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Linggo, Mayo 6, 2012, 2:11 PM
INSIGHT IN "THE FUTURE OF NURSING AND THE INFORMATICS AGENDA " 

I agree with what was written on the article, that Health Information Technology will change the way nurses plan, deliver, document, and review patient care. Integration of information management and technology in the health institutes has influenced the quality of care rendered by the health care providers. It influenced the delivery of care in a way that medical errors are prevented, data and information are communicated so that health care providers can work interdependently and have an access in the time and place when they are needed in making medical decision.

Second, because nursing profession, or should I say working in the healthcare field reflects how dynamic the world is today. Nurses today are required to be knowledgeable of how to use computers efficiently, hence, computer courses are included in the subjects that a student nurse would have to take-up. Also, some institutes offer programs that aims to meet the educational and training needs of working nurses in terms of their skills in informatics.

I see the nursing as a profession that will continuously develop over time. Technology will continue bringing impact both on nursing practice and education.

Source: Academic OneFile [Click on the title]
The future of nursing and the informatics agenda


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Biyernes, Mayo 4, 2012, 3:34 AM
INSIGHT ON "NURSES' PERCEPTIONS OF AN ELECTRONIC PATIENT RECORD FROM A PATIENT SAFETY PERSPECTIVE: A QUALITATIVE STUDY" 
The article that I have read explored onto how nurses preceive the use of electronic health record in everyday practice and delivery of care. Based from what I have learned from our Nursing Informatics class, integration of EHR assists in the transition of data, information and knowledge into action. Also, they provide applications which can be used to furtyher support the nursing practice and improve the quality of care as well as to evaluate outcomes of care.

Nowadays, electronic patient records are  used and has become the main method of documentation in the nursing practice in certain countries. According to the article, emerging evidence suggests that they fail to capture the essence of clinical practice and support the most frequent end-users: nurses. They mentioned that the general impact of using EPR in the ward was not still explored.

To determine how nurses see the implementation of EHR in the healthcare setting, focus group interviews were conducted having 23 registered nurses as the interviewees. It was a qualitative study of the data and analysed by content analysis. During the time where the interviews were conducted, EPR's has been in use for already a year.

As a result, nurses reported that EPR's don't support nursing practice in terms of documenting  crucial patient information such as vital signs. From what I have learned for NI, I thought that computer applications which will be used when the EHR is already implemented in a health institute already includes allowing nurses to document client's vital signs.

I agree to what the conclusion in the article said, that the view and suggestions of the nurses who are considered as the primary users of the EHR in a hospital institute should be taken into consideration when designing a CIS and the EHR itself so that, specific nursing needs are met and that patient's safety is promoted.

Article Source:
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3:26 AM
INSIGHT ON "REVIEWING THE IMPACT OF COMPUTERIZED PROVIDER ORDER ENTRY ON CLINICAL OUTCOMES: THE QUALITY OF SYSTEMATIC REVIEWS" 
One of the evidences of the integration of technology in the healthcare setting is the computerized provider order entry where medical practitioners electronically enters their instructions and orders for the treatment of the patient. The article claimed that the use of CPOE is central to current efforts at improving clinical care. I think that CPOE can improve clinical care by preventing practice errors like medication errors to happen. There were some issues about factors which lead to errors in the patient care, one of which, if I remember it right, is the readability of the physician's penmanship. Plenty of times have I heard that doctors write like anyone can understand what they wrote, they don't write legibly, hence, some health care providers commit errors because of having misunderstood the handwritten order. We can incorporate here the factor that has become a great initiative why electronic systems and informatics are integrated in the healthcare setting- PATIENT'S SAFETY. In addition, the article has claimed that CPOE is important to the practical decision of implementation and future design efforts.

They did a systematic search about CPOE. In the process, resources and reviews from PubMed, CINAHL, Scopus, Cochrane, INSPEC, and PsychInfo databases from the years 1987–mid 2010 in English only were included. Reviews which focused on CPOE, electronic ordering, Electronic Health Record, or Health Information Technology were included. They assessed the quality of which by using systemic crtieria developed by Oxman and Guyatt, QUOROM, and PRISMA who conducted the reviews independently. With these, I am not aware as to how they conducted the reviews to study the effectiveness of CPOE.

Based on the article, the search process yielded 185 initial unique references with 13 final reviews meeting the criteria. If I understand it right, QUOROM/PRISMA got the highest rating in overall quality, averaged 63% completion. How PRISMA/QUOROM did the search process wasn't stated so I don't know how they were evaluated.

ARTICLE: 
Academic OneFile  
Accessed at International Journal of medical informatics via AcademicOneFIile link: www.ijmijournal.com/article/S1386-5056(12)00028-7/abstract
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Miyerkules, Mayo 2, 2012, 4:00 AM
IMMEDIATE NEWBORN CARE 

Importance of Immediate Newborn Care: Getting the Basics Right

Importance of immediate newborn care can never be under-estimated, and parents will be learning things they have never experienced before. It is the basics of being parents that is often never taught. Although parents may prepare for the much awaited homecoming to a beautifully decorated nursery with every material item the baby could need, the essential hands-on care needs to be achieved first.

Goals:

  • To establish, maintain and support respirations.
  • To provide warmth and prevent hypothermia.
  • To ensure safety, prevent injury and infection.
  • To identify actual or potential problems that may require immediate attention.
Establish respiration and maintain clear airway
The most important need for the newborn immediately after birth is a clear airway to enable the newborn to breathe effectively since the placenta has ceased to function as an organ of gas exchange. It is in the maintenance of adequate oxygen supply through effective respiration that the survival of the newborn greatly depends.
Newborns are obligatory nose breathers. The reflex response to nasal obstruction, opening the mouth to maintain airway, is not present in most newborns until 3 weeks after birth.
To establish and maintain respirations:
1. newbornsuctioning thumb Immediate Care of the Newborn Wipe mouth and nose of secretions after delivery of the head.
2. Suction secretions from mouth and nose.
  • Compress bulb syringe before inserting
  • Suction mouth first, then, the nose
  • Insert bulb syringe in one side of the mouth
3. A crying infant is a breathing infant. Stimulate the baby to cry if baby does not cry spontaneously, or if the cry is weak.
  • Do not slap the buttocks rather rub the soles of the feet.
  • Stimulate to cry after secretions are removed.
  • The normal infant cry is loud and husky. Observe for the following abnormal cry:
4. Oral mucous may cause the newborn, to choke, cough or gag during the first 12 to 18 hours of life. Place the infant in a position that would promote drainage of secretions.
  • Trendelenburg position – head lower than the body
  • Side lying position – If trendelenburg position is contraindicated, place infant in side lying position to permit drainage of mucus from the mouth. Place a small pillow or rolled towel at the back to prevent newborn from rolling back to supine position.
5. Keep the nares patent. Remove mucus and other particles that may be cause obstruction. Newborns are obligatory nose breathers until they are about 3 weeks old.

Care of the Eyes
It is part of the routine care of the newborn to give prophylactic eye treatment against gonorrhea conjunctivitis or opthalmia neonatorum. Neisseria gonorrhea, the causative agent, may be passed on the fetus from the vaginal canal during delivery. This practice was introduced by Crede, a German gynecologist in1884. Silver nitrate, erythromycin and tetracycline ophthalmic ointments are the drugs used for this purpose.

Erythromycin or tetracycline Opthalmic Ointment:
  1. These ointments are the ones commonly used now a days for eye prophylaxis because they do not cause eye irritation and are more effective against Chlamydial conjunctivitis.
  2. Apply over lower lids of both eyes, then, manipulate eyelids to spread medication over the eyes.
Vitamin K or Aquamephyton
The newborn has a sterile intestine at birth, hence, the newborn does not possess the intestinal bacteria that manufactures vitamin K which is necessary for the formation of clotting factors. This makes the newborn prone to bleeding. As a preventive measure, .5 (preterm) and 1 mg (full term) Vitamin K or aquamephyton is injected IM in the newborn’s vastus lateralis (lateral anterior thigh) muscle.
cuttingtheumbillicalcord thumb Immediate Care of the Newborn 
Care of the cord
The cord is clamped and cut approximately within 30 seconds after birth. In the delivery room, the cord is clamped twice about 8 inches from the abdomen and cut in between. When the newborn is brought to the nursery, another clamp is applied ½ to 1 inch from the abdomen and the cord is cut at second time. The cord and the area around it are cleansed with antiseptic solution. The manner of cord care depends on hospital protocol. What is important is that the principles are followed. Cord clamp maybe removed after 48 hours when the cord has dried. The cord stump usually dries and fall within 7 to 10 days leaving a granulating area that heals on the next 7 to 10 days.
Instruction to the mother on cord care:
  1. No tub bathing until cord falls off. Do not sponge bath to clean the baby. See to it that cord does not get wet by water or urine.
  2. Do not apply anything on the cord such as baby powder or antibiotic, except the prescribed antiseptic solution which is 70% alcohol.
  3. Avoid wetting the cord. Fold diaper below so that it does not cover the cord and does not get wet when the diaper soaks with urine.
  4. Leave cord exposed to air. Do not apply dressing or abdominal binder over it. The cord dries and separates more rapidly if it is exposed to air.
  5. If you notice the cord to be bleeding, apply firm pressure and check cord clamp if loose and fasten.
  6. Report any unusual signs and symptoms which indicates infection.
    • Foul odor in the cord
    • Presence of discharge
    • Redness around the cord
    • The cord remains wet and does not fall off within 7 to 10 days
    • Newborn fever
umbilicalcordhealing thumb Immediate Care of the Newborn
THE APGAR SCORING SYSTEM
apgarscoring thumb Immediate Care of the Newborn The APGAR Scoring System was developed by Dr. Virginia Apgar as a method of assessing the newborn’s adjustment to extrauterine life. It is taken at one minute and five minutes after birth. With depressed infants, repeat the scoring every five minutes as needed. The one minute score indicates the necessity for resuscitation. The five minute score is more reliable in predicting mortality and neurologic deficits. The most important is the heart rate, then the respiratory rate, the muscle tone, reflex irritability and color follows in decreasing order. A heart rate below 100 signifies an asphyxiated baby and a heart rate above 160 signifies distress.
ASSESS
0
1
2
HEART RATE
Absent
Below 100
Above 100
RESPIRATION
Absent
Slow
Good crying
MUCLE TONE
Flaccid
Some flexion
Active motion
REFLEX IRRITABILITY
No response
Grimace
Vigorous cry
COLOR
Blue all over
Body pink,
Extremities blue
Pink all over
Score:
  • 7 – 10 Good adjustment, vigorous
  • Moderately depressed infant, needs airway clearance
  • Severely depressed infant, in need of resuscitation.
ASSESSING THE AVERAGE NEWBORN

Head Circumference
34 – 35 cm
Temperature
97.6 – 98.6 F axillary
Chest Circumference
32 – 33 cm
Heart Rate
120 – 140 bpm
Respirations
30 – 60 bpm
Weight
2.5 to 3.4 kg
Length
46 to 54 cm

Sources: http://baby.lovetoknow.com/wiki/Importance_of_Immediate_Newborn_Care
             http://nursingcrib.com/nursing-notes-reviewer/immediate-care-of-the-newborn/
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3:53 AM
ASCEPTIC TECHNIQUE 

Definition

Aseptic technique is a set of specific practices and procedures performed under carefully controlled conditions with the goal of minimizing contamination by pathogens.

Purpose

Aseptic technique is employed to maximize and maintain asepsis, the absence of pathogenic organisms, in the clinical setting. The goals of aseptic technique are to protect the patient from infection and to prevent the spread of pathogens. Often, practices that clean (remove dirt and other impurities), sanitize (reduce the number of microorganisms to safe levels), or disinfect (remove most microorganisms but not highly resistant ones) are not sufficient to prevent infection.
The Centers for Disease Control and Prevention (CDC) estimates that over 27 million surgical procedures are performed in the United States each year. Surgical site infections are the third most common nosocomial (hospital-acquired) infection and are responsible for longer hospital stays and increased costs to the patient and hospital. Aseptic technique is vital in reducing the morbidity and mortality associated with surgical infections.

Principles

  • Only sterile items are used within sterile field.
  • Sterile objects become unsterile when touched by unsterile objects.
  • Sterile items that are out of vision or below the waist level of the nurse are considered unsterile.
  • Sterile objects can become unsterile by prolong exposure to airborne microorganisms.
  • Fluids flow in the direction of gravity.
  • Moisture that passes through a sterile object draws microorganism from unsterile surfaces above or below to the surface by capillary reaction.
  • The edges of a sterile field are considered unsterile.
  • The skin cannot be sterilized and is unsterile.
  • Conscientiousness, alertness and honesty are essential qualities in maintaining surgical asepsis

Description

Aseptic technique can be applied in any clinical setting. Pathogens may introduce infection to the patient through contact with the environment, personnel, or equipment. All patients are potentially vulnerable to infection, although certain situations further increase vulnerability, such as extensive burns or immune disorders that disturb the body's natural defenses. Typical situations that call for aseptic measures include surgery and the insertion of intravenous lines, urinary catheters, and drains.

Asepsis in the operating room

Aseptic technique is most strictly applied in the operating room because of the direct and often extensive disruption of skin and underlying tissue. Aseptic technique helps to prevent or minimize postoperative infection.
PREOPERATIVE PRACTICES AND PROCEDURES. The most common source of pathogens that cause surgical site infections is the patient. While microorganisms normally colonize parts in or on the human body without causing disease, infection may result when this endogenous flora is introduced to tissues exposed during surgical procedures. In order to reduce this risk, the patient is prepared or prepped by shaving hair from the surgical site; cleansing with a disinfectant containing such chemicals as iodine, alcohol, or chlorhexidine gluconate; and applying sterile drapes around the surgical site.
In all clinical settings, handwashing is an important step in asepsis. The "2002 Standards, Recommended Practices, and Guidelines" of the Association of Perioperative Registered Nurses (AORN) states that proper handwashing can be "the single most important measure to reduce the spread of microorganisms." In general settings, hands are to be washed when visibly soiled, before and after contact with the patient, after contact with other potential sources of microorganisms, before invasive procedures, and after removal of gloves. Proper handwashing for most clinical settings involves removal of jewelry, avoidance of clothing contact with the sink, and a minimum of 10–15 seconds of hand scrubbing with soap, warm water, and vigorous friction.
A surgical scrub is performed by members of the surgical team who will come into contact with the sterile field or sterile instruments and equipment. This procedure requires use of a long-acting, powerful, antimicrobial soap on the hands and forearms for a longer period of time than used for typical handwashing. Institutional policy usually designates an acceptable minimum length of time required; the CDC recommends at least two to five minutes of scrubbing. Thorough drying is essential, as moist surfaces invite the presence of pathogens. Contact with the faucet or other potential contaminants should be avoided. The faucet can be turned off with a dry paper towel, or, in many cases, through use of a foot pedal. An important principle of aseptic technique is that fluid (a potential mode of pathogen transmission) flows in the direction of gravity. With this in mind, hands are held below elbows during the surgical scrub and above elbows following the surgical scrub. Despite this careful scrub, bare hands are always considered potential sources of infection.
Sterile surgical clothing or protective devices such as gloves, face masks, goggles, and transparent eye/face shields serve as barriers against microorganisms and are donned to maintain asepsis in the operating room. This practice includes covering facial hair, tucking hair out of sight, and removing jewelry or other dangling objects that may harbor unwanted organisms. This garb must be put on with deliberate care to avoid touching external, sterile surfaces with nonsterile objects including the skin. This ensures that potentially contaminated items such as hands and clothing remain behind protective barriers, thus prohibiting inadvertent entry of microorganisms into sterile areas. Personnel assist the surgeon to don gloves and garb and arrange equipment to minimize the risk of contamination.
Donning sterile gloves requires specific technique so that the outer glove is not touched by the hand. A large cuff exposing the inner glove is created so that the glove may be grasped during donning. It is essential to avoid touching nonsterile items once sterile gloves are applied; the hands may be kept interlaced to avoid inadvertent contamination. Any break in the glove or touching the glove to a nonsterile surface requires immediate removal and application of new gloves.
Asepsis in the operating room or for other invasive procedures is also maintained by creating sterile surgical fields with drapes. Sterile drapes are sterilized linens placed on the patient or around the field to delineate sterile areas. Drapes or wrapped kits of equipment are opened in such a way that the contents do not touch non-sterile items or surfaces. Aspects of this method include opening the furthest areas of a package first, avoiding leaning over the contents, and preventing opened flaps from falling back onto contents.
Equipment and supplies also need careful attention. Medical equipment such as surgical instruments can be sterilized by chemical treatment, radiation, gas, or heat. Personnel can take steps to ensure sterility by assessing that sterile packages are dry and intact and checking sterility indicators such as dates or colored tape that changes color when sterile.
INTRAOPERATIVE PRACTICES AND PROCEDURES. In the operating room, staff have assignments so that those who have undergone surgical scrub and donning of sterile garb are positioned closer to the patient. Only scrubbed personnel are allowed into the sterile field. Arms of scrubbed staff are to remain within the field at all times, and reaching below the level of the patient or turning away from the sterile field are considered breaches in asepsis.
Other "unscrubbed" staff members are assigned to the perimeter and remain on hand to obtain supplies, acquire assistance, and facilitate communication with outside personnel. Unscrubbed personnel may relay equipment to scrubbed personnel only in a way that preserves the sterile field. For example, an unscrubbed nurse may open a package of forceps in a sterile fashion so that he or she never touches the sterilized inside portion, the scrubbed staff, or the sterile field. The uncontaminated item may either be picked up by a scrubbed staff member or carefully placed on to the sterile field.
The environment contains potential hazards that may spread pathogens through movement, touch, or proximity. Interventions such as restricting traffic in the operating room, maintaining positive-pressure airflow (to prevent air from contaminated areas from entering the operating room), or using low-particle generating garb help to minimize environmental hazards.
Other principles that are applied to maintain asepsis in the operating room include:
  • All items in a sterile field must be sterile.
  • Sterile packages or fields are opened or created as close as possible to time of actual use.
  • Moist areas are not considered sterile.
  • Contaminated items must be removed immediately from the sterile field.
  • Only areas that can be seen by the clinician are considered sterile (i.e., the back of the clinician is not sterile).
  • Gowns are considered sterile only in the front, from chest to waist and from the hands to slightly above the elbow.
  • Tables are considered sterile only at or above the level of the table.
  • Nonsterile items should not cross above a sterile field.
  • There should be no talking, laughing, coughing, or sneezing across a sterile field.
  • Personnel with colds should avoid working while ill or apply a double mask.
  • Edges of sterile areas or fields (generally the outer inch) are not considered sterile.
  • When in doubt about sterility, discard the potentially contaminated item and begin again.
  • A safe space or margin of safety is maintained between sterile and nonsterile objects and areas.
  • When pouring fluids, only the lip and inner cap of the pouring container is considered sterile; the pouring container should not touch the receiving container, and splashing should be avoided.
  • Tears in barriers and expired sterilization dates are considered breaks in sterility.

Other clinical settings

A key difference between the operating room and other clinical environments is that the operating area has high standards of asepsis at all times, while most other settings are not designed to meet such standards. While clinical areas outside of the operating room generally do not allow for the same strict level of asepsis, avoiding potential infection remains the goal in every clinical setting. Observation of medical aseptic practices will help to avoid nosocomial infections. The application of aseptic technique in such settings is termed medical asepsis or clean technique (rather than surgical asepsis or sterile technique required in the operating room).
Specific situations outside of the operating room require a strict application of aseptic technique. Some of these situations include:
  • wound care
  • drain removal and drain care
  • intravascular procedures
  • vaginal exams during labor
  • insertion of urinary catheters
  • respiratory suction
For example, a surgical dressing change at the bedside, though in a much less controlled environment than the operating room, will still involve thorough handwashing, use of gloves and other protective garb, creation of a sterile field, opening and introducing packages and fluids in such a way as to avoid contamination, and constant avoidance of contact with nonsterile items.
General habits that help to preserve a clean medical environment include:
  • safe removal of hazardous waste, i.e., prompt disposal of contaminated needles or blood-soaked bandages to containers reserved for such purposes
  • prompt removal of wet or soiled dressings
  • prevention of accumulation of bodily fluid drainage, i.e., regular checks and emptying of receptacles such as surgical drains or nasogastric suction containers
  • avoidance of backward drainage flow toward patient, i.e., keeping drainage tubing below patient level at all times
  • immediate clean-up of soiled or moist areas
  • labeling of all fluid containers with date, time, and timely disposal per institutional policy
  • maintaining seals on all fluids when not in use
The isolation unit is another clinical setting that requires a high level of attention to aseptic technique. Isolation is the use of physical separation and strict aseptic technique for a patient who either has a contagious disease or is immunocompromised. For the patient with a contagious disease, the goal of isolation is to prevent the spread of infection to others. In the case of respiratory infections (i.e., tuberculosis), the isolation room is especially designed with a negative pressure system that prevents airborne flow of pathogens outside the room. The severely immunocompromised patient is placed in reverse isolation, where the goal is to avoid introducing any microorganisms to the patient. In these cases, attention to aseptic technique is especially important to avoid spread of infection in the hospital or injury to the patient unprotected by sufficient immune defenses. Entry and exit from the isolation unit involves careful handwashing, use of protective barriers like gowns and gloves, and care not to introduce or remove potentially contaminated items. Institutions supply specific guidelines that direct practices for different types of isolation, i.e., respiratory versus body fluid isolation precautions.
In a multidisciplinary setting, all personnel must constantly monitor their own movements and practices, those of others, and the status of the overall field to prevent inadvertent breaks in sterile or clean technique. It is expected that personnel will alert other staff when the field or objects are potentially contaminated. Health care workers can also promote asepsis by evaluating, creating, and periodically updating policies and procedures that relate to this principle.

Sources: http://www.surgeryencyclopedia.com/A-Ce/Aseptic-Technique.html
              http://nursingcrib.com/nursing-notes-reviewer/principles-of-aseptic-technique/
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