The purpose of the paper is to provide a summary and reflection of the article on nursing safety. Patient violence in acute care psychiatry setting is a major concern for registered nurses. The key points to be discussed include the impact of patient violence on the outcomes of the organization and nurses. Additionally, the paper will discuss the different strategies used by nurses to prevent and handle patient violence as well as to maintain their personal safety.
According to Stevenson, Jack, Omara and LeGris (2015), Registered nurses are at increased risk of experiencing violence from patients and families in the workplace. The study has shown nurses have reported being victims of violence, which affects their ability to effectively deliver medical services and quality care to patients in psychiatric settings. It is evident that exposure to violence has an adverse impact on the nurse's outcomes as well as that of the organization. For instance, it can have a psychological and emotional effect on nurses. Examples of the physical impact that nurses may experience include disability, which can either be temporary or permanent as well as injuries. The psychological consequences may include decreased job satisfaction, anxiety, anger, or Post Traumatic Stress Disorder. The negative outcomes of patient violence on the organization include decreased morale, high staff turnover rates, increased medical errors, increased costs associated with disability leave, nurse absenteeism, hostile work environments, and reduces the quality of patient care.
In this research study, Stevenson et al. (2015) indicate that nurses use various strategies to manage patient violence. These strategies include the use of a team approach and nurse-centered approaches that are focused towards maintaining personal safety, controlling the situation, and preventing any further cases of violence. However, nurses have reported these strategies to be ineffective to address the current issues and thus provided a suggestion of more appropriate methods of preventing and managing patient violence. These include creating a supportive work environment by the management, debriefing after an incident has occurred, and improving education to enhance nurse’s knowledge on how to effectively deal with patient violence and enhance nursing safety. It also entails the establishment of the best practice guidelines to minimize patient violence and to eliminate the obstacles to reporting experiences of violence.
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Since I started my nursing profession back in 2005, I have had some personal and professional experiences regarding patient violence. I have become increasingly aware of patient violence over time and has had a negative impact on my ability to effectively carry out y nursing role in psychiatric settings. One example of patient violence I experienced include an incident with a family member who was admitting a patient in the psychiatric ward. The admission process as still underway but the family member insisted on taking the patient to the ward. When I asked him to wait, he started yelling and cursing in front of patients and other staff. Another example of patient violence I experienced occurred when I was physically attacked by a patient when administering drugs to him. The patient did not like taking medication, and the moment he saw me approaching, he attacked me by beating me up. Fortunately, I was rescued by other male nursing practitioners. This incident left me with significant injuries on my face. Moreover, another example occurred when I was redirecting a particular patient with cognitive impairment. I had directed him several times but seems not to be understanding. Therefore, I told him to pay attention while giving him instructions. The patient felt that I was rude towards him and thus he became violent. I felt terrified and afraid and left the scene immediately (Stevenson et al., 2015).
Nursing safety is an essential aspect of the nursing profession and the work environment. However, it is being compromised by patient violence that has a significant effect on nurses and organizational outcomes. Various strategies such as the creation of a supportive environment have been suggested as an appropriate measure to tackle patient violence. Therefore, it is essential to understand nurses’ experiences of patient violence to establish interventions that would adequately address the problem.
Evidence Based Practice on Pediatric Health Promotion and Protection
Poor quality newborn and maternal care is a major concern across the continuum of care. It leads to high rates of maternal mortality, psychological morbidity, and acute and chronic illness among newborn and mothers. This aspect has resulted to the need for implementation of affordable, sustainable, and effective improvements in quality of care such as midwifery. Midwifery can improve care and outcomes by minimizing neonatal and maternal morbidity and mortality, promoting public and psychosocial health outcomes, reducing number of unnecessary interventions, and decreasing preterm birth and stillbirth (Renfrew et al., 2014).
Midwifery has significant contribution to the quality of care of infants and women and facilitating effectiveness of newborn and maternal care providers.
Midwifery and its Contributions to Maternal and Newborn Quality of Care
There exists an increasing consensus among public health professionals that midwifery care is a crucial component in promoting high-quality newborn and maternal services. Midwifery is defined as the practice of compassionate, knowledgeable, and skilled care for newborn infants, childbearing women, and families throughout the scope of care in pregnancy, pre-pregnancy, post-partum, birth and the period of early life. Souza, Gülmezoglu and Vogel et al. (2013) indicate that although there are other interventions that have proved to minimize mortality rate among the newborn and maternal, midwifery has been proved to be an evidence-based framework that enhances quality of care for maternal and newborn care. It consists of working in collaboration with women to improve their capabilities for self-care and that of their families, respect the individual opinions and situations, timely prevention and management complications, cultural, psychological, biological, and social reproduction process and early life, and consultation and referral to other more advanced services. Therefore, these aspects makes midwifery to be a more reliable intervention to improving maternal and newborn care.
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Some case studies offer opposing views and arguments against the implementation of the midwifery practice in nursing care. They suggest that putting more efforts on emergency and faculty based care can contribute significantly towards minimizing perinatal and maternal mortality. They argue that the scope of midwifery care can only be effective if it has a balancing effect but without it, it cannot work. They reveal that the midwifery care practice strategy has in some cases led to fast increasing numbers of needless, costly, and possibly iatrogenic interventions as well as disparities in the delivery of care and outcomes (Black, Victora & Walker et al., 2013). Moreover, the case studies indicate that despite the implementation of the midwifery care in countries such as China and Brazil, they are among the nations in the world with prevalence of caesarean sections. Also, India records high number of mortality rate and disparities associated with poverty despite its current development in economy. The poor outcomes have been linked to scarcity of resources for prevention of mortality rate and care for maternal and newborn (Finlayson & Downe, 2013).
According to the writer’s opinion, midwifery is related with more effective utilization of resources that lead to improved outcomes. The writer suggest that improved outcomes can be achieved if essential measures are put in place such as the midwifery services being provided by well educated, licensed, trained, and regulated midwives. The International Labour Organization (ILO) defines a midwife as an individual who has finished the midwifery education programme successfully, demonstrates the qualifications to be licensed legally to practice midwifery, and exhibits competency in midwifery practice (Ryan, Revill, Devane and Normand, 2013). Information and education are crucial component in maternal and newborn care whereby it enables women to learn what they need to know and have comprehension of the services of the organization so that they can have access to them in a timely manner. Moreover, well trained and educated health care professionals demonstrate cultural competence and clinical knowledge and interpersonal skills who are able to provide personalized needs and care in a kind, empathic and respectful way thus eliminating inequalities in maternal care. Furthermore, midwifery practice can be enhanced through improved communication and good quality clinical care are a combination of factors required to provide the safety of newborn infants. Factors such as disrespectful care or low quality services have a negative impact on worldwide minimization of newborn and maternal morbidity and mortality. These factors makes it difficult for women to access healthcare services and meet their needs thereby contributing to high mortality and morbidity rate among mothers and newborns. Therefore, the writer believes midwifery is a new evidence-based framework that would contribute towards achievement of high-quality newborn and maternal care and enhanced maternal and neonatal outcomes.
It is evident that midwifery is an integral approach towards eliminating factors that contribute to poor maternal and neonatal outcomes. It comprises of supportive and preventive care that enhances the capabilities of women in offering self-care and across families. It focuses on improving the normal reproductive process, meeting individual needs, and promote respectful relationships, which facilitates accessibility of emergency treatment and management of complications that improves quality of care and outcomes. Hence, its implementation of midwifery as a quality framework across the community and facility settings and effective interdisciplinary teamwork would contribute significantly improving maternal and neonatal outcomes.
The bacterial and viral infections have posed a significant challenge because of considerable resistance to drugs. Arcangelo, Peterson, Wilbur, and Reinhold (2017) have further acknowledged the difficulties involved in identifying proper antimicrobial agents to be a serious challenge to manage the bacterial and viral infections. With the ability of the bacteria to develop resistance, these microbial agents have become life-threatening. Nonetheless, it has proved necessary to develop appropriate medicines which can avoid antibacterial resistance. The development of better medication can be achieved when stakeholders direct careful attention TO the use of these drugs in human beings and animals. To this effect, this article focuses on describing categories of these antimicrobial agents, describing the differences between bacterial and viral infections, and explaining the reasons for proper identification of bacterial and viral infections.
Categories of antimicrobial agents
The antimicrobial agents are synthetic, semi-synthetic, or natural substances which can inhibit or disrupt the growth of microbial organisms; however, they cause insignificant harm to the host (Arcangelo et al., 2017). Although antibiotics are antimicrobials, some antimicrobials are never antibiotics. Studies have identified various antimicrobial agents including anti-parasitic, antiviral, antifungal, and antibacterial drugs (Arcangelo et al., 2017). These antimicrobial agents can help to prevent diseases and infections which are caused by pathogens. Antibacterial drugs have been used in inhibiting the pathogenic activity associated with criteria. For example, antibacterial drugs like Zithromax have helped to treat bacterial infections. The antibacterials are common drugs which many physicians have misused, especially when prescribing for patients with viral respiratory tract (Tanwar, Das, Fatima, & Hameed, 2014). With the widespread use of these drugs, the antibiotic-resistant pathogens have emerged leading to serious threats to the public health. The growth of resistance to the drug has called for new strategies to identify the best bioactive compounds to resolve the situation.
Antifungal drugs have helped many patients in preventing the growth of fungi. In most cases, physicians use these drugs to treat fungal infections, such as thrush, ringworm, and athlete foot (Scourfield, Waters, & Nelson, 2011). The fungal drugs have the capacity to kill fungal organisms without affecting the host. The fungal drugs could present adverse effect on the user when improperly prescribed. Similarly, the antiviral agents are medications or drugs which are used to treat viral infections like the human immunodeficiency virus (Arcangelo et al., 2017). The antiviral drugs can stop the pathogenic activities. Many antiviral drugs have the potential of treating retrovirus infections, especially HIV. The protease inhibitors are the most common antiretroviral drugs. Finally, the antiparasitics are known medication class meant to treat infections associated with parasites including infectious protozoa, trematodes, nematodes, and amoeba. The antiparasitic drugs like anthelmintics can inhibit the growth of parasites (Steckelberg, 2017).
Differences between viral and bacterial infections
The viral and bacterial infections share many common features because both infections are caused by viruses and bacteria or microbes. Similarly, these types of infections are spread through contact with infected microbial or creatures like insects, livestock, pets, and insects. Bacterial and viral infections can also be spread through sneezing, coughing, contact with contaminated substances, and infected people. These microbes can also cause latent infections which can rarely indicate symptoms but can appear after some years or months. They may also cause chronic and acute infections can last for even a lifetime (Ratini, 2017). Without a doubt, viral and bacterial infections can cause severe, moderate, and mild syndromes.
It is no secret that millions of people across the world have succumbed to various diseases including the Black Death or Bubonic plague which was associated with smallpox, and Yersinia pestis bacteria (Ratini, 2017). Recently, viral infections for various pandemics like the Spanish flu which killed millions of people and the current HIV/AIDS epidemic which continues to reclaim millions of lives across the world (Mayer & Krakower, 2012). Viral and bacterial infections could share some symptoms, such as cramping, fever, fatigue, diarrhea, coughing, vomiting, sneezing, and inflammation which point to the role of immune system in responding to the infectious organisms. However, viral and bacterial infections are also distinct because of the structural differences of organisms and responses to medications.
Viruses and bacteria are small agents which can rarely be seen without the microscope but remains distinct. The bacteria are single-celled and complex creatures whose membranes and walls are thin, rigid, and rubbery (Ratini, 2017). The bacterium reproduces on their own. Interestingly, these microbes can survive difficult environments such as radioactive and cold waste. Nevertheless, bacteria appear harmless as they can help in food digestion; therefore, provide essential nutrients, fighting cancer cells, and destroy disease-causing microorganisms. Compared to bacteria, viruses are tinier and have a protein coat with core genetic materials. Unlike the bacteria, viruses can never live devoid of a host because they need to attach to cells to reproduce. Interestingly, these viruses transform normal cells into cancerous or malignant cells.
Reasons for proper identification of viral and bacterial infections
The proper identification ensures the physician avoids drug resistance, especially of the microbes causing infections. In most cases, microbes cause bacterial and viral infections which have since evolved to be resistant to the drugs. Therefore, improper identification makes it difficult to achieve the plan of treatment (Leekha, Terrell, & Edson, 2011). Proper identification enhances the use of vaccination; hence preventing microbes from causing malady.
Antimicrobial agents are essential in treating various bacterial and viral infections because they inhibited the growth or mutation of microbes. With proper prognosis, it has become possible to treat bacterial and viral infections. As exhibited in this paper, there are different categories of antimicrobial agents which have proved critical to proper identification of the microbes to avoid mistakes. Nonetheless, the bacterial and viral infections are either similar or distinct depending on various factors including the structure.
Information Systems in Nursing
Information technology seems to have defined the future of health system. The healthcare modernization has completely improved care delivery today. In the past decades, healthcare providers and stakeholders have invested in technology expansion; thus, using the computer programs to perform the administrative process. With patient care becoming a primary focus in creating new knowledge and concept, healthcare technology has defined the current trend in healthcare and clinical applications. Given the significance of information technology in healthcare, it becomes critical to discuss how the current information system has helped to deliver quality patient care and improve patient outcomes by assessing the four competencies.
Nurses are professionals entrusted with offering quality patient care and improve clinical outcome. Based on this function, the nurses rely on the scholarship of application to make it a germane to practice. They are expected to apply their classroom theory into practice. The nursing faculty promotes the scholarship of applications in different ways, such as staff development, consultation work, clinical problem solving, and advanced clinical practice (Cashin & Cook, 2010). Therefore, an effective scholarship and evidence-based information ensure the nursing professional gets the grip and knowledge needed in the field.
The healthcare industry has acknowledged the significance of communication in the delivery of services because healthcare practitioners and information technology personnel must engage and address the issues affecting patient care (Gerrish & Lacey, 2013). With the nurse informatics, the healthcare delivery process can support high-quality, safe, and patient-centered care. The nurse informatics integrates computer science and nursing science to communicate and manage data; thus, utilize the knowledge and information for nursing practice (Campbell, 2013). The nursing informatics ensures nurses utilize information technology to enhance patient outcomes, nursing research, nurse education, and healthcare management. With the information technology, healthcare setting has found it possible to integrate telehealth, mobile laboratories, online appointment scheduling, and electronic medication prescription. The informatics nurses have guaranteed the computerized solutions, therefore, accomplishing information-related activities and assure an efficient workflow.
The healthcare information has become a vital element in nursing because it involves documentation. The information systems have helped nurses to utilize their knowledge regarding quality patient care. The use of electronic patient record has improved service delivery and quality of nursing care. With the help of these e-patient records, the information workflow has improved because the use of information technology has improved efficiency and patient outcome quality (Al-Rawajfah, Aloush, & Hewitt, 2014). Patient documentation has helped nurses in communicating the conditions of patients and organizes care based on the needs of patients. Therefore, an electronic documentation assembles information about patient needs; hence making it possible for nurses to improve the accuracy of patient’s information leading to quality patient care.
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Studies have demonstrated that a properly designed information system has the potential of facilitating faster and efficient information flow needed for processing documentation (McBride, Delaney, & Tietze, 2012). Without a doubt, nurses continue to play a critical role regarding patient’s safety and this must be supported by quality electronic documentation and nursing environment. According to Al-Rawajfah et al. (2014), the evolution of electronic documentation has guaranteed patients the best care plan because communication between clinicians has improved; hence, improving processes related to direct patient care. The nurse researchers are always diligent and they prefer using the information system to coordinate, monitor, and deliver patient care based on the efficient documentation flow (McBride et al., 2012). The nurse researchers have relied on computer-based software to collect, store, retrieve, and restore data as well as integrate clinical data with available nursing management resources. Nurses need essential data to interpret and make decisions. They can also use the computers to schedule staff, order medications, and manage time through electronic medical records.
The information management technology tools designed for healthcare are unique and complex. They require the nurse to possess relevant skills to handle and interpret them for an efficient delivery of quality patient care. It encompasses the nursing informatics which combines IT and nursing (Schwartz, 2012). With the nursing information management technologies, especially nursing informatics, it has become possible to blend information systems with the nursing expertise to deliver quality patient care. The information technology has helped to improve nursing practice by transforming clinicians’ decision-making process because the information stream is made efficient. The nurse informatics and nurse leaders have to introduce proper information structure, technology, and information processes which can facilitate the integration of data, knowledge, and information; thus, supporting patients (Schwartz, 2012). Therefore, ICTs use in this sector educates patients and health professionals, improves quality patient care, and enhances patience-centered services.
In conclusion, it is undeniable that information technology has transformed healthcare industry by promoting clinical outcomes and quality patient care. Nursing informatics provides an opportunity for clinicians to encompass their inputs in designing information system infrastructure; hence improve patient care. For instance, the electronic health records have enhanced communication workflow; therefore, making it easy for nurses to share relevant information regarding patient’s needs. The nurse leaders and informatics nurses should encourage evidence-based practices among nurses through research and scholarships. This is the only way nurses will fit in the technological era and deliver quality patient care efficiently.
Epidemiology and Communicable Diseases: Tuberculosis
Tuberculosis (TB) is one of the infectious diseases which affect the lungs. Unlike other diseases, this communicable syndrome is caused by more than a single agent. Today, TB is the second leading killer in the world. In fact, a report posted by Mclntosh (2017) on the Medical News Today shows that over 1.8 million people die from the syndrome while 10.4 million falls sick. In the nineteenth century, this epidemic was widespread in North America and Europe until the microbial causes were identified. Because of this discovery, vaccines and drugs were introduced; thus, making people believe that the disease was defeated. In fact, even the UN had predicted that TB would be no more by 2025 (Mclntosh, 2017). However, the situation worsened in the subsequent years leading to the WHO decision to declare it a global emergency. The disease continues to cause havoc among the global population leading to this research.
Description of TB
The TB is a communicable disease caused by different infectious agents. Many health practitioners have distinguished the disease into two based on the TB infections. To this effect, they have classified them into active and latent TB (Debi, Ravisankar, Prasad et al., 2014). Active TB is caused by bacteria with symptoms, which make it possible to be transmitted to others. On the other hand, in latent TB, the infectious agent or bacteria is confined in the body where it remains in an active form. These inactive bacteria show no symptoms; hence making them not contagious. Studies have predicted that about thirty percent of the global population has latent TB and the possibility of the inactive TB becoming active is imminent. The individuals whose immune systems have compromised because of malnutrition, smoking, and HIV are vulnerable (Mclntosh, 2017).
The major cause of this communicable disease is the Mycobacterium tuberculosis complex (Bernando & Roncarati, 2012). This bacterium is unique because it can be spread through the air, especially whenever an individual with the syndrome coughs, talks, laughs, sneezes, and spits. Although this disease is communicable, catching it is never easy because the chance to catch it from a person whose lungs are infected, especially a stranger is difficult. However, a person can contrast it when an individual interacts with workmates and family members. Sometimes the disease can be transmitted through droplets and mucus or saliva when expelled through the air.
Currently, studies are yet to provide symptoms for latent TB because the inactive TB never shows signs of infection (Mclntosh, 2017). Nonetheless, the symptoms may develop gradually but individuals need regular checkups. Although it can affect any organ, the lungs are the most common. The most common symptoms of active TB include a cough, fatigue, weight loss, chest pain, fever, and night sweats. Loss of appetite, chills, and shortness of breath could also be attributed to TB.
When diagnosed with TB, doctors can prescribe proper treatment and prevention measures to the patient. In fact, there are several antibiotics which physicians have recommended to treat TB because of its bacterial infections nature. For patients with TB lung infections, doctors would combine up to 4 antibiotics for at least two months of therapy. The most common antibiotics which doctors prescribe for TB patients include ethambutol, isoniazid, pyrazinamide, and rifampin (Mclntosh, 2017). The complications have also been identified by different studies, especially where the syndrome is never treated swiftly (Debi et al., 2014). Although this contagious disease affects the lungs and spread through the air, it can be spread through blood leading to fatal complications including heart disorders, joint damages, meningitis, kidneys and liver damages, and spinal pain.
Demographic most affected
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TB remains the leading killer disease in the world as reported by WHO in 2018. By 2016, the WHO reported that 10.4 million people were suffering from the scourge. The world lost 1.7 million people to the disease who included about 0.4 million people suffering from HIV. Unfortunately, it has emerged that the majority of the TB death cases are reported in middle- and low-income economies. China, South Africa, Nigeria, Pakistan, Indonesia, and the Philippines are the leading countries in terms of incidences because they account for about 64 percent of the total global infection. The multidrug-resistant TB has become the public health crisis. Today, the incidence of TB is declining at 2 percent annually and WHO predicts the rate would accelerate to about 5 percent by 2020 (WHO, 2017).
Although TB can affect anyone, there are certain groups who are more vulnerable. In the United States, for instance, the foreign-born individuals seem to be affected disproportionately (ALA, 2013). It affects all age groups, but it mostly affects people and young adults residing in the emerging economies. Regarding gender, males were likely to contract the syndrome than male. Nonetheless, in 2011, the incidence reduced by over 50 percent in both genders (ALA, 2013).
The determinants of health affecting TB
Social determinants of health have affected TB as explained by Hargreaves, Boccia, Evans et al. (2011). The growing consensus has indicated that controlling TB in middle- and low-income patients will need significant investments in treatment, diagnostics, and control programs. This falls under the policymaking determinants which will help in improving population health. The social determinants of TB entail the use of practical ideas that would support the efforts to reduce the scourge. The social determinants encompass interventions beyond the health sector including urban planning and social protection; therefore, strengthening TB control (Millet et al., 2013). This shows that the key risk factors would include overcrowding and poor ventilation in communities, homes, and workplaces; hence, exposing healthy individuals to the disease. Studies have also found that hunger, malnutrition, and poverty can increase the severity of clinical results and susceptibility to infection (ODPHP, 2018). In most cases, TB patients who experience severe coughs experience economic and social barriers; thus, delaying appropriate diagnosis leading to stigmatization.
The epidemiologic triad
The epidemiological triad remains the most popular tool that has enhanced explanation of the spread of diseases in communities. The triad consists of different factors including an environment, host, and agent which make it possible for the identification of interventions, transmission and investigate the epidemiology of TB (Bernando & Roncarati, 2012). Mycobacterium tuberculosis is an agent which transmits the disease. The Mycobacterium tuberculosis complex is a rod with the potential of reproducing slowly. The bacterium is hypersensitive to ultraviolet light and heat. Although the disease affects the lungs, it can have an impact on other organs, such as kidneys, reproductive organs, joints, bones, lymph nodes, and intestines (Raviglione & Sulis, 2016). Since 1990, THE TB death rates have declined by over 35 percent despite being the leading infectious killer (WHO, 2017).
The bacterium is spread through airborne droplets, talking, sneezing, and coughing. With smaller droplets in the air left by an infected individual, the healthy person can inhale the infected air. The TB can also be passed from one family member to another than strangers (Raviglione & Sulis, 2016). Mycobacterium tuberculosis is also an agent of the disease because any susceptible person (host) can readily spread it by exposing the respiratory system in an environment or public gathering or communal settings. Other environmental factors which can expose a person to the disease include overcrowded housing, immigrants, homeless, racial minority, prison systems, and impoverished (Bernando & Roncarati, 2012).
Role of the public health nurse
Healthcare workers are some of the healthy individuals whose immune systems can be susceptible to the syndrome. This is because they are exposed to illness in the hospitals and public health facilities. Since the public health nurses handle the TB patients, they are at risk for the disease (Raviglione & Sulis, 2016). Importantly, these professionals are responsible for treating and detecting the actively infected individuals; hence, prevent TB transmission within the clinical setting.
The public health nurses always engage in surveillance and investigation of the disease. During the investigation, the infection control nurses, clinicians, or the pharmacists have the capacity to report cases of active TB cases. This is because early reporting is necessary for controlling and preventing the disease. The nurse has the capacity to collect data from the infected individuals to compare infected patients and the trends. Since health departments conduct contact investigations regularly, the cases of pulmonary TB can be detected and acted upon. The health department through the staff would notify the exposed contacts; thus, allowing the contact to schedule for testing. The health department staff is expected to conduct a follow-up test some months after the last exposure to determine whether the case is active or inactive. Therefore, the health nurse strives to work collectively with the community and care providers.