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Respond to the following 3 posts.
1. Identifying a Framework
“Knowledge as a component of the socio-cultural orientation basic conditioning factor enhances the prevention of hazards” is a theory developed by Jacqueline Fawcett. The framework of this theory is concept A leads to proposition to concept B as the result. Knowledge is concept A. The proposition is the orientation or basic condition factor that enhances the knowledge. The result or concept B is the prevention of hazards. According to Fawcett, nursing knowledge is comprised of domains such as the conceptual model, empirical indicators, metaparadigm, and philosophy. These domains are comprised of concepts and propositions in theory. The empirical indicator is an exception to these domains because it measures component concepts (Jang & Vincent, 2019).
An example of this theory is the use of bed alarms on all inpatients while in the hospital. Patients are educated and are knowledgeable in the fact that the bed alarm is turned on to remind patients to call for assistance. The alarm also sounds to notify staff on the unit that the patient is exiting the bed and needs assistance immediately. The patients are also educated that since they are in the hospital they need to be closely monitored for safety. Staff is educated on the bed alarm being set when the patient is in the bed after assisting the patient with ambulation. Proposition is the continued use of the bed alarm for safety of the patient. The nursing staff should always turn the alarm back on after the patient as been assisted. Bed alarms that go off should be immediately investigated by all staff to prevent a fall and possible injury of the patient. A fall is a never event that is considered preventable in the hospital. The concept B is the result of no falls on the hospital unit in relation to the correct use of bed alarms.
The use of bed alarms is not a fool proof way of preventing falls. Despite all the education and knowledge given and received falls continue to occur. Staff members forget to turn on bed alarms or simply do not answer the alarm immediately. Sometimes bed alarms go off and the staff does not hear them or there is limited staff on the unit to answer the alarm immediately. Bed alarms do work when they are turned on and when there is ample staff to attend to the census on the unit (Oliver, 2018).
One way to measure the effectiveness of bed alarms on a unit is to monitor the number of falls that occur over a certain amount of time. There are other ways in which data could be collected and bed alarm fall prevention could be monitored. The charge nurse could round on patients every other hour and check beds for the alarms being activated. The data for bed alarms could be collected over two weeks and evaluated for effectiveness of the staff turning bed alarms on. Another way to collect bed alarm use is to collect data on bed alarms going off the time and how long it took to be answered and who answered the alarm. This data would evaluate the responsiveness and effectiveness of the staff in relation to bed alarm response.
A 36-bed unit in a community hospital conducted a bed alarm effectiveness study. This hospital educated the nursing with the Iowa Model of Evidence-Based Practice for fall prevention for quality improvement plan in the hospital. The nursing staff received education that was modeled after the Iowa Model for fall prevention that enhanced the fall prevent that was already in place. Data collection on fall prevention determined that the average monthly preintervention fall rate was 8.67 falls/1000 patient days, as compared with 5.07 falls postintervention, which resulted in an overall decrease of 44.5% in the average number of falls per month. In conclusion, education and bed alarm use may be an important component of an effective evidence-based falls prevention program (Meline, 2018) .
2. Inappropriate medication regimen and cultural differences
I never really understood cultural differences and belief systems with Western medicine until I finished nursing school. I grew up in a traditional Hispanic family and was the first to receive an education outside of high school. As my grandparents got older, I began to help with their medications more. For some reason, I never noticed their medication cabinet that was overflowing onto the counter before. They were not completing their antibiotics and they certainly did not take their medications as prescribed. They are not the only ones of their culture to do this. One time my grandmother stated she did not like the way her diabetic pills made her feel so instead of taking the whole pill she would just “take a bite” of the pill. After learning this, I took the time to discuss each medication with them and thoroughly explained antibiotics and the importance of taking the whole prescription. They had no idea they should be talking about medication side effects with their doctor. “They may not be aware that preventing adverse drug interactions depends on discussing all the medicines they take with their doctor” (Carteret, 2011, para. 4).
“Adherence to medications is dependent upon a variety of factors, including individual characteristics of the patient, the patient’s family, and culture, interactions with healthcare providers, and the healthcare system itself” (McQuaid & Landier, 2018, para. 1). Not only did my grandparents not discuss their reactions to the medications and how they were not taking them correctly, but they also turned to natural remedies that had been passed down. My grandmother always had a home remedy for any issue we had. The combination of not taking their medications appropriately and turning to home remedies while skipping their medications really taught me the importance of education. Making sure the education is clear and in laymen’s terms is significant as well. “There is also compelling evidence about the value of being sufficiently informed; a patient’s misunderstanding of a condition and its care can result in non-compliance to a doctor’s recommendations, significantly and adversely affecting outcomes” (Koren, 2016, para. 1).
3. Failing to Carry Out Bowel Care can lead to Post-Op Ileus
One thing all Nurses have in common is their most prolific poop story. When we all meet up for our in-person assessment skills, we can share them and see whose story reigns supreme. On that note, as an RRT, I have discovered 3 perforated bowels due to ileus forming in post-operative patients in May alone. Chart reviews have shown that the floor RN charted that the patient refused their bowel care medications. I am completely a proponent of patient autonomy but I also feel that some of these medications should be fully explained to the patient so that they can make a more informed decision about whether they do in fact want to refuse said medication.
Failure to prevent the formation of an ileus can often lead to surgical intervention, prolonged hospital stays with increased costs associated. “The manifestations of ileus and its degree of severity generally depend on the site of the blockage, and the rule until recently was that a patient with suspected mechanical ileus should be taken to surgery within 12 hours” (Vilz et al., 2017). Being that all my cases advanced to perforation, they were all emergently taken to the OR. Additionally, all three had elevated lactate levels suggesting the development of sepsis for having fecal matter in the peritoneum. One patient’s ileus was so bad that part of his digestive tract went beyond ischemic to necrotic.
“Despite numerous advances in surgical technique and perioperative care, postoperative ileus continues to be one of the most common and expected aspects of abdominal surgery. It prolongs hospital stays, increases medical costs and frustrates patients and surgeons” (Saclarides, 2008). Postoperative ileus is the transient cessation of gut motility after surgery (Adiamah & Lobo, 2020). What can be done to help prevent and or treat the development of Postoperative Ileus? We all know that Opioids can cause constipation or aperistalsis. Maybe using a different medication like IV Tylenol (Ofirmev) which does abate moderate to severe pain yet does not affect gut motility might be a viable option.
Postoperative ileus and constipation are common secondary effects of opioids and carry significant clinical and economic impacts. μ-Opioid receptors mediate opioid analgesia in the central nervous system (CNS) and gastrointestinal-related effects in the periphery (Chamie et al., 2020). So what can be done? I think a big percentage of the onerous falls on the Med/Surg RN to vehemently educate the patient to the benefits of taking bowel care meds as well as getting up and ambulating versus not wanting to deal with a Code Brown or walking a patient around the unit. I would also suggest that in hand-off during bedside report that the off-going RN reports how long it has been since the patient had a bowel movement as well as what the current bowel sounds are. I would also suggest that if the hospital system is using Epic that a note should be placed in the Treatment Team sticky note section on the patient’s main summary page as to how long it has been s/p surgery that the Pt has not had a bowel movement. Lastly, get that PRN order for a soap suds enema to help disimpact the patient if indicated.
The overall 30-day morbidity and mortality rates were 28% and 13%, respectively for small bowel obstructions requiring emergent laparotomy surgery (Jeppesen et al., 2016). Postoperative ileus and Small Bowel Obstructions are legitimate conditions that need to be given due deference to.