Quantitative Research Article Critique : ' Acute Delirium '

Nursing theories have been a fundamental tool used to explain, guide and improve the practice of nursing. Theorists have contributed enormously to the growth of nursing as a profession. The four grand theorists I chose are Virginia Henderson, Peplau, Myra Levine and Jean Watson. These theorists have contributed tremendously in the field of nursing through their theories, and research. One thing the theorists have in common is that they are patient centered. They are all concerned on ways we can improve our responsibility to the patients, their families and the environment. They have different ideas but they are all aiming towards achieving the same goal, which is patient satisfaction and safety. Their differences are in their areas of

For the most part, hospitals are places where one comes for healing and it is place where our clients should feel safe and away from harm. Nurses have an important role as a patient advocate and are to provide all clients with safe, compassionate, and quality care at all times. Nonetheless, the hospital can also be a dangerous place for inpatients. It is a foreign environment to clients and there may be alterations in their medical condition in regards to their physical and/or mental status. With this said, there is a need to improve upon how we care for our clients, especially those who are at most risk for various incidents.

The purpose of this paper is to conduct an in depth exploration of the nursing care considerations of patients in a specific clinical area. Through the synthesis of prior knowledge, clinical experiences and skills, evidence based best practices, and care of patients a comprehensive care and teaching plan will be composed. Integration of critical thinking and clinical reasoning skills, combined with evidence-based research will provide confirmation of nursing process comprehension. The inclusion of reviewed literature will further support knowledge and understanding.

In today 's world, many health care organizations encounter the most critical problem, such as chemically impaired nursing practice, on a daily basis. All areas of the nursing profession are affected by a chemical dependency and the cost associated with this problem is a great concern for the health care organizations. According to Church (2000), “nurse impairment affects the safety of the public, the nurse’s well being and the profession as a whole” (p. 2). The delivery of care provided by the chemically impaired nurse lowers the standards and the prestige of the whole profession, creates serious liability for the employer, lowers productivity, increases the turnover rate, decreases staff members morale, and increases the risk for medication error (Wennerstrom and Rhooda, 1996). People’s lives, function and lifestyle can be dramatically changed due to a medication error caused by a chemically impaired nurse (Cook, 2014). The chief nurse executive (CNE) is frequently confronted with the problem of impaired nurse, furthermore, the CNE is responsible for the policy and decision making involving this issue (Hughes, 1995). The purpose of this paper is to examine nurse executives response to allegations of a chemically impaired nurse.

While there was a policy in place for conscious sedation, even good policies rely on the vigilance of staff to adhere to them. Often times, working conditions allow for distractions, and even the best of practitioners, with the best of intentions, make errors. There were several areas presented in this scenario that require examination and improvement.

Delivering quality care is the priority of the nursing profession as an institution and in order to facilitate this, data driven indicators are employed to measure how effective the care environment is. These nursing sensitive indicators include complications such as urinary tract infection, patient falls, surgical complications, length of hospital stay, restraint prevalence, incidences of failure to rescue, patient satisfaction, pressure ulcers and nursing satisfaction. In the case of Mr. J, the demented rabbi, who as a nurse supervisor I am responsible for, nursing sensitive indicators are crucial in monitoring the level of care and making adjustments so that the

The US News ranked a Nurse Anesthetist number 4 in the top 100 best jobs of 2016. Although satisfying, a Certified Registered Nurse Anesthetist (CRNA) is a highly stressful nursing specialty (Phillips, 2010). According to Gouveia (2016), a registered nurse is ranked top 5 in most stressful jobs. Some of the brightest and best CRNAs, even past presidents of the American Association of Nurse Anesthetists (AANA) have taken their own life because of addiction (Quinlan, 2009). Substance abuse and addiction is a well-known topic unfortunately, it continues to be an issue and struggle everyday for some anesthesia providers. CRNAS are well-educated individuals; however, the prevalence, and relapse rates for substance abuse are alarming. The

The investigation of how anesthesia effects cognitive functioning has had a long history. Overtime, it has been suggested that there is an association between anesthesia, surgery, delirium, dementia and postoperative cognitive dysfunction (Inan & Ozkose Satirlar, 2015). The theory of anesthesia’s impact on cognitive functioning was derived in 1887, by Savage, who began to observe the “insanity” that follows the use of anesthesia. He suggested that “Any cause which will give rise to delirium may set up a more chronic form of mental disorder quite apart from any febrile disturbance” (Savage, 1887, p. 1199). Delirium can be defined as an altered level of consciousness that may cause a sudden decline in attention and focus perception (Isik, 2015). Postoperative delirium was reevaluated in 1955 when Bedford used a series of case studies collected over a 50 year span to describe a connection between anesthesia and dementia. The results suggest that 10% of the patients had postoperative cognitive dysfunction (Bedford, 1955). Since these initial studies, research has persisted using a variety of methods, in an attempt to determine: both long- and short-term effects of anesthesia on cognitive functioning and memory; whether the anesthesia administration technique will change the outcome of postoperative cognitive dysfunction; and other risk factors that may be associated to AD.

A study conducted by Young, Minnick, and Marcantonio (1996) compared the opinions of more than a thousand staff nurses, numerous nurse managers, and more than two thousand patients from 17 hospitals regarding certain aspects and perceptions of patient care needs. Interestingly, staff nurse and managers

Enhanced assessment and nursing implementations to better prevent and detect ICU delirium will bring improved outcomes for this particular patient population. There are many ways to assess for ICU delirium. Two of the most reliable and easiest methods are basic observations from the bedside nurse and The Confusion Assessment Method (CAM). The CAM includes nine different criteria for delirium (1) acute onset and fluctuation, (2) inattention, (3) disorganized thinking, (4) altered level of consciousness, (5) disorientation, (6) memory impairment, (7) perceptual disturbances, (8) psychomotor agitation or retardation, and (9) altered sleep-wake cycle. A delirium diagnosis is given when criteria one and two and either three or four are present. The second assessment tool for delirium detection is made from nursing observations. The nurse observes the patient throughout their

According to the American Nurses Association, an impaired nurse is unable to meet the requirements of the code of ethics and standards of practice of the profession. This nurse has cognitive, interpersonal or psychomotor skills affected by psychiatric illness and/or drug or alcohol abuse of addiction (American Nurses Association, 2010). Not only do these nurses create a potential threat to their clients, but they have also neglected to care for themselves.

I will methodically analyze all parts of the study to assess the validity of the article, by contrasting and comparing the information provided, with previous literature. I will try to make sure that recommendations provided by the authors are congruous with nursing practice and beneficial to the advancement of it. I will as much as possible provide in depth detail of previous studies on the same topic that either support or contradict the analysis provided by this study and its authors.

Does the compliance with a sedation protocol improve after nurses receive a sedation competency over a three month period? The available data supported the hypothesis that nursing education and competency can lead to consistent best practices and positive outcomes for patients. The answers to this research question can help develop interventions that support best practices for patients who are mechanically ventilated and receiving intravenous sedation.

Changes in the Health Care System and the Practice of Nursing have become complex. Technological changes, complicated client needs, short hospital length of stay, and departure from acute care to community based care, all these changes have underscore the need for professional nurses to think critically in order to provide safe and effective client care. A better educated nursing workforce can provide good health education to patients and their families. The affordable care of 2010 has required the need for nurses to expand their role of practice to meet complicated patient demands. This has prompted the Institute Of Medicine to review the “Future of Nursing, Leading change and Advancing Health”. {Creasia & Fribery,2011}

One of the many goals of the nursing profession is to provide high-quality, safe patient care. There are many responsibilities that come with a nursing career and when the nurse to patient ratio increases, there is a possibility that it may hinder the safe care that patients deserve, and this may result in negative patient outcomes and level of satisfaction. Staffing is one of the many issues that healthcare facilities face. In many facilities, there never seems to be enough nurses per shift to provide high quality, thorough patient care which often leads to burnt out staff, and frustrated patients and families. This review discusses the findings of quantitative studies and one systematic review that involves patient outcomes in relation to nurse staffing.