NURS 4100 – Nursing Care of Children Essay Paper

NURS 4100 – Nursing Care of Children Essay Paper

Objectives:

• Don’t like to mingle with others.
• When talked to, he always looked at different directions.
• Isolate him from others.
  We will write a custom essay sample on Nursing Care Plan for Impaired Social Interactionor any similar topic only for you

• Does not participate in ward activities.

Subjective: “Ayoko sa kanila makihalubilo minsan kasi pakiramdam ko sasaktan nila ako at pinagtritripan. ” |Impaired Social Interaction related to social isolation of self to others. A state in which an individual participates in either an insufficient or an excessive quantity of social exchange, or with an ineffective quality of social exchange. |Short Term: Within 1 week of nursing interactions and interventions, the patient will: NURS 4100 – Nursing Care of Children Essay Paper

1. Minimize his pacing in different directions when talked to.
2. Develop a therapeutic nurse-client relationship through frequent, brief contacts and an accepting attitude.
3. Respond to social contacts in the environment such as interacting with the staff for a specific period of time.

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Long Term: Within 3 weeks of nursing interactions and interventions, the patient will:

1. Demonstrate effective social interaction skills in both one-on-one and group settings.
2. Will maintain a good relationship with other patients.
3. Demonstrate appropriate social interactions.

Independent:

1. Provided opportunities for socialization and encourage participation in group activities.
2. Allowed patient time to reveal delusions to you without engaging in a power struggle over the content or the reality of the delusions.
3. Used a supportive, emphatic approach to focus on patient’s feelings about troubling events or conflicts.
4. Helped patient to identify behaviors that alienate him from the environment.
5. Assisted patient in learning neutral social topics such as weather or local events. Dependent: 1. Administered medications as ordered and checked after administering. NURS 4100 – Nursing Care of Children Essay Paper

Collaborative: 1. Encouraged same nurse to work with the client.

1. To increase the client’s abilities and confidence in socializing.
2. To understand the feelings he is experiencing.
3. Empathy conveys your caring, interest and acceptance of the client.
4. To explore the feelings he is undergoing.
5. To develop a greater success in social interactions.

To control signs and symptoms of hallucinations and delusions of the client and to verify if he swallowed the medicines.

1. To promote development of trusting relationship. |Short Term Outcome: Met After 1 week of nursing interactions and interventions the client was able to: 1. Minimized his pacing in different directions when talked to.
2. Developed a therapeutic nurse-client relationship through frequent, brief contacts and an accepting attitude.
3. Responded to social contacts in the environment such as interacting with the staff for a specific period of time. Long Term Outcome: NURS 4100 – Nursing Care of Children Essay Paper

Met After 3 weeks of nursing interactions and interventions the client was able to:

1. Demonstrated effective social interaction skills in both one-on-one and group settings.
2. Maintained a good relationship with other patients.
3. Demonstrated appropriate social interactions.

Vietnam’s population is older and older and it is important for young people, especially politicans, to seriously think about the issue of nursing homes. Should elderly parents live in nursing homes or not? Sending elderly parent into nursing homes is the best choice for them in the rest of their lives for three main reasons. First, elderly parents live in nursing homes will be good for their children. Nowadays, young people are too busy. They have o go to work and have no time to take care of their parents. NURS 4100 – Nursing Care of Children Essay Paper

They leave their parents at home lonely for whole day and feel nervous about their parents. Consequently, they can not concerntrate on their work and nursing homes are a good choice for them to send their parents into. Second, when elderly line in nursing homes, they can make friends with the people at the same age. They will fell very happy because they can chat whole day with their friends, do some helpful excercises such as jogging, tai chi, instead of being lonely at home when their children go to work.

Third, the most important reason, is that nursing homes can provide elderly parents with modern health care facilities. In nursing homes, professional doctors, nurses and high quality equipments are always available to take care of elderly parents. Doctors here also give them a suitable diet which is good for their health. Opponents of sending elderly parents into nursing homes say that elderly parents will fell lonely when they live far from their children and it is also against Vietnamese moral value. However, as stated previously, nursing homes are the place which provide old people with the best health care. Moreover, their children can come and visit them whenever they want. In conclusion, there are undoubtly many benefits to send elderly parents into nursing homes. Most of old people who live in nursing homes show that they live better and happier with their friend here. Sending elderly parents into nursing homes becomes an important issue for both young people and elderly parents themselves to think about. NURS 4100 – Nursing Care of Children Essay Paper

In Sprakes and Tyrer’s (2010) research article entitled “Improving Wound and Pressure Area Care in a Nursing Home”, the effectiveness of wound and pressure ulcer management was examined. The rate of wounds and pressure ulcers in a nursing home is often an indicator of the quality of care received as these injuries can lead to illness and a decreased quality of life (Sprakes & Tyrer, 2010). Sprakes and Tyrer have identified gaps in overall management of wound and pressure ulcers.

They have also identified a large volume of referrals regarding advice and support for wounds and pressure ulcers.

For these reasons the authors’ research was aimed toward whether utilization of a new wound and pressure ulcer management system in the nursing home would decrease rate and severity of these injuries (Sprakes & Tyrer, 2010). The reason this article was selected for critique was due to personal encounters with pressure ulcers in the nursing home setting and first-hand observations of the debilitating effects they can have on an individual. NURS 4100 – Nursing Care of Children Essay Paper

Summary Research took place in a nursing home that was selected due to observations of poorly managed wounds and pressure ulcers.

The authors’ overall aim of the research was to “improve outcomes for patients requiring wound and pressure ulcer management” (Sprakes & Tyrer, 2010, p. 47). The authors planned on meeting this goal through improving staff knowledge, improving documentation, and finally encouraging owners to uphold the proper standards of care. Before implementing their management framework, the authors obtained data to establish a control. The authors collected data over a six month period regarding frequency of wounds and pressure ulcers and regarding the number of times additional support nurses were contacted to aid with wounds/pressure ulcers.

Next, staff knowledge was assessed regarding wound and pressure ulcer assessment and management (Sprakes & Tyrer, 2010). The authors then created a unique competency-based framework. This competency-based framework served as the standard of care to be used throughout the project. It also served as an evaluating tool when measuring staff performance. From there the authors then went on to discuss the project with the staff. Concerns, barriers, and benefits were all discussed as the authors felt “if staff understand why change is occurring, they are more likely to implement the required change” (Sprakes & Tyrer, 2010, p.

47). When implementing their competency-based framework the authors selected four nurses to be supported through the program. Only four were chosen due to the amount of time required to support each individual member. The four nurses then received two theoretical training sessions with a day on wound assessment and a day on pressure ulcer prevention and management (Sprakes & Tyrer, 2010). Once complete, the nurses worked alongside one of the authors in implementing the framework in the clinical setting. Completion of the process took an average of six weeks per nurse (Sprakes & Tyrer, 2010). NURS 4100 – Nursing Care of Children Essay Paper

After completion of the program the four nurses had their knowledge reassessed and another set of data was collected over a six month period to allow time for the nursing staff to incorporate the framework into practice (Sprakes & Tyrer, 2010). After analyzing the data, the authors found a 77% decrease in the number of wounds and a 57% decrease in the number of pressure ulcers. The data also revealed a significant increase in wound and pressure ulcer documentation and a decrease in the number of contacts to supportive nurses. When reassessed the staff demonstrated an increase in knowledge and skill.

Overall the authors came to the conclusion that both the nursing staff and patients considerably benefited from the project. Based off the results, they encourage the implementation of similar projects in other nursing homes (Sprakes & Tyrer, 2010). Analysis of the authors’ references affirms their appropriateness to the study; however, 66% of the references used are not current as indicated by a publication date greater than 5 years. Critique Based on the article, the authors’ purpose of the study was apparent and the results were conclusive. NURS 4100 – Nursing Care of Children Essay Paper

The authors’ decision to implement an evidenced-based wound assessment tool was a great choice as it significantly benefited documentation rates as one was not being used in the nursing home prior. Through this choice it was evident that the authors were able to help the nursing staff to “ensure the credibility of their profession and provide accountability for nursing care” (North Carolina Concept-Based Learning Editorial Board, 2011, p. 2324). When analyzing the study it clearly demonstrates the impact that proper guidelines and education can have on wound and pressure ulcer management.

Through education the authors were able to aid the nursing home in preventing the occurrence of more wound and pressure ulcers as “prevention is the goal for the clients at risk for pressure ulcers” (NCC-BLEB, 2011, p. 1918). Although this article is a good resource for information and statistics on wound and pressure ulcers, it is not recommended for individuals looking for particular nursing interventions used for wound and pressure ulcers. While the authors did broadly explain their competency-based framework, they lacked depth in explaining specific information and interventions taught and used throughout the project.

In conclusion, this work greatly contributes to the nursing profession because it created a unique quality management plan that has the potential to better numerous nursing homes and improve the lives of many patients. References North Carolina Concept-Based Learning Editorial Board. (2011). Nursing: A concept-based approach to learning (Vols. 1-2, pp. 1915-1926, 2324, 2425). Upper Saddle River, NJ: Pearson Education, Inc. Sprakes, K. , & Tyrer, J. (2010). Improving wound and pressure area care in a nursing home. Nursing Standard, 25(10), 43-49. Retrieved from http://search. ebscohost. com/login. aspx? direct=true&db=rzh&AN=2010893921&site= NURS 4100 – Nursing Care of Children Essay Paper

Approximately 1.4 million elderly people reside in long term care facilities, such as nursing homes. The families that admit their loved ones to these long term care facilities believe that excellent care is being provided to them. Many of the residents in nursing home settings receive adequate health care, but a numerous amount of other residents are subjected to abuse and neglect. It is believed that nearly one-third of all nursing homes have residents that are subjected to abuse either by staff or other residents (Masters in Health Care).

Definitions of elder abuse vary. It is difficult to pinpoint exactly what actions or inactions constitute abuse. Besides a variety of definitions, the major types of abuse that occur in nursing homes are categorized into physical abuse, sexual abuse, emotional or psychological abuse, neglect, abandonment, financial or material exploitation. The solution to such nursing home abuse is rather simple. To prevent the inhumane treatment of the elderly in nursing homes, the nursing shortage needs to be addressed. NURS 4100 – Nursing Care of Children Essay Paper

The scandal of elder abuse in nursing homes appears to be new phenomena, but in reality this god forsaken crime has occurred for decades. Due to an elder’s physical and cognitive make up, they are not able to defend themselves from the heinous acts of abuse by their caregivers. Abuse in nursing homes is mainly thought of as physical aggression, but the elderly are subjected to psychological abuse also. One would think that no man or woman could commit abuse onto a helpless individual; however the issue of elderly abuse in nursing homes has been a growing problem. In 2003, there were 20,673 complaints of abuse, gross neglect, and exploitation on behalf of nursing home and “board and care” residents (American Association for Justice). By 2010 the number of elderly abuse complaints rose to a number between one million and two million (National Center on Elder Abuse). NURS 4100 – Nursing Care of Children Essay Paper

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A study prepared by the staff of the Special Investigations Division of the House Government Reform Committee found that thirty percent of nursing homes in the United States (5,283 facilities) were cited for almost nine-thousand instances of abuse over a recent two year period. The common problems of the study included untreated bedsores, inadequate medical care, malnutrition, dehydration, preventable accidents, and inadequate sanitation and hygiene. These common problems can be categorized into the major types of elder abuse in nursing homes. Physical abuse, sexual abuse, psychological abuse, neglect, abandonment, and financial exploitation are considered the major types of such abuse.

Physical abuse is defined by the use of physical force that may result in bodily injury, physical pain, or impairment. Physical abuse may include but is not limited to such acts of violence as striking (with or without an object), hitting, beating, pushing, shoving, shaking, slapping, kicking, pinching, and burning. In addition, inappropriate use of drugs and physical restraints, force-feeding, and physical punishment of any kind also are examples of physical abuse (National Center on Elder Abuse). Nearly sixteen-percent of nursing home abuse cases involve physical abuse (Brent & Adams). An article published by ABC news interviewed Helen Love, a 75 year-old grandmother of three that was a victim of nursing home abuse. Helen told ABC, “He choked me and he went and broke my neck. NURS 4100 – Nursing Care of Children Essay Paper

He broke my wrist bones, in my hand. He put his hand over my mouth.” Two days after the interview, Helen Love died. Nursing home officials did not report her beating to a state official who was at the nursing home at the time. Ultimately, though, Love’s attacker served a year in prison. An investigation revealed that he had been fired by two previous nursing homes for aggressive behavior. A report by the Senate Select Committee on Aging found that many nursing home abuse cases are not immediately reported to law enforcement official (Robinson). In fact, a recent report indicated that one in fourteen incidents of elder abuse where not reported to the authorities (American Association of Justice).

Emotional or psychological abuse is defined as the infliction of anguish, pain, or distress through verbal or nonverbal acts. Emotional/psychological abuse includes but is not limited to verbal assaults, insults, threats, intimidation, humiliation, and harassment. In addition, treating an older person like an infant; isolating an elderly person from his/her family, friends, or regular activities; giving an older person the “silent treatment” and enforced social isolation are examples of emotional/psychological abuse (National Center on Elder Abuse). Almost twenty percent of reported elder abuse cases involve emotional abuse (Brent & Adams). With emotional abuse being the most abundant, it is also the most difficult to define. Emotional abuse is purely subjective which therefore is difficult to reprimand nurses against these crimes. The other major crimes however are objective, and are more easy to identify, such as neglect. NURS 4100 – Nursing Care of Children Essay Paper

Neglect is defined as the refusal or failure to fulfill any part of a person’s obligations or duties to an elder. Neglect may also include failure of a person who has fiduciary responsibilities to provide care for an elder (e.g., pay for necessary home care services) or the failure on the part of an in-home service provider to provide necessary care (National Center on Elder Abuse). According to Brent & Adams, twelve percent of abuse cases involve caretaker neglect.

Neglect typically means the refusal or failure to provide an elderly person with such life necessities as food, water, clothing, shelter, personal hygiene, medicine, comfort, personal safety, and other essentials included in an implied or agreed-upon responsibility to an elder (National Center on Elder Abuse). The Federal Bureau of Investigation published an article in May of 2012 about a case of nursing home neglect. The owner of three Georgia nursing homes, George Dayln Houser, was convicted in Atlanta of defrauding Medicare and Medicaid for $32.9 million dollars.

To receive Medicare and Medicaid payments, Houser agreed to provide his residents with a safe and clean physical environment, nutritional meals, medical care, and other assistance. Houser not only failed to maintain a nursing staff sufficient to take proper care of the residents but did not pay food suppliers or providers of pharmacy and clinical laboratory services, medical waste disposal, trash disposal, and nursing supplies (FBI). Neglect, alongside physical abuse, are the most detrimental to a residents health. Not only do caregivers subject their residents to the atrocious crimes of neglect, but they also exploit them financially and materially. NURS 4100 – Nursing Care of Children Essay Paper

Financial or material exploitation is defined as the illegal or improper use of an elder’s funds, property, or assets. Examples include, but are not limited to, cashing an elderly person’s checks without authorization or permission; forging an older person’s signature; misusing or stealing an older person’s money or possessions; coercing or deceiving an older person into signing any document; and the improper use of conservatorship, guardianship, or power of attorney (National Center on Elder Abuse). In 2009, a Chicago nursing home worker faced financial exploitation and aggravated identification theft charges for allegedly stealing $4,008 from a Illinois nursing home. The criminal remained free on bail and was fired from the Illinois nursing home. Authorities acknowledge that the criminal had a previous criminal conviction for forgery (Nursing Home Blog).

The major types of nursing home abuse have a direct correlation to inadequate staffing levels. A recent statistic by the American Association for Justice, found that ninety-percent of United States nursing homes had staffing levels too low to provide sufficient care. Residents of those nursing homes falling below minimal staffing standards are much more likely to develop bedsores and experience excessive weight loss than those in other nursing homes. This is because enough staff must be available so that all residents who cannot eat by themselves receive help. Also, unless immobile elderly residents are repositioned frequently, they may develop bedsores. To add to the problem, understaffing contributes to low morale and frustration among employees, decreasing their ability to deal with residents patiently and respectfully. NURS 4100 – Nursing Care of Children Essay Paper

According to the American Association for Justice, a series of reports revealed that many nursing homes do not have enough staff to meet the levels recommended by federal officials (3.45 nursing hours per patient daily) and nursing home experts (4.55 nursing hours per patient). Insufficient hours per patient hosts all sorts of potential problems for nursing care, the most problematic being neglect.

Many nursing home residents need constant nursing attention to ensure that they do not develop medical problems. In many cases, residents need to be turned, moved, or given skin assessments to avoid developing pressure ulcers or from forming deadly blood clots. John A. Fisher, Ph. D, said there have been an alarming amount of recent cases in which New York nursing homes have been found liable for elder abuse after a resident died or was injured due to inadequate care. In every case, inadequate staffing was named as a contributing factor to the cause of the abuse. With inadequate staffing being the undeniable cause of nursing home abuse, how does the projected nursing shortage effect this issue?

The projected nursing shortage in the United States is expected to intensify as baby boomers age and the need for health care grows. “In the July/August 2009 Health Affairs, Dr. Peter Buerhaus and coauthors found that despite the current easing of the nursing shortage due to the recession, the U.S. nursing shortage is projected to grow to 260,000 registered nurses by 2025. A shortage of this magnitude would be twice as large as any nursing shortage experienced in this country since the mid-1960s. In the article titled The Recent Surge In Nurse Employment: Causes And Implications, the researchers point to a rapidly aging workforce as a primary contributor to the projected shortage (American Association of Colleges of Nursing).” NURS 4100 – Nursing Care of Children Essay Paper

In some instances today, nurses are forced to attend to 20 patients at a time, and that is at the lower part on the nurse- patient spectrum. Federal law requires Medicare and Medicaid certified nursing homes to have an registered nurse (RN) director of nursing (DON); an RN on duty at least 8 hours a day, 7 days a week; and a licensed nurse (RN or LPN) on duty the rest of the time. However, there are no minimum staffing levels for nurse’s aides, who provide most of the day-to-day care. Instead, nursing homes are required “to provide sufficient staff and services to attain or maintain the highest possible level of physical, mental, and psychosocial well-being of each resident. (Elder Law Answers)” If a nursing home met only the federal nurse staffing requirements described above, a resident would receive 20 minutes of nurse time per day.

In 2000, the Centers for Medicare and Medicaid Services (CMS) reported that the preferred minimum staffing level was when nursing home residents received three hours of total staff time per day — two hours of nursing assistant time and one hour of licensed nurse time. The optimum staffing level, according to the CMS, is one hour of licensed nurse time and three hours of nursing assistant time (Elder Law Answers).

Most states have standards that are higher than the federal requirements, but still fall short of the levels recommended by the CMS. According to a recent study, the key to improving nursing home staffing levels is increasing state standards. The study by Charlene Harrington, a UCSF School of Nursing professor, found that states with the highest standards for nursing staff levels are the only states where nursing homes have enough staff to prevent serious safety violations. According to the study, the act of raising the state minimum staffing ratio has a direct impact on the quality of care nursing home residents receive. With such an impact that state and federal standards have on quality of care, how can the state enforce nursing homes to follow such mandates? NURS 4100 – Nursing Care of Children Essay Paper

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According to an article published by nursing home reality endorsed by Aaron Delurey, the best way to ensure that residents are receiving an ample amount of care is for state officials to introduce these three procedures: Have each state mandate an increase in the percentage of surprise inspections that must take place outside of regular business hours on weekdays. Second, require management personnel to work staggered shits all the time, not just when the state is in their building. Why require this change?

When the management is out of the building the quality of care given often suffers. Third and foremost, when the state shows up for an any kind of inspection, the inspectors should immediately seize the payroll data to verify staffing levels for the 14 continuous days immediately prior to the inspection. The inspectors should also insist that while they are in the building that no additional staff can be called in. These procedures would ultimately address the nursing shortage, therefore depleting the abuse within nursing homes. NURS 4100 – Nursing Care of Children Essay Paper

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