antiretroviral medications. Second, pregnant mothers need to have a cesarean section delivery. Last, mothers should bottle feed their babies and not breast feed.
Reference Page
Center for Disease Control and Prevention. (October 2007). Mother-to-child (perinatal)HIV transmission and prevention. CDC HIV/AIDS Fact sheet. Retrieved November 17, 2007 from http//:www.cdc.gov.
Kirshenbaum, S., Hirky, E., Correale, J., Goldstein, R., Johnson, M., Rotheramborus, J., et al. (2004). Throwing the dice: Pregnancy decision-making among HIV-positive women in four U.S. cities. Perspectives on Sexual and Reproductive Health, 36 (4), 106-113. Retrieved on November 12, 2007 from CINAHL database.
Mohlala, B., Tucker, T., Besser, M., Williamson, C., Yeats, J., Smit, L., et al. (August 2005). Investigation of HIV in amniotic fluid from HIV-infected pregnant women at full term. The Journal of Infectious Diseases, 192, 488-491. Retrieved on October 28, 2007 from CINAHL database.Richardson, B., John-Stewart, G., Hughes, J.,
Nduati, R., Mbori-Ngacha, D., Overbaugh, J., et al. (March 2003). Breast-milk infectivity in human immunodeficiency virus type1-infected mothers. The Journal of Infectious Diseases, 187, 736-740. Retrieved on November 20, 2007 from CINAHL database.
Rousseau, C., Nduati, R., Richardson, B., John-Stewart, G., Mbori-Ngacha, D., Kreiss, J., et al. (November 2004). Association of levels of HIV-1-infected breast milk cells and risk of mother-to-child transmission. The Journal of Infectious Diseases, 190, 1880-1888. Retrieved on November 2, 2007 from CINAHL database.
The Boston Women’s Health Book Collective. (2005). Our bodies, ourselves. New York: Simon & Schuster.Walensky, R., Paltiel, A., Losina, E., Mercincavage, L., Schackman, B., Sax, P., et al. (July 2006). The survival benefits of AIDS treatment in the United States. The Journal of Infectious Diseases, 194, 11-19. Retrieved on November 2, 2007 from CINAHL database.
Whitney, E., Cataldo, C., DeBruyne, L., Rolfes, S..(2001). Nutrition for health and health care. California: Peter Marshall.
Socioeconomic status is a barrier to bottle feeding instead of breast feeding. Baby formula is very expensive and many low income mothers can not afford it. Instead it is very cost effective for them to breast feed because it doesn’t cost anything and it is easy to access. Also, in many third world countries, like Africa they do not have access to clean water and using the water they have with formula will make their child very sick. In America we have running water to almost every building but in other countries the women have to walk miles to just get water. Walking to get water is not feasible when you have a crying child. Cesarean sections(c-section) are very expensive and if you don’t have insurance most people can’t afford it. In many third world countries there is no choice but to have the baby vaginally because they have very limited resources when it comes to doctors and nurses.
A. Cesarean delivery instead of vaginal delivery
I. Infection of the abdominal incision.
1. Being a mother brings many obstacles and is life changing. Just to take care of the baby is an all day job but then if you have a c-section you have a huge abdominal incision. The incision is painful and requires you to not lift heavy things like the baby and to not twist your body. This makes it very difficult to take care of the babies day-to-day needs. Also, the incision has many potential problems like infection. Taken care of properly the incision can heal nicely but taken care of in an unclean way is very dangerous and will cause an infection which will cause a delay in healing.
2. “Numerous factors have the potential to delay healing and cause infection. These should be identified as early as possible, ideally pre-operatively, to optimize post-op care and recovery. Over a period of 35 weeks, data was collected from 715 women undergoing c-section. Of these 80 developed surgical incision infections and for 57 symptoms were not identified until after discharged(Gould 2007).”
II. Obesity
1. A major problem in America is obesity. Being obese and pregnant puts you at high risk for surgical site infections after c-sections. Due to the excess belly fat it is hard for the incision site to heal due to the extra fat and weight.
2. “Obesity has been associated with a higher rate of infections after c-sections. It puts greater mechanical stress on the wound and this delays healing, even when there is no sign of infection(Gould 2007).”
B. Bottle feeding instead of breast feeding
I. No weight reduction
1. Breast feeding helps mothers to take off the weight they gained to conceive the baby. Many women fear getting pregnant just because they do not want to gain weight. Let’s face it we live in a world where beautiful means being a size 0-5 so many women have a hard time choosing to have a baby so if they do they want to breast feed right away to help lose the weight.
2. “Believing that breast feeding allow mothers to get back their figure more easily and protects from breast cancer is linked to the choice to breast feed. Indeed, mothers that breast feed return faster to pre-pregnancy weights and may be protected from developing breast cancer (Chabrol etal).”
II. Bad, unmoral mothers
1. Breast feeding is a healthy, bonding experience for mother to child. So mothers who do not breast feed are seen as depriving their child what they need. Many mothers are seen as uncaring and lazy if they don’t breast feed. The first day of colostrum is very boosting to the babies immune system but beyond that there a very few differences with bottle or breast feeding.
2. “The relationship between the moral reasoning factor and bottle feeding may reflect guilt in the mother if she doesn’t breast feed. It was found that many mothers associate bottle feeding with feelings of guilt and failure. Many mothers feel an obligation to breast feed or to be a perfect mother. They also may feel inadequate or fear of failure to breast feed (Chabrol etal).”
References
Chabrol, H., Walburg, V., Teissedre, F., Armitage, J., & Santrisse, K. (2004) Influence of Mother’s Perceptions on the Choice to Breast Feed or Bottle Feed: Perceptions and feeding choice. Journal of reproductive and infant psychology 22:3 August 2004 pgs.189-198. Retrieved Jan. 30, 2008 from cinahl database
Gould, D. (2007) Cesarean Section, Surgical Site Infection and Wound Management. Nursing Standard 21:32 April 2007 pgs.57-66. Retrieved Jan. 30, 2008 from cinahl database.