Stephen Ball
Pregnancy, even for “healthy” women, can be difficult. Being overweight or obese adds another risk factor to this complex process.
Pregnancy, even for “healthy” women, can be difficult. Being overweight or obese adds another risk factor to this complex process. In a 2003-2004 National Health and Nutrition Examination Survey, it was estimated that 66% of adults in the United States were either overweight or obese, a figure that is expected to increase (Centers for Disease Control). Individual health risks of being overweight or obese include high blood pressure, coronary heart disease and the potential development of Type II diabetes. Coupled with pregnancy, weight issues carry harmful effects not only for the mother, but they can also impact fetal development. Given the current rise in obesity rates, not only in the United States, but worldwide, nurses need to be aware of pregnancy risks with maternal obesity and should educate women about safe weight gain, nutrition, and pre-pregnancy considerations, to prevent unwanted pregnancy outcomes that can develop from maternal weight issues.
Obesity is associated with numerous health risks for women in all stages of life. During pregnancy, this condition carries with it increased risks of pregnancy induced hypertension, pre-eclampsia, and gestational diabetes mellitus (GDM) (Villamor and Cnattinguis, 2006). During the second half of pregnancy, increased fetal nutrient demands and maternal nutrient ingestion result in higher levels of maternal blood glucose which in turn can lead to maternal insulin resistance (Wong, Perry, Hockenberry, Lowdermilk, Wilson, 2006). During a “normal” pregnancy maternal insulin production increases to compensate for this resistance. When the pancreas is unable to produce sufficient insulin or there is ineffective insulin use, gestational diabetes may result. Obesity increases insulin resistance leading to an even greater risk of GDM. GDM not only affects pregnancy but can result in increased trauma during labor and delivery (Wood, 2004). Macrosomia (large for gestational age), resulting from insulin resistance, puts a woman at an increased risk of perennial lacerations and the need for episiotomy (Wong et al, 2006). Many LGA infants require a cesarean section to be born, placing the mother at increased risk of infection due to impaired skin integrity. Shoulder dystocia is a common birth trauma for the LGA infant delivered vaginally. Educating women on the risks they will face during pregnancy is the first strategy nurses should use.
The next strategy is to educate parents about the risks of obesity to the fetus. Maternal obesity not only affects maternal health, but may also affect the development of the fetus. Maternal obesity before birth has an increased correlation with unwanted pregnancy outcomes, especially neural tube defects such as spina bifida (Watkins, Rasmussen, & Honein, 2003). An association is also indicated between obesity and a risk for omphlocele, heart defects like left ventricular outflow, and infants with multiple anomalies (two or more unrelated birth defects). Metabolic changes, such as hyperglycemia or increased hormone levels, impact fetal growth and development. Furthermore, prepregnancy and prebirth nutrition in obese and overweight woman may be deficient compared to average weight women. Overweight woman have increased requirements for certain nutrients including folic acid, which protects against birth defects. Lack of folic acid increases the risk for neural tube defects. Neonates born to mothers with gestational diabetes have an increased risk for hypoglycemia, hypocalcemia, hyperbilirubinemia, and respiratory distress syndrome (Wong et al, 2006).
In an effort to further prevent unwanted pregnancy outcomes, education of reproductive age women about nutrition and healthy weight gain should be another strategy used by nurses and other health care providers. It is recommended that weight gain is approximately 3 to 6 pounds during the first trimester and 6 to 12 pounds for both the second and third trimesters (Wood, 2004). Weight loss during pregnancy is not advised, as woman, even those who are overweight or obese, need to gain at least enough weight to equal the products of conception (Wong et al, 2006). Furthermore, limiting caloric intake during pregnancy also limits nutrient intake. It should be stressed to pregnant women that they should not eat more than they feel they need to despite the fact that they are told they are “eating for two.” Pregnant women have a recommended intake of 60 grams of dietary protein per day and should eat plenty of fruits and vegetables, which are low in calories but satiate the appetite for longer periods of time. When choosing grain products they should try to eat whole grain products and avoid high glycemic foods such as white bread, cookies, sugary cereals, and other empty calories. Moderate exercise, recommended to control weight during pregnancy, can also lower blood sugar levels and should be an intervention for women with GDM.
Obesity may increase birth complications up to 200% (Villamor and Cnattingius, 2006). Along with interventions for obese women who are pregnant, a final, but perhaps the most important strategy, if for nurses to encourage woman to achieve a healthy weight before becoming pregnant (Watkins, Rasmussen, & Honein, 2003). A study in the American Journal of Perinatology found that prepregnancy obesity and weight gain of more than 34 pounds both significantly increase the risk of adverse pregnancy outcomes. The results of the study support other reports by the Institute of Medicine, which recommend education during preconception with regard to the importance of optimal BMI at the start of pregnancy (Obesity Risk Factors, 2007).
Through education and encouragement of healthy lifestyles, nurses can improve the outcomes of pregnancy for all women, especially those at increased risk, such as women with obesity. By reducing negative outcomes, nurses not only improve the future well being of infants but they are also improving the quality of life of mothers, insuring a healthier life with their new child. Lastly, family life altogether will be improved as the cost of health care for both mothers and children will be reduced due to their improved health status and their reduced risks for other complications in life.
Centers for Disease Control (2007) Overweight and Obesity Trends Among Adults. Retrieved October 23, 2007, from http://www.cdc.gov/nccdphp/dnpa/obesity/trend/index.htm
Obesity Risk Factors; New Obesity risk factors findings from N.J. Jain and co-researchers published. (2007, August). Women’s Health Weekly, 171. Retrieved November 26, 2007, from Proquest database.
Villamor, E. and Cnattingius, S. (2006). Interpregnancy weight change and risk of adverse pregnancy outcomes: a population-based study. The Lancet 368(9542), 1164-1170. Retrieved April 12, 2007, from Expanded Academic ASAP database.
Watkins, M., Rasmussen, S., Honein, M. et al (2003).Maternal obesity and risk for birth defects. Pediatrics, 111(5), 1152-1158. Retrieved April 21, 2007, from Expanded Academic ASAP database.
Wong D., Perry S., Hockenberry, M., Lowdermilk, D., and Wilson, D. (2006) Maternal Child Care Nursing Third Edition. St. Louis, Missouri: Mosby Elsevier.
Wood, S. (2004). A weighty issue. Baby Talk, 69(3), 54-58. Retrieved April 12, 2007, from Proquest database.
Intervention 1: Educate women about the risks of obesity on fetal development
Disadvantage 1: Not all women seek prenatal care.
Despite increased access to prenatal health care, several factors including; socio-economic status, language barriers, and knowledge deficits, prevent many woman from seeking prenatal health care. In a 2002 study only 68% of black non-Hispanic and Hispanic women received early and adequate prenatal care compared with 79% of white non-Hispanic women. A study specific to pregnant women on Medicaid found that only 20% to 42% of minority women received private care, where as 52% of white women did. The ability to find prenatal care also varies based on proximity to health care providers. Generally, fewer health care providers are found in rural areas, requiring that pregnant women in rural areas travel outside their county to obtain needed services. Limited access to private health care decreases the likelihood of women following up with a health care provider (Adams, Gavin, And Benedict, 2005).
Adams, E., Gavin, N, and Benedict, M. (2005). Access for Pregnant Women on Medicaid: Variation by Race and Ethnicity. Journal of Health Care for the Poor and Underserved, 16(1), 74-95. Retrieved February 5, 2008 from Proquest database.
Disadvantage 2: Education alone does not guarantee change.
Despite an increasing awareness of the growing obesity epidemic and its causes, promoting public health requires more than simply educating the public about the risks of obesity. Educating about risk factors does not guarantee that women will be motivated to make life-style changes that can reduce the risks associated with obesity and pregnancy. Furthermore, while it is important that woman know the risks of obesity and their pregnancy, this information can result in increased psychological stress. Rather than educate about risks, the focus should be on promoting small life-style changes that can improve the health of pregnant women, such as a healthy diet and physical activity (Obesity research, 2007)
Obesity Research; Getting people to move is one of the challenges in promoting physical activity (2007, January 13). Obesity, Fitness & Wellness Week, 6. Retrieved February 4, 2008, from Proquest database.
Intervention 2: Encourage women to achieve a healthy preconception weight.
Disadvantage 1: Conception is not planned in all cases.
The time before a woman becomes pregnant is crucial to reducing the risk of birth defects, however, nearly half of all pregnancies are unintended. Limited access by many women to health care prevents regular access to a health care provider prior to conception. Furthermore, as advanced prenatal care has improved maternal and infant health, preconception care has slowed (Prenatal Care; Preconception, 2006).
Prenatal Care; Preconception care crucial to improving maternal and infant health (2006, October 22). Medical Letter on the CDC & FDA, 86. Retrieved February 4, 2008, from Proquest database.
Disadvantage 2: Delaying pregnancy may place women at other risks for future pregnancy.
In the developed world, an increasing proportion of births are attributable to women of advanced maternal age. Advanced maternal age has been associated with an increased risk for stillbirth. For women who are obese and of an advanced maternal age, delaying pregnancy to achieve a healthy preconception weight may negate the beneficial effects of weight loss. “Prepregnancy counseling for patients who delay childbearing into their late 30s may be too late to inform decisions about preventing pregnancy risks” (Benzies, 2008).
Benzies, K. (2008). Advanced maternal age: Are decisions about the timing of child-bearing a failure to understand the risks? Canadian Medical Association Journal, 178(2) 183-184. Retrieved February 5, 2008, from Proquest database.
Wednesday, February 6, 2008
Obesity during pregnancy.
Education: Key To A Satisfying Birth Experience
Caesarean births and the use of anesthetics to cope with the pains of labor are on an upward trend across the US (Wong & Perry, 2006). They are becoming more prevalent daily. The RN plays an integral role in educating a pregnant woman toward her best labor and birthing experience because in many instances the RN may be the primary source of information during prenatal care. The pregnant mother should be very well informed on what her body will be going through.
Caesarean births and the use of anesthetics to cope with the pains of labor are on an upward trend across the US (Wong & Perry, 2006). They are becoming more prevalent daily. The RN plays an integral role in educating a pregnant woman toward her best labor and birthing experience because in many instances the RN may be the primary source of information during prenatal care. The pregnant mother should be very well informed on what her body will be going through. The nurse can be detrimental in assessing her fears of labor and childbirth and in turn do something to calm and ease those fears. The pregnant woman should also be educated by the RN on all her choices ranging from when and where the birth is going to take place, birth support systems, options for pain and discomfort management, prenatal, birthing and parenting classes, and also options to include spirituality as part of her birthing experience. The mother should know that this is her experience and she has the right and influence to make it what she wants it to be.
The first nursing strategy is to assess the pregnant woman’s knowledge and fears of pregnancy, labor and delivery. The RN’s education of the client as to the process of a normal pregnancy and birth can be started early in the months before the baby is born giving her increased confidence. “A study by Nancy Lowe, associate professor of nursing, Ohio State University, Columbus, found that, among first-time mothers, less-confident women had a greater fear of labor and birth than did those who scored high on confidence and self-esteem tests,” (Unknown, 2001). By teaching and educating an expectant mother what her body will be undergoing in the following months you are empowering her to make decisions based on fact rather than based on horror stories or myths that may have been told to her throughout her years as a woman. Lowe maintains, “Western women are bombarded with messages that undermine their beliefs in the ability of their bodies to give birth successfully, as well as their beliefs in their personal ability to exercise control over their birth experience,” (Unknown, 2001). Pregnancy and birth are natural processes with which women have been blessed to be the partakers of. In an uncomplicated pregnancy there should be no need for fear or anxiety. In order to help a woman overcome any possible fears or anxieties the RN can use this opportunity to completely and truthfully inform the mother about the process of birth. She can also inform her on what complications can happen because preparedness in both situations is a necessity. “The goals for all childbearing women are safe, esteem-building, satisfying birth experiences that launch them into motherhood with a sense of competence and self-confidence,” (Ballen & Fulcher, 2006, p. 305). The expectant mother should be encouraged to enroll in classes on the birthing process as well as classes on care for a newborn after birth. The RN should also encourage the mother to ask any necessary questions that she may have. Books, websites, magazine articles, and any other information can be suggested, and if needed, support services should be put into place.
One of the most effective ways to have a great outcome in the birthing experience is to have the right support. Midwives and/or doulas are alternatives to a doctor and may be more apt to understand and handle this in a satisfying way. The midwife is trained for delivery in low risk situations and refers to a physician for high-risk deliveries. In contrast a doula would be one who is supportive in the hospital environment. She is not trained to handle the birth on her own but rather to be the main support for the laboring woman. In this type of situation the RN and the doula can work together. “The goal of the nurse is to ensure a safe outcome. The goal of the doula is to ensure that the woman feels safe and confident,” (Ballen & Fulcher, 2006, p.305). The doula knows beforehand the woman's wishes and is prepared to carry them out as an advocate when the woman may not be thinking straight in the heat of the moment. "A woman's satisfaction with childbirth is influenced more by the quality of support she receives, feeling in control of herself, and feeling that she was actively involved in decisions than by her degree of pain, the number of interventions she experiences, or even the medical outcomes," (Ballen & Fulcher, 2006, p. 304-305). By working as a team, a doula and an RN can help produce an environment where the laboring woman and her needs are the number one priority. In order for this to be effective the roles of the RN and doula need to be strictly followed as to not cause tension or confusion between the caregivers. Where an RN cannot be involved a doula can. "The hallmark of doula care is her continuous, rather than intermittent presence." At times when the RN is doing paperwork or out in other rooms, the doula can stay at the woman's side. "The doula's care includes direct hand-on physical care and comfort . . . She keeps the laboring woman informed about her progress in labor . . . She helps explain medical terminology used by healthcare staff. If the plan of care changes, the doula facilitates the mother's adjustment to the new plan." (Ballen & Fulcher, 2006, p.305) By working together and understanding the woman's needs this can be a great time for empowerment and satisfaction for the woman and her long-term self-esteem.
If a woman decides it would be best to include pain relief into her birthing experience, the nurse can educate beforehand on what, when and how each option is used. She should be informed on both the positive and negative outcomes of different pain relief choices including affects on herself and the yet unborn baby. Pain relief comes in many different forms, from narcotics, parenteral opioids and analgesics, to hydrotherapy, breathing techniques, and spiritual components like prayer or just belief. The most common pain relief choice for women right now is the epidural. “More than half of women giving birth choose to have an epidural and some labor and delivery units report 85-90% epidural rate,” (Wong & Perry, 2006). For some women the epidural is a lifesaver. The unfortunate thing about epidurals though is that they can cause the woman to have a fever, which in turn can be potentially harmful to the fetus. “The need for oxygen therapy in the nursery was 6 times higher among infants whose mothers had a temperature,” and “most fever during term labor is not, in fact, related to infection but rather to the use of epidural,” (Lieberman, et al, 2000) “In a study of 1,218 women in labor, 123 developed a fever. Ninety-seven percent of these women had received epidural anesthesia for pain relief. Babies born to these women were more likely to have a low Apgar score, to be inactive after delivery, and to require resuscitation and oxygen therapy. They were also more likely to have a seizure,” (Lieberman, et al, 2000). Other drugs, such as opioid drugs like meperedine (Demerol) and fentanyl (Sublimaze) are commonly used but researchers have found that they “are associated with neonatal respiratory depression, decreased alertness, inhibition of sucking, lower neurobehavioral scores, and a delay in effective feeding,” (Leeman, 2003).
However, there are many options of pain relief that are not drug related. These options are more along the lines of relaxation and focus techniques, as well as the woman’s knowledge of what her body is going through, giving her increased self-confidence. Many women when looking for a place to give birth look for a hospital or birth center that includes a tub for hydrotherapy. Other options include acupuncture, breathing techniques such as Lamaze or Bradley methods, continuous labor support, maternal positioning and touch and massage techniques. Some women use spirituality to help them through the birth experience because they may feel that women’s bodies are supposed to carry and bear children, they may believe that is what women were specifically created for. In the Bible the first woman’s name is “Eve” which means “life” or “life producer,” which may give the pregnant woman added self-confidence if that is her belief. The woman should be told of all the options available to her and make the choice which best fits her view of what the labor, delivery and birth experience should entail.
Overall, being fully informed of any decision to be made in life causes the best outcome to be brought forth. The RN’s role is to assess the knowledge and fear/anxiety levels of the expecting woman and then determine the best method to overcome this. She also has a responsibility to communicate with and educate the pregnant woman on a variety of issues like what pregnancy and labor are, possible birthplace, support of mom, pain relief, etc. Of course there will be times when things outside of the plan may happen, but in the event that were to happen the RN can help the mother to be prepared. The RN is a critical component in advocating for mother and making one of the most important events in a woman’s or families life something to be looked back upon and only think of it as a wonderful experience and cherished memories. Overall the experience includes many facets, which when working together can create a beautiful outcome for mother, baby and family.
Intervention 1 – Having Labor Support That Is In The Best Interest Of The Mother & Baby
Disadvantage 1 – RN & Doula not understanding each other’s role and not working together toward the best outcome and same goal.
- It is critical that an RN and Doula understand which role each other serves as to not become a hinderance for the mother and baby outcome. Some RN’s see the Doula as a threat but it does not need to be seen this way because the two professions serve different purposes. If an RN understands the Doula’s role she can be more relaxed in her role as a nurse and less stressed and more able to give competent patient care.
- Ballen, L.E., & Fulcher, A.J. (2006). Nurses and doulas: Complementary roles to provide optimal maternity care. Journal of Obstetric, Gynecologic, and Neo-Natal Nursing, 35(2), 304-311.
Disadvantage 2 – Having a midwife who is not properly trained! Make sure to check them out!
- State suspends midwife for unprofessional conduct, she was suspected of “putting a patient’s fetus at risk by failing to provide prenatal attention, not adequately managing her labor and failing to transport the patient during an emergency, the child was stillborn.” The midwife is also suspected of not consulting with a doctor when it appeared another baby’s condition was “significantly abnormal, the child ended up on life support for four days and died after being removed from a respirator.” There is always a bad one out there.
- Esposito, S. (2003) “State suspends midwife for unprofessional conduct.” The News Tribune. B02. Retrieved February 6, 2008 from ProQuest. Tacoma Community College.
Intervention 2 – Pain Relief Options For Example The Epidural
Disadvantage 1 – Loss of bodily control
- Although epidural analgesia is the most effective form of pain relief during labor it is associated with increased rates of instrumental vaginal delivery, prolonged labor and oxytocin augmentation. This results from dense paralysis of motor function from the epidural. Some of the adverse events might be related to this motor paralysis because it affects the mothers pelvic floor tone, mobility, and ability to push during labor.
- MacArthur, C., Shennan, A., May, A., Whyte, J., et al. (2001) “Effect of low-dose mobile versus traditional epidural techniques on mode of delivery: A randomized controlled trial.” The Lancet. 358(9275). Retrieved February 6, 2008 from ProQuest. Tacoma Community College
Disadvantage 2 – Harmful effects on baby
- Intrapartum maternal fever is a great concern to doctors because it may indicate negative effects on the newborn. Recent studies have demonstrated that for women of term pregnancy, much of fever developing during labor may not be infectious in origin but a consequence of the use of epidural analgesia. Even when the fever is not infectious in origin it is still a cause for concern in regard to the fetus. In primate studies it has been directly associated with the development of fetal hypoxia, metabolic acidosis, and hypotension.
- Lieberman, E., Lang, J., Richardson, D.K., Frigoletto, F.D., Heffner, L.J., & Cohen, A. (2000). "Intrapartum Maternal Fever and Neonatal Outcome." Pediatrics 105(1). Retrieved January, 22, 2007 from Expanded Academic ASAP. Thomson Gale. Tacoma Community College
References
Ballen, L.E., & Fulcher, A.J. (2006). Nurses and doulas: Complementary roles to provide optimal maternity care. Journal of Obstetric, Gynecologic, and Neo-Natal Nursing, 35(2), 304-311.
Esposito, S. (2003) “State suspends midwife for unprofessional conduct.” The News Tribune. B02. Retrieved February 6, 2008 from ProQuest. Tacoma Community College.
Florence, D.J., & Palmer, D.G. (2003). Therapeutic choices for the discomforts of labor. Journal of Perinatal & Neonatal Nursing. 17(4), 238-252.
Leeman, L., Fontaine, P., King, V., Klein, M.C., & Ratcliffe, S. (2003). The nature and management of labor pain: Part II. Pharmacologic pain relief. American Family Physician 68 (6), 1115. Retrieved January 22, 2007 from Expanded Academic ASAP database. A108993892
Lieberman, E., Lang, J., Richardson, D.K., Frigoletto, F.D., Heffner, L.J., & Cohen, A. (2000). "Intrapartum Maternal Fever and Neonatal Outcome." Pediatrics 105(1). Retrieved January, 22, 2007 from Expanded Academic ASAP. Thomson Gale. Tacoma Community College.
MacArthur, C., Shennan, A., May, A., Whyte, J., et al. (2001) “Effect of low-dose mobile versus traditional epidural techniques on mode of delivery: A randomized controlled trial.” The Lancet. 358(9275). Retrieved February 6, 2008 from ProQuest. Tacoma Community College
Unknown Author. (2001). Self-confidence key to easier childbirth. USA Today Magazine. 10. Retrieved 22 Jan. 2007 Expanded Academic ASAP. A79340037
Wong, D.L., Perry, S.E., Hockenberry, M.J., Lowdermilk, D.L., & Wilson, D. (2006) Maternal Child Nursing Care. 3rd. ed. (pp.455).China: Mosby.
Best Practices in the Prevention and Treatment of Pressure Ulcers
With health care reform, staff downsizing, and the lengths of hospital stays decreasing, it is inevitable that the incidence of wounds will increase. The Joint Commission of Accreditation of Hospital Organizations (JACHO) suggests the appearance of a pressure ulcer may indicate the quality of care provided by a hospital. Of course the patient’s complex condition must be viewed before it can be related to inferior quality-of-care (Hall, Schumann, 2001).
Preventing the incidence of a wound is one of the most important responsibilities that nurses have. Recognizing the stages of a pressure ulcer is a basic competency for nurses, however the National Pressure Ulcer Advisory Panel (NPUAP) identified, based on research, that nurses did not have the skills to identify even stage 1 pressure ulcers (Ayello, Baronoski, Salati, 2006). Regulatory bodies set guidance for staging pressure ulcers, depending on the care setting, which may determine how the same pressure ulcer is staged. Providing the best possible nursing care means staying current with the development of better products and prevention techniques that support better healing (Ayello, et. al., 2006).
The quality of wound care education received in school affects the knowledge and competence of the clinician’s wound care management. The contents of many textbooks are either incomplete or inaccurate and only provide a brief description of wound care and prevention of pressure ulcers. The caregiver’s ability in providing wound care and their knowledge about the skills needed in preventing wounds may be shown to have greater importance even than assessing the patient’s risk factors. Medical and physical conditions, environmental sources and iatrogenic causes are the three major risk factors that contribute to the failure of wound healing. Pressure ulcer development may now be determined not by how sick the patient is, but by the clinician’s knowledge and abilities which can have direct impact on outcome of healing (Hall, et. al., 2001).
The Centers for Medicare and Medicaid Services (CMS) track pressure ulcers in acute care as medical errors through the Medicare Patient Safety Monitory System (MPSMS) (Ayello, et. al., 2006). In their sister publication, Nursing 2006, Ayello set out to examine if the latest nursing wound care practices reflected the current best practice standards. According to the results of the survey, older nurses with many years of experience knew a lot about wound care where as the newer, younger and less experienced nurses needed more wound care education.
Identifying patients at risk for pressure ulcers led to the development of The Braden risk assessment tool. Overemphasis on documenting risk based on The Braden scale is important upon admission and or when the patient’s condition begins to change no matter the location of the care setting. The implementation of prevention protocols at any of the six subscales must be done rather that relying to the total risk score (18 or below) (Ayello, et. al., 2006).
In providing guidance and clinical decision making, algorithms, guidelines and clinical pathways are tools that should be used along with clinical expertise in preventing delays and enhancing appropriate treatments. The United States Department of Health and Human Services (USDHHS) has provided a list of six areas that are used to develop pressure ulcer treatment plans such as 1) a complete history and physical, 2) identification of complications and comorbid conditions, 3) nutritional assessment, 4) pain assessment, 5) psychosocial assessment, and 6) evaluation of the individual’s risk for the development of additional pressure ulcers (Hall, et. al., 2001).
Lewis, Pearson, and Ward (2003) recognize the need for straightforward guidelines for treatment and prevention of pressure ulcers. It is believed that the duration and magnitude of pressure exertion on a particular body part or region can increase the variations of pressure ulcers making it difficult to be successful with treatment.
However, practices in staging of pressure ulcers may vary from care setting to care setting; wound prevention and treatment has evolved over the years. Benbow (2006) indicates that an ‘all-in-one’ guideline on pressure ulcer prevention and management was published by the National Institute for Health and Clinical Excellence (NICE) in 2005. It is published in two parts The Management of Pressure Ulcers in Primary and Secondary Care is the first part and the second part is on risk assessment and prevention which also includes the use of pressure-relieving devices. The guideline highlights what healthcare professionals should do to prevent and treat pressure ulcers using evidence-based best practice (Benbow, 2006).
a. Intervention 1 - Continuing education for nurses in the prevention of pressure ulcers
i. Disadvantage 1 – knowledge deficit
1. Although not all pressure ulcers are preventable. Patients
with multisystem failure are particularly at risk despite the aggressiveness of
interventions. Knowledge deficit amongst nurses is a key factor in the
prevalence of pressure ulcers.
2. Education and training of healthcare professionals must be an
interdisciplinary approach. With technological and therapeutic advances
systematic implementation and updates systematic implementation needs
to be adaptable. Ultimately this education should be easily accessible to
both nurses and patients in the form of resource manuals and brochures
and easily comprehended.
Source: Lewis, M., Pearson, A., & Ward, C. (2003, April). Pressure ulcer
prevention and treatment: transforming research findings into
consensus based clinical guidelines. International Journal of
Nursing Practice, 9(2), 92-102. Retrieved November 14, 2007,
from CINAHL database.
ii. Disadvantage 2 – Not keeping up with current standards and technology
1. Management of wound care is constantly evolving. As technology
advances keeping up with the changes plays a major role in wound
healing.
2. If clinicians do not keep current with the standards and
guidelines as they become updated even the most aggressive interventions
may not be useful in preventing pressure ulcers. Knowledgeable staff
performing the initial assessment and accurate staging is essential.
Source: Calianno, C. (2007, May). Pressure ulcers a quality issue. Nursing
Management, 38(5), 42-51. Retrieved February 6, 2008, from
Academic Search Premier database.
b. Intervention 2 – Treatment options for already existing pressure ulcers
i. Disadvantage 1 – Socioeconomic status
1. Socioeconomic status affects both healthcare institutions as well as the
patients. It is important to be aware of the costs involved in treatment of
pressure ulcers which should be a good motivator for reducing the
incidence.
2. Hall and Schumann state that only one half of 1% of the aggregate health
care dollar is spent on wound care in the United States. A total national
cost of treatment has been estimated to exceed $1.36 billion dollars per
year. The average cost to heal a single pressure ulcer ranges from $1,951
for a leg ulcer to $29,373 for a diabetic ulcer. An independent study of
Medicare claims data shows that more than $20,000 is spent per patient,
per ulcer episode.
Source: Hall, P., & Schumann, L. (2001, June). Wound care: Meeting the
challenge. Journal of the American Academy of Nurse
Practitioners, 13(6), 258-268. Retrieved November 4, 2007,
from CINAHL database.
ii. Disadvantage 2 – Having trouble with this one
References:
Ayello, E., Baranoski, S., & Salati, D. (2006, September). Best practices in wound care
prevention and treatment. Nursing Management, 37(9), 42-48. Retrieved November
4, 2007, from CINAHL database.
Benbow, M. (2006, September 6). Guidelines for the prevention and treatment
of pressure ulcers. Nursing Standard, 20(52), 42-44. Retrieved November 4, 2007,
from CINAHL database.
Hall, P., & Schumann, L. (2001, June). Wound care: Meeting the challenge. Journal of
the American Academy of Nurse Practitioners, 13(6), 258-268. Retrieved November
4, 2007, from CINAHL database.
Lewis, M., Pearson, A., & Ward, C. (2003, April). Pressure ulcer prevention and
treatment: transforming research findings into consensus based clinical guidelines.
International Journal of Nursing Practice, 9(2), 92-102. Retrieved November 14,
2007, from CINAHL database.
Issues challenging obese population
Many research studies have addressed ways obesity affects the human body biologically, but few have actually highlighted other surrounding issues that affect obese population such as discrimination and lack of accommodation in public places. Therefore, this paper will highlight and address great roles that nurses can play to bring a change in perspective of “other” ignored issues about obesity.Joseph
To make this possible a nurse can implement the following strategies.
1. As health care provider, the nurse can set a good example by not practicing bias and discrimination against obese population.
2. As a manager of a health care organization, the nurse can mobilize resources to ensure equipment like oversized beds, commodes, walkers and wheelchairs are available and ready for use by bariatric patients.
3. A nurse can act as an educator to help in creating public awareness about obesity with the correct perception.
The first strategy is for the nurse to be open-minded, understanding, resourceful and free from bias and discrimination. This can prove to be a big challenge to the body image obsessed society which has done little to help address and solve issues of obesity. Instead, the society has marginalized and labeled obese individuals as lazy, irresponsible and, generally of less worth. As a result, many obese individuals are hesitant to go out in public places like colleges, churches, hospitals and gymnasiums.
A research study found physicians and nurses to be among predominant groups that were most stereotypical about obesity. Physicians associated obesity and other negatively perceived conditions with poor hygiene, noncompliance, hostility, and dishonest. Doctors were less motivated and less optimistic when caring for obese patients because they viewed them as unsuccessful, weak willed and unintelligent. (Puhl & Browell, 2001)Therefore, it is important that nurses set a good example for the rest of the society to follow by caring for obese patients with dignity and an open minded approach. For instance if a bariatric patient requested for bed change and the nurse needed some help to turn the patient she should kindly respond, “Let me get someone to help me” instead of “ You are too heavy I need someone to help me roll you over”.
A second strategy involves the nurse as a manager of a healthcare organization and a patient’s advocate. A nurse can mobilize resources to ensure that facilities and equipment can safely accommodate obese patients. This goal can be achieved by construction of infrastructure that can support the growing obese population such as investing in wider beds that can accommodate weights between 300 and 800 pounds, building wide doorways, purchasing or renting wider wheelchairs, lifts, commodes, gowns, bariatric beds, commodes, and walkers. In addition, hiring more staff to help in safer transfers of obese patients is key to avoid back injuries as, Gallagher (2005) explains “Injuries that result from manual lifting and transferring of patients are among the most frequent causes of nurse related injuries with more than half of strains and sprains being attributed to manual lifting tasks while assisting dependent patients with their mobility needs” (Pg 1). Although this may mean additional expenses, this will serve as a long-term investment as the numbers of overweight patients persistently keep rising.
The third strategy is education of the public. Nurses can change the way the public views obesity through education and enlighten on cause of obesity and surrounding factors. But before the healthcare professionals can educate the public, Maxwell (2005) urges all healthcare professionals to educate themselves and other hospital staff first on ways of being sensitive to the plight of the obese people. In her article Obesity: Pain and Prejudice (2005) she exemplifies, “Don't be like the doctor who told his patient that she would have to be weighed at the zoo” (Pg 4). In comparison to HIV/AIDS epidemic, education about obesity will lead an overall public awareness and change of attitude hence change of behavior. Additionally, early education on obesity is paramount to young children to serve as a preventive measure before they turn into young obese adults by creation of healthy food programs in school such as reduction or eradication of vending machines in schools and promotion of Physical education (Malone, 2005)
After, the nurse sets a good example by not practicing bias and discrimination against obese population, mobilize resources to ensure equipment like oversized beds, commodes, walkers and wheelchairs are available and ready for use by bariatric patients and, educate people to create a public awareness about obesity. This will improve empower and encourage public awareness about obesity with the correct perception and aid obese population to lead healthier lives.
Reference:
Gallagher, S. ((2005)). Caring for the Child Who is Obese: Mobility, Caregiver Safety, Environmental Accommodation, and Legal Concerns. Batriatric Nursing Surgical Patient care , 1.
Malon, S. (2005). Improving Quality of dietary intake in the school setting. Journal of School Nursing , 21, 70-76.
Maxwell, B. (2005). Obesity: Pain and Prejudice. Medscape General Medicine , 7, 3.
Puhl, R., & Browell, D. (2001). Bias, discrimination and obesity. The NOrth American Associaton for the study of Obesity , 9, 788-805.
Joseph Njenga
NUR 211
John Miller
Research paper
2/4/2008
Intervention 1
As a manager of a health care organization, the nurse can mobilize resources to ensure equipment like oversized beds, commodes, walkers and wheelchairs are available and ready for use by bariatric patients
Disadvantage 1
One major disadvantage of this intervention is lack of enough funds to meet the need of this intervention. Limitation in coverage of most bariatric procedures by insurance has done little to improve the situation at hand. With scarce resources that the facilities have to depend on, tight budget cuts in many healthcare facilities have been enforced leaving no room for expansion in provision of bariatric services and purchase or required equipment. In a research study to find ways of predicting cost by a bariatric clinic, Mosti states, “Although bariatric surgery is highly effective for controlling obesity and its complications, it is uncovered by third-party payers in many countries. High cost and unpredictable expenses account for the lack of coverage”
Disadvantage 2
The second disadvantage is multiple stages of managerial approval in many organizations. The more the stages of approval the hard it becomes to approve any policy in an organization; this is because each stage of a policy approval questions the chances of success in implementation of an idea. Although it is essential to assess the chances of success of any policy before investing, this practice discourages creative employees from coming up with good idea that would in fact help the organization grow. For instance in the Wikipedia encyclopedia (Espo, 2007), the Stem cell research has gone over multiple challenges and yet it has not been approved as illustrated:
The bill passed House of Representatives by a vote of 238 to 194 on May 24, 2005.[1], then passed the Senate by a vote of 63 to 37 on July 18, 2006. President Bush vetoed the bill on July 19, 2006.
The House of Representatives then failed to override the veto (235 to 193) on July 19, 2006. In a second trial The bill passed the Senate on April 11, 2007 by a vote of 63-34, then passed the House on June 7, 2007 by a vote of 247-176. President Bush vetoed the bill on June 19, 2007,[2] and an override was not attempted..
Intervention 2
The second intervention is for nurses to educate the public about obesity through creation of the right perception about obesity and factors that can be employed to reduce it.
Disadvantage 1
As a result of the well known fact about nursing shortage, this phenomenon has affected nursing educators too. Andrea (2007) in her article states, “Of the 2900 nursing doctoral students who enroll each year, only 440 graduate. The average age of a new doctoral graduate in nursing was 45.7 years and 6.5% of the graduates were 55 years or older.” She goes on to say that this demographic has done little to improve the situation of the nursing scholarly culture. In return there is a shortage of faculty that is supposed to teach new nurses and the public in general. The few nurses that graduate from nursing school are hence siphoned to more critical healthcare system like the hospitals. This means that community based care that is meant to be the primary mode of prevention has been left with no educators creating a whole new challenge for public education on issues such as obesity.
Disadvantage 2
Unavailability of health care centers, information coupled with public illiteracy has been a major disadvantage for wellness promotion through community education. Nurses who teach on the community level greatly depend on this resource for their service as educators to be effective. Lack of this resource has lead to an increase in health care cost through Emergency department response and chronic diseases such as diabetes and hypertension. Parker( 2005) states, “Widespread problems with health literacy significantly limit effective dissemination and understanding of relevant health information in society, especially among many vulnerable populations where health literacy challenges are especially pervasive” she goes on to explain that an improvement in community healthcare will reduce disparities, cost and quality of care. Therefore a well furnished community health care center can greatly reduce the cost of health care in the long run (Parker, 2005)
Bibliography
Andrea L. Smesny, P. J. (2007). Barriers to Scholarship in Dentistry, Medicine, Nursing, and Pharmacy Practice Faculty. American Journal of pharmaceutical education , 5 (71), 91.
Espo, D. (2007, April 12). Stem Cell Research Enhancement Act. Retrieved Feb 5, 2008, from Wikipedia: http://en.wikipedia.org/wiki/Wikipedia:Text_of_the_GNU_Free_Documentation_License
Mosti M, D. G. (2007, nov 27th). Calculating Surgical Costs: How Accurate and Predictable is the Cost of a Laparoscopic Roux-en-Y Gastric Bypass? Obesity surgery , 1555-7.
Parker, L. G. (2005). Library outreach: overcoming health literacy challenges. Journal of the medical library association , 4 Suppl (93), S81- S85.
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Crohn's Disease
Crohn’s Disease is a life-long, debilitating form of Inflammatory Bowel Disease (IBD) that can cause many complications. Like most autoimmune diseases, these complications and unpleasant symptoms may be unpredictable and difficult to control, which can cause a sense of powerlessness and lead to depression. A. Lei Correa
Because Crohn’s Disease affects mental as well as physical health, the nurse promotes wellness by thoroughly educating the patient on the disease process of Crohn’s Disease, nutrition and pharmacological management, and uses specialty skills to provide care and emotional support using a holistic approach.
The most common and initial indicators of Crohn’s Disease are fatigue, diarrhea, abdominal pain, gastrointestinal bleeding, and weight loss. These symptoms may also be present in patients with other forms of IBD, therefore thorough assessments and specific diagnostic testing is extremely important to avoid misdiagnosis. Since Crohn’s Disease is most often autoimmune (the body tissues attacking itself), patients may experience a multitude of other complications and exacerbations including arthritis, osteoporosis, anemia, malnourishment, fistulas, renal and hepatic disorders, vision problems and sensitive skin, just to name a few. Rayhorn and Rayhorn (2002) explain that this disease does not always effect just the bowel, “Internal organs, the eyes, blood, skin, and the musculoskeletal system are all potential targets for the devastating effects of this disease, known collectively as extraintestinal manifestations, or EMs”.
Gaining knowledge of Crohn’s Disease is the first step to remission. Patient education is one of the most important aspects of nursing; what is told to the patient about the disease and what to expect, and how well that information is understood will determine the patients’ self-perception, self-care, and choices in regards to disease management. The nurse educates the patient according to their learning ability, and (with permission of the patient to protect health information) educates family members who may be taking on the role of care-giver. An individual experiencing the unpleasant signs and symptoms of Crohn’s Disease is not necessarily eager to learn, and the nurse prepares for this by providing resources, pamphlets, and other reading material so it is convenient for the patient when they are ready to soak in more information. The age of the patient is also a factor. The patient should be informed of support groups in their area and can also be referred to the Crohn’s and Colitis Foundation of America (http://www.ccfa.org) (Rayhorn, 2003). Providing information with pictures will of course make it easier to visualize that which cannot be seen. The severity of the patient’s condition should be clearly understood, as well as warnings of potential problems.
Nutrient deficiency is a complication that should constantly be monitored because it can occur during flare-ups or while the patient is in remission. A significant amount of calories and carbohydrates for energy, and adequate hydration every day is absolutely vital in maintaining optimal health. Nutrient absorption is decreased in patients with Crohn’s Disease because the intestines do not function as well as in a healthy individual. Patients will become aware of the type of foods that will irritate their bowels and which foods are well tolerated. According to a webpage created by the New York Methodist Hospital, foods that have irritation potential include raw vegetables, alcohol, simple sugars, and caffeine because they are associated with inflammation. Other inflammatory foods are fruits with a lot of sugar such as grapes, watermelon or pineapple (2002). Sometimes medications can be the culprit for malnutrition. For example, Prednisone is a common drug for Crohn’s Disease patients, but it can cause osteoporosis, and therefore is treated with calcium and Vitamin D supplementation. Iron deficiency is also common, but oral iron supplementation is often not tolerated in patients with Crohn’s Disease and would then iron delivered intravenously or by injection. In extreme cases of the disease, enteral feeding can induce remission, as well as TPN in which bowel rest may be required (Jeejeebhoy, 2002).
Such a debilitating disease can cause the patient to feel powerless and depressed. Being a counselor and an active listener can make a drastic difference in the patient’s self-perception and quality of life. Specialty nurses who have become active participants in gastroenterology have made a huge difference in patients with Crohn’s Disease. Specialty nurses can improve disease management on a whole different level than just a practitioner. There is a motivation for change in the healthcare system as we advance and make new discoveries. Kamm & Norton (2002) agree that, “Changes may also come from a real desire to move the focus of healthcare away from an insensitive technological approach to one based on holistic care” (p. 331). Patients can be taught how to self-medicate when they are having a flare-up; this means utilizing home remedies and adhering to pharmacological measures as instructed. This will increase autonomy and decrease clinic visits. Kamm and Norton (2002) also provide evidence showing, “in a controlled study this reduced clinic visits by 30%, decreased the delay between symptom onset and treatment from 4 days to under 24 hours, increased the quality of life scores, and decreased costs” (p. 334). Patients with Crohn’s disease need a high level of nursing care; one that combines holistic as well as technical approaches.
Crohn’s Disease does not follow a predicted cycle of flare-ups and remissions; rather it can be rollercoaster of unexpected events. Patients are experiencing a total loss of control over their bodies and overall health. Uncontrollable bowels and discomfort can be extremely embarrassing and disheartening. The exacerbation of other problems caused by this disease, adds to this disparity. The pain and discomfort the patient experiences can be managed more effectively through proper education, pharmacological/nutritional management, and emotional support. This is an opportunity for nurses to take advantage of their specialty skills while providing a holistic type of care.
References
Jeejeebhoy, N. K. (2002). Clinical nutrition: 6. Management of nutritional problems of patients with crohn's disease. Canadian Medical Association Journal, 166(7),
913–918. Retrieved January 29, 2007, from PubMed Central Database.
Norton, C, & Kamm, M.A. (2002). Specialist Nurse in Gastroenterology. Journal of the royal society of Medicine. 95(7): 331-335. Retrieved April 22, 2007, from PubMed Central Database.
Rayhorn, N. (2003). Inflammatory Bowel Disease. Nursing, 33(11), 54. Retrieved November 07, 2007, from Proquest Database.
Rayhorn, N., & Rayhorn, D.J. (2002). An in-depth look at inflammatory bowel disease. Nursing, 32(7), 26-36. Retrieved November 07, 2007, from Proquest Database.
What is the Role of Diet in Crohn’s Disease? (2001). New York Methodist Hospital. Retrieved February 05, 2007, from http://www.nym.org/healthinfo/docs/103/doc103diet.html
Intervention 1: Nutrition therapy along with pharmacological Management
Disadvantage 1: Debilitating side effects from necessary drugs.
The immunosuppressive drugs that are necessary for disease remission are life-long, and produce very unpleasant side effects that although the patient is in a state of “remission”, day-to-day life is still difficult. Remicaid (infliximab) is a drug used for the treatment of rheumatoid arthritis, and is used in Crohn’s patients to keep symptoms at bay, maintain remission, and treat rheumatoid arthritis that gets exacerbated by the disease. However, this drug can cause abdominal pain, nausea, vomiting, fatigue, headache, infusion reactions, and drug-induced lupus (Deglin & Vallerand, 2007, p.642). Azathioprine (Imuran) is another immunosuppressant that can cause the same kind of G.I. upset, along with thrombocytopenia, anemia, and hair loss (Deglin & Vallerand, 2007, p. 180). Methotrexate (Rheumatrex) is a heavy duty immunosuppressant that is actually used on cancer patients, as well as severe Crohn’s Disease. This drug can cause anorexia, G.I. upset, nephropathy, anemia, rashes, malaise, hair loss, and hepatotoxicity (Deglin & Vallerand, 2007, p. 772). In addition to any of the mentioned drugs, prednisone is usually used in addition to a chosen drug therapy. This drug can cause depression, muscle wasting, G.I. upset, peptic ulceration, abnormal fat deposits, and cushingoid appearance (moon face, buffalo hump) (Deglin & Vallerand, 2007, p. 323-327). Unfortunately, the Crohn’s patient will likely go through different therapies such as these before finding one that is effective and somewhat tolerable. Physicians use an algorithm of which drugs to try first, and depending on the reactions, what the next step would be (Knutson, Greenberg, & Cronau, 2003).
Deglin, J, & Vallerand, A. (2007). Davis’s drug guide for nurses. (10th ed.). Philadelphia: F.A. Davis Company.
Knutson, D, Greenberg, G, Cronau, H. (2003). Management of crohn’s disease – a practical approach. American Family Physician. 68(4), 707-14, 717-8, 595-7. (CINAHL Accession No. 2004070944)
Disadvantage 2: Unknown underlying G.I. problems preventing remission.
Some patients with Crohn’s Disease may also have other things going on with their digestive tract even before the onset of their disease. They could have just IBS, and therefore diet will be more selective. There is also a strong possibility of the patient having Celiac Disease (glutten-sensitive enteropathy), which would mean even more diet restrictions to take into consideration. Once Crohn’s Disease has been diagnosed, it seems imperative to also screen for Celiac Disease. It is quite common, affecting 1 in 100 to 1 in 300 (Edwards, 2006). Celiac, like Crohn’s, can cause similar symptoms of G.I. upset, so misdiagnoses can be more common than preceived. If a Crohn’s patient adheres to their drug regimen, and still not feeling well, it is difficult to assess if it is just the wrong drug regimen for them or if they actually have Celiac Disease as well and the glutten ingestion is inhibiting remission.
Edwards, M. (2006). Coeliac Disease – an update. Practice Nurse. 31(7), 42-4. (CINAHL Accession No. 2009176315)
Intervention 2: Specialty nursing
Disadvantage 1: Shortage of specialty nurses.
The field of gastroenterology indeed needs more specialty nurses. However, there is a shortage of nurses in general all around the world, as well as in specialties. It is a huge intervention to attempt to recruit individuals into the nursing field, let alone encouraging nurses to further specialize. The ICN conducted a survery and found some reasons why the number of nurses are declining. Nurses are already dealing with high nurse to patient ratios, long working hours, inadequate compensation, and reduced time with patients due to overburdened administration (“Where”, 2007). The ICN has called on the WHO, but the nursing shortage continues to rise.
(2007). Where are all the nurses. Australian Nursing Journal. 15(1), 19. (CINAHL Accession No. 2009645084).
Disadvantage 2: Not enough. Need communication - team medicine.
Crohn’s Disease can cause extra-intestinal manifestations (rheumatoid arthritis, anemia, osteoporosis, ulcers, malnourishment, renal and hepatic disease, etc.). These other diseases, mean other specializing physicians. One patient with Crohn’s Disease, may be seeing a rheumatologist, gastroenterologist, nephrologist, pharmacist, and dietician, as well as their general physician. If these physicians are not actively and accurately communicating, the patient’s health may be in jeopardy. It is suggested that stress can exacerbate Crohn’s symptoms, and Crohn’s symptoms can exacerbate stress. The need to see so many different doctors can be quite stressful, and may even be detrimental if it is not an efficient team. The patient’s stress level, and means of seeing the necessary specialties are not taken into account as much as it should.
Smith G,D, Watson, R, Roger, D, McRorie, E, Hurst, N, Luman, W, & Palmer K,R. (2002). Impact of a nurse-led counselling service on quality of life in patients with inflammatory bowel disease. Journal of Advanced Nursing. 38(2): 152-60. (CINAHL Accession No. 2002073703).
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best nursing practice for gastric bypass surgery
According to the Centers for Disease Control (CDC), statistics show that of adults in the United States, 20 years of age and older, over 60 million people are obese(Marquerite, 2006, p.1-2).Options to resolve this problem include preventative medicine, diet, exercise, and education. Yoon- heui coffman
Nursing best practice:
Post-op care for the gastric bypass patient
According to the Centers for Disease Control (CDC), statistics show that of adults in the United States, 20 years of age and older, over 60 million people are obese (Marquerite, 2006, p.1-2). Options to resolve this problem include preventative medicine, diet, exercise, and education. After all of these options have been exhausted with a health care professional, gastric bypass surgery should be considered. According to Marquerite, Roux-en-Y gastric bypass (RYGB), Biliopancreatic diversion (BPD), and Laparoscopic adjustable gastric banding (LAGB) are the three main types of gastric bypass surgery (Marquerite, 2006, p.3). Short-term complications include marginal ulcers and stenosis at the gastrojejunal anastomosis necessitating dilatation, anastomotic leakage, and gastrointestinal hemorrhage. Other complications are wound infection, incision hernia, pneumonia, pulmonary embolus, and prolonged nausea or vomiting. Long-term complications include regained weight or inadequate weight loss and nutritional deficiencies (Marquerite, 2006, p.3-4). Most morbidly obese patients report experiences of humiliation, embarrassment, insults, and blatant verbal abuse regarding their weight from their treating physicians. Obesity promotes incredible feelings of worthlessness, powerlessness, and a poor quality of life (Reto, 2003, p. 140-141). Therefore, in order for gastric bypass surgery to be successful, post-operative nursing intervention must integrate the following three approaches: physiological, psychosocial, and educational restoration.
Physiological facts
There are several important physiological facts when considering gastric bypass surgery. In obese patients, the increased size of normal structures and fat deposits interferes with the mechanics of numerous body functions. Fat deposits in the diaphragm and intercostals muscle cause decreased functional residual capacity, expiratory reserve volume, and forced expiratory volume. Sleep apnea also occurs due to airway narrowing (Hurst, Blanco, Boyle, Douglass, & Wikas, 2004, p. 77). Research has shown that prophylactic use of biphasic positive airway pressure (BiPAP) at a level of 12/4 postoperatively reduces pulmonary dysfunction and accelerates preoperative pulmonary function in obese patients (Davidson, Kruse, Cox, & Duncan, 2003, p. 110). Continuous positive airway pressure (CPAP) helps to prevent atelectasis by improving tidal volume during sleep (Davidson et al., 2003, p. 107). Therefore, it is necessary for proper respiratory care such as CPAP and BiPAP to prevent obesity hypoventilation syndrome.
If we consider wound infection, adipose tissue is poorly vascularized and may cause delayed healing of open wounds, so infection control and daily inspection of skin are needed (Hurst et al., 2004, p. 78-80). Obese patients are at risk for developing pressure ulcers and yeast infection. With each turning, skin folds are assessed, cleansed, and dried as needed. All lines and tubes are visually inspected to make sure they are not trapped in a skin fold (Hurst et al., 2003, p. 113). Monitoring for cellulitis, frequent turning and repositioning are all helpful (Hurst et al., 2004, p. 80). Difficulty getting out of bed in the early postoperative period may worsen the situation. Nurses can help with personal hygiene performance and need to encourage the patient to begin early ambulation.
Another important physiological issue is blood clotting. The morbidly obese are at higher risk of deep vein thrombosis (DVT) and pulmonary embolism (PE) because of immobility stasis in addition to polycythemia related to chronic respiratory insufficiency (Davidson et al., 2003, p. 109). Low molecular weight Heparin such as Dalteparin (Fragmin) injection with careful monitoring of prothrombin time (PT) and partial prothrombin time (PTT) is needed to help prevent clot formation (Davidson et al., 2003, p. 111). Use of a sequential compression device and early ambulation can be helpful to decrease pain and enhance recovery (Hurst et al., 2004, p. 80).
Psychosocial facts
Empathetic nursing care is also needed. Studies show that patterns of eating connect to mood, anxiety, stress, and other hidden reasons (Reto, 2003, p. 140- 142). Overeating and obsessions with food allow for the redirecting and narrowing of thoughts, attention, and affect as well as shutting out thoughts (Reto, 2003, p.145). At the time of bariatric surgery, patients may deem themselves as taking “desperate, last resort measures” and hence becomes self-loathing, shameful, and even express suicidal ideation (Hurst et al., 2004, p. 78). Nonjudgmental, supportive, and sensitive staffs are important to promoting partnership with patients (Hurst et al, 2004, p. 79). These patients may believe that it is impossible for others to understand their life. Negative stereotype regarding the morbidly obese patient can interfere with professionalism. Regardless of how a nurse feels about obesity, one should not allow personal attitudes to influence the way care is delivered to an obese client.
Cultural influences also need to be considered. Sociocultural factors that promote thinness and self-concept relating to beauty cause binge eating disorder. The combination of a growing fast food business, multibillion dollar fashion industry, and diet programs lead to unhealthy eating habits (Reto, 2003, p.140-142). Cultural factors such as forced feeding where young children required cleaning their plates contribute obese society (Reto, 2003, p.144). Parents lacking in parenting skill may succumb to their children’s insistent request in unhealthy food (Reto, 2003, p.145). Some patients may compensate for past psychological trauma by developing a very strong personality, while others have low self- esteem. Nursing staff need to discuss fat bias openly and try to understand each patient personally.
Educational facts
Obesity can alter the pharmacokinetic properties of medications. Highly lipophylic drugs require dose calculations based on actual weight, while minimally lipophylic drugs require dosage calculations based on a patient’s ideal weight (Hurst et al., 2004, p. 77). Diabetics, for example, may need insulin dose and or oral hypoglycemic medications adjusted frequently to match the caloric intake and weight loss of the patient. It is important to identify the changing form of medication, dosage alteration, and new medication administration with the patient. Patients also should be encouraged to share any side effects of medications due to polypharmacy.
Patients are at risk for developing deficiencies of iron, B12, folate, and calcium because ingested food bypasses the duodenum, the primary site of absorption of theses nutrients (Elliot, 2003, p. 134). Patients need to take multivitamins on a life-long basis and will address the changes in dietary intake as well as in vitamin and mineral absorption (Marquerite, 2006, p.5). When sugar is consumed, it can cause dumping syndrome which consists of hypoglycemia, bloated sensation, and watery diarrhea. Patients should avoid sugar, caffeine, carbonated drinks and consume high- protein supplements or shakes (Elliot, 2003, p. 136). Diet modification can help restore fluid/ electrolyte balance, prevent dumping syndrome, and ensure the nutritional balance. Therefore, all weight loss patients should have a dietary consultation prior to discharge.
Planning exercise as conditions permit with help from physical therapist (PT)/ occupational therapist (OT) will bring a maximum effect after surgery. According to Marquerite, many well- known medical associations recommend a minimum of 150 minutes of physical activity per week over three to seven days (Marquerite, 2006, p.4). Many morbidly obese individuals, due to size, energy limitations, and/ or co- morbid conditions, may benefit from a planned and monitored, exercise program. Short and long term goals should be set to achieve optimal levels of activity (Marquerite, 2006, p.4-5). Regular physical activity promotes physical and psychological health. It can enhance cardiopulmonary functioning, musculoskeletal fitness, weight control, and psychological well- being.
Conclusion
Gastric bypass surgery is a complicated procedure that involves many risk factors to consider. Weight loss maintenance will not be achieved if we neglect these considerations. Physiologic developmental changes, behavioral aspects, family and social support, cultural origin, and environmental issues are important things for each patient and must be incorporated into the plan of care. Nurses are effective in providing postoperative care for gastric bypass patients when they provide holistic, physical, and psychological care, while collaborating in patient education.
References
Davidson, E., Kruse, W., Cox, H. & Duncan, R. (2003, Apr). Critical care of the morbidly obese. Nursing Quarterly, 26(2), 105- 116. Retrieved October 25, 2007 from Ebsco database.
Marquerite, S. (2006, Oct). Breaking through obesity with gastric bypass surgery. The Nurse Practitioner, 31(10), 12-23. Retrieved October 25, 2007 from CINHL database.
Hurst, S., Blanco, K., Boyle, D., Douglass, L., & Wikas, A. (2004, Mar). Bariatric implications of critical care nursing. Dimensions of Critical Care Nursing, 23(2), 76-83. Retrieved Oct 27, 2007 from Ebsco database.
Reto, C. (2003, June). Psychological aspects of delivering nursing care to the bariatric patient. Critical Care Nursing Quarterly, 26(2), 139-149. Retrieved Nov 1, 2007 from Proquest database.
Elliot, K. (2003, Apr). Nutritional considerations after bariatric surgery. Critical Care Nursing Quarterly, 26 (2), 133-138. Retrieved Nov 9, 2007 from CINHL database.
Nur 211
Intervention 1
Non judgmental and non- stereotypical nursing attitudes are needed with dealing with patients. Regardless of how a nurse feels about obesity, one should not allow personal attitudes to influence the way care is delivered to an obese client.
Disadvantage1;
Obesity seems still seen as somebody’s fault.
In modern societies, slenderness generally is associated with social acceptability, success, and beauty. One study found that individuals who were obese who underwent simulated job interviews were rated less qualified for jobs and viewed as having poorer work habits, as well as more emotional and interpersonal problems than participants in a control group (Murray, 2003, p. 990). The problem is health care providers often have negative perceptions of people who are obese. According to Brownnell, a study of over 400 physicians identified patient characteristics that aroused feelings of discomfort or dislike(Brownell, 2001, p.789- 792). So, there is a stereotype that obese people ought to just pull themselves together and stop eating so much and exercising more. As a nurse, one should be aware of this unconscious prejudice and discrimination towards obese patients.
Murray, D. (2003, Dec). Morbid obesity-psychosocial aspects and surgical interventions. Association of Operating Room Nurses, 78(6), 990-995. Retrieved Jan 1, 2008 from Ebsco database.
Brownwell, K. & Puhl, R. (2001, Dec). Bias, discrimination, and obesity. Obesity Research, 9(12), 788-805. Retrieved Jan 1, 2008 from Pubmed database.
Disadvantage 2;
There is minimum protection of obese individuals’ civil rights, to include the potential lack of insurance coverage.
Many reimbursement systems do not categorize obesity as a disease so physicians often have difficulties getting reimbursement for their services for the gastric bypass surgery. No federal laws exist to prohibit discrimination against obese individuals, and only a few states prohibit employment discrimination on the basis of weight. While many courts do not recognize obesity as an actual impairment, obese individuals must often use impairment claims (Brownell, 2001, p.793- 794). Whether it is advantageous for obesity to be considered a disability is a matter of debate, but it is important to consider patient’s rights and treat equally as a nurse.
Brownwell, K. & Puhl, R. (2001, Dec). Bias, discrimination, and obesity. Obesity Research, 9(12), 788-805. Retrieved Jan 1, 2008 from Pubmed database.
Intervention2
Diet modification and a plan of exercise are needed for post-op gastric bypass surgery patient to maintain weight loss.
Disadvantage1;
Lack of education opportunity and resources are common in many obese patients.
According to Najman, being overweight or obese is highly associated with lower socioeconomic status (Najman, 2006, p.977-980). Low socioeconomic status may influence a variety of factors including health insurance, local schools and their resources, local food stores and the extent to which they carry healthful foods, the price of food, tendency to watch television and participate in other sedentary activities, and access to gyms and health clubs (Vieweg, 2007, p.1-7). Education strategies considering specific population like SES (socioeconomic status) to reduce health inequalities can help solve this problem.
Najman, J. (2006, Dec). Socioeconomic disadvantage and changes in health risk behaviors in Australia: 1989-90 to 2001. Bulletin of the World Health Organization, 84(12), 976-979. Retrieved Jan 1, 2008 from Ebsco database.
Viewer, V., Johnston, C., Lanier, J., Fernandez, A., & Pandurangi. A.(2007, Jan). Correlation between High Risk Obesity Groups and Low Socioeconomic Status in School Children. Southern Medical Journal, 100(1), 8-13. Retrieved Jan1, 2008 from Proquest database.
Disadvantage 2
Patients who do not comply with prescribed health instructions are a common problem that can cause frustration for health care providers.
Compliance with behavior and lifestyle changes, that are needed to lose weight and maintain weight loss, can be extremely difficult because of genetic background, environmental pressures, and ingrained, life-long behaviors (Vieweg, 2007, p.1-7). Nurse should have realistic expectations and be aware of the considerable barriers. Nurses can help patients identify barriers, explore how these can be removed, and devise new strategies to achieve the same objectives.
Viewer, V., Johnston, C., Lanier, J., Fernandez, A., & Pandurangi. A.(2007, Jan). Correlation between High Risk Obesity Groups and Low Socioeconomic Status in School Children. Southern Medical Journal, 100(1), 8-13. Retrieved Jan1, 2008 from Proquest database.
Brown, I. (2006, Jan). Nurses’ attitudes towards adult patients who are obese. Journal of Advanced Nursing, 53(2), 221-232. Retrieved Jan1, 2008 from CINHL database.
Tuesday, February 5, 2008
Childhood Obesity
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.
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