Diabetes mellitus (DM) is a long lasting chronic metabolic disorder characterized by elevated blood sugar,  including increased blood pressure, body fat around the waist and cholesterol level. As per  the International Diabetes Federation (IDF), around between the ages of 20 to 79 years, 415 million adults had DM  in 2015. DM is a major issue  worldwide,  and they estimate this number  to go up  to another 200 million by 2040. To avoid this problem, all patients with diabetes need to educate how to check blood sugar at home to avoid the DM complications. DM and lifestyle change, including  physical exercise and diabetes diet which is low fat, low calories and naturally rich in nutrients. Self-checking blood sugar at home is important for them. Regular screening for A1C and cholesterol levels is necessary in diabetes patients (Goyal,  & Jialal2018).

Involving family and caregivers in diabetes management is important because family makes a big impact on DM patients to help in deciding to follow recommendations for medical treatment, and ability to start and maintain changes in physical activity, diet and exercise. 

What are the common barriers to evidence translation in addressing this problem?

The most frequent barriers to implementation of EBP lack of resources includes, Lack of internet service at work to use, medical and nursing libraries, medical database and nursing eBooks, UpToDate  to find the information for evidence-based practice. 

Lack of time, shortage of nurses, management fail to provide support to nurses to use EBP, lack of leadership direction and  organizational support for EBP.

Lack of equipment and  in-service training  

Lack  of continued education for evidence based practice and  also lack of  teaching strategies (White et al.,2016).

What strategies might you adopt to be aware of new evidence?

Encourage  unit staff and  management leaders to take part in the EBP committee for updates including the chief nurse executive (CNE), to create an environment to implement evidence based practice. Choose  the  model for assuring  that the EBP team has  appropriate knowledge and skills considering a change in to  practice ( Dang and Dearholt,2018).

Use good teaching strategies for EBP knowledge and skills including, free internet access at work,  interactive lectures, clinical practicum projects, small group work, journal clubs for nurses, reading quizzes question free for nurses, clinical nurse PowerPoint presentations, post-clinical conferences and  workshops for free of cost for nurses. 

At work create a learning environment. Keep teaching strategies simple so staff can enjoy learning and make EBP a natural part of the academic culture. Increase awareness and understanding in new graduate nurses for EBP to stay updated for new protocol. Study shows oral presentations of students’ research found in a hospital and outpatient setting  as an important part of the teaching and learning method (Horntvedt,2018).

How will you determine which evidence to implement?

Step 1: Ask clinical questions using the  PICOT formula.  Identification of a clinical issue or practice in question using the model. 

P – Patient problems, 

I – Intervention, medication, education, treatment and diagnostic tests).

C – compared to other treatment

O – Outcome, consequence

 Step 2: Searching for the best evidence to use in the practice to  make effective and justifiable decisions. Evidence should have been obtained from credible research sources and peer-reviewed ranked based on strength using a standardized obtained from scientific research

Step 3: Critically appraising the evidence, and proven by scientific methods evidence for delivering safe, effective, patient centered health care to a specific population. 

Step 4: Addressing the enough to meet the need  evidence: to apply or not to apply 

Step 5:  Evaluate the outcomes of the decision  of evidence (White et al.,2016).

How will you ensure continuation or sustainability of the change?

Methods to help sustain improvement include, assess ability,  process  performance boards to check to visually track staff, setting standard work, and daily huddle improvement. Process control and performance boards are changing the way of institution Strategies  to communicate improvement results to  employees  and management. To attain sustainable change, organizations  will start new ways of working rather than adding something on to routine work including training for new staff , review the staff monthly performance, focusing on the small things rather than major issues, daily huddles to discuss the problem and improvements. Daily 15 minutes huddles not only solve the frontline staff problems on a daily basis also helps to  engage  unit staff members and a culture of improvement (Silver etal.,2016).

                                               References 

Goyal, R., & Jialal, I. (2018). Diabetes Mellitus Type 2.https://www.ncbi.nlm.nih.gov/books/NBK513253/ (Links to an external site.)

White, K. M., Dudley-Brown, S., & Terhaar, M. F. (2016). Translation of evidence into nursing and health care (2nd ed.). Springer Publishing Company.

Dang and Dearholt (2018) . Chapter 9: Creating a Supportive EBP Environment. https://sigma.nursingrepository.org/bitstream/handle/10755/623549/FreeDownload_JohnsHopkinsEBPModelGuidelines3rdEdition_DangDearholt.pdf;jsessionid=6B3D94356C96B32DAC91ABD3182FB352?sequence=1 (Links to an external site.)

Horntvedt, M. E. T., Nordsteien, A., Fermann, T., & Severinsson, E. (2018). Strategies for teaching evidence-based practice in nursing education: a thematic literature review. BMC medical education, 18(1), 1-11.

Silver, S. A., McQuillan, R., Harel, Z., Weizman, A. V., Thomas, A., Nesrallah, G., … & Chertow, G. M. (2016). How to sustain change and support continuous quality improvement. Clinical Journal of the American Society of Nephrology, 11(5), 916-924.

I NEED A COMMENT FOR THIS POST WITH AT LEAST 2-4  PARAGRAPH AND  SOURCES NO LATER THAN FIVE YEARS

 After having watched the movie Puncture (2011), write a detailed report on the nurse’s incident (first 3:30 minutes). The report should be written from the nurse’s perspective as if you were that nurse. Your report must incorporate the following elements:

* the nurse’s name

* place of work

* time of incident

* what exactly happened

* individuals involved in the incident

* how was the incident handled

* interventions taken during the incident 

* interventions taken after the incident

* witnesses

 

The following three weeks we will be discussing the clinical preventive service and our role on disease prevention.

A valuable website to review the screening prevention recommendations based on the latest evidence based practice :

https://www.uspreventiveservicestaskforce.org/Page/Name/home

On your discussion this week answer the following questions:

1.) What is the U.S. Preventive Task Force (USPTF)?

2. ) Select a disease for example colon cancer and discuss the screening age recommendations and the screening tools recommended for early prevention?

In lateral knee–chest position, the patient lies on their side, torso lies diagonally across the table, hips and knees are flexed. In prone knee–chest position, the patient kneels on the table and lower shoulders on to the table so chest and face rests on the table.

Diamond shape position is when the women lies on her back with her knees bent and positioned with both legs spread flat and her heels meet at the foot of the table. The speculum must be inserted with the handle up and the exam performed from the side or the foot of the bed.  

M-shape position is when you have the woman lie on her back with her knees bent and apart feet resting on the exam table close to her buttocks.  Speculum inserted with the handle up and exam takes place from the foot of the bed.  

V-shape position  the women lies on her back with her straightened legs opened wide with each leg opened to each corner of the table.  Speculum to be inserted with handle up and exam can take place from the side or the foot of the table.  

Women are at a higher risk of developing UTI’s than that of male’s because the urethra is shorter in women than in men.  Bacteria has a shorter distance to travel in women than in men.  Education for women needs to include:

1. Wiping from front to back when cleaning can help reduce risk of infection.

2. Increase fluid intake.  

3. Good hygiene.

4. Education

5. Monitor for signs and symptoms of infection.  

Pro’s and Con’s of circumcision: Mayo Clinic Review is 100:1 benefits outweigh risk.

Pro’s:  Con’s:

Reduced risk of acquiring HIV.   Post surgical pain, bleeding, swelling, 

Reduces amount of UTI’s   or inadequate skin removal.  

Reduces risk of getting STI’s

Decreased risk of Bacterial Vaginosis

• Goodell-Softening of the cervix and vagina caused by increased vascular congestion with pregnancy. 
• Hegar’s-Softening of the isthmus of the uterus at about 6-8 weeks of pregnancy.
• McDonald’s-results from the cervical softening, the ability of the flex the body of the uterus against cervix.  
• Chadwick-Violet blue mucosa and cervix due to increased vascularity. 
• Indirect inguinal-Sac herniates through internal inguinal ring: can remain in canal or pass into scrotum.  Pain with straining; soft swelling that increases with increased intra-abdominal pressure; may decrease when lying down.
• Direct inguinal-Directly behind and through external inguinal ring, above inguinal ligament; rarely enters scrotum.  Usually painless, round swelling, close to the pubis in area of internal inguinal ring easily reduced when supine.
• Femoral-Through femoral ring and canal, below inguinal ligament, more often in the right side.  Pain may be more severe; may become strangulated. 

REPLY 2

Pelvic examination involves the routine medical screening of a woman’s reproductive organs, both internal and external organs. The routine examination is essential to assess gynecological health and the diagnosis of medical conditions (Bialy & Wray., 2020). The procedure is often uncomfortable for patients. Other than lithotomy, which involves bimanual evaluation processes, the physician may perform urine tests on a patient to check whether they manifest any urinary tract infections in a procedure known as urinalysis.

Women are at a higher risk of developing UTIs due to several reasons. First, based on anatomy, women’s urethras are located closer to their anuses, making it easier for bacteria to infiltrate. Besides, due to their short urethra compared to men, bacterial infections are highly likely to reach the bladder. Lastly, women’s physiological processes involve changes in hormones, such as during the menstrual cycle, increasing the susceptibility to infections (Tan & Chlebicki, 2016). For any disease, it is better to prevent it than to wait for treatment after contracting. To prevent UTI, one can observe their reproductive health by urinating as soon as there is the urge, drinking plenty of fluids, urinating after sexual intercourse and swiping from front to back after bowel movements. These procedures reduce the likelihood of developing UTI. For instance, drinking plenty of fluids such as water dilutes urine and thus keeps it moving through the urinary tract and therefore makes it hard for bacteria to stay at the wall of the urethra or bladder (Anon, 2021).

Newborn circumcision is essential to decrease the risk of urinary tract infections, skin conditions such as phimosis and penile cancer. It is also essential for hygiene purposes as it allows for ease when cleaning. However, the procedure is painful and the child may be subjected to excessive bleeding, and at times death. The procedure may also expose the newborn to infections and damage to the penis, which may manifest later in life. Even though this is a procedure done for religious and cultural beliefs, parents and physicians should weigh the pros and cons of each case before performing the procedure.

Pregnancy attaches several signs that are visible through examination. For instance, one might have a blue discoloration of the mucous membranes vagina and cervix (Chadwick’s sign), the softening of the cervix (Goodell’s sign), softening uterus (Hegar’s sign) and the McDonald’s sign, which involves the flexing of the uterus’ body against the cervix (The Brookside Associates Medical Education Division, 2016).

A hernia occurs when an internal organ’s part or tissue bulges through a weak muscle, mostly around the abdomen. An inguinal hernia is the most common and affects the groin. A direct inguinal hernia occurs when the abdomen’s walls become weak, allowing a part of the intestines to push through. The weakening may be a result of daily activities, including lifting things improperly. On the other hand, an indirect inguinal hernia results from the close-up of the inguinal ring. Essentially, this often occurs as a congenital condition in infants (U.S. Department of Health and Human Sciences, 2019). A femoral hernia is less frequent than inguinal hernias and appears in the femoral canal (Goethals, Azmat, & Adams, 2020). It is characterized by a bulge below the inguinal ligaments and can lead to strangulation.

References 

Anon. (2021, January 28). Urinary Tract Infection. Retrieved February 16, 2021, from Labs Tests Online: https://labtestsonline.org/conditions/urinary-tract-infection

Bialy, A., & Wray., A. A. (2020). Gynecologic Examination. Treasure Island: StatPearls Publishing. Retrieved February 16, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK534223/

Goethals, A., Azmat, C. E., & Adams, C. T. (2020). Femoral Hernia. Treasure Island: StatPearls Publishing. Retrieved February 16, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK535449/

Tan, C. W., & Chlebicki, M. P. (2016). Urinary tract infections in adults. Singapore Medical Journal, 57(9), 485-490. Retrieved February 16, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5027397/

The Brookside Associates Medical Education Division. (2016). Operational Obstetrics & Gynecology. Retrieved February 16, 2021, from https://www.operationalmedicine.org/ed2/Enhanced/Pregnancy.htm

U.S. Department of Health and Human Sciences. (2019, September). Inguinal Hernia. Retrieved February 16, 2021, from U.S. Department of Health and Human Sciences: https://www.niddk.nih.gov/health-information/digestive-diseases/inguinal-hernia

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