EBP Practice Environments

29 Apr

     Nurses who feel supported are more likely to use evidence-based practice (EBP) because it is important to feel like we are doing the right thing and we have people to back us up.  EBP is the right thing to be doing if there is strong evidence behind the policy or practice that proves patient well-being.  We want the best for our patients, so I feel that if the hospital and unit supported EBP efforts then these measures would be used more often by the nurses.  The same goes for the unit support.  The support of the people working directly above staff nurses, such as the nursing director and charge nurses, are important as well.  Knowing that they support this practice and have the resources readily available for use will help the nurses on the floor or unit practice without any inhibitions.  Of course, it all comes down to the individual.  If the individual nurse does not support their own efforts or other nurses’ efforts to implement EPB into their job, then no one can help them.  Possibly, they have worked in an environment where this was condoned and the nurses were only able to operate under the hospitals policies which were not evidenced-based.  Individual nurses like this may need additional resources to turn to for advice on practice standards and standing up for EBP.

     The culture on the floor or unit also has an effect on the measures to use or promote EBP.  The values and beliefs of the unit drive the importance of measures of practice.  Usually, those who stay on a unit for a long time may develop the environmental culture of their coworkers.  Some employers will not hire individuals who may go against the culture on the unit and/or disrupt its flow.  Depending on the unit or their boss’s overall attitude towards the use of EBP will change the confidence of a nurse who is going against the grain.  If EBP is not widely accepted, they may fall back on the idea to have the support of their coworkers.  For an individual to thrive they must be prosperous and successful.  To achieve this, it would be necessary to use EBP.  The same goes for a unit.  But in order for a unit to thrive, the coworkers who make it up must have the same motivation to thrive.  The use of EBP by all coworkers may be enough to make this change.  The group as a whole could innovate their future as a thriving unit within a thriving hospital system.

     Innovation is defined as the introduction of something new.  Selman (n.d.) has an excellent breakdown of this meaning, stating that innovation is “intentionally ‘bringing into existence’ something new that can be sustained and repeated and which has some value or utility” (para 6).  This is essential for nursing and happens frequently.  No matter what is being innovated, there are some characteristics that go hand-in-hand with innovation, these being communication skills, leadership, professional development, and lifelong learning. 

     Communications skills are essential for innovation.  They are what drives the idea and are important for “selling” it to co-workers and supervisors.  Meyer (2010) states that “[t]op-notch communication skills with senior executives, peers, partners help drive open innovation success” (p. 2).  Another skill that is important for innovation is leadership.  Leaders are people who strive for success, so of course they are going to be important people in the innovation process.  Innovation is an element of the leadership process; therefore, leadership will result in innovations (Selman, n.d.).  Essentially, they feed off each other.  The next characteristic of innovation is professional development.  Professional development is the building up of skills and knowledge related to that individuals job field.  In nursing, this is a constant process.  The medical field is ever-changing, which means that those who work in it need to be adaptable to this change and can respond in a timely manner.  Professional development building programs can lead to more satisfaction from the nurse to become more confident in their jobs (Wood, 2006).  The final characteristic is lifelong learning.  Lifelong learning is an important part of innovation because it is the motivating factor behind it.  It is what makes an individual, or leader, strive to achieve further excellence and continue innovating.  Skills that are needed for innovation are not able to be taught.  They are learned over time by active use and constant accommodation.  All of these characteristics are needed to be a successful innovator.  Successful innovators have to ability to thrive by changing their environment for the better. 

 

References

Meyer, A. (2010). Communication in Open Innovation. Retrieved from http://www.innovationexcellence.com/blog/2010/08/18/communication-in-open-innovation/

Sahlberg, P. (2009). Creativity and Innovation throughout lifelong Learning. Retrieved from http://www.pasisahlberg.com/downloads/Creativity%20and%20innovation%20in%20LLL%202009.pdf

Selman, J. (n.d.). Leadership and Innovation: Relating to circumstances and change. Retrieved from http://www.innovation.cc/discussion-papers/selman.pdf

Wood, J. (2006). Exploring staff nurses’ views on professional development. Nursingtimes.net, 102(13). Retrieved from http://www.nursingtimes.net/nursing-practice-clinical-research/exploring-staff-nurses-views-on-professional-development/203320.article

 

Nursing and Medical Research: What is Christian?

15 Apr

Embryonic stem cell research is still a controversial topic today, and will likely always be.  Personally, I am on the pro side.  I believe that embryonic stem cell research is important to improve current health care needs and create possible cures for diseases.  Scientists believe that it one day could help cure diseases such as cancer, Parkinson’s, and genetic diseases.  On the other hand, many others may disagree.  The Church teaches its individuals to believe that life begins at conception.  This then in fact would ban any use of human cells because they are the start of life at all stages.  According to Hodges (n.d.), the Orthodox Church believes “that human life begins at conception, the extraction of stem cells from embryos, which involves the willful taking of human life — the embryo is human life and not just a clump of cells — is considered morally and ethically wrong in every instance” (para. 4).  Unfortunately, the embryo does have to be destroyed in order to extract stem cells, which is the overall cause of this controversy. 

It all returns to the question, where does life truly begin?  Some Christians would respond to this by saying that these embryos are already considered to be human life; I agree.  Others may further say that it is already a baby and destroying it would be committing murder; here I would have to disagree.  The extraction of the embryonic stem cell occurs within a week to two weeks after fertilization.  At this phase the embryo is deemed a blastocyst, not a fetus or baby.  In addition, the embryonic cells that used were made specifically for this purpose; research.   

While I don’t disagree with embryonic stem cell research, I think that it can be done by using other stem cells.  Stem cells are found in other parts of the body, such as cord blood and numerous adult tissues.  The only downfall to using these tissues for research is they form into limited types of cells while the embryonic stem cell can potentially form into any cell type within the human body.  At the least, fewer embryos could be used with the research weighing more heavily on other types of stem cells.  This type of research would definitely be the hardest type of study for a Christian to participate in.  Other unchristian research would include physician-assisted suicide, euthanasia, and cloning.

 
References

Hodges, Mark. (n.d.). Destructive Embryonic Stem Cell Research.  Retrieved from http://www.antiochian.org/stem-cell-research

Nurse Reflection

1 Apr

I have been a nurse for about a year now within an acute care setting. I work overnights on a surgical floor, so we are constantly admitting and transferring patients. I have had many instances similar to those that the nurse in Chapter 1 of the Doombos, Grenhout, and Hotz text experienced. Moments like these come up more frequently than one may think, but the nurse cannot always recognize them. Acute care nursing is a busy job. Most of the time there is not enough time during a shift to get everything done. I often find myself zipping from room to room checking off all the tasks on my list that I need to complete within my shift. This interferes with my ability to respond as a Christian nurse.

The overload that is on my shoulders cuts out the “free time” I get to spend with the patients. Many patients do not understand the patient load that is on a single nurse. This can make the situation even more frustrating. As Doombos, Grenhout, and Hotz (2005) were explaining, the small and personal tasks “take up precious time that acute care nurses, who provide care for multiple clients, can ill afford. But the client does not know this” (p. 18). For example, when I’ve been an a single patient’s room for 15 minutes already helping them reorganize their table, put their socks on, and so on; I begin to get frustrated. Not frustrated at the patient, but at fact that I have a million other things on my mind that I need to do that are a higher priority as a nurse. In nursing school it is drilled into our heads to complete the highest priority task first, but in the real world it is hard to carry through with that when you’re trapped in a patient’s room.

To overcome these situations, honesty with the patient may help the nurse. After completing the task you had needed to do with the patient, still try to connect with them and ask if they need anything else. If they need something else that will require a few minutes to complete, just let them know that you have another patient to see real quick and that you will be back in a few minutes. The patient should respects your honesty and gain your trust if you do carry through with your agreement. It is still important to have a close relationship with the patient, but reordering the way things are done may make the situation less stressful for all involved.

References

Doornbos, M. M., Grenhout, R. E. & Hotz, K. G. (2005) Transforming care: A Christian vision of nursing practice. Grand Rapids: William B. Eerdmans Publishing Co.

Christian and Secular Views of Nursing Meta-paradigms

10 Feb

Let’s begin with what is a meta-paradigm?  It is a model that explains how science, philosophy, and theories are linked together, and how they are applied to a discipline, such as nursing (Current Nursing, 2011). The nursing meta-paradigms are nurse, person, environment, and health.  The definitions of the meta-paradigms are given below:

Nurse: the actions and characteristics of the person providing care.

Person: the individual/patient, family, or group/community.

Environment: all of the external or internal conditions, circumstances, and influences affecting the individual.

Health: the degree of wellness or illness experienced by the person/patient. (Current Nursing, 2011)

A Christian nurse is expected to be confident in their work, care for their patient’s, and be active in advocating for their patient’s.  Christian nurses also held responsible to be involved within their practice and organization to promote the development of the nursing profession as a whole (Doornbos, 2005, p. 50-51).  These views do not differ from the secular views of nursing and are basic standards of nursing care.  A difference between views could be based off how nurses view their job, whether it is just a job or a service provided.  According to Doornbos (2005), nurses who deal with “less pleasant aspects of embodiment and sickness are not, from a Christian perspective, inherently demeaning or lower in status.  In fact, Jesus specifically names caring for basic bodily needs as the service that is proper to those who would be his followers” (p. 51).  Other non-Christian’s may not believe that caring for other individuals at this level is a service towards a superior-being, but instead just a way to earn a living to take care of oneself and family.

The person meta-paradigm differs between the secular and Christian views as well.  Christians are bearers towards the image of God (Doornbos, 2005, p. 59).  Doornbos (2005) goes onto explain that “in discipline, life becomes a truly human life, lived in service of God through attending to one’s neighbor” (p. 59).  Christians are viewed as subjects living their life for God since He created them to do so.  The secular view differs by how non-Christians live their life for themselves. Believer Central (2008) explains that secular individuals live to increase self-worth and their position in the world (para 2).

Defined by Doornbos (2005), “health in the fullest sense is the complete physical, mental, and spiritual flourishing that allows us to fulfill our created purpose” (p. 70).  The purpose of Christian life of course is based off the expectations of the Creator.  Christians also view the environment as a creation of God.  These to thoughts are interlaced together to aide the Christian nurse to fulfill their requirement.  To remain health, individuals need to maintain the proper environment to do so.    Many times, people with secular views believe in putting their needs ahead of others, which destroys the environment as a whole.

 

References

Believer Central (2008). Christian vs. Secular World View. Retrieved from http://www.christian-information-center.com/christian-secular.html

Current Nursing. (2012). Nursing Theories: An overview. Retrieved from http://currentnursing.com/nursing_theory/nursing_theories_overview.html

Doornbos, M. M., Groenhout, R. E., & Hotz, K. G. (2005). Transforming care a christian vision of nursing practice. Grand Rapids, MI: William B. Eerdmans Publishing Company.

Webliography: Huntington’s Disease

22 Oct

            “Huntington’s disease (HD) results from genetically programmed degeneration of brain cells, called neurons, in certain areas of the brain. This degeneration causes uncontrolled movements, loss of intellectual faculties, and emotional disturbance” (NINDS, 2010). Huntington’s disease is an autosomal dominant disease, meaning it is a genetic disease, passed from carrier parent. Since this is a dominant disease, there is a 50-50 chance a child will be passed the mutated gene if one parent is a carrier. Research has found that a mutated gene is responsible for causing HD. The National Human Genome Research Institute (2011) explains that “a single abnormal gene produces HD. In 1993, scientists finally isolated the HD gene on chromosome 4. The gene codes for production of a protein called ‘huntingtin,’ whose function is still unknown. But the defective version of the gene has excessive repeats of a three-base sequence, ‘CAG.’ In the normal huntingtin gene, this sequence is repeated between 11 and 29 times. In the mutant gene, the repeat occurs over and over again, from 40 times to more than 80.” Overproduction of this protein is what is thought to cause the symptoms of HD.

            Signs and symptoms originate and progress differently for all individuals with HD. NINDS (2010) describes early symptoms of HD as “mood swings, depression, irritability or trouble driving, learning new things, remembering a fact, or making a decision. As the disease progresses, concentration on intellectual tasks becomes increasingly difficult and the patient may have difficulty feeding himself or herself and swallowing.” This is a progressive and irreversible disease. There are only a few medications for patients that help provide relief for some of the symptoms, mainly the use of tetrabenazine to treat chorea. These are only so effect and do not stop the progression. There currently is no cure for Huntington’s disease. Research is being conducted worldwide to strive for an answer for families suffering from this disease.

            I chose to write my webliography over Huntington’s disease because this disease is present within my family. Since this is a genetic disease, it has a long history in my family. My grandmother on my mother’s side died when my mom was in her late teens. My grandfather was not a carrier of the disease, so the chances of their children developing the disease were 50/50. My mother, the eldest, was one of four children. She and her younger sister have yet to show signs or symptoms of this disease, but neither has chosen to have genetic testing done. My mom’s youngest sister and only brother began to develop signs of HD in their 20’s. My aunt passed away last summer, after battling HD for years. My uncle’s health is slowly declining without any sort of cure. Two out of the four children developed the disease (50-50). My family is involved with charity work and raising money for Huntington’s disease. Every year, family members play in the Hope for Huntington’s Golf Classic in Illinois, which is organized by the HDSA to raise money for HD research.

            While choosing websites for my webliography I looked at many different factors. Those including, credibility of the source from the URL and domain name, credentials of the author(s), copyright, and published/updated date. Since HD research is constantly changing and evolving, a resource with all of the latest research and news is ideal. I also looked to see if there are sources listed and if it’s listed in a reliable directory.

MedlinePlus
Huntington’s Disease
http://vsearch.nlm.nih.gov/vivisimo/cgi-bin/query-meta?v%3Aproject=medlineplus&query=huntington%27s+disease

This directory is a very good resource for HD research. It is nicely organized with no distracting advertisements. There is a brief description describing HD and I noticed this entire website can be translated to Spanish. The links provided are good websites and articles related to HD. A sidebar option can control what exact aspects of HD to find by keyword.

WebMD
Huntington’s Disease Directory
http://www.webmd.com/a-to-z-guides/huntingtons-disease-directory

This site provides a basic description of Huntington’s disease. There are links towards research and genetic testing for HD, as well as links for the latest news on HD. Video links are also provided to explain genetics.

Huntington’s Disease Society ofAmerica
http://www.hdsa.org/

This website is a reputable source of legitimate HD information. It is organized and easy to browse through. It also provides links to the current research efforts to fight HD. It provides links to families on how to live with HD, as well as personal stories, and what you can do to help.

Huntington’s Disease: Lighthouse Family
Huntington’s Disease Research Reports
http://www.hdlf.org/research

This is a great resource for all the research that has been done on HD. It is very well organized, and has many links to past research. All of the research is organized by most recent and explains the basis of the research in the title. Research ranges from April 2011 all the way back to March of 2002 and was posted by a credible source.

ColumbiaUniversityMedicalCenter
FAQ’s About HD
http://www.hdny.org/FAQ.html

This site is great for the basic breakdown of explaining what HD is and what is currently being done in researching HD. It also provides links off to the side about research, clinical trials, treatment, genetic testing, etc.

American Speech-Language-Hearing Association
Huntington’s Disease
http://www.ninds.nih.gov/disorders/huntington/huntington.htm

This is a great resource for basic explanation of HD and the disease process. It also provides links to HD publications, organization, news, and research literature. It is from a reputable source, is easy to read, and it up-to-date information.

Brief Overview of Health Care Informatics

7 Oct

What is Health Care Informatics?

Health care informatics is a combination of nusing science, information science, and computer science. According to McGonigle & Mastrian (2008), “nursing informatics implementation requires us to view nursing informatics from the perspective of our current healthcare delivery system and specific, individual organizational needs, while proactively anticipating and creating the future applications in both the healthcare system and our profession” (pp 1). In simplier terms, it combines all of the scientific research done on nursing with newer technology and research. In all, it’s goal is to provide better care for patients.

Electronic Health Record

Who owns the Electronic Health Record (EHR)? Is it the patient? The health system? The computer software company?

I think that the EHR is technnically owned by a health care system, such as, St. John’s Mercy. The health care system employees are the ones that have compiled the patient’s health care information and history into a single, user-friendly, site. The hospital buys the right to use software for the EHR, so it should not be considered the software company’s property. Yes, the patients do and should have a right to view their chart, but the copyright on it should not belong to them because they didn’t write it. When an extra copy is printed off for the patient to have to keep for their own records, it still remains in EPIC. Therefore, the health system owns the EHR, it should not be considered the patients private property.

McGonigle, D., & Mastrian, K. (2008). Nursing Informatics: A foundation of knowledge. Sudbury, MA: Jones & Bartlett.