Comment1

Nursing practice has changed in how nurses handle and care for central lines as well as how central lines are inserted specifically peripherally inserted central catheters.  The reduction of CLABSI’s (central line associated blood stream infection) and the use of an insertion bundle have greatly improved patient outcomes in the last many years.   These practice changes have reduced patient mortality and decreased the length of patient stay in the ICU.  Through these studies and by implementation of new processes brings awareness to nursing staff on what needs to be done to better care and protect our patients.  The findings have changed my overall view of central lines. When I cared for central lines I was more careful at assessing, accessing, documenting and advocating for earlier removal of these devices when no longer needed in my patient.  At the hospital where I work, dressing changes of central lines are a two person process and the use of CUROS caps to cover needless connectors or injectable ports on tubing is required to prevent infection.  The insertion bundle is utilized by our PICC team who do their part in following strict guidelines when placing the central line catheter.    

Comment2

Hospital Acquired Pressure Ulcers (HAPU) is a topic of great concern in health care delivery due health impact and complications on affected patients, as well as the cost and reimbursement issues.  The costs of pressure ulcers are extremely high.  Patients die from sepsis related to pressure ulcers that become chronic.  According to National Pressure Ulcer Advisory Panel 2017, more than 2.5 million patients develop pressure injury (PI) a year, national incidence rate of 2.5% in hospitals, and 60, 000 death a year (William Padula, John Hopkins University). PI injury cost US Health system $9-11 billion a year.  In an effort to prevent HAPU, death caused by sepsis related to pressure ulcers, Stage II and III pressure Ulcers are among the eight preventable conditions identified by Medicare and Medicaid which extra payment are eliminated. Medicare and Medicaid stop reimbursing hospitals for certain hospital-acquired conditions considered preventable in the hospital setting, private insurance also follow this step.  Pressure ulcers are a potential complication of prolonged bed rest and are included in the category of hospital-acquired conditions. Incontinent patients are especially prone to pressure ulcers if moisture is not managed adequately. The key to prevent pressure entails is to first identify patients at risk; and second implementing strategies for all patients who are identified at risk. Health care delivery has the duty to focus patient care to prevent PI by inspecting skin daily, managing moisture on skin, conducting a pressure ulcer admission assessment for all patients, minimizing pressure, optimizing nutrition and hydration, reassessing risk for all patients daily. Following these steps help improving patient care and prevent incidence of PI in my facility. Adherence to skin care protocol program is effective way to prevent pressure ulcers.

The other evidence-based practice that has improved patients’ outcome is deep vein thrombosis prophylaxis, especially in the surgical patients undergoing general anesthesia and patient undergoing orthopedic surgery for fracture hips. Fatal pulmonary embolism (PE) rates range from 0.1% to 0.8% for all patients and may be as high as 7% for patients undergoing surgery for fractured hips (Medscape medical News, 2013). The frequent causes of DVT are due to augmentation of venous stasis due to immobilization or central venous obstruction. Nurses and surgeon needs to implement early ambulation for patient who are able to get out of bed early is the most important to prevent deep vein Thrombosis. For patient who cannot be up and ambulation, early treatment of anticoagulant therapy is crucial.  

How can community health nurses apply the strategies of cultural   competence to their practice? Provide at least one example from each   of the following four strategies: cultural preservation, cultural   accommodation, cultural repatterning, and cultural brokering. What is   a possible barrier to applying the strategy/example chosen? Use an   example that is different than the postings of other students. This   example should include an evidence-based article that addresses a   cultural issue. Response should include an APA referenc

Select a global health issue impacting the international health community. Briefly describe the global health issue and its impact on the larger health care system (i.e., continents, regions, countries, states, and health departments). How can health care delivery systems work collaboratively to address global health concerns?Who are some of the stakeholders that may work on these issues?

Readings within your text covering international/global health and the following websites will assist you in answering these questions:

1. U.S. Centers for Disease Control and Prevention (CDC) Global Health website: http://www.cdc.gov/cogh/index.htm
2. U.S. Department of Health & Human Services (HHS) Global Health website: http://www.globalhealth.gov/index.html
3. Families USA – Why Global Health Matters—Here and Abroad website: http://www.familiesusa.org/
4. World Health Organization (WHO) website: http://www.who.int

Building and Sustaining Virtual Groups or Teams    For this discussion, consider how to build and sustain virtual groups or teams. 

•What online nursing forums do you currently use, and how do you use them? (YOU CAN USE ALLNURSES.COM or any other American site)  

•What are the benefits and limitations of using an online nursing forum?   •How does your current organization use its own Web site, Facebook page, YouTube page, or other social media?   

•What legal or ethical concerns could result from the use of social media?   

•What does your Board of Nursing say about the use of social media for registered nurses?    

Write a succinct initial post of at least 150 words. Demonstrate clarity of thought and precision in writing. Support your discussion with at least one APA formatted reference in the post, and at the end. 

Comment 1

  Evidence-based practice is the conscientious integration of best research, evidence with clinical expertise and patients’ values and needs in the delivery of high-quality, and cost-effective healthcare (University of Illinois at Chicago, 2015).

Evidence-based practice (EBP) promotes quality, safe, and cost-effective outcomes for patients, families, healthcare providers, and the healthcare system. It evolves from the integration of the best research evidence with clinical expertise and patients’ needs and values (Grove, Gray & Burns, 2015. 6th ed).

        The treatment for acute muscle strain has changed over the years.  In the past, nurses learned to ice certain injuries for the first 24 hours and then apply heat to increase blood flow. Presently, evidence-based practice shows that only heat is beneficial (The university of New Mexico, 2016, Nov.30).

       Evidence-based practice has been developed to prevent healthcare–associated intravascular device–related bloodstream infections with the use of I-Care and the acronym stands for:

• I—IV device management
• C—Cleaning of hands
• A—Access: Use of alcoholic chlorhexidine to prepare the insertion site, and use of sterile alcohol swabs to clean the injection port before accessing.
• R—Reviewing the need for the IV device on a daily basis and remove when no longer required
• E—Education about I-Care given to: staff, patients, and other care-givers (The Joint Commission, 2013, Nov.20).

       I work in prison facility and we had several cases of flu infection during this last episode. Hand washing with soap and water and contact precaution was evidence-based practice used to prevent the spread, also screen and testing others in the same dorm help to control spread of infection.

Comment 2

Evidence-based practice (EBP) is the combination of using research and clinical expertise, and include the patients’ values when making decisions about the care of individualized patients (Rauen, Chulay, Bridges, Vollman, & Arbour, 2008). Research findings are a group of facts and they become evidence when the findings are relevant and useful in particular patient situations. One example of EBP is collecting an accurate measurement of blood pressure, and it starts with picking the correct cuff size according to the circumference of the patient’s arm. Positioning the arm is also important and that should be based on how the patient is positioned. The study also found that using an automatic cuff to measure blood pressure in patients with atrial fibrillation was interchangeable with checking the blood pressure manually (Rauen, Chulay, Bridges, Vollman, & Arbour, 2008).  

Another EBP used when assessing pain is to intervene appropriately in patients that are non-verbal or have dementia. Assess for pain and intervene with non-verbal and/or demented patients when they have conditions that typically cause pain (Flynn Makic, n.d.). Assess for facial expression, verbalizations, a change in activity, and rubbing of certain parts of the body. The nurse can also evaluate for restlessness, agitation, and combativeness. Nurses should use a valid, reliable tool for assessing pain and re-evaluate frequently (Flynn Makic, n.d.).

The first EBP on accurately measuring blood pressure is widely used in all settings of health care including home health where I work. We manually check blood pressure and are instructed on choosing the proper cuff size and proper positioning of the patient for the most accurate results. The EBP for pain assessment we use the Numeric Pain Rating Scale as well as the Wong-Baker Faces Rating Scale. The numeric scale can tell us the intensity of pain which can help guide the nurse’s choice for pain medication and for the non-verbal, limited cognitive ability, and/or patient with mild to moderate dementia we use the scale with pictures (Wong-Baker). Patients with advanced dementia will need behavioral observation to determine the presence of pain (Wells, Pasero, & McCaffery, n.d., Chapter 17).