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

TYPES OF TOOLS USED FOR EVALUATION

There are many tools or instruments used in evaluation process. Some of the tools have been briefly discussed here:

Questionnaire
Most commonly used method of evaluation is questionnaire in which an individual attempts answers in writing on a paper. It is generally self-administered in  which person goes through the questionnaire and responds as per the instruction. It is considered to be the most cost-effective tool of evaluation in terms of administration. While developing teacher should ensure that it is simple, concise, and clearly stated. Evaluation done with the help of questionnaire is quantitative.

Interview 
Interview is the second most important technique used for evaluation in which students participating in evaluation are interviewed. Interview can help in getting information both quantitatively and qualitatively. Interview can be conducted in group or individually. It is a time-consuming process; therefore it should be arranged as per the convenience of interviewer and interviewee. It can also be used to evaluate a programme at the time of exist of student called exit interview. Interview should be held in a quiet room and the information obtained should be kept confidential. An interview guide can be created, which is an objective guideline to be followed by the interviewer.

Observations

Observation is the direct visualization of the activity performed by the student. It is very useful in assessing the performance of the students, to know how many skills they have attained. Observation is needed to be recorded simultaneously, if delayed some important points of the observation could be missed. There is scope for subjectivity in observation and the same can be overcome by developing an objective criterion. Students should also be aware of the criteria, so that they can prepare themselves accordingly and their anxiety levels will be controlled. Teacher should also prepare himself to enable fair assessment.

Rating Scale 
Rating scale is another tool of assessment in which the performance of the student is measured on a continuum. Rating scale provides objectivity to the assessment. Later on, grades can be given to the students based on their performance on rating scale.

Checklist 
Checklist is a two-dimensional tool used to assess the behavior of the student, for its presence or absence. Teacher can evaluate the performance of the student with a detailed checklist of items and well-defined and developed criteria. Checklist is an important tool that can evaluate students' performance in the clinical area. Order in which steps to be used to complete the procedure can be put in sequential order, which help the teacher to check whether the required action is carried out or not. It is an important tool used in both summative and formative assessment

Attitude Scale

An attitude scale measures the feeling of the students at the time of answering the question. Likert scale is the most popular. Attitude scale contains a group of statements (usually 10-15) that reflect the opinion on a particular issue. Participant (student) is asked the degree to which he agrees or disagrees with the statements. Usually, five point Likert scale is used to assess the attitude of the student. To avoid any kind of bias, equal number of positively and negatively framed statements is included.

Semantic Differential 
Another scale used to measure the attitude of the student is semantic differential. This tool contains bipolar scale (adjectives) like good-bad, rich-poor, positive-negative, active-passive, etc. Number of intervals between two adjectives is usually old like five or seven, so that the middle figure represents neutral attitude.

Self-Report or Diary
A self-report or diary is a narrative record maintained by the student, which reflects his critical thoughts after careful observation. It can be a one-time assignment or regular assignment. Regular assignment is maintained in a spiral book which can be evaluated on daily, weekly, monthly or semester basis. Self-report or diary helps in improving any existing programme or constructing a new one based on self-report submitted by the student.

Anecdotal Notes
Anecdotal record is the note maintained by teacher on the performance or behavior of student during clinical experience. It proves to be a very valuable tool for both formative and summative evaluation of the student's performance. It is maintained soon after the occurrence of event. It is an assessment done on continuous basis that allows student to be judged fairly. It is the duty of the teacher to give feedback to the student.

SELECTION OF EVALUATION TOOL

Process of evaluation requires careful selection of evaluation tool. There are some guidelines to be followed while selecting the evaluation tool. Points to be observed while selecting evaluation tool are given as under:

  • Appropriate: The tool should be able to measure what it intends to measure.
  • Appropriate: The tool should be appropriate for the domain to be measured.
  • Comprehensive: The tool should be able to evaluate all variable to be studied.
  • Valid and reliable: The tool should be pretested, reliable and valid.
  • Cost-effective: The tool should not be very costly to use.
  • Time-saving: The tool should not be very lengthy.
PROBLEMS IN EVALUATION

Lack of Time
Nursing faculty often makes complaints/excuses of lack of time for not evaluating the students regularly. Lack of time may be a result of poor time management skills, hence faculty must try to overcome this barrier; still, if it is not manageable then they can hire external evaluators from outside to manage the affairs so that, this core activity of the education will not be jeopardized. They must consider that evaluation is as important as delivering lectures or demonstrating skills to the nursing students.

Lack of the skills to Carry Out Evaluation
Some teachers may not be competent enough to plan and execute the evaluation schedule. These teachers must be identified by the principal of the college and remedial actions, e.g. in-service education, refresher courses, etc., can be planned for those who are in need.

Error in Measurement and Evaluation
There are various sources of errors in measurement. One of the important errors in measurement is the respondent himself. He himself may not be able to express his true feelings. Measurer's behavior, style and looks of the person measuring the phenomenon, is another sources of error that may distort the process of measurement. Other factors that can contribute to error in measurement are situational factors. Poor quality of test or defective measuring instrument is another factor responsible for error in measurement.

Psychology Quiz Series - 5


Psychology Quiz Series - 4


COMMON PROBLEMS IN OLD AGE

There are certain medical problems which are very common in old age as discussed below:


Alzheimer's Disease

  • Alzheimer's disease is a brain disorder and a slow and gradual disease that begins in the part of the brain that control the memory.
  • It affects a greater number of intellectual, emotional and behavioral abilities. There is no known cause for this disease.
  • As a person grows older, he is at greater risk of developing Alzheimer's. After 60, the risk is one in 20, but after 80, it is one in five."
Rheumatoid Arthritis

  • Rheumatoid arthritis (RA) is caused by inflammation of the joint lining in synovial (free moving) joints.
  • It can affect any joint, but is more common in peripheral joints, such as the hands, fingers and toes. RA can cause functional disability, significant pain and joint destruction, leading to deformity and premature mortality.
Osteoarthritis

  • Osteoarthritis (OA) is the most common from arthritis. It is a chronic, irreversible and degenerative condition ranging from very mild to very sever. It is characterized by the breakdown of cartilage in joints, which causes affected bones to rub against each other leading to permanent damage.
Heart Diseases

  • Hypertension has been called the "silent killer" because it usually produces no symptoms. Untreated hypertension increases slowly over the years. Hypertension can cause certain organs (called target organs), including the kidney, eyes, and heart to deteriorate overtime.
  • The WHO (World Health Organization) estimate that in 2006, 3 millions people die of cardiovascular (CVD) disease such as heart disease and stroke in India, heart disease is the single largest cause of death in the country.
Diabetes

  • Diabetes in old age is a serious sickness.
  • Old people in fact are more prone to suffer from diabetes primarily because of lack of movement and work.
  • Yet another difficulty is reduction in weight of the elderly, since they cannot be made to undergo hard strenuous exercises.
  • The old age people are more prone to developing various complications. 
Stroke

  • There are 15 million people who have a stroke each year. Stroke is the second leading cause of death for people above the age of 60, and the fifth leading cause in people aged 15 to 59 years.
Urinary Incontinence 

  • About one-third of women and 10% of all men above 60 years have incontinence. Incontinence is the loss of control over urine and fecal elimination. This means that people lose control over their bladder and bowel movements and cannot control the excretion process. 
Social Isolation 

  • Isolation may be a choice, the result of a desire not to interact with others.
  • May also be a response to conditions that inhibits the ability or the opportunity to interact with others.
  • causes of isolation:- Loss of work role, Health problems i.e. impaired hearing, diminished vision and reduce mobility, Feeling of rejection, Feeling of unattractiveness,


HOSPITAL INFECTION CONTROL PROGRAMME

NURSING CARE OF THE PATIENT ON VENTILATORS


  • Observe the physical signs such as color, secretions, breathing pattern and state of consciousness.
  • Observe the tidal volume and pressure manometer regularly. Intervene when they are abnormal (i.e. suction if airway pressure increases).
  • The nurse should continually assess the patient for adequate gas exchange, signs and symptoms of hypoxia, and response to treatment.
  • Continuous PPV increases the production of secretions regardless of the patient's underlying condition. The nurse should assess for the presence of secretions by lung
    auscultation every 2-4 hours.
  • Perform measures to clear the airway of secretions by doing suctioning, chest physiotherapy, frequent position changes, and increased mobility as soon as possible.
  • Maintain humidification of the airway via the ventilator to liquefy secretions so that are easily removed.
  • Monitor vital signs as directed.
  • Monitor for adequate fluid balance by assessing for the presence of pulmonary edema, calculation daily intake and output, and monitoring daily weights.
  • Maintain oral hygiene frequently in the intubated and compromised patient because oral cavity is a primary sources of contamination of the lungs in such patients.
  • maintain aseptic technique to prevent infection.
  • The nurse should assist a patient whose condition has become stable to get out of bed and to a chair as soon as possible. If the patient cannot move out of bed, the nurse encourages the patient to perform active range-of-motion exercises every 6-8 hours. If the patient cannot perform these exercises, the nurse performs passive range of motion exercises every 8 hours to prevent contractures and venous stasis.
  • Develop alternative methods of communication for the patient on a ventilator, such as lip reading, notepad and pencil or magic slate, gesturing, etc.

ROLE OF A NURSE IN EPIDEMIOLOGY

Role of a nurse in epidemiology can be explained in 4 aspects. These are:

  1. Preventive role
  2. Promotive role
  3. Curative role
  4. Rehabilitative role
Role in Prevention

  • Epidemiology is one of the basic sciences applicable to nursing. The nurses working in a community deal with people in various settings and help them solve their health problems. They make the nursing process. They identify and investigate the problem, formulate and test the hypothesis regarding the causal factors, formulate alternative interventions and implement to prevent and control the problem and evaluate effectiveness of intervention.
  • They have an active role in the prevention and control of communicable diseases which include:
            - Identify sources of infection and methods of spread of infection.
            - Health education of people in general.
            - Having an important role in the prevention and control of chronic and noninfectious problems, such as cardiovascular conditions, accident, cancer, etc.
           - Notification of certain diseases like measles, diphtheria, tetanus, etc. to health authority.
  • They can also teach and supervise other workers in surveillance activities.
Role in Promotion of Health

  • Using knowledge of epidemiology, the community health nurses can set priorities for health programs according to the immediate health needs.
  • Using knowledge of epidemiology, they establish the health resources more effectively, by giving more emphasis to urgent health problems needing attention.
  • Plan the strategies to meet the new health needs. Nurses in the community as a member to health team participate in surveillance at all levels, which will depend on the existing situation, their preparation, and the level at which they work.
Curative Role


  • They may deal with the problem independently, especially when these are the nursing problems, minor ailments or simply health conditions and they are only the health workers in a healthcare setting.
  • They may participate as them members, especially when it is large scale investigation, e.g. occurrence of any epidemic.
  • They may participate in data collection, data analysis, planning, implementation and evaluation.
  • They may early diagnosis and treatment.
  • They traces the contacts and keep  them under surveillance.
  • They identify sources of infection and methods of spread of infection.
Role in Rehabilitation

  • They evaluate the effectiveness of measures used to control specific disease or disorder.
  • They can help people in the restoration of family and social life.
  • They can also play a role in psychological rehabilitation by helping in restoring personal dignity and confidence of a person.



NEED OF STAFF DEVELOPMENT

Staff development activities are normally carried out for one of these three reasons:



  • To establish competence
  • To meet new learning needs 
  • To satisfy interests that the staff may have in learning in specific areas.
If educational resources are scarce, staff desires for specific educational programmes may need to be sacrificed to fulfill competency and new learning needs. Because managers and staff may identify learning needs differently, an educational 'needs assessment' should be carried out prior to developing programmes.

Many staff development activities are generated to ensure that each level of worker is competent to perform the duties assigned to his position. Competence is defined as having the abilities to meet the requirements for a particular role. Health care organizations use many resources to determine competency. State board licensure, national certification and performance review are some of the methods used to satisfy competency requirements. Other methods are self-administered checklists, record audits and peer evaluation. Many of these methods are explained in the unit on control. It is important  for staff development purposes to remember that if competencies are found to be deficient, some staff development activity must take place to correct the deficiencies.

The other common learning need that occurs frequently in all health care organizations is the requirement of new learning to meet new technological and scientific challenges. Medical technology and science are developing rapidly, resulting in the need to learn new skills and procedures and acquire the knowledge necessary to operate complex equipment. Much of the manager's educational resources will be used to meet these new learning needs.

Many organizations implement training programmes because they are very fashionable and have been advertised and marketed well. Educational programmes are expensive and should not be undertaken unless a visible need exists. Educational resources must be justifiable. In addition to having a proper rationale for educational programmes, the use of an assessment plan will be helpful in meeting learner needs. The following plan outlines the sequence that should be used in developing an educational programme.
  1. Identify the desired knowledge or skills the staff should have and the present level of their knowledge or skills.
  2. Determine the required knowledge and skills.
  3. Determine the resources available while making the maximum use of the available resources. 

STATES OF EMOTION

There are ten different basic emotional states five positive and five negative as enumerated below:

Positive Emotions:
a. Love: The power of love has a remarkable healing potential in major illnesses like cancer, colitis, etc. Babies who get a lot of love grow up healthier than children deprived of it. Forgiveness brings good health.

b. Laughter: Some of the physical benefits of laughter are:

  • Increase muscular and respiratory activity
  • Stimulates cardiomuscular system and sympathetic nervous system
  • Increases antibodies, the body's first line of defence
  • Decreases levels of stress hormones
  • Decreases heart rate and breathing becomes easier
  • Increases pain tolerance
  • Even your relationships improve.
c. Hope: If your life has hope, purposes and meaning, you will be happier and healthier.

d. Optimism: Optimists put failures behind them, do their best to look at the bright side and generally have better health.

e. Self-confidence: If you lack confidence and find it difficulty to assert yourself, you may suffer from indigestion and headaches.
Positive emotion can play wonders with your biology.

Negative Emotions:

  • Anger: Suppressed anger causes high blood pressure, heart attacks, strokes and stomach ulcers. Get rid of it with physical activity, chat with a friend or leave that irritating situation.
  • Fear: We worry about future, money health, children, etc. To combat fear, learn as much as you can about it. If it is health related, meet a specialist doctor.
  • Sadness: It is our natural reaction to problems. Crying helps the body get rid of harmful wastes.
  • Boredom: Inactivity and boredom can damage your health like stress. Cultivate some hobby.
  • Guilt: It is the most damaging of emotions and very difficult to be distinguished from conscience. To counteract guilt build up your self confidence. Think of your strengths and you will feel distinctly better.
   

SPECIFIC SPEECH ARTICULATION DISORDER

A specific developmental disorder in which the child's
use of speech sounds is below the appropriate level for his or her mental age, but in which there is a normal level of language skills.

Diagnostic guidelines:
The age of acquisition of speech sounds, and the order in which these sounds develop, show considerable individual variation.

Normal development. At the age of 4 years, errors in speech sound production are common, but the child is able to be understood easily by strangers. By the age 6-7, most speech sounds will be acquired. Although difficulties may remain with certain sound combinations, these should not result in any problems of communication. By the age 11-12 years, mastery of almost all speech sounds should be acquired.

Abnormal development occurs when the child's acquisition of speech sounds is delayed and/or deviant, leading to: misarticulations in the child's speech with consequent difficulties for others in understanding him or her; omissions, distortions, or substitutions of speech sounds; and inconsistencies in the co-occurrence of sounds (i.e. the child may produce phonemes correctly in some word positions but not in others).

The diagnosis should be made only when the severity of the articulation disorder is outside the limits of normal variation for the child's mental age; nonverbal intelligence is within the normal range; expressive and receptive language skills are within the normal range; the articulation abnormalities are not directly attributable to a sensory, structural or neurological abnormality; and the mispronuciations are clearly abnormal in the context of colloquial usage in the child's subculture.

Include: - developmental articulation disorder
              - developmental phonological disorder
              - dyslalia
              - functional articulation disorder
              - lalling 

Excludes: articulation disorder due to:
              - aphasia NOS (R47.0)
              - apraxia (R48.2)
              - articulation impairments associated with a developmental disorder of expressive or receptive language (F80.1, F80.2)
             - cleft palate or other structural abnormalities of the oral structures involved in speech (Q35-Q38)
             - hearing loss (H90-H91)
             - mental retardation (F70-F79)

CARE OF CENTRAL VENOUS CATHETER

Placement of central venous catheter 
central catheter internal tip will be in one of the positions below:

  • superior vena cava SVC)
  • Right atrium/superior vena cava junction
  • Right atrium (RA)
  • Inferior vena cava (IVC) above the diaphragm (in case of femoral catheters).
Indications:
  • To maintain central venous pressure (CVP).
  • To administer large amount of intravenous fluids in case of emergency, e.g. colloids, blood products, etc.
  • To administer irritants, vesicant and hyperosmolar drugs/fluids, e.g. adrenaline, sodium bicarbonate, Total Parental Nutrition (TPN), etc.
  • To have a long-term access for frequent or prolong usage, e.g. hemodialysis, chemotherapeutic agents, broad spectrum antibiotics, blood sampling, etc.
Complications:
  • Pneumothorax 
  • Infection
  • Thrombosis
  • Mechanical phlebitis 
  • Air embolism
  • Cardiac tamponade 
  • Patency impairment 
  • Blood clots in catheter 
  • Mechanical obstruction 
  • Catheter fracture 
  • Extravasation of fluids
  • Separation of port and catheter 
  • Surgical emphysema.
Important Points to Remember:
  • Chlorhexidine impregnated dressing help to reduce catheter associated bacteremia compared to other dressings.
  • Prefer a transparent dressing for clear assessment of site.
  • If there is bleeding or oozing, use dry dressing until it resolve.
  • Dressing has to be changed on weekly-basis to decrease skin irritation.
  • Dressing has to be changed soon after its get soiled or loosen.
  • Follow aseptic technique during dressing (wash hands using alcohol hand rubs).
  • Flush using normal saline after a injection or infusion will helps to keep catheter clean and prevent blood clots in catheter.
Guidelines of Healthcare Infection Control Practice Advisory Committee (HICPAC) to Prevent Intravascular Catheter-Related Infections:
Education, Training and Staffing
  • Educate health team members in regard with indications for intravascular catheter usage.
  • Periodically assessment of IV catheters.
  • Assign only trained person who is competent for insertion and maintenance of central intravascular catheters.
Hand Hygiene and Aseptic Technique
  • Perform hand hygiene
  • Maintain aseptic technique.
Skin Preparation 
  • Prepare skin with 0.5% chlorhexidine, tincture of iodine, an iodophor (or) 70% alcohol.
Catheter Site Dressing Regimens
  • If catheter site is bleeding or oozing, use gauze dressing until it gets solved.
  • Change catheter-site dressing when it is damp, loosen or soiled.
  • Do not use topical antibiotic creams on insertion sites except the dialysis catheters because of high-risk fungal infections and antimicrobial resistance.
  • Do not wet catheter site in water during bath likelihood to get infection.
  • Replace transparent dressing used in tunneled (or) implanted Central Venous Catheter sites not more than once in a week, until dressing is visibly soiled or loosen.
  • Monitor the catheter sites while changing dressing whether patient has tenderness at insertion site, fever without obvious reason, or other symptoms suggestive to local or bloodstream infection, then dressing has to be removed ans allow complete examination of catheter site.

Child Health Nursing Quiz Series - 6


Nursing Practice - 3


Nursing Practice - 2


Mental Health Nursing Quiz Series - 9



Medical-surgical Nursing Quiz Series - 10


Mental Health Nursing Quiz Series - 8


Medical-surgical Nursing Quiz Series - 9

Medical-surgical Nursing Quiz Series - 8


OUTCOME BASED EDUCATION