Wednesday, January 29, 2020

Pressure Ulcers in the Hospital Essay Example for Free

Pressure Ulcers in the Hospital Essay Introduction   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Pressure ulcers remain a common health problem throughout the health care system. It has been conservatively estimated that annually 1 million adults develop pressure ulcers due to faulty nursing or care management. The incidence rates vary greatly depending on the health care sector. However, pressure ulcer incidence rates for hospitals range from 0.4% to 38%, for skilled nursing facilities from 2.2% to 23.9%, and for home health agencies 0% to 17%. The development of pressure ulcers occurs when there is sufficient progressive or reoccurring pressure over time to case capillary destruction, which in the end results to tissue necrosis. The development of a pressure ulcer or failure to prevent such condition from progressing to a more severe stage can result in negative consequences for the health care system (Fitzpatrick and Wallace, p.482). Nursing research has remained at the force-front in building knowledge-based related to pressure ulcer prevention. Pressure ulcers have become a quality issue for all areas of health care. The incidence and severity of the condition are used as markers of quality of care by agencies and acute care hospitals. This emphasis on pressure ulcers across the spectrum of health-care settings highlights the importance of the condition for clinicians (Sussman and Jensen, 2007 p.337). Pressure ulcer management can be based on clinical practice guidelines, which can be a source of enhancement for care plan development. The existing guidelines are broad based and general and, as such, for a good basis for wound care when the goal is comfort as well as healing (Coyle and Ferrel, 2005 p. 320). Purpose of Research   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The purpose of the study is to illustrate the physiological relationship between wound healing and the occurrence of pressure ulcers in hospital work-settings in order to provide means to come-up with another research procedure. In this case, we have utilized various quality researches and validated supporting studies in order to illustrate probable connections. Critical analysis, comprehensive data integration, and interpretation of research outcomes are the founding methodologies applied in the course research. The value significance of this study provides awareness to the public especially in terms of what can these contributing factors impregnate to the condition occurrence. The relationship of wound healing and the occurrence of pressure ulcers are necessary knowledge contribution in the field of health care; since, this is one of the major quality indicators in the clinical setting. Problem and Rationale   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Pressure ulcers or decubitus ulcerations are the result of mechanical injury to the skin and underlying tissues. The primary forces involved are pressure and shear, which is the perpendicular force or load exerted on a specific area causing ischemia and hypotoxia of the tissues. High-pressure areas in the supine position are the occiput, sacrum, and heels. In the sitting position, the ischial tubersosities exert the highest pressure, and the trochanters are afflicted in the side-lying position (Beck 2005, p.205).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   As the amount of soft tissue available compression decreases, the pressure gradient, consequently, increases, and vise versa. The occurrence of these pressure ulcers are greatly manifested on bony prominences where there is less tissue for compression and the pressure gradient within the vascular network is altered easily upon compression. The changes in the vascular network allow an increase in the interstitial fluid pressure, which exceeds the venous flow. This results in an additional increase in the pressure and impedes arteriolar circulation. The capillary vessels collapse and thrombosis occurs. Increased capillary arteriole pressure leads to fluid loss through the capillaries; hence, tissue edema, and subsequent autolysis results. Lymphatic flow is decreased as well, allowing further tissue edema that contributes to the occurrence of tissue necrosis (Sussman and Jensen, 2007 p.337).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Unfortunately, there is substantial evidence to show that many patients develop their sores in hospital. Versluyen (1995) demonstrated that 66% of patients admitted with fractures involving hip developed pressure ulcers in hospital. This particular medical condition occurs almost exclusively among the elderly and involves immobilization for at least 24 hours. Areas such as accident and emergency, X-ray department, and theatres are all implicated in the causation of pressure sores as trolleys in these areas have been shown to generate pressures (Walsh and Ford, 1999 p.71).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Pressure ulcers are serious and frequent occurrence among the elderly, especially those who are immobile and debilitated. There are estimated 1.5-3 million Americans affected. A pressure ulcer will develop in approximately 5% of patients admitted to acute care hospitals. Studies have shown that 60% of pressure ulcers develop in the hospital, 18% in the nursing home, and 18% at home. Pressure ulcers prolong the hospital stay, and the pre-operative mortality rate is increased to 27%. The prevalence of pressure ulcers in the long-term care setting is reported to be 15-25% at the time of admission (Moylan, 2003 p.55). Obstacles and Solutions The problem of pressure development is a natural consequence of faulty health care management, poor health care quality, and negligence. Such condition is now associated, especially those with prolonged pressures, with contractures and/or shearing forces that frequently occur during transfers. Without diligent behavior modification related to skin inspection, and unless intervention strategies are employed to abort the process of skin breakdown, there will always be an open invitation to local, systemic, and generalized infection caused by pressure ulcerations (Whiteneck, 1993 p.231).Various proposed treatments in enhancing wound healing of pressure ulcerations are expensive and to be considered rare; hence, the treatment means may still be unrealistic. In this case, another research to enhance pressure ulceration healing is through the use of therapeutic air mattresses. According to the research of Sinclair and the group (2004), the utilization of air mattresses can further enhance the conditions of wound healing among pressure ulceration incidents. The proposed argument of the research involves the effectiveness of traditional turning and positioning protocols, which is evidently predominant in the nursing setting, and the therapeutic air mattresses. The study has covered elderly patients not less that 75 more than 75 years of age and in a condition of long-care term facility. Upon the progression of the overall research process, the results obtained do suggest that therapeutic mattresses are effective in preventing and healing ulcers. However, considering surface characteristics between beds utilized are still on the process of determining. Therefore, the clinically accepted practice of bed turning and repositioning still needs to be adhered until further research proves such intervention absolutely effective or otherwise (Sinclair, 2004).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   However, further researches may be suggested especially in air mattresses’ effectiveness in providing healing enhancements as well as pressure ulcer prevention. Such procedure is more practical and publicly realistic than the other proposed treatment measures. Research in antimicrobial application for the benefit of pressure ulcers should be well researched again considering the number of subjects involved in the research. The implication of such methodologies in accordance to wound healing involves the utilization of bed mattresses as the most economic and nursing-care enhancing procedure for clinical setting. If such procedure is proven effective, nursing efforts of bed turning and repositioning shall be reduced significantly. If such procedure is proven effective, treatment measures on such condition can be enhanced in terms of cost-effectiveness and practicality. In general view, pressure ulcer occurrence in a particular clinical setting connotes decreased quality of care management; since, pressure ulcers are prevented acceptably through bed turning and repositioning; hence, such methods are essential. Prevention of pressure sores in the hospital is a complicated process involving the assessment of complicated factors and accordingly the recommendation of interventional strategies. The traditional idea that the nurse alone should be responsible for the prevention of pressure ulcers is therefore ineffective (Coyle and Ferrel, 2005 p. 320; Webster, 1991p.53). A team of nursing and medical staff responsible for this task can produce more effective outcomes in terms of preventing such pressure sore occurrences. Nevertheless, the nurse remains the most essential part of such a team and acts as the main source of information about patient condition (Webster, 1991p.53). Executive Summary and Conclusions The problem of the study is basically the occurrence of pressure ulcers among hospital setting, which on the irony, should not even occur due to the presence of clinical managers. The condition of pressure ulcer is basically caused by prolonged stationary immobility conditions of the patient, such as those with paralyzed conditions, unconscious, in coma, and basically immobile. With prolonged immobility, the parts of the body exposed to pressure, such as bony prominences (e.g. trochanters, hip area, scapular region, etc.) are the usual site for its occurrence. The etiological character of the pressure acts in two ways in order to induce the condition: (1) Obstruction of vascularization, which further impedes oxygenation of the area causing tissue necrosis, and (2) prevents healing process of the area. Pressure ulcerations have been a major health care problem as well as the indicators of adequate and proper delivery management of care. In such case, it is therefore necessary to maintain strict, adequate and the best possible appropriate intervention against the occurrence of pressure ulcerations. In the light or research developments progressing in the medical field, various wound enhancing treatments have been proposed in order to enhance the means of curing pressure ulcers. Hospital setting accounts as the highest place of occurrence of pressure ulcerations with percentage rates of 60% as of 2002 survey. The primary age group involved is the elderly individuals who are usually prone to immobilizing conditions, such as (CVA) Cerebrovascular Accident, cardiac problems, etc. With the impaired capacity of the patient to move, pressure accumulates in those sites afflicted; hence, inducing the condition of ulcerations or sore-formation. There are two basic rationales that cause the condition of pressure ulcers for the elderly: (1) aging conditions that impairs the skin integrity of the aged patients, which further predispose them from the conditions of pressure ulcers, and (2) degenerative conditions that cause their immobility. The obstacles of such condition occurrence involve the faulty care delivered by the health care managers (nurses and medical physicians). Hospital management is the prime essential intervener of the condition. In fact, clinical settings view that such condition depicts the status of health care system in the hospital. The justifications of such perspectives are based on the logic that nursing and medical interventions involved in this condition are the most basic procedure of health care field. The inadequacy of proving such care protocol is mainly the responsibility of the health care team. As with the standard protocol of bed turning and positioning, the patient obtains reduction of risks in terms of pressure ulcerations. However, nurses are not the only one involved in the care management of such condition but also the medical care team, although nurses are the primary managers of care delivery for this condition. With the advent of nursing research and enhanced interventions, air mattresses has been deemed to reduce the risks of bed sore formations. As the conducted study proposes, air mattresses reduces the pressure thus aiding in the partly oxygenation of the area exposed to pressure. Such action helps prevent and even slows down the progression of pressure ulcerations. However, due to the small population size of the research, further study has been advised. If the study is proven effective, this may provide decrease work load from the health care practitioners and also helps prevent or reduce the risk of progression of the condition. References Beck, J. C., Ferrell, B. (2005). Geriatrics Review Syllabus. Blackwell Publishing. Coyle, N., Ferrell, B. (2005). Textbook of Palliative Nursing. Oxford University Press Publishings. Fitzpatrick, J. J., Wallace, M. (2006). Encyclopedia of Nursing Research. Springer Publishing Publisher. Moylan, K. (2003). The Washington Manual Geriatrics Subspecialty Consult. Lippincott Williams Wilkins. Rai, G. S., Mulley, G. P. (2002). Elderly Medicine: A Training Guide. Informa Health Care. Sinclair etal, H. J. (2004, February). Do Therapeutic Mattresses Enhance the Healing of Pressure Ulcers in the Frail Elderly Population?. American Journal of Nursing, 62, 243-2451. Sussman, C., Jensen, B. (2007). Wound Care: A Collaborative Practice Manual. Lippincott Williams Wilkins. Walsh, M., Ford, P. (1999). Nursing Rituals, Research and Rational Actions. Elsevier Health Sciences. Webster, J. G. (1991). Prevention of Pressure Sores. CRC Press. Whiteneck, G. G. (1993). Aging With Spinal Cord Injury. Demos Medical Publishing.

Monday, January 20, 2020

Essay --

Cousin Kate is a poem about a young woman who is seduced by a Lord. He soon ensnares her and marries her cousin Kate instead, leaving behind a broken-hearted cottage maiden. The maiden is soon classed as a fallen woman and is treated like an outcast in society. She is bitter and jealous of her cousin but soon reveals that she has the one thing her cousin does not and desperately wants: a son and replacement to the Lord. The poem begins by saying ‘I was a cottage maiden’. It is a simple beginning, talking in the past tense. She tells us she is lower class person. It later says she is ‘Hardened by sun and air’ this shows that the cottage maiden is strong and worked outside on land and it also suggests by the use of the words â€Å"contented with my cottage mates† that she was happy and a sense of community . Then it says ‘why did a great lord find me out,’ this tells us that the lord has been chasing after her and she has been caught by him. In this stanza there is a question asked to the question reveals that the girl is puzzled about the lord is after her. This suggests that she is aware that he has different motives rather than love and romance. This also shows that she knows the compliment is false and just a way of seducing her into bed. The second stanza is where the great lord isn’t so â€Å"great† anymore. He lured and tricked her into going to his palace home. She then saw another life. Life without working and cleaning; however, the lord doesn’t take her seriously. He doesn’t feel like he has too as they are not married. â€Å"He wore me like a silken knot† is a simile which defines how he used her in his own way. He just wanted her as an accessory. â€Å"He changed me like a glove† this quote is also a simile which outlines h... ...fair haired son, my shame, my pride† We are told she has a son, and that not only is it a memory of her shame but he is her pride. He’s all she has. Then the last three lines on stanza six are switched. The narrator is now talking to her son, her pride. â€Å"Your father would give lands for one† she is telling her son that if his father really wanted to, he would take him and would leave her (the narrator) with nothing. In conclusion, â€Å"Cousin Kate† is an extremely complicated poem, and even though there’s hate and heartbreak throughout, she ends up with pride. The narrator let the lord control her, power over her and make her what he wanted; however, Cousin Kate didn’t. She would only let him have sex with her if she could still be pure; this means that she would have to be married to do so. This probably made the lord have massive respect for Kate and not the narrator.

Sunday, January 12, 2020

Compare the Characters of Ralph and Jack. Essay

How does Golding influence the reader’s responses to his characters? In the beginning of Lord of the Flies, Ralph is aware of the fact that he is on a deserted island, but is in a sort of daydream. He’s very rude and immature towards Piggy and acts awkwardly towards Piggy, as if there was no one else on the island. â€Å"This is an island. At least I think it’s an island.† The author tells in that line that Ralph is possibly in a daydream and can’t tell fantasy from reality. When it is only Ralph and Piggy at the start, he is rather lazy, sleepy and quick tempered, but not the least bit worried about being abandoned on an unknown island. â€Å"Now the shell was no longer a thing seen but not to be touched.† Ralph discovers the conch, which’s something that interests him but doesn’t know what it is so he turns to Piggy for knowledge. Ralph realizes that the conch is something valuable just by looking at it, but doesn’t know that it is very significant and would become the symbol of his future leadership. â€Å"The creature was a party of boys marching approximately in step in two parallel lines and dressed in strangely eccentric clothes.† The author places the reader in Ralph’s body so that they see everything he seeing. This gives us an insight into Ralph’s mind, which influence our views about him. Jack appears wearing a ‘cap badge’ and a cloak, which tells the reader that Jack has some type of hierarchy, he is the one leading the choir and they all seem to obey him. The author description of Jack is very unappealing and devilish, and through the description of his eyes we can work out that he probably very short tempered. As soon as he meets Piggy he starts bullying him and putting him down, as if he’s already organized in his mind who should speak and who shouldn’t. â€Å"He’s not fatty,’ cried Ralph, â€Å"his real name’s Piggy.† Ralph defends Piggy because he feels sorry for him, but makes the situation worse by being careless and breaking his promise. Ralph suggests that the children should have a chief because he wants to bring law order to the island. When they are voting for a leader Jack exclaims that he should be chief as if it were a natural thought for him because he comes from a private school, where as Ralph is middle classed, therefore he probably attended a grammar school education. Ralph wins the election, although the choir votes for Jack unhappily, because of his leadership characteristics and mainly due to the blowing of the conch. â€Å"The choir belongs to you of course.† Ralph tries to make peace with Jack after the voting and reminds him that he still in charge of the choir, and this shows that he has got natural leadership qualities although he doesn’t know how lead yet. Jack meets his first hurdle in becoming a savage when he has to cut the throat of a pig but his ideas of civilization prevents him from doing so. Jack has still has sanity in the beginning and agrees with the making of rules, but doesn’t intend to keep them because he wants to punish people and have fun by destroying things in the process. The author introduces the idea of there being a snake on the island, which the little children observe at night, which is slightly in contrast to the Garden of Eden where a snake is the symbol of evil. â€Å"There isn’t a snake thing. But if there was a snake we’d hunt it and kill it.† The author doesn’t actually let us see into Jack’s mind but from the outside we know that he is very cunning and clever, by turning situations to his advantage. He tries to get power by offering protection to the little children and increasing their confidence in him, so that they would support him and not Ralph. â€Å"The conch doesn’t count on top the mountain.† Here Jack is undermining the conch and its importance to annoy and re-establish his assumed superiority over Piggy. Also this way he is attacking Ralph at the same time, because the conch is the main reason why Ralph gets elected. Jack wants everyone else to obey the rules, but doesn’t keep to them and therefore is very hypocritical about what he says and does. He knows the smaller children want to have fun and uses that to his advantage by fooling around and bullying Piggy. The author describes Jack as a sprinter and gives him the characteristics of native hunter when he is in the forest, and gives him animal forms turning from ‘dog-like’ to ‘ape-like’, which gives the reader the impression that Jack is animal and no longer a human. When Jack goes after the pigs you can tell that he is more determined than ever because the author puts in ‘the promise of meat’, which tells the reader that he has gained the hunter’s instinct. When Ralph and Jack interact again they almost get into an argument, but then they talk about the â€Å"little’uns† and open up their feelings to each other and end up agreeing on the construction of the shelters, although Jack is thinking about killing a pig first and not on being rescued, while talking. â€Å"He looked in astonishment, no longer at himself but at an awesome stranger.† Jack paints his face, gets some leaves for his new mask, because he wants to look like savage and the twins, Bill and Roger become frightened of him so he gains a certain control over them. Some of the older boys now enjoy hunting, killing pigs for their meat and boasting about how they participated. The author is making Jack the snake and its like he’s luring them to eat the forbidden fruit, which means there also turning into savages as well. Ralph starts to protect Piggy, this is due to the fact Jack inflicted bodily harm on Piggy. He starts to side with Piggy even when Jack apologized, because he knows that Piggy is being victimized too much. He realizes the importance of Piggy’s brains and has support him to maintain authority. â€Å"Jack, Simon, Maurice, most of the hunters, on Ralph’s right; the rest on the left.† The group has basically separated into two groups, Jack and his loyal hunters and Piggy and the little’uns. This is a very important incident as Jack can now put down Ralph’s authority because he has the backing of half the group. Ralph boosts his authority by giving orders to everyone and starts to plan a decent environment to live in, but Jack is still stirring up trouble. The author has been clever about creating intensity because he has brought in two different characters, which are complete opposites of each other. On coming on the island, Jack already leads the choir, wants to be chief and doesn’t get elected, while on the other hand Ralph doesn’t know anyone, has no wish to be leader but becomes leader and has to mould into the role of being a leader. The author also shows how Jack changes from being civilized to turning into a primitive savage and how other boys follow him. Ralph learns a lot from his mistakes and adjusts so that he can uphold his position. The author also lets us see Ralph innermost thought so we know what type of person he is, but we only get to view Jack from the outside, which influences are sympathy towards Ralph. He also introduces the ‘snake-thing’, which is linked to the Garden of Eden and always gives the reader a sense of evil. The first five chapters are in complete contrast to the book Coral Island, which is a book about children who help each other out, when they are left on a desert island.

Saturday, January 4, 2020

Booker T. Washington ( 1856-1915 ) - 1856 Words

Booker T. Washington (1856-1915) was a standout amongst the most persuasive (and questionable) African Americans ever. Brought up the child of a slave mother, Washington was self-propelled and focused on his own training from a youthful age. The tumultuous time in America s history amid which he lived managed him new opportunities that originated from Abraham Lincoln s Emancipation Proclamation of 1863 and the inevitable achievement of the North in the Civil War. He took the first chance to go to a formal school, Hampton Institute, which prompted residency and the establishing of a standout amongst the most prestigious African American instructive organizations of the nineteenth century, Tuskegee Institute in Alabama. Washington was seen as pleasing the norm of African American subordination on the grounds that the message of his works and addresses was that the street to accomplishment for blacks was through attaining to monetary dependability through training (primarily, profession al preparing); he didn t dissent, did not challenge the political framework, did not talk about the absence of social fairness like his commentators, Frederick Douglass and W.E.B. Du Bois. Washington decided to focus on what blacks could fulfill by concentrating on learning mechanical abilities; he accepted this would help his race secure financial confidence. Washington felt the aggressor talk of Douglass and Du Bois redirected his kin from the way to success through monetary achievement. ItShow MoreRelatedBooker T. Washington Essay1249 Words   |  5 Pagesposition that one has reached in life as by the obstacles which he has overcome† –Booker T. Washing. 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