PICOT Statement

The paper addresses the outcomes of unprecedented amalgamation of care and research in pediatric oncology from the nurses and parents point of view. A substantial number of children living with cancer register in treatment trials as a significant number of ecologist pediatrics carry out investigations in clinical research.

Patient/ population problem: The research analysis explained that both integrations of care and research have substantial consequences for consent process that is informed. Additionally, the incorporation as well impacts nurse’s duties and the interest of the children. However, the influence brings out the conflict between scientists and nurses. Parents have a strong dependency on the physicians of their children. The research hence turns hectic to achieve owing to stress emotions and research protocols complexity hence making it difficult to achieve the intended consent of the work. Parents have a duty of providing parental care to their children where they have to register them in trials. Parents to the kids are to some extent never in equipoise in taking part in trials. The situations leave them in an agony of yearning to do the best for their kids. However, parents fear wrong choices with regards to the health situations of their kids. Satisfying misapprehension jeopardizes collect participation assessment which makes parents attribute inaccurate intent to research procedures. Nurses have a strong preference to therapists than a researcher. However, nurses may believe that the investigation praises the interest of the children thus maintaining a calming misconception amongst them and the parents (Kieft, Francke & Delnoij, 2014). Capstone Project Topic Selection and Approval

Intervention: The integration of the research and care brings out intertwining of distinctive ethical perceptions in pediatric oncology daily practice. The increase in awareness of the meaning of the communication for nurses and parents is essential. Possibilities of future research should look into efforts of overcoming problems owing to care and research synchronicity.

Comparison: Children involved in the question are under the age of six years. Parents to the kids are motivated by the duty of attention and protection of their children. Parents find it hard to think of research as distinct from the best of the children. However, parents support research that may improve future patients’ chances. To parents, the participation of other kids before their cases has grown their current treatment services to their children, and hence they feel it worth giving back. However, parents have the key duty of protecting their kids, which define their attitudes towards trials. However, nurses will only make tests that are of better quality and seem to have a high chance of high-quality outcome. Nurses play a significant role in allowing the involvement of children to take part in research works. However, the nurses must first be convinced that the research work will pose no harm to the kids. Moreover, the nurses must be satisfied that the investigation will improve the health of the children (Yang, 2012).

Outcome: The results of integrated health services have prompted health facility parties to consider their choices carefully with regards to the interest of the parties involved. Nurses and parents put the interest of the children most forward while research teams ensure continued improvement of their services. Currently, the sector has recorded a constant improvement of the services and the level of research works. The teams make decisions based on what is best for the entire health status of the patients.

Time: The data collection was done in 2015 where the information is qualitative. The data collection involved interviews of the stakeholders including the parents and the nurses in some public health centers.

References

Kalyani, M. N., Kashkooli, R. I., Molazem, Z., & Jamshidi, N. (2014). Qualitative Inquiry into the Patients’ Expectations regarding Nurses and Nursing Care. Advances in Nursing, 2014, 1-6. doi: 10.1155/2014/647653

Kieft, R. A., Brouwer, B. B., Francke, A. L., & Delnoij, D. M. (2014). How nurses and their work environment affect patient experiences of the quality of care: A qualitative study. BMC Health Services Research, 14(1), 249. doi: 10.1186/1472-6963-14-249.

Stavropoulou, A., Kaba, E., Obamwonyi, V. A., Adeosun, I., Rovithis, M., & Zidianakis, Z. (2012). Defining nursing intimacy: Nurses’ perceptions of intimacy. Health Science Journal, 6(3), 17.

Yang .et aL. (2012). Psychosocial precursors and physical consequences of workplace violence towards nurses: A longitudinal examination with naturally occurring groups in hospital settings. International Journal of Nursing Studies 49 (2012) 1091-1102.

PRESSURE ULCER (PU) PREVENTION DURING HOSPITAL STAY Capstone

Introduction

Development of Pressure ulcer (PU) has been a serious and the topic of concern in health care setting today. PU is defined as any breakdown of skin lesion that is caused by constant pressure, cutting blood flow and oxygen supply in the that area. Capstone Project Topic Selection and Approval

Problem

Do the implementation of pressure relieving mattress and protective heel protector in elderly patient with limited mobility reduces the risk of developing pressure ulcer during hospitalization? Several evidences -based studies have suggested the use of pressure relieving mattress along with heel protective devices have reduced the prevalence of hospital acquired PU (Beal, M. E., & Smith, K. (2016). Early skin assessment and identifying the risk factors in older adults decrease the length of hospital stay as well as speed up recovery.

Setting

The clinical setting for this project will be an acute care facility where surgical orthopedic patients, such as hip fracture is admitted in a higher ratio. The majority of the population admitted for surgical procedures are older adults between age 60-100 years old. The risk factor for PU on these age groups are age, fragile skin, bed bound, urinary or bowel incontinent, mobility issues, disease condition and mental disability.

Description of problem

Pressure ulcer compromises the quality of life in the older patient specially after hospitalization or any other surgical procedure. Not all the hospital beds meet the patient`s need and shoots their skin, therefore, health care providers should be educated on the identifying the patient that are at risk for developing pressure ulcer and early risk assessment is vital. When body tissue is compromised pressure ulcer can be developed any time. The use of appropriate bed after identifying the problem for skin breakdown and early prevention is the essential component in maintaining the health status of the patient.

Impact of the problem

More than 2.5 million people in the United States (US) develop pressure ulcers every year (WALTON-GEER, P. S. (2009). Even though evidence -based guidelines is present for PU prevention, there has always been a problem of pressure ulcer in healthcare. PU prevention is lacking in hospitalized patient for various reasons. “The cost of caring for these preventable pressure ulcers may now be as high as 60,000 dollars per patient (McInnes E et al., 2011). If appropriate action is not taken on time the quality of the patient`s life will be hampered as well as the cost for a hospital will be higher after pressure development during hospital stay.

Significance of the problem

Lack of nursing knowledge, workload and staffing issues, inadequate supplies can be some of the contributing factors associated with early identification and prevention of PU. All health care team providing direct patient care should be aware and educated on skin assessment, its prevention and management. Reporting skin breakdown or abnormal on time is crucial for PU prevention. Research Studies have also revealed that after implementing the preventive guidelines, the prevalence of PU has decreased Beal, M. E., & Smith, K. (2016). Therefore, to prevent PU collaborative team work, practicing Evidence -based practices (EBP), use of assessment tool, staff training can save hospital cost and quality of patient`s life.

Proposed solution

To decrease the incidence pressure ulcer in hospitalized older patient, health care workers must follow the EBP, be aware of the consequences of not following the guidelines of skin assessment. PU usually associated with lack of staff knowledge, workload, staffing issues and inadequate supplies associated in early identification and prevention of PU. Skills lab, in- services education to all staff on a pressure reducing bed types and its use, education and early identification of risk population will be done. A PUP team will be created who rounds on each patient twice a week in the unit and also audit on skin assessments documentation. A poster will be created to remind staff on skin assessment and its prevention into care board, break room and sink. A monthly audit will also be performed for the effectiveness, as well as rapid feedback from staff members will be accepted for improvement. In order to prevent PU, direct care provider will be accountable in maintaining repositioning patient every 2 hours, use pressure reducing pillow/mattresses, protective heel protector, maintain adequate fluid and nutrition, increase activity, daily exercise, keep dry and clean. The implementation of this proposal will be will be started immediately following the approval. Capstone Project Topic Selection and Approval

References:

Beal, M. E., & Smith, K. (2016). Inpatient Pressure Ulcer Prevalence in an Acute Care Hospital Using Evidence-Based Practice. Worldviews On Evidence-Based Nursing, 13(2), 112-117. doi:10.1111/wvn.12145

Beeckman, D., Schoonhoven, L., Kottner, J., Moore, Z., Meaume, S., & Fletcher, J. (2017). Meeting

report: pressure ulcer prevention and management: do we all agree? Wounds International, 8(3), 40-45.

FEECE, R. (2017). Educating and campaigning for pressure ulcer prevention. Wounds UK, 13(3), 58-61.

Pagnamenta, F. (2017). The provision of therapy mattresses for pressure ulcer prevention. British Journal Of Nursing, 26(6), S28-S33.

McInnes E, Jammali-Blasi A, Bell-Syer SEM, Dumville JC, Cullum NA. Support services for pressure ulcer prevention. Cochrane Database Syst Rev. 2011; 4. (Level 1)

Souza Galvão, N., Barbosa Serique, M. A., de Gouveia Santos, V. C., & Nogueira, P. C. (2017). Knowledge of the nursing team on pressure ulcer prevention. Revista Brasileira De Enfermagem, 70(2), 294-300. doi:10.1590/0034-7167-2016-0063

STANG, D., & BALLARD-WILSON, A. (2015). The role of innovation in heel pressure ulcer prevention. Wounds UK, 11(4), 106-110.

Takashima, A., Misaki, A., Takasugi, S., & Yamamoto, M. (2014). Characteristic analysis of an air cell for active air mattress of prevention for pressure ulcer. Advanced Robotics, 28(7), 497-504. doi:10.1080/01691864.2013.876937

WALTON-GEER, P. S. (2009). Prevention of Pressure Ulcers in the Surgical Patient. AORN Journal, 89(3), 538.