BSN Professional Portfolio

Welcome to my professional portfolio created for my Senior Capstone at Dixie State University. Please use the  above links to find and reference material I have created and researched throughout my time at Dixie State University. The experiences and material have helped to shape my learning and nursing practice so that I am prepared to provide exceptional care to my patients, their families and the community in which I serve.

Thank you for taking the time to read my work and consider my progression throughout this course of study and into my professional career.

Outcome1

Apply leadership concepts, skills, and decision making in order to provide oversight and accountability for the delivery of safe, quality care in a variety of healthcare settings.  

I have had the opportunity to be in a leadership position for most of my nursing career. I have always enjoyed teaching, mentoring and helping my fellow nurses. I enjoy knowing what is going on with patients and being involved in every aspect of their care whether it is the actual nursing part of their care or helping them manage their emotions or putting out fires; I enjoy it all.

Since being in the BSN program I have learned a lot and have been able to apply those things while practicing nursing and help my coworkers to excel in their nursing care as well. I learned a lot while in the health assessment class. I think the first time through my nursing courses I was so worried about passing the NCLEX that I didn’t really absorb everything I should have. This time around with less pressure I have been able to absorb and apply my learning right away into my practice. I know that my patients have benefited from what I learned in that class.

Another area that I have been able to apply into my daily routine is the concepts I learned in Transcultural Nursing. I take care of people from different cultures on a daily basis and I learned many things in that class that not only benefited me as a leader (as I was able to help my coworkers) but also benefited me as a person.

These are just two examples, but throughout the course I have caught myself saying “Oh! That’s how I should do it!” and then changing my practice.

I am including a link to the Fadiman paper I wrote after reading the book The Spirit Catches You and You Fall Down written by Anne Fadiman.

Fadiman Response Paper

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Outcome 2

Integrate reliable evidence from multiple perspectives to inform practice and make reasonable clinical judgments.  

Integrating reliable evidence from multiple perspectives and using that to guide practice and make reasonable judgments can sometimes be difficult. I have found that in my practice, before I go to see a patient I will read the transcribed history on the computer, the history submitted by the patient, and progress notes. This allows me to not only go into the patient room with a better understanding of why they are here, but what everyone did while working with them.

If I come across a particular illness, medication, or procedure that I am not familiar with I will research it so I can be familiar with it. I have not always done this and found myself guessing or making assumptions about patient care. Once I learned to prioritize my time so that I could use different people’s perspectives and research in my practice, I found my patients were happier, I was more confident and my peers started to look to me for advice and help.

While I cannot pinpoint one specific course that has helped me with this particular situation, I can say that nursing research, and leadership helped me to hone my research skills and become a better leader/teacher for my peers and also for my patients.

Clinical judgment isn’t something that everyone has, but I do believe that it can be learned and that it can be honed if you work at it. By making time to research, read histories, review progress notes from the dietitians/physical therapists/ and other members of the interdisciplinary team, and talk to the patient about their concerns, clinical judgments will be more accurate and patients will be better cared for.

Outcome 3

Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice in a variety of healthcare settings.

The first thing that came to mind when reading the post for this week was the new scanning process for medications. Scanning medications isn’t new, but the process has changed and now all units within the hospital where I work are required to scan where this wasn’t the case until just this month.
Scanning patient medications and the patient identification band on the unit I used to work on was always best practice, however, it wasn’t always done in real time and often, medications were “overrode” for nurse convenience and speed when giving medications. Now, nurses are required to scan the patient band and the medication in real time.

If the medication is a “high alert” medication (some vasoactives, insulin, heparin/lovenox, pediatric medications, PCA and PCEA) another nurse is required to witness and scan their badge into the system for proof that they witnessed the correct medication being given to the correct patient in the correct dose.

This change was not happily accepted as it took time to find another nurse to go into the room with you and made medication administration slower. The process has improved patient safety and decreased medication errors.

The new unit I work on has just started the scanning process. Although some nurses are upset, most have embraced the change because of the benefits. Real time charting, patient safety, and it really is easier than having to go in and document everything by hand.

Outcome 4

Demonstrate basic knowledge of healthcare policy, finance, and regulatory environments including local, state, national, and global health care trends.

This has been a difficult discussion for me to respond to. I am currently in Nursing Policy and Ethics and I find each post and discussion takes me many hours to be able to get my thoughts out in a manner that conveys how I feel and what I know. This is an area where I think constant learning and growth happens (and has to) because it is always changing. Healthcare policy, finance, and regulatory environments are the subject of many topics on all levels of government right now due to Obama Care and other health care options that are being put forth.

Right now there is only one paper that I plan to put into my portfolio. This may change based on the rest of the semester, but for the Public Health Nursing Ethics assignment I not only researched information but I interviewed nurses and physicians on their opinions and experiences regarding the changes in health care and the “us” vs. “them” mentality of the health care community. I learned a lot and am proud of the work I put into the assignment.

Even though I am not as familiar with this subject as I should be, I think that I am in a good position right now because I am currently in the class and there is so much going on in the community it gives me the opportunity to not only take part if I want to, but to understand better the consequences and benefits of proposed changes.

Public Health Nursing and Ethics

Outcome 5

Communicate, collaborate, and negotiate as a member and leader within interdisciplinary health care teams to improve patient health outcomes. 

Trying to remember a time when I had the opportunity to communicate, collaborate, and negotiate as a member and leader of the interdisciplinary team reminded me of the Research class when we researched a topic and reviewed the literature about that certain topic. I chose to research c-diff. At that time there were many cases of C-diff not only among the patients on the post surgical unit where I worked, but two staff members had also gotten C-diff.

I researched this topic for many, many hours and came up with some pretty interesting information. I worked with my manager and spoke with some of the physicians about the research I was doing in hopes they could share some of their expertise with me. After the paper was complete I gave a copy to one of the surgeons to see what he thought about it and I was surprised that he said there was information in my paper that he didn’t know and he would take that into consideration if he had another case of c-diff with his patients. I presented my paper to my clinical educator in hopes it would facilitate change within my unit. Because I was a charge nurse, I talked with the staff during our shift huddles about the information I discovered and encouraged them to follow the small changes outlined. 

Before I quit working on that unit we started to wear full PPE (we were probably supposed to anyway, but no one did) including shoe covers and everyone was better at watching the labs of suspected patients and getting the C. diff test sent sooner. Now that I don’t work there I’m not sure if things are still in place of if they have gone a different route. I plan to include this paper in my portfolio.



Clostridium Difficile Literature Review

Outcome 6

Manage the direct and indirect care of individuals, families, groups, communities, and populations to promote, maintain, and restore health.

During the Community Nursing class I was able to participate in several different health fairs and flu shot clinics. These health fairs consisted of testing glucose, cholesterol, blood pressure and body fat percentages. School district employees, state employees, private businesses in the community all enlisted our services to screen and educate their employees and anyone under the insurance or in the household of the employee. This made it so that I was able to interact with and educate not only individuals but also their families and the community that they worked in  to promote, maintain and restore health.

During my interactions I saw that many people didn’t understand what caused high blood sugar or high cholesterol. They didn’t understand how cholesterol was used in the body or what the consequences were if it were untreated. Many people I saw were obese or nearly obese, had high cholesterol and high blood pressure. Providing education about diet and exercise was not only fun, but it was also rewarding to see them respond and actually seek out change.

In response to the unhealthy lifestyles I encountered I did my Community Health Assessment and plan of action obesity within my community. I put together a plan of action and power point with suggestions for education and health promotion within the community based on the interactions I had with the clients at the health fairs. I enjoyed answering questions, and educating families and the community about lifestyle changes that were easy and maintainable. I plan to include this assessment and power point in my portfolio.

Please access the power point from the link found on the side bar and the Community Health Assessment from the link at the top of the page.

Outcome 7

Integrate professional standards of moral, ethical, and legal conduct into the care of persons, families, groups, communities, and populations.

There are several classes that have helped me to integrate professional standards of moral, ethical, and legal conduct into the care of my patient, their families, groups, communities and the population. The leadership and management class was a good starting point because it helped me to look past what I was currently doing and start to integrate other aspects of decision making and care into my practice. I did a project in that class where I made a hard bound book under the direction of my manager and plan to include that in my portfolio.

Another class that I am finding to be very beneficial is the nursing policy and ethics class that I am currently in. I am learning the different ways that policy is developed and how it is based in part on legal, ethical and moral issues. There are a few assignments that I think I will include in my portfolio from this class but I am still undecided on which ones.

The last class that comes to mind is the Gerontological nursing class. I enjoyed this class and plan to include my journals and visit entries from the elderly person I visited. I learned not only the care of older adults, but also the care of their families and immediate environment.
It’s hard to choose one or two classes that have contributed to my ability to incorporate professional standards into my practice. This program has helped me develop and learn new ways to be a better nurse.

As I look through my past assignments I can’t help but be grateful about the direction this program has taken me in.

I am including my journal and visit entries from Gerontological Nursing because during this course and throughout my experience while visiting with my chosen elderly person, I not only learned a lot about assessment in the older adult, but I also learned patience, compassion, and developed my listening skills.

Gerontological Nursing Assessment Journal/Visit #1
Gerontological Nursing Assessment Journal/Visit #2
Gerontological Nursing Assessment Journal/Visit #3
Gerontological Nursing Assessment Journal/Visit #4

Gerontological Nursing Assessment Journal/ Visit #1

Visit 1 Journal Entry

Description of work

I arrived at Randi’s house on February 1 at 1:15 pm. Upon arriving she was busy with laundry and cleaning her house. After discussing the assignment I felt strange sitting at her table while she was doing her dishes so I helped her load her dishwasher while we talked. I think that this helped to break the ice and allowed us to bond.

I found it hard to remember all of the questions from the Mini Mental Assessment and Geriatric depression scale, so as we worked we talked about her children, family and her new boyfriend. She was married for over 30 years and divorced her husband. During this time she was depressed and often wondered why she was moving on every day. Her son stepped in and made her go online to a dating website specifically designed for older adults. That is where she met her new boyfriend. They have very similar stories and they have been dating for over a year at this point.

After the dishes we done and the kitchen was clean we sat on the couch to do the assessment. Randi answered the questions with ease and appeared happy, laughing often and taking time to ponder the questions so that I could have the most accurate assessment of her.

There were no challenges during this visit, Randi was easy to talk to, laughed and was open with events in her life and openly shared stories of her children, marriage, divorce and her life as she is aging.

Synthesis of visit

From t his visit I learned that talking with her about her day and life was easier than I thought. I tried to start out with the assessment questions but I felt like I was intruding on her and her cleaning.

When I started to help her and stopped worrying about the assignment she was very open to talk to me and when I did start to ask the questions she was honest and forthcoming. I don’t know if I would have gotten the same information if I would have gone in and just followed my agenda and not helped or talked about her interests.

Concepts in this class tie with this visit because I was able to assess her situation, I could see that she is high functioning, she does not require help around her house, although she is happy now she did say that she has been depressed in the past. In the future I plan to talk to her about ways to avoid and deal with depression in the future. The readings that we have done allowed me to view her situation from a provider’s point of view rather than a friend. I think I was able to understand her situation and feelings better than I would have if I had not taken the class or completed the readings.

I need to work on my time management. I only allowed myself a set amount of time for the visit and I felt rushed trying to get all the information needed. In the future I will plan the visit so that I do not have to leave the conversation feeling like it wasn’t finished. I also need to practice my communication skills. There were times in the conversation that I didn’t know what to say or how to lead into another subject and it felt like I was forcing the conversation.

I would like to know more about her divorce, how long it has been since she was divorced and how she handled her depression. What steps she took, if she saw a health care provider or tried to deal with it on her own. 

Plan of Action

Visit #1

Visit with Randi on February 1, 2012 from 1:15-3:00pm

Randi is a Caucasian female who completed her formal high school education but did not go to college as she stayed home to raise her six children. She did open her own daycare after her children were grown and took childcare related classes that were offered in the community.

When performing the Mini Mental Status exam Randi was able to answer all questions correctly and without hesitation.

The Geriatric Depression Scale:

Are you basically satisfied with your life? Yes

Have you dropped many of your activities and interests? No

Do you feel your life is empty? No

Do you often get bored? No

Are you in good spirits most of the time? Yes

Are you afraid that something bad is going to happen to you? No

Do you feel happy most of the time? Yes

Do you often feel helpless? No

Do you prefer to stay home and night, rather than go out and do new things? No

Do you feel that you have more problems with memory than most? No

Do you think it is wonderful to be alive now? Yes

Do you feel pretty worthless the way you are now? No

Do you feel full of energy? Yes

Do you feel your situation is hopeless? No

Do you think that most people are better off than you are? No

Randi has maintained high level of activity and regularly attends community activities. The plan that we decided on together to maintain her cognitive function, maintain her happy disposition and avoid depression is as follows:

Continue to be physically active by walking daily with her social group, riding her bike and hiking with her significant other and to continue to attend social events and outings with friends, family and grandchildren.

Engage in mind stimulating games such as scrabble, cross word puzzles, trivia and other word games. Randi also likes to learn new information and concluded that she will read about a new subject or watch an educational show at least once weekly.

Randi has never ridden the train or utilized it as a means of transportation. She has decided that she wants to gather all the needed information to take a short train ride to Salt Lake with her significant other and spend the day exploring the area.

Gerontological Nursing Assessment Journal/Visit #2

Visit #2

Part 1- Description of work

This time when I made my appointment to visit Randi I did not have a time frame like I did the first visit. I had an open schedule that allowed me to visit for as long as needed without feeling like I was rushing through my assessments or cutting off her answers. When I got to the appointment she was reading a book and waiting for me. She mentioned that she was learning to play the card game hearts and wanted to try and teach me how to play it. I tried to play the game with her, but I wasn’t good at it and so the game didn’t last very long. We did laugh a lot while she was trying to remember the rules and teach them to me.

After the unsuccessful card game we started in on the OARS and DETERMINE assessments which went faster than I had planned. Originally I planned for a break in between those and the activity assessments but since it was so quick I went through and completed them all. When I started to talk to her about Living Wills she didn’t have one and assured me that her kids would take care of her if the time came when she couldn’t make her won decisions. I talked to her about it and why it is important to have one. We got online at her house and printed one off of the Internet. I stressed the importance of having one just in case her kids were not all on the same page as she was. I encouraged her to fill it out and offered to help her but she said that she would do it later.

Things went really well this visit. Our dialogue was open and honest, I felt like she trusted what I was saying and that we are starting to bond with each other. She invited me to look at pictures of her family and shared stories about them. We played scrabble again and before I left we arranged a time when we could meet again for our next visit.

Synthesis of Visit 2’s Experience

I don’t necessarily see a need for a change in my perceptions of older adults and their communication skills. I think that I have always appreciated their life and stories and enjoy when they share stories with me. Some times I think that because I am younger they might not think what I have to say is important, and so if I was to learn better ways at expressing important issues without seeming forceful maybe they would respond better to what I have to say. For instance when I was discussing the importance of Living Wills, I caught myself where it seemed like I was being forceful when really I was just trying to emphasize the importance of them.

I can see that the concepts in this class tie together with my Community Elder Project because I understand the importance of remaining active, remaining social in one’s later years, the importance of cognitive function and keeping the elderly’s cognition sharp as well as maintaining as much independence as possible. I think that because I have taken this class I am able to help the elderly when I’m at work or in other settings remain independent and encourage them to be active not only physically but mentally as well.

I know that there is so much more that I need to know. Every day is a learning experience and every time I have the opportunity to interact and spend time with my elderly patients and neighbors I find that there is one more thing I learn that I didn’t know before.

I still need to work on listening more. Sometimes I find that I want to say something when really it would be OK if I just listened. I also need to practice becoming more comfortable around the elderly. I find that I am uneasy because I’m not sure what to do and I try not to offend them. I realize that we are different generations and there is a difference in how we were raised, so I tend to get uncomfortable when there is an awkward silence or wonder if something I said is being taken the wrong way or even if they think that I have bad manners or am immature.

Visit #2

When assessing my client’s level of support, although she is divorced, she has a boyfriend that she is able to talk to and do activities with on a daily basis. In addition to her boyfriend, she has great family support in the form of her daughters, her son (she has 4 sons, three are unreliable, one is very reliable and she talks to him daily), her grandchildren and her sisters and has no problems finding someone she can trust and confide in. If she were to need to be cared for she has several family members that would care for her indefinitely taking care of her meals, cleaning and helping with her medical needs as well.

The DETERMINE nutrition scale did not find anything significant. She is capable of cooking and buying food for her meals. She does not have a chronic illness that inhibits what she can eat. She enjoys cooking and tries to cook 1 new meal per week or try one new food. She does not take medication besides a daily multivitamin.

No deficits were found when using the Barthal scale as well as the independent activities of daily living scale. She is able to perform all ADL's independently. 

She has good sleep habits and patterns. She gets at least 8 hours of sleep per night. She has a nightly routine that includes her hygiene, yoga and light reading before bed. She does not report waking up or other sleep disturbances. She has a tempurepedic mattress that she states is very comfortable, she sleeps with a white noise machine and has found that having her her room dark and cool helps her sleep better.

She does not have a living will. Right now she is not interested in making a living will and says that her children can take her of her and know what she wants.

The plan to help her maintain her independence is still to continue with her cognitive activities such as scrabble and cross word puzzles. Recently she has picked up the game "hearts" and is trying to learn that as well. She will continue with her daily exercises to maintain her strength and agility and hopefully prevent falls or other injuries. She will also continue to cook one new healthy food recipe per week and has decided that she would like to try the new meal out on her son and his children. I printed out a copy of a living will from online and encouraged her to fill it out and give a copy of it to her children so that they are aware of her wishes.

Gerontologic Nursing Assessment Journal/Visit #3

Visit #3

Part 1- Description of work

When visiting with Randi for the third time our schedules didn’t coordinate as well as they had in the past but we managed to get together for a short time. Talking with her this time we discussed her falls risk, her activities and any new things that she was doing. She has been trying to bike ride 6-8 miles per day in order to maintain her health, keep her balance but she said mostly because she enjoys the scenic route that she mapped out.

She continues to play scrabble, cross word puzzles and attempts to play Hearts with her boyfriend. She says that although she still doesn’t play the game very well, she enjoys the mental challenge of remember all the rules and playing it. Because our schedules did not coordinate as well this time we did not play any games like we did on the last visit. Instead after talking for a short while we started the assessment portion of the visit.

The health history was long, and we were both sure that we had already completed one on the last visit, but because we weren’t sure we continued and finished it. Taking her history was like taking one from a young adult. She doesn’t complain of any problems, past health issues other than arthritis in her fingers and some vision changes that have occurred with age. We discussed maintaining her prescription for her glasses and if it was easy for her to get to the doctor. She rides her bike to her doctor’s office and ophthalmologist’s office; both are about half a mile away. She says that if she needed to drive she could borrow her son’s car.

Performing the Tinetti Balance test was interesting and although she wasn’t sure about some of the things I was asking her to do (close her eyes and turn in a circle) she was a good sport, participated and did very well.

Overall this visit was successful, out dialogue was smooth and it was very clear that we have been able to develop a trusting relationship. I was disappointed that she had not filled out the Living will paperwork yet, but she said that she would do it when her daughters came to visit. At our next visit I plan to sit and fill it out with her if it isn’t’ done at that time.

Synthesis of Visit 3’s Experience

I tend to feel the same way that I felt after our last visit in that I don’t see a need to change my perceptions of older adults and their communication skills. Maybe I am visiting with the best older adult, but we communicate easily, honestly and we seem to enjoy our time together. I still feel as though there is so much that I can learn from them, and so much that they can learn from me. I need to learn how to express myself and my ideas in a way that doesn’t come across like I am teaching, but rather talking and have them learn from me that way. Sometimes I feel like if I am always trying to teach someone in a formal way that they tune me out. If we are able to have a conversation that flows smoothly and has good dialogue I think that they will learn more and remember more of what I am trying to teach them. I do realize that I might not have done as well a job as I thought on our last visit when discussing the importance of living wills and so this time I tried to stress that again, but as I said before, if it isn’t done at our next visit I will sit with her and try to complete it with her.

I still see that the concepts I have learned in this class help me with my Community Elder Project because I understand the importance of remaining healthy, staying active and doing activities that will strengthen not only their body but also their minds as well as enabling them to maintain as much of their independence as they can. Because I have taken this class I am able to help the elderly when I’m at work and in other settings remain independent and encourage them to be active not only physically but also mentally.

I don’t think that I will ever feel like I know enough about the elderly community that I need to stop learning. Everyday I learn new things whether it has to do with my children, my job, the elderly or myself and I know that as long as I am open to learning opportunities and take advantage of them that I will continue to grow and develop my skills.

As always, I still need to work on listening. I think that this will be something that I struggle with my entire life. I find that I always want to say something even when I should listen. I still need to practice being comfortable around the elderly. I’m afraid I’ll say or do something that will offend them or make them think I’m a silly young girl and so I come off as awkward and uneasy.

Visit #3

When assessing my client’s level of pain and amount of pain I found that she has a slight amount of pain in her fingers that she thinks is from arthritis and sometimes her legs hurt after she is really active throughout the day. The pain is tolerable and she manages it with Ibuprofen as well as Bengay rub. It doesn’t prevent her from performing her activities of daily living or her leisure activities.

After using the Health history form found in the text on page 60-62 I found that she is generally very healthy and takes an active role in her own health and health maintenance. She is retired, takes care of herself as well as babysitting her grandchildren. She doesn’t have problems with nutrition and states that she tries to eat a balanced diet including fruits, vegetables, dairy and keeps away from sugars and sweets. Her only complaint at this time is that she feels like she needs a new prescription for her glasses. We discussed the importance of keeping her prescription up to date as it would reduce her risk of falling and improve her ability to stay active and maintain her independence.

When discussing and evaluating her falls risk we found that it was low. She does not suffer from neuropathy, joint problems, pain in her feet, vertigo, hearing or balance problems. As stated before, she requires prescription glasses and has slight pain in her hips after an active day, but again, it does not limit or prevent her from doing her ADLs. I performed the Tinetti Balance and gait evaluation to assess her fall risk and was pleased to have her get a perfect score. She easily maintained her balance, steadiness, and gait and attributes it to the fact that she tries to stay active on a daily basis.

Due to her active lifestyle we have been able to maintain the same plan of care, only adding a few other activities that will help maintain her cognitive and physical abilities.  She continues to play scrabble, cross word puzzles and says that although she hasn’t gotten very good at the game “hearts” she still enjoys playing it as it is a challenge for her mentally. She will continue with her daily exercises to maintain her strength and agility and help her to prevent falls and other injuries. We discussed the living will at our last visit, I printed a copy off of the Internet and she has not yet filled it out. I offered to help her fill it out, but she declined saying she will do when her daughters come to visit in a few months. She has been lucky to have avoided any chronic illness or health problems to date and by keeping up with this plan we hope it will prevent any future health problems from occurring.

Gerontological Journal/Visit #4

Description of Visit #4

On the last visit for the class I was happy to see that Randi had her Living Will filled out. She had sent a copy to her daughter to keep on file and she had a copy at her house as well. I also gave Randi a flyer I made with some health promotion activities, a few activities in her area that promote health as well as some free health clinics that were coming up. I tried to include activities that I know she already enjoys doing and information that will help her maintain her health.  Some of the things I included in the flyer are:

Activities:

Antelope Moonlight Bike Ride. July 6, 2012 at 10:00pm at the Antelope Island Marina and is lit by the full moon. http://daviscountyutah.gov/go/moonlight/

Utah Valley Women’s Expo in Orem on April 20 and 21. This is at UVU in the events center from 11-8:00pm www.utahvalley.org/events/details.aspx?ID=1646

Health Promotion in the area:

Autumn Glow Senior Activity Center (801)544-1235; Golden Years Senior Activity Center (801) 295-3479; North Davis Senior Activity Center (801) 525-5080. http://www.daviscountyutah.gov/health/family_health/senior_activity_centers/default.cfm

Activities at these centers include Legal Aid, Blood pressure monitoring, Bingo, Lunch (Mon-Fri), Ceramics and China Painting, Knitting, Crocheting, Low impact Aerobics, Exercise groups and equipment, Dances, Trips and Tours, Tai Chi and painting to name a few.

Davis County Health Promotion Bureau. http://www.daviscountyutah.gov/health/family_health/health_promotion/default.cfm

This site has programs for Heart Health, Injury prevention and safety, Nutrition, Physical Activity and Tobacco Prevention.

Health Fairs in the area that I included:

Family Health and Wellness Fair at the South Davis Recreation Center in Bountiful. April 27, from 11-7:00 and April 28 from 10-4:00

“Get F.I.T” Health Fair at the DATC in Kaysville on May 1 from 10-1:00

Arthritis Fair in Salt Lake on April 20 and noon. This is a free seminar that is put on by a physician discussing how to maintain an active lifestyle while suffering from arthritis. 1002 E South Temple

Part 2 – Synthesis of Visit

I learned a lot from the visits with Randi. I enjoyed talking and playing games with her and seeing how physically and mentally active she still is. I hate to say it, but in the past when an elderly person would come into the hospital “Full Code” status I never understood it. Why would they want to be full code when their quality of life was so poor? I have learned so much not only from visiting with her, but also in the class and have changed my mind and attitude.

I recognize that there are not enough resources out there for the elderly, and the few that I was able to find were all the same. There needs to be more available for all different activity levels and interests. Its seems like BINGO is a typical one, but who really likes to play that? I would be very interested to find other activities and free fairs/clinics for the elderly to help them maintain their independence and health. In the long run, this would benefit everyone as there wouldn’t be as many chronically ill elderly patients putting a strain on the economy.

Clostridium Difficile Literature Review

Tawna Bruun

Literature Review

Nurs 3600

Article #1: Prevention and Control of Clostridium Difficile Infection

Clostridium difficile (C. diff) is an anaerobic Gram-Positive bacillus. Infection with C. diff usually happens when the normal flora in the colon is altered because of broad-spectrum antibiotic use. Symptoms of C. diff  range from mild diarrhea to profuse, watery diarrhea. Instances of large areas of intestinal epithelium becoming necrosed with ulceration and life-threatening perforation have occurred.

Transmission of C. diff is by the fecal-oral route. Transmission can take place in the hospital from the workers and environmental reservoirs (urinals, bedpans). Spores can live month or years if not properly destroyed by detergent. Treatment of C. diff can be done by IV vancomycin or oral metronidazole. Infection prevention and control can be accomplished through meticulous hand hygiene, isolating the patient, and environmental cleaning. Hand hygiene (using soap, water and friction and avoiding alcohol products as they are not effective and do not kill the spores) and Personal Protective clothing (such as gown, gloves, and shoe covers) can help to prevent and control the spread of the disease.

Reference

Gould, D. (2010). Prevention and control of clostridium difficile infection. Nursing Older People, 22(3), 29-37. Retrieved from http://web.ebscohost.com.libproxy.dixie.edu/ehost/detail?vid=4&hid=13&sid=13c78a82-5606-409e-9615-ec0413be58e9@sessionmgr14&bdata=JmxvZ2luLmFzcCZzaXRlPWVob3N0LWxpdmU=

Article #2: Clostridium Difficile Infection: Risk factors, diagnosis and control

Clostridium difficile (C. diff) is one of the most common causes of nosocomial diarrhea in humans. Morbidity and mortality rates for C. diff have increased in many developed countries and is estimated to be responsible for about 3 million cases of diarrhea and colitis each year. C. diff spores pass through the gastric acid in the stomach and germinate in the small intestine.. C. diff may be accompanied by toxic mega colon, electrolyte imbalance and occasional bowel perforation. There are several risk factors associated with C. diff. Age, immunoglobulin level, antibiotic treatment, surgical manipulation, and antacid and other treatment regimes. C. Diff is transmitted by commonly  touched surfaces in hospitals such as bed rails, telephones, call buttons, door knobs, toilet seats and bedside tables of rooms in which the patient has C. diff. Treatment and control include metronidazole and vancomycin, and avoiding unnecessary proton pump inhibitors. Health care workers must wear gloves, appropriate chemicals need to be used to clean and disinfect.  Disinfection with 10% bleach and chlorine-based compounds are shown to inactivate C. diff spores.

Reference

Koleci, X., & Janvilisri, T. (2012). Clostridium difficile infection: Risk factors, diagnosis and control. Albanian Journal of Agricultural Sciences, 11(1), 21-28. Retrieved from http://web.ebscohost.com.libproxy.dixie.edu/ehost/detail?vid=8&hid=13&sid=13c78a82-5606-409e-9615-ec0413be58e9@sessionmgr14&bdata=JmxvZ2luLmFzcCZzaXRlPWVob3N0LWxpdmU=

Article #3: Clostridium difficile: Implications for nursing

Clostridium difficile is a health care challenge due to the many complications it can cause (hypovolemia, sepsis, pain, peritonitis). C. difficile colonizes in approximately 40% of hospitalized patients due to the spores frequently present in the environment on the floors, side rails, bathroom and health care worker’s hands. Signs and symptoms of C. difficile include abdominal fullness, abdominal discomfort, malodorous frequent loose stool, elevated white blood count, elevated temperature, and signs of dehydration. Nursing management includes discontinuing the prescribed antibiotic, administering a different antibiotic to treat the infection, assessment of temperature, WBC count, skin care, assistance with bowel elimination. Also important is the use of contact precautions, keeping surfaces disinfected with hypochlorite-based cleanser or household bleach diluted with water (1:10)/. It is important to teach patients and their families to wash their hands with soap and water and not use alcohol based cleansers as they are not effective.

Reference

Grossman, S., & Mager, D. (2010). Clostridium difficile: Implications for nursing. MEDSURG Nursing, 19(3), 155-158. Retrieved from http://web.ebscohost.com.libproxy.dixie.edu/ehost/detail?vid=14&hid=13&sid=13c78a82-5606-409e-9615-ec0413be58e9@sessionmgr14&bdata=JmxvZ2luLmFzcCZzaXRlPWVob3N0LWxpdmU=

Article #4: Hospital infection control strategies for vancomycin-resistant Enterococcus, methicillin-resistant Staphylococcus aureus and Clostridium difficile

Four key hospital interventions are the cornerstone for infection control of Clostridium difficile among other diseases. These cornerstones are hand hygiene, environmental cleaning, barrier precautions and screening. Patients who have an infections serve as reservoirs for microorganisms. Risk factors for colonization include age, severity of illness and the use of antibiotics. Although alcohol based cleansers are an important part of hand hygiene they are not effective in killing C. difficile, only the use of soap and water is. Keeping a clean environment and using disinfectant solutions known to kill the virus. Barrier precautions to use include gloves and gown and placing the patient in contact precaution and a private room. Screening ill patients who show symptoms of C. diff and identifying patients who are ill in a timely manner so treatment can begin is imperative to treating and reducing the spread of the disease.

Reference

Johnston, B. L., & Bryce, E. (2009). Hospital infection control strategies for vancomycin-resistant enterococcus, methicillin-resistant staphylococcus aureus and clostridium difficile. Canadian Medical Association Journal, 180(6), 627-631. Retrieved from http://web.ebscohost.com.libproxy.dixie.edu/ehost/detail?vid=23&hid=13&sid=13c78a82-5606-409e-9615-ec0413be58e9@sessionmgr14&bdata=JmxvZ2luLmFzcCZzaXRlPWVob3N0LWxpdmU=

Article #5: Clostridium difficile- Associated Disease Diagnosis, Prevention, Treatment, and Nursing care

Clostridium difficile-associated disease (CDAD) includes diarrhea, pseudomembranous colitis, toxic megacolon, perforation of the colon, and in some cases, sepsis. The use of high-risk antibiotics, reduction in housekeeping staff, increased nursing workloads, antiquated facilities and general changes in hospital populations (increased number of immunocompromised, debilitated, and elderly patients) and contributing factors. C. diff spores are resistant to many types of disinfectants, heat and dryness and may remain on surfaces for months. Transmission is via the fecal-oral route. Healthy people are able to keep C. diff at bay due to the healthy flora in the gut. The use of antibiotics and medications and decrease stomach acidity, such as proton pump inhibitors cause the bacteria to proliferate. To prevent the spread of C. diff hands must be washed with an antimicrobial soap for at least 15 seconds. Hands should be washed before and after contact with a patient and after glove removal. Cleaning with 1:10 bleach solution is recommended. High touch surfaces such as doorknobs, light switches, call lights, television remote control, soap dispensers, faucets, bed rails and telephones need frequent cleaning. Nursing care includes preventing dehydration, promoting comfort, and maintaining skin integrity.

Reference

Pelleschi, M. E. (2008). Clostridium difficile- associated disease diagnosis, prevention, treatment, and nursing care. Critical Care Nurse, 28(1), 27-36. Retrieved from http://web.ebscohost.com.libproxy.dixie.edu/ehost/detail?vid=25&hid=13&sid=13c78a82-5606-409e-9615-ec0413be58e9@sessionmgr14&bdata=JmxvZ2luLmFzcCZzaXRlPWVob3N0LWxpdmU=

Article #6: In the Clinic: Clostridium difficile Infection

Transmission occurs through the fecal-oral route, usually by person-to-person transmission. Contaminated fomites and the hands of health care workers are another source of transmission. The primary means of prevention are to limit the use and type of antibiotics and to adhere to infection control measures. This includes using the appropriate environmental cleaning solutions, limiting the use of antibiotics, and strict hand washing. Conventional hand washing with soap and water should be adhered to when caring for patients during an outbreak or suspected outbreak. Wearing gloves and gowns if contact with patient is to occur is also necessary (the use of gowns has not had any trials however is recommended because C. diff has been cultured from the uniforms of workers).

Reference

Clostridium difficile Infection. (2010). Annals of Internal Medicine, 153(7), ITC4.1-ITC4.16. Retrieved from http://web.ebscohost.com.libproxy.dixie.edu/ehost/detail?vid=28&hid=13&sid=13c78a82-5606-409e-9615-ec0413be58e9%40sessionmgr14&bdata=JmxvZ2luLmFzcCZzaXRlPWVob3N0LWxpdmU%3d#db=aph&AN=54279457

Article #7: Preventing healthcare-associated infections: risks, healthcare systems and behaviour.

Modern health care generates a wide range of infection risks for patients through practices that compromise the patient against infection. To prevent infections from spreading the use of hand hygiene is important. During the normal work activities of the healthcare provider, they transfer a patient’s own microorganisms from one body site to another, they transfer microorganisms from one patient to another patient, they transfer microorganisms to and from the equipment they are working with. Portable equipment must be cleaned and disinfected prior to contact with a patient and their environment.

Reference

Ferguson, J. K. (2009). Preventing healthcare-associated infection: risks, healthcare systems and behaviour. Internal Medicine Journal, 39(9), 574-581. doi:10.1111/j.1445-5994.2009.02004.x Retrieved from http://web.ebscohost.com.libproxy.dixie.edu/ehost/detail?vid=28&hid=13&sid=13c78a82-5606-409e-9615-ec0413be58e9%40sessionmgr14&bdata=JmxvZ2luLmFzcCZzaXRlPWVob3N0LWxpdmU%3d#db=aph&AN=44218307

Article #8: Role of hand hygiene in healthcare-associated infection prevention

Healthcare workers’ hands are the most common vehicle for the transmission of healthcare-associated pathogens from patient to patient. Optimal hand hygiene is considered the cornerstone of healthcare-associated infection prevention. Following the widespread use of alcohol-based hand rubs concern has been raised about their lack of efficacy against spore forming pathogens. Friction while washing hands with soap and water may help to physically remove spores from the surface of contaminated hands. The use of alcohol based hand rubs has been blamed for the increase in C. diff associated disease rates although there has not been a study to prove this to date of this article. The improvement of healthcare workers compliance to hand hygiene will decrease the spread of infection within the hospital setting.

Reference

Allegranzi, B., & Pittet, D. (2009). Role of hand hygiene in healthcare-associated infection prevention. Journal of Hospital Infection, 73, 305-315. doi: 10.1016/j.jhin.2009.04.019