Nursing Path

CARING is the essence of NURSING. -Jean Watson

Nursing Path

Knowing is not enough, we must APPLY. Willing is not enough, we must DO. -Bruce Lee

Nursing Path

Treat the patient as a whole, not just the hole in the patient.

Nursing Path

Success is not final. Failure is not fatal. It is the courage to continue that counts. -Winston Churchill

Nursing Path

A problem is a chance for you to do your best. -Duke Ellington

20 WAYS TO PREVENT INFECTION WITHOUT ANTIBIOTICS

 Many of us overuse antibiotics postoperatively, which can lead to side effects, such as vomiting and diarrhea, and antibiotic resistance in out patients.

There are, however, many other ways to reduce the infection rate in surgical patients. In human surgery, such practices have enabled a 25% reduction in nosocomial infections, also called hospital-acquired infections.

Beyond antibiotics, there are a number of ways to prevent infections.

  1. Oxygenation good oxygenation of the patient allows killing of bacteria via oxidative processes. Preoxygenation and short-term postoperative oxygenation can therefore be beneficial to fight surgical site infection.
  2. Control body temperatures many studies show that hypothermia is a common cause of infection. Hypothermia causes peripheral vasoconstriction and therefore poor local oxygenation. Hypothermia also decreases the patient's immunity, among other deleterious effects.
  3. Control blood sugar hyperglycemia can also potentiate infections. Glycemia should therefore be monitored closely, especially in poorly regulated diabetic patients, which are at increased risk of infection.
  4. Reduce anesthesia time duration of anesthesia is statistically correlated to the infection rate.
  5. Prevent licking or chewing of surgical incisions using an Elizabethan collar or Bite-Not collar.
  6. Perform sterile IV catheter placement, conscientious patient clipping (i.e. wide enough) and meticulous scrubbing technique.
  7. Improve the nutritional status of debilitated patients.
  8. Have constant awareness of asepsis during scrubbing, gowning, gloving and throughout surgery. Actually wearing a gown, cap and mask happens to be standard protocol, just like actually wearing clothes! wearing booties could be considered optional, if not debatable.
  9. Convert contaminated wounds into "clean contaminated" or cleaner wounds as soon as possible.
  10. Avoid elective surgery on immuno-suppressed or immuno-deficient patients.
  11. Use gentle tissue manipulation and careful tissue apposition to decrease the risk of hematomas or seromas.
  12. Treat distant infections such as dermatitis, otitis externa or tooth abscesses if possible before elective surgery.
  13. Change gloves whenever they are contaminated or perforated. The first step is to be honest with yourself.
  14. Avoid clipping the patient too long before surgery. Microtrauma by the clippers facilitates entry of bacteria into the skin and triples the risk of incisional infection.
  15. Limit the use propofol, which has been associated with a four-fold increase in surgical site infection.
  16. Avoid dental prophylaxis on the same day as an elective surgery.
  17. Meticulously clean the operating room, including the surgical lights and the table. Some veterinarians hide silver dollars in conspicuous places as an incentive!
  18. Use sharp, good quality, sterile instruments
  19. Establish a comprehensive plan to prevent nosocomial diseases, starting with frequent hand washing, especially after treating each patient.
  20. The standard for most elective procedures is to give an intravenous antibiotic such as cefazolin 30 minutes before the skin incision and every 90 minutes under anesthesia.



Petition calling for legal protection of ‘nurse’ title passes key milestone

A new petition calling on the government to protect the job title "nurse" in UK law has gained more than 10,000 signatures already, meaning ministers must respond with a statement. The petition was launched just five days ago on Monday and calls for the title…

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Exclusive: Further delay confirmed to process for new nurse pay deal

The timeline for a new pay deal being agreed for nurses in the NHS has fallen even further behind schedule, Nursing Times has learnt. The NHS Pay Review Body had been asked by the health and social care secretary to provide a report to government…

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Hampshire council looking to cut 47 nursing staff to meet ‘saving obligations’

Plans to cut almost 50 public health nursing posts in Hampshire would have a “very detrimental impact” on health visiting and school nursing services in the area, the union Unite has warned. Hampshire County Council has this week opened a consultation which outlines plans to…

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Nurses ‘feel pressure’ from patients to prescribe unnecessary antibiotics

Many nurse prescribers feel under pressure from patients to give unnecessary antibiotics for upper respiratory tract infections, sometimes leading them to do so against their better judgement, according to UK researchers. They highlighted that the number of nurse prescribers was increasing, but said that little…

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Nurse leads call for better psychological support for young cancer patients

The problems that young cancer patients are facing in accessing specialist mental health support is “not good enough”, the chief nurse at Teenage Cancer Trust has warned. Dr Louise Soanes spoke out as a new survey by the charity found that more a third (35%)…

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BURNOUT SYNDROME AND COPING STRATEGIES FOR NURSES

 Nursing involves activates and interpersonal relationships that are often stressful. Some of the activities identified as highly stressful are:

  • Assuming responsibilities for which one is not prepared. often novice beginners in nursing face this.
  • Working with unqualified persons. Seniors face the stress when accountable for the actions of novices or unprepared nurses.
  • Unsupportive working environment, where seniors, supervisors or administrators do not support workers.
  • Caring for critically ill patients, terminally ill patients.
  • Conflict among peers.
  • Financial and family responsibilities.
  • Disharmony and conflicts at home.
  • Staff shortage, long working hours, inadequate time off, work load, fatigue, lack of sleep.
  • work-life imbalance.
When one is overwhelmed with stress it results in burnout a complex of symptoms of stress. Burnout can be compared with the exhaustion stage of anxiety and characterized by wide range of behaviors.

Reporting sick, frequent absenteeism, frequent errors, withdrawal, overactive, irritable and easily angered are some common behaviors. In extreme cases alcoholism, drug addiction or leaving the nursing profession may be seen.
Physiological burnout symptoms are fatigue, headache, sleeplessness, repeated gastric disturbances, irritable bowels etc.

Coping Strategies
Coping needs to focus on prevention, early identification and support. These need to be built into the nursing curriculum early, and part of regular appraisals at work places in order to retain nurses in the profession.
  1. Self-care behavior are the best means of preventing burnout. Being realistic in achievements as against trying to be a super nurse. Self-awareness of stress and anxiety is essential when caring for patients. Reflective nursing, reflective
    journaling and self-reflection are important steps to building strong nurses. These need to be started early in the career, even during the student period.
  2. Counseling session for novice nurses by introducing buddy system or preceptorship
    program to reduce the reality shock and ease into the work environment. Support by all level seniors for nurses. Provision of professional and family counseling facilities in case required by an staff. If a staff been identified as undergoing stress, provision of leave to recover or transfer by request to a less stressful work area are also helpful.
  3. Appraisal of work load reasonable work distribution equally among staff and as per individual capacity. 
  4. Use of humor at work goes a long way in reducing stress. Making work place enjoyable through the provision of facilities for games, fun, sports, picnics.
  5. Educational opportunities must be provided to build capacity and improve self confidence and also provide a break in the monotony of routine work. This can be in the form of attending workshops, seminars or short courses sponsored by the institution.
  6. Regular exercising adequate rest and sleep, healthy diet and appropriate meal breaks are necessary group meditation, breathing exercises, help in maintaining balance.
A nursing force strong in emotional quotient is a healthy force for any institution. Emotionally healthy nurses can provide excellent nursing care to the patients.



Children’s charity to pump-prime epilepsy specialist nurse posts  

Roald Dahl’s Marvellous Children’s Charity has committed to raise nearly £1m to establish and support seven new NHS specialist nursing posts to care for children and young people with epilepsy. It is “offering funding and significant investment in support, professional development and peer-to-peer networks” to…

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HEARING IMPAIREMENT OR HEARING LOSS

 Having any degree of hearing loss that interferes with communication, development, learning or interpersonal interactions.

Type of Hearing loss:

1. Conducting hearing loss

  • When sound waves are blocked to reach inner ear because of external and middle ear disorder.
Cause

  • Obstruction of external and middle ear may be due to dry wax, foreign bodies and tumors.
  • Thickening and perforation of ear drum.
  • Otosclerosis (immobility of joint between stapes and oval window due to bone overgrowth or otitis media).
2. Sensorineural hearing loss or nerve deafness

  • Hearing loss caused by permanent or temporary damage to the sensory cells or nerve fibers of the inner ear.
  • It results from damage of any structure in cochlea (such as hair cell, organ of Corti, basilar membrane and cochlear duct) or disease of nerve pathway ear and cerebral cortex
Cause

  • Degeneration of hair cell and VIII cranial nerve (vestibulocochlear nerve) due to some antibiotic like streptomycin and gentamicin.
  • Damage of cochlea due to prolonged exposure to loud noise more than 85dB.
  • Myxedema, DM, trauma, surgery and infection
  • Meniere's Syndrome or endolymphatic hydrops - Excessive endolymph fluid called meniere's syndrome, which cause tinnitus, vertigo and hearing loss.
  • Presbycusis (presby means old) - Atrophy of ganglion cell (group of nerve cell bodies) in cochlea & loss of elasticity of basilar membrane, occur mainly old age. 
Diagnosis 

        Test uses for hearing impairment are audiometry test and Tuning fork tests.

Audiometry test:

  • It is use to measures hearing acuity.
  • The nature and severity of auditory defect could be determined by the techniques called audiometry.
  • The instrument used is called audiometer.
  • Audiometer is capable of generating sound waves of different frequency from lowest to highest.
  • At a particular frequency, if the patient hears the sound with than 30 dB above zero level, the person said to have hearing loss of 30 dB.
Tuning fork tests:

  • Tuning fork test used to differentiate, conductive or sensorineural hearing loss.
  • These are two types e.g. Weber's tuning fork test (test for unilateral deafness) and Rinne's tuning fork test (it use to compare bone conduction hearing with air conduction).
Management

  • Advice to use hearing aid (an electroacoustical device that amplifies sounds).
  • Face the patient when speaking to facilitate the communication.
  • Talk to person in normal volume and lower pitch because shouting is not helpful and higher frequency are less easily heard.
  • Advice to avoid exposure to loud noise.
  • Cochlear implantation in sensory neural hearing loss.
  • Management of Meniere's disease in acute attacks are bed rest, antihistamines, vasodilators (e.g. nicotinic acid), sedatives, discontinuation of smoking avoid watching T.V, low-salt diet (less than 2 g/day) and diuretics.


NMC asks government for ‘discussion’ on protecting ‘nurse’ job title

The Nursing and Midwifery Council is seeking to open a dialogue with the government over whether “nurse” should become a job title protected by law, as a new petition calling for the move builds momentum. The regulator has told the government that its current powers…

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CNO announces funding to fast-track online access to maternity records

Every mother in England should soon be able to access their maternity records on their smart phones or other online device, the chief nursing officer has announced today. Speaking at the NHS Confederation’s annual conference, CNO for England Ruth May said £52m would be invested…

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Extra £15m pledged towards nursing student placements for 2021-22

Additional funding has been announced by Health Education England for extra clinical placements for nursing and midwifery students, with a focus on increasing opportunities in community, primary care and social care settings. HEE has today pledged a further £15m to help increase the number of…

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Majority of NHS staff back standardised uniforms in England

More than 80% of nursing, midwifery and allied health professionals in England are in favour of the introduction of standardised NHS uniforms, according to preliminary consultation findings. The seven-week consultation, by NHS Supply Chain, sought to uncover views on whether a culturally sensitive, national approach…

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Nurse pay failing to keep up with ‘spiralling’ house prices, finds report

The prospect of a nurse being able to buy a house has “declined even further”, according to new analysis, which warned nurses are leaving the NHS to take higher paid work and save for a deposit. A new report from London Economics, commissioned by the…

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ROLE OF THE NURSE EDUCATOR IN THE 21 CENTURY

 There are many national reports indicating the need for change in health care and in the education of health-care professionals in particular. In its report entitled
crossing the Quality Chasm: A New Health System for the 21
st Century, the Institute of Medicine (IOM, 2001) acknowledges that the education of health professionals in need of major change and asserts that the clinical education of health professionals is outdated and not responsive to the present or future needs in health care. As its guiding vision, the IOM (2003) makes the recommendation that health professionals should be educated to deliver patient-centered care within an interdisciplinary team that emphasizes evidence-based practice, quality improvement approaches, and informatics. The backdrop of needed change will serve as the starting point for discussions regarding essential attributes needed in nursing education. Emphasis on student learning, promotion of evidence-based practice and development of authentic student-teacher relationships are those attributes that are foundational to effective teaching.

 EMPHASIS ON STUDENT LEARNING:

Over the past decade, education has shifted from a teacher-centered to a student centered approach. Understanding and facilitating student learning must be a priority for the nurse educator of the 21st century.

In nurse education research, there always has been a greater focus on the outcomes of learning, rather than on understanding the processes involved in learning. Research aimed at understanding how students learn result in the development of best practices in teaching. For example, there is some empirical support for the use of concept mapping as a strategy that promotes critical thinking. In order to facilitate learning, nurse educators must be cognizant (aware) of a variety of factors that students bring to the learning setting. For example, a typical classroom may consist of second-degree students or second career students (Boomers), returning or transfer students who may be in their mid 20s and 30s (Geneses) or students who attend college immediately after graduating from high school (Millennials).

Skillful assessment of student learning outcomes is also needed in order to evaluate how students learn and the degree to which teaching strategies encourage meaningful learning. A recent survey of nursing students suggests that the content demands of the nursing curricula are so great that little time is left for students to assimilate that content into useful clinical knowledge. Novice nurses are less aware of their thinking and learning processes when compared with experiences nurses.

PROMOTION OF EVIDENCE-BASED PRACTICE

The primary focus of health care institutions today is on the provision of quality care within a cost effective framework. This emphasis on outcomes has led to a national movement requiring evidence based care. A survey to determine the readiness of U.S. nurses for evidence-based practice and found that respondents reported a lack of value for research in practice.

The movement toward evidence based practice requires that educators and practitioners engage in collaborative research. The nurse educator of the future must form collaborative relationships not only with practicing nurses but also with other members of the health care team.

With patient-centered care as its focus, nursing and medicine, for example, need to collaborate in clinical studies in order to improve outcomes of care. Most importantly, nurse educators must role model this behavior for students so that students learn that practice and research coexist and cannot be seen as separate entities. Research becomes meaningfully grounded in practice rather than a theoretical topic unrelated to the practice setting.

Evidence-based practice is here to stay and discussions centering on nursing education and nursing practice must be strongly grounded in nursing research.

EMPHASIS ON AUTHENTIC STUDENT-TEACHER RELATIONSHIPS

There is mounting evidence to suggest that a thoughtful student-teacher relationship is essential for students to develop and grow. The traditional behaviorist model viewed students as empty vesicles who were eager to receive knowledge transmitted from the teacher. The humanistic approach recognizes that students have their own experiences that enrich learning while also viewing the student as a participant in learning.

Since that time, others have carefully examined the centrality of the student-teacher connection in promoting learning. The current research suggests that learning and student development are promoted through strategies aimed at getting to know students and connecting to students through more thoughtful, concerted means.

When investigating student perceptions of effective and ineffective clinical instructors, it was found that students perceived that the most effective clinical instructors were those having strong interpersonal relationships with students. The nurse educator of the future will need to establish authentic relationships with students grounded in mutual trust and respect so that students gain the self-confidence to achieve their potential.



NHS England sets expectation for executive nurses to sit on ICS boards

A director of nursing should be among the executive members of the new integrated care system (ICS) boards, NHS England has said in new guidance. The new ICS design framework, published today, makes clear NHS England’s expectations for who should sit on the decision-making boards…

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Covid-19 vaccines to be made mandatory for all care home staff in England

Nurses and colleagues working in all care homes across England must be vaccinated against Covid-19 under new legislation which will come into force this autumn, the government has announced. Meanwhile, a new consultation is to be launched on whether to extend mandatory Covid-19 vaccines to…

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NHS safety director elected as new president of the RCN

The Royal College of Nursing has announced Dr Denise Chaffer, an experienced nurse leader who has held director roles at national, regional and local level, as its new president. Dr Chaffer, who was elected from three candidates who ran for the position, will take up…

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Union expresses fears over ‘cruel’ health visitor and nursing cuts in Stoke

Proposed budget cuts to children and young people’s services in Stoke-on-Trent could see around 10 health visitors and nurses lose their jobs, the union Unite has warned. If plans go ahead, Unite feared these services would be “stretched to breaking point”. “This financial ‘hit’ will…

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SHOCK

 A clinical syndrome marked by inadequate perfusion and oxygenation of cells, tissues and organs, usually as a result of severe or markedly lowered blood pressure. The shock syndrome is a life-threatening medical emergency and requires very careful therapy and monitoring.

Type of Shock: Based on causes of shock

1. Cardiogenic shock-

  • Failure of the heart to pump an adequate supply of blood and oxygen to body tissues.
  • The most common cause of cardiogenic shock is acute myocardial infarction.
2. Anaphylactic shock-

  • Rapidly developing, systemic anaphylaxis that produces life-threatening acute airway obstruction and vascular collapse within minutes after exposure to an antigen.
  • The most common cause is a type I allergic or hypersensitivity reaction.
  • The most common agents are bee or wasp venoms, drugs (e.g. penicillin) and radiographic contrast media.
3. Hypovolemic shock-

  • Shock occurring when there is an insufficient amount of fluid in the circulatory system.
  • Most common causes are excessive bleeding, diarrhea, vomiting, fluid loss from fistulas or burns and third space shifting of fluid into the abdominal cavity (ascites) or other intestinal tissue (edema).
4. Neurogenic shock-

  • A form of shock due to decreased peripheral vascular resistance caused by damage to either the brain or the spinal cord.
  • The decreased peripheral vascular resistance (vasodilation) and subsequent pooling of blood within peripheral vessels results in hypotension and warm, dry or pink skin.
5. Septic shock-

  • Shock as the result of sepsis (the presence of pathogens in the bloodstream).
  • The most common organism are gram-negative (common) and gram-positive bacteria, but fungi and other organisms may also be responsible.
6. Hypoglycemic shock or insulin shock-

  • Shock produced by extremely low blood sugars (e.g. less than 40mg/dl) usually caused by an injection of an excessive amount of insulin, failure  to eat after an insulin injection and insulinomas (insulin secreting tumors which cause hypoglycemia).
  • Insulin-related hypoglycemic shock may be intentionally induced in the treatment of certain psychiatric conditions.
Clinical Manifestation:

  • Shock results in failure of multiple organ systems including the brain, heart, kidney , lungs, skin and gastrointestinal tract.
  • Subjective (symptom): Restlessness, Paresis of extremities, Confusion, Syncope
  • Objective (sign): Weak, rapid, thready pulse (tachycardia); Shallow, rapid respiration (tachypnea); Diaphoresis; Cold, clammy and cyanotic skin (except neurogenic shock); Pallor; Decreased  urine output (oliguria); Progressive loss of consciousness; Decreased mean arterial pressure (normal is 80 to 120 mm Hg).
Management:

  • The shock syndrome  is a life-threatening medical emergency and requires very careful therapy and monitoring 
  • Attempts to restore normal blood pressure and tissue perfusion include:-
            - Fluid resuscitation (in hypovolemic shock)

            - Control of hemorrhage (in shock caused by trauma or bleeding).

            - Administer corticosteroids and antihistamine such as chlorpheniramine maleate,                  cetirizine etc. in anaphylactic shock.

            - Administration digoxin for pressor support (in cardiogenic) and antibiotic (in septic                shock).

            - Administration of epinephrine (in anaphylaxis or neurogenic shock for peripheral                     vasoconstriction).

            - Administration oral or parenterally sugars, typically glucose (in hypoglycemia or                 insulinomas).  

  • Insert indwelling urinary catheter to track urine output hourly.
  • SaO2, arterial blood gas levels (ABGs), and ventilatory functions are monitored to determine the need for ventilatory support.
  • Suitable position used during shock is trendelenburg position.