Elder Abuse and Neglect

You are a charge nurse in the emergency department. An elderly woman arrives with bruises all over the upper torso of her body and down her left arm. She was brought in by her grandson who resides with her, and the grandson shares that he brought her in to be checked out because he thinks she may have fractured her wrist when she fell on the last step going down in the cellar to do laundry. He appears extremely stressed and states that his grandmother suffers from Alzheimer disease. When you put the patient’s name and demographic information into the electronic medical record it indicates that this patient was in 2 weeks prior with a concussion. 

Instructions:

1. Read the scenario above and answer the following question:
   1. How would you assess the situation?
   2. What nursing interventions would you utilize to help both the elderly woman and the grandson?
2. Your paper should be:
   • One (1) page or more.
   • Use factual information from the textbook and/or appropriate articles and websites.
   • Cite your sources – type references according to the APA Style Guide.No Plagiarism.

  Knowledge of the Healthcare Environment Project

The purpose of this project is to integrate knowledge of quality improvement, motivation, collaboration, team building, communication, leadership, managing outcomes, problem-solving, and business planning into a plan to address the problem.

The student learning outcomes of the communication and relationship building project include:

1. Implement an appropriate decision-making model
2. Develop a plan to address barriers to planning, as well as actions the leader-manager can take to reduce or eliminate these barriers
3. Assess concepts of line and staff relationships, span of control, span of influence, and unity of command to create an effective plan to resolve the problem
4. Use an evidence-based approach in determining problem solutions
5. Consider internal and external climates, upward and downward, horizontal and diagonal, and grapevine communication strategies
6. Integrate concepts of quality control  and quality improvement in the analysis of the problem and the development of solutions to the problem

Scenario

You are the manager of a 36-bed orthopedic unit. The average age on your nursing unit is 76.  A high percentage of patients on the unit are postoperative total hip replacement related to hip fracture secondary to fall.  The average length of stay is 6.5 days before transfer to a rehabilitation level of service. Since 2003, the average length of stay has decreased by 49%.  Since 2010, the postoperative complication of urinary tract infection has declined by 28%. Since 2009, the use of catheters greater than 48 hours post-op has decreased by 45%. However, circumstances have changed in the past five months.  There is a significant increase in postoperative nosocomial urinary tract infections which are defined as the presence of >105 organisms/mL or symptomatic infection with 103 organisms/mL  Recent data on postoperative hip replacement patients reflects:

Month

Baseline

1

2

3

4

5

Admitted From Nursing Facility

6.1%

7.9%

3.3%

3.0%

4.5%

3.7%

Mean Length of Stay

6.5 days

7.0 days

7.0 days

10.25 days

10.5 days

11.5 days

Percentage Nosocomial Post Op UTI

3%

6.8%

15.8

19.6

20.5

23.1

Percentage Post-Operative Catheters Indwelling for > 48 Hours.

3.6%

10%

22%

32%

46%

45.1%

Mean Nosocomial UTI Cost excess per patient

$3652.17

$3652.17

$9,130,43

$9739.13

$12,173

The patient population has been stable in terms of co-existing disease, reasons for admission, and types of surgery. The orthopedic medical staff have remained constant.

The reasons justifying urinary catheterization by percentages during the four-month period were:

Documented Reason

 Percentage out of 100%

Urinary retention

17%

Bladder outlet obstruction

3%

History of paralysis or stroke

12%

Neurogenic bladder

3%

Multiple sclerosis

1%

Prostate disease

23%

Obesity

4%

Unknown, not documented

37%

The unit is staffed with 80% full time, 10% part-time, and 10% hospital float pool in order to keep overtime within benchmark levels. Over the five months, the monthly mean hours per patient day by all nursing staff was between 15.86 hours and 17.39, and the monthly mean RN hours per patient day is 14.89 and 16.39 hours. A typical 7 am to 7 pm shift is staffed with 5 to 6.5 RNs and 2 nursing assistants. A typical 7 pm to 7 am shift 4 to 5 RNs and 2 nursing assistants. There are two newly graduated nurses that have completed a three-month orientation as part of the full-time staff. 

On any given weekday, there are between 6-8 associate degree, baccalaureate degree, and nursing assistant students. The registered nurse students are supervised by an instructor and are assigned to direct patient care in tandem with the registered nurse.  The nursing assistant students are assigned to work with an employed nursing assistant.

Assignment

Prepare a 1200-2000 word plan to present to the Infection Control Committee. The Infection Control Committee is comprised of the Medical Director, the four infectious disease specialists, the hospital’s Infection Control nurse, the various Directors of Nursing, and the two hospital’s pathologists. The order of the paper should be a title page, the plan, and references. The plan should be evidence-based.  The textbook should be one reference.  Include a minimum of three additional references from the literature. Use APA format. Refer to the BSN Handbook and to the course syllabus to identify the acceptable sources for references. The rubric can be viewed in Introduction to Written Assignments. 

Include in the plan the following components:

• Identification of the problem
• Explanation of the problem
• Impact of the problem on the interpersonal roles and decisional roles of management
• Solution alternatives, including the pros, cons, and potential consequences/outcomes
• Selected approaches and the implementation plan
• Quality control and quality improvement activities

Integrate into the body of the paper the following elements:

1. Rationales for problem resolution strategies 
2. Leadership role/s and a leadership style appropriate to the situation and the rationale
3. Effective strategies to facilitate team building as an outcome of effective collaboration

When you are ready to submit your assignment, you will attach your assignment as one single document including the reference page by submitting your assignment below under Submit. 

 You are encouraged to use Smart Thinking as a resource for review of your paper.  All scholarly papers will be run through Canvas to Turnitin and a Similarity report will be produced. Please review your Similarity report after the first submission. If you wish, you will be able to make corrections and resubmit no more than two additional times up until the due date and time.