1.I currently work in the surgical unit and one of the major recovery enhancements is early ambulation after any surgery, especially orthopedic and abdominal. Early ambulation will accelerate the return of bowel function (as evidenced by passage of stool and flatus) reduce the rate of overall complications and decrease the length of hospital stays. Evidence-based practices have shown that early post-operative ambulation contributes to decreased pulmonary complications. “When exploring postoperative activity in the general and orthopedic nursing literature, there is sparse evidence outlining nursing's critical thinking skills associated with decreasing the first postoperative activity from the historical 14-day mark to the most current model of day 1 or 2 for the joint replacement population. Also, there were no recently published reports describing a contemporary …show more content…
clinical practice guideline (CPG).” (Oermann and Huber 1999). Benefits of early ambulation include stimulation of circulation, a decrease in venous stasis, prevention of DVT/PE, increases in muscle tone, encourage independence, and improved gastrointestinal, genitourinary and pulmonary functions. In the unit that I am working at patients get out of bed on post -op day #1, right in the recovery room. 2. “The Morse Fall Scale (MFS) is a rapid and simple method of assessing a patient’s likelihood of falling. A large majority of nurses (82.9%) rate the scale as “quick and easy to use,” and 54% estimated that it took less than 3 minutes to rate a patient. It consists of six variables that are quick and easy to score, and it has been shown to have predictive validity and interrater reliability. The MFS is used widely in acute care settings, both in the hospital and long term care inpatient settings ”(Morse Fall Scale). The Morse Fall Score is used to help determine the risk factors for falls in hospitalized patients. Besides performing clinical assessments and reviewing medications, staff nurses use this tool to help prevent and predict possible falls and plan patient care to address those factors. . Patient satisfaction and safety are a significant measure of patient service quality.
Unit-specific satisfaction and fall data evaluated pre and post implementation of EBP nursing strategies. Beside the promptness of responses to the call bell, “hands off reports“ at the bedside now implemented new hourly rounds, which significantly decrease patient falls and improve satisfaction. “In the hospital setting, falls continue to be the number one adverse event with approximately 3-20% of inpatients falling at least once during their hospitalization. Of those, 30-51% of falls in hospitals result in some injury“ (Oliver, Healey, & Haines, 2010). This can cause serious injuries (fracture, subdural hematomas, bleeding), which can lead to death. For example falls in the elderly can lead to a downward, negative effect on emotional health, physical health, long term functioning, and quality of life. “All hospitals have to conduct fall risk assessments for hospitalized patients to identify patients’ risk for falls so that prevention measures can be implemented into the plan of care“ (The Joint Commission,
2013). Reference: (n.d.). Retrieved January 13, 2016, from http://networkofcare.org/library/Morse Fall Scale.pdf Oermann M. H., Huber D. (1999). Patient outcomes: A measure of nursing's value. American Journal of Nursing, 99(9), 40-48. Hospital-Based Fall Program Measurement and Improvement in High-Reliability Organizations. (n.d.). Retrieved January 11, 2016, fromhttp://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-18-2013/No2-May-2013/Fall-Program-Measurement.html
Patients expect instant response to call lights due to today’s technological advancements. This can negatively impact nurse stress and cause contempt toward the patient. However, the expectation to respond promptly improves safety and encourages frequent rounding. Also, aiming for high patient satisfaction scores on the HCAHPS/Press Ganey by fulfilling patient requests can overshadow safe, efficient, and necessary healthcare. Although patient satisfaction is important, ultimately, the patient’s health takes precedence over satisfying patient and family requests, especially when those requests are unnecessary, harmful, or take away from the plan of care (Junewicz & Youngner, 2015). The HCAHPS/Press Ganey survey focuses on the patient’s perception of care. The problem with this aspect of the survey is that the first and foremost goal of nurses should not be to increase a patient’s score based on perception. According to an article in Health Facilities Management, the nurse’s top priority is to provide the safest, most quality care possible for patients with the resources they are given (Hurst, 2013). Once this has been accomplished, the nurse can then help the patient realize that the most
Falls in nursing homes residents are associated with morbidity, mortality, and healthcare costs. The centers for Medicare and Medicaid indicate falls as the quality indicator. (Leland, Gozalo, Teno, Mor, 2012). Factors such as new environment, medication, cognition, and non-compliance contribute to falls. A significant number of falls occur from wheelchairs. (Willy, 2013). Newly admitted residents to long-term care facilities are confused with the change. The new environment and the new unfamiliar faces increase the level of anxiety. Pain may also contribute to falls. In order to take tailor made preventative measures, fall risk factors for each resident should be evaluated periodically. Tools scoring risk factors can be utilized.
Most falls occur in the hospital setting when the patient is trying to get to the bathroom or bedside commode and ambulating on their own. (Tucker et al., 2012) With hourly rounding the nurse can help address elimination needs for the patient and help assist the patient to the bedside commode or the bathroom. With hourly rounding on patient this can help address the issue of marinating turning patients every two to help reduce the presence of a pressure ulcer and reduce pressure ulcers rate up to 56% (Ford,
In addition, the charge nurse needs to reinforce the safety check among nurses in regular basis. On the other hand, nurses are spending a great amount of time on charting their assessments outside the patients’ rooms. Knowing that every patient room is equipped with a computer, nurses can complete all their nursing risk assessment at the patient’s bedside in order to provide some supervision to the patients especially clients at high risk for falls and injuries. Furthermore, nurses are great educators. Teaching patients how to use their call bell during admission and have the patient demonstrate back is a big intervention to encourage patients to press the call button when help is needed instead of getting out of bed on their
Hinkle, J., Cheever, K., & , (2012). Textbook of medical-surgical nursing. (13 ed., pp. 586-588). Philadelphia: Wolters Kluwer Health
Stomberg, M., Sjöström, B., & Haljamäe, H. (2003). The Role of the Nurse Anesthetist in the Planning of Postoperative Pain Management. AANA Journal, 71(3), 197.
Ignatavicius, D. D., & Workman, M. L. (2013). Care of Intraoperative Patients. Medical-surgical nursing: patient-centered collaborative care (7th ed.). St. Louis: Elsevier.
The hospital promised early ambulation following hernia surgery. The hospital facility was designed to encourage movement without unnecessarily causing discomfort. Postoperative regimen designed and communicated by the medical team to patients
Which nursing interventions are most likely to reduce the number of patient falls and associated injuries per month in Behavioral Health Services?
...ches indicate how nurses can ensure prevention and mitigation of the problems experienced due to falls. There are various strategies that can be used to enhance the safety of individuals from falls. In order to be able to deal with these issues within the healthcare facilities, nurses must be involved in the effective policy making so that the risks of patient falling can be amicably dealt with. On the other hand, the nurses must be placed at the forefront of the implementation process of the designed interventions. Leaders must engage the nurses in applying the evidence-based therapies so that they can ensure good safety for the patients. Nurses are important in ensuring advocacy, education and the management of the facility environment. The nurses will therefore apply various necessary interventions that guarantee safe environments for the patients and the nurses.
Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner & Suddarth’s textbook of medical-surgical nursing (12th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Elderly clients, who fall recurrently at home are often admitted to nursing care homes. According to British Journal of Healthcare Assistants, individuals living in a nursing care home are more than three times likely to fall more than they did at home (Nazarko, 2011, p. 323). Optimal healthcare should ensure safety and identify any potential elderly
During the incident, I was shocked and never realize that this incident would ever happen to me. As all know, the incidence of patient falls will be the huge thing in every health care centre. I am worried if Madam Y experienced any complications, I might not be able to forgive myself. This critical incident made me feel sad, guilty and disappointed in myself. After this incident, I started to blame myself for the fall and this affected my nursing practice until the end of my shift. I still being uncomfortable and not confident on that day while performing my nursing skills and felt sad throughout the day. Even until now the incident still affect my daily routine of nursing care. I became more paranoid to patient and afraid it will happen
Although students were not allowed in the recovery unit, I was able to talk to one of the recovery nurses. I learned that a nurse’s duty of care includes monitoring the patient’s vital signs and level of consciousness, and maintaining airway patency. Assessing pain and the effectiveness of pain management is also necessary. Once patients are transferred to the surgical ward, the goal is to assist in the recovery process, as well as providing referral details and education on care required when the patient returns home (Hamlin, 2010).
I went to the operating room on March 23, 2016 for the Wilkes Community College Nursing Class of 2017 for observation. Another student and I were assigned to this unit from 7:30am-2:00pm. When we got their we changed into the operating room scrubs, placed a bonnet on our heads and placed booties over our shoes. I got to observe three different surgeries, two laparoscopic shoulder surgeries and one ankle surgery. While cleaning the surgical room for the next surgery, I got to communicate with the nurses and surgical team they explained the flow and equipment that was used in the operating room.