With more than 400,000 Americans currently on some form of dialysis, dialysis nurses who know how to provide good patient care and promote positive patient outcomes have become more important than ever (Johns Hopkins Medicine, 2005). One of the biggest obstacles these nurses face in providing quality care is non-adherence by their patients (Kammerer, Garry, Hartigan, Carter, & Erlich, 2007). However, nurses can provide better quality care with improved outcomes by approaching dialysis care in a holistic manner. This includes giving patients a sense of control over their treatment, using positive reinforcement to help modify behavior, and incorporating spirituality into patient care.
According to White (2004), most American people already have trouble adhering to a healthy lifestyle and complying with prescribed medical treatments. Many diabetic patients do not exercise or control their weight or diet properly, and patients diagnosed with a bacterial infection and prescribed a ten-day course of antibiotics often do not finish out the course. So it is even more challenging for patients who are diagnosed with End-Stage-Renal-Disease (ESRD) because suddenly they are told they must follow a highly restrictive diet, limit their fluid intake, and follow a specific medical regimen which includes many medications and undergoing dialysis treatments at least two times a week. If they do not follow their treatment plans closely, serious complications often develop. Such a lifestyle change is a huge undertaking, and many dialysis patients can feel entirely overwhelmed. Therefore, it is no surprise that one of the biggest challenges dialysis nurses face is getting their patients to adhere to treatment regimens.
Many patients placed on dialysis believe they no longer have control over their lives. Some of these people may try to regain control in a negative way by deciding to shorten their treatment or not taking prescribed medications. Kammerer (2007) notes that some might feel such a loss of control that they develop a “sense of futility” and just give up, discontinuing all treatment (p. 481). Nurses can help combat these feelings of helplessness by involving the patient as much as possible in their healthcare decisions, informing them of all treatment options, and by placing an emphasis on self-care. Landreneau’s (2006) study found that the patients interviewed were not aware that they had any choices concerning treatment; in fact, they did not even know what the available options were. It was discovered that most patients do indeed want to be involved in making decisions regarding their treatment, and that more desirable outcomes occur as a result (Landreneau, 2006). In addition, nurses can give patients a sense of control by teaching them to perform as much self-care as possible. This can include preparing the dialysis machine, performing self-monitoring during hemodialysis, and choosing their own interventions based on signs and symptoms they have self-assessed. This type of self-care has recently been suggested as a strategy to improve adherence (Richard, 2006).
Just possessing the knowledge about their choices and treatment, though, is not necessarily enough to keep patients compliant. Studies have shown that patients must not only be made aware of available resources, but they must also have the motivation to follow a treatment plan (as cited in Kammerer, 2007). A method that has been met with some success by nephrology nurses is cognitive behavioral modification. This works on the premise that patients will not adhere to a treatment plan unless they feel it is “personally worthwhile” and stresses the importance of positive interactions and relationships between nurses and patients (White, 2004). Nurses must be sensitive to the needs and feelings of their patients, and leave them feeling that their opinions are important. Instead of lecturing patients about not maintaining their blood pressures, a nurse using the behavioral modification approach might ask his or her patients if they notice a difference in their appearance or in the way they feel on days when their blood pressure is high. By using this approach, nurses help patients become aware of the way their treatment works and how non-adherence can affect them personally.
Another way nurses can improve adherence while helping patients retain a sense of purpose is by incorporating spirituality into their care. Walton’s study in 2002 found that a patient’s spirituality, which includes faith, prayer-life, and “meaningful relationships,” provides a strong support system that can help the patient through the difficulty of dialysis treatment (as cited in Tanyi, 2006 ). As a result, Tanyi (2006) conducted a study to examine the role of the dialysis nurse in regards to spirituality. It was found that the level of care a nurse is perceived to have provided was directly affected by the nurse’s level of spirituality, their own as well as their patients’. The respondents stated that nurses could incorporate spirituality into their care not just by addressing religious issues, but also by displaying caring behaviors such as showing genuine concern for their patients’ well-being, active listening, and using therapeutic touch (Tanyi, 2006).
Because adherence to treatment is such a problem for dialysis patients, it is important for nurses to incorporate different strategies for adherence into their dialysis care plans. Giving patients more of a sense of control over their treatment, teaching them how the treatment affects them personally, and including spirituality as a part of care are some ways that dialysis nurses can combat non-adherence. When patients have a sense that they are in control of what happens to them, the outcomes are generally better (White, 2004). All three of these nursing approaches have patient empowerment as a common theme. As more of these methods are researched and utilized, dialysis patients will have much better success at consistently following their treatment plans.
Intervention #1
Nurses can use cognitive behavioral modification to promote adherence.
Disadvantage #1
It is important for patients with Chronic Kidney Disease (CKD) and End Stage Kidney Disease (ESRD) to monitor and maintain strict control of their blood pressures, reduce proteinuria in order to slow down the progression of the disease, and to take all medications as prescribed (Costantini, 2008). This requires a patient’s active involvement in his or her treatment and frequent self-assessment of symptoms. However, many of these patients have no apparent symptoms, and therefore find it difficult to take seriously the need for adhering to a treatment plan. It is very difficult for some patients to grasp the severity of their disease, since many experience no adverse effects until the disease has progressed towards the end-stages. As one patient remarked about his disease, “There’s no way it could be that bad, you feel good... (Costantini, 2008).”
Disadvantage #2
In order for cognitive behavioral modification to work, the patient must have a certain level of cognition and ability to learn. Research has suggested that people who have kidney disease can have some cognitive impairment as a result of their disease, and those with End-Stage Renal Disease (ESRD) are much more likely to be cognitively impaired than those in earlier stages of the disease (Hain, 2008). This can be a vicious cycle because pathologies that exist with kidney disease can be exacerbated by non-adherence to treatment and can cause worsening cognitive impairment. Older dialysis patients have many risk factors for vascular dementia which include older age, hypertension, and diabetes. With the number of people who are 65 and older and undergoing dialysis steadily rising, and 16% of the dialysis population 75 or older, cognitive impairment is a big factor in adherence. This is because cognitive impairment can impact decision-making, medication compliance, ability to learn, and the ability of patients to perform self-assessments, all of which are key components of cognitive behavioral modification. Nurses working with these populations will have to learn to recognize when a patient is non-adherent due to cognitive impairment and adopt different approaches to teaching those patients.
Intervention #2
Nurses can improve adherence by incorporating spirituality into their patients’ care.
Disadvantage #1
Heavy patient loads leave little time for addressing spiritual issues, and dialysis nurses tend to have extremely heavy workloads. A dialysis nurse typically oversees the treatment of between 25-30 patients in a 12 hour shift, which can mean administering 200 injections in that time (MacReady, 2008). With this kind of patient load, it can be very difficult to find the time to do things that are usually considered “extras,” such as discussing patients' faith with them, and still practice safe nursing care.
Disadvantage #2
Losing empathy for their patients can be another barrier to incorporating spirituality into patient care. Studies have shown a direct link between nurse burnout and loss of empathy (Bodin, 2008). Because of their heavy patient loads, nurse burnout is a big problem with nurses who work in dialysis units (MacReady, 2008). Burnout can cause job dissatisfaction, which in turn leads to high turnover rates among dialysis nurses, and, as a result, heavier patient loads. It is a problem that continues to perpetuate itself. In a recent survey, twenty percent of the dialysis nurses that were interviewed planned to leave their jobs (MacReady, 2008). It is very difficult for people to be caring and compassionate when they are exhausted, and don’t feel a sense of satisfaction in the work they do.
References
Bodin, S. (Mar/Apr 2008). Keeping individuals with kidney disease safe: raising awareness of the effects of nurse fatigue. Nephrology Nursing Journal, 35, 115-116. Retrieved May 8, 2008, from ProQuest database.
Costantini, L., Beanlands, H., McCay, E., & Cattran, D. (Mar/Apr 2008). The self-management experience of people with mild to moderate chronic kidney disease. Nephrology Nursing Journal, 35, 147-154. Retrieved May 8, 2008, from ProQuest database.
Hain, D. (Jan/Feb 2008). Cognitive function and adherence of older adults undergoing hemodialysis. Nephrology Nursing Journal, 35, 23-29. Retrieved May 8, 2008, from ProQuest database.
Johns Hopkins Medicine (2005, August 1). Dialysis treatment choice affects risk of death in patients with end-stage kidney disease. Retrieved January 14, 2008, from http://www.hopkinsmedicine.org/Press_releases/2005/08_01_05.html
Kammerer, J., Garry, G., Hartigan, M., Carter, B., & Erlich, L. (Sep/Oct 2007). Adherence in patients on dialysis: strategies for success. Nephrology Nursing Journal, 34, 479-486. Retrieved January 16, 2008, from ProQuest database.
Landreneau, K., & Ward-Smith, P. (Jul/Aug 2006). Patients’ perceptions concerning choice among renal replacement therapies: A pilot study. Nephrology Nursing Journal, 33, 397-402. Retrieved April 10, 2007, from ProQuest database.
MacReady, N. (April 2008). System Overload. Dialysis & Transplantation, 118-122.
Richard, C. (Jul/Aug 2006). Self-care management in adults undergoing hemodialysis. Nephrology Nursing Journal, 33, 387-394. Retrieved January 16, 2008, from ProQuest database.
Tanyi, R., Werner, J., Recine, A., Sperstad, R. (Sep/Oct 2006). Perceptions of incorporating spirituality into their care: A phenomenological study of female patients on hemodialysis. Nephrology Nursing Journal, 33, 532-538. Retrieved October 14,2007, from ProQuest database.
White, R. (Jul/Aug 2004). Adherence to the dialysis prescription: Partnering with patients for improved outcomes. Nephrology Nursing Journal, 31, 432-435. Retrieved January 16, 2008, form ProQuest database.
Tuesday, May 27, 2008
Adherence to Treatment: the Nurse's Role in Promoting Wellness in Patients Undergoing Treatment for End-Stage kidney Disease
Monday, May 26, 2008
Nursing Management of Multiple Sclerosis
Multiple Sclerosis (MS) is a disease that affects a person’s entire life. Since MS has major neurological effects that are progressive, it can force a person to alter many routine activities within their daily life.
MS, a chronic illness, causes those affected to balance their disease and feelings about their illness within their already busy and bustling life. Keeping this in mind, nurses and MS nurse specialists can have a profound impact on helping a patient manage their Multiple Sclerosis. Because it is the MS nurse that helps manage patient expectations, it is imperative for the MS nurse to develop a therapeutic relationship with the patient, help patients and their families incorporate the disease into their lives and to encourage the patient to seek medical interventions early.
According to the Multiple Sclerosis Society website (2007), “MS is the result of damage to myelin- a protective sheath surrounding nerve fibres of the central nervous system. When myelin is damaged, this interferes with messages between the brain and other parts of the body” (Paragraph 1). Multiple Sclerosis is a disease that has caused a host of problems from a patient care and disease management perspective. For instance, “for the majority of people diagnosed many years ago and told to ‘get on with life,’” today new treatments and support are offered to those who are diagnosed with this life changing disease (D’Arcy, 2005, p. 2). Though there is no cure for MS, great strides “have focused on pharmacological management and therapeutic strategies, education, provision of emotional support and advocating change in governmental policies” (D’Arcy, 2005, p. 2). Hence, the disease management process for MS has come a long way since it was first discovered as being a life threatening and altering disease. The health care community is working hard to educate people living with this disease while at the same time alleviating the unnecessary complications that come with Multiple Sclerosis.
Multiple sclerosis brings with it a multitude of issues. One of the most important topics to address is patient expectations. A significant way this can be done is for the nurse to develop a healthy, therapeutic relationship with the patient and the patient’s family during the patient’s first visit to the clinic. The nurse should concentrate on establishing a connection with the patient and their family, having an open dialogue with them about how things are going and how they are feeling. People who are affected by MS are looking for that one person who will truly listen to their needs and feelings. Furthermore, “the desired outcomes for this relationship are for patients to have an increased awareness and knowledge about MS, DMDs, and the rationale for treatment” (Ross, Costello, & Kennedy, 2005, p. 1). This piece is so important to the nurse/patient relationship. Honesty and trust are key in developing the therapeutic relationship needed and these characteristics of successful communication pave the way to success for the relationship and health goal at hand.
Incorporating any disease into ones life is so important, which stands true for Multiple Sclerosis. According to D’Arcy (2005), one way a nurse specialist may help a patient and their family incorporate a disease into their lives is by “[helping] deliver personlised, patient focused care and [giving] appropriate information so that patients can make informed choices” (p. 3). Often, a newly diagnosed MS patient does not know what his/her needs are going to be. The nurse specialist may help this patient with focused goals, such as continuing with daily activities and exploring new treatments, to better manage the disease and prevent relapse. These goals may be set over a few visits with the nurse specialist and will change as the person’s disease progresses. “Part of the MS nurse’s role involves the correct identification of relapse, assessment and the application of appropriate intervention” (Embrey, 2003, p. 2). A relapse, also called an exacerbation, could be the patient developing optic neuritis, which would than be treated.
Inquiring about interventions and following through with them is essential with a disease like Multiple Sclerosis. According to a study done by Fleming-Courts (2004), MS focus groups “support nursing interventions that empower and teach self-management techniques” (p.1). It is very important for the patient to understand the options he/she has to fight this disease. The patient should be prepared to "Fight your own fight…be your own advocate and [take] charge (Fleming-Courts, 2004, p. 12).” During routine visits with the MS nurse specialist, the patient is encouraged to use various interventions and follow through with therapies. The nurse may follow-up with the patient after their appointments to ensure that the patient left with all of the information needed and questions answered. The MS nurse specialist is a great resource and in a unique position to help the person on a medical regimen and be forthcoming with therapies.
Within any disease process, it is important for the nursing staff to assess the patient’s expectations, which help guide the MS nurse specialist to the appropriate treatments for patients and their individual needs. Further assessment of these expectations provides focus to the nurse and their responsibility to develop a therapeutic relationship with the patient; help patients and their families incorporate the disease into their lives; and to encourage the patient to seek medical interventions early. Essentially, these steps provide a very good start to the management and treatment of a disease that is progressive and unrelenting, yet treatable to whatever extent the patient is willing to go.
Intervention #1
Nurses need to guide patients through the process of setting realistic expectations and getting the right treatments early for the patient.
Disadvantage #1
There are several things that happen when a person is diagnosed with Multiple Sclerosis (MS). Patients are often new to the disease and have to deal with the knowledge deficit that they face because of this newly diagnosed disease. Because of this knowledge deficit, the nurse is expected to help guide the patient through the entire process. The nurse is responsible for filling in where there is a deficit in knowledge as well as being abreast of the latest resources and treatments that are offered. With being knowledgeable about these treatments, at times practitioners and patients can get over excited with the “hype” of new products that show promise in treating MS. With this “hype,” unrealistic expectations may be set by the patient and nurse. Therefore, the nurse must stress that the Disease Modifying Drugs (DMD’s) “reduce exacerbation and slow disease progression but are not cures” (Ross p. 2). The patient must understand that relapse is expected with a disease like MS. If the nurse prepares the patient for this kind of reality, the patient will be less likely to be emotionally distraught during a relapse. Nurse must ensure that patients are setting realistic expectations for their disease process.
Disadvantage #2
With setting realistic expectations also comes choosing the right treatment and getting the patient treated early. The nurse must help the patient decide on the correct treatment by taking into consideration several factors. Lifestyle, stage or severity of disease and the patient’s ability to adhere to treatment are all things that should be considered when choosing a treatment. Another very important aspect of treating MS is to start early. Early interventions should include “pharmacological management and therapeutic strategies, education, provisions of emotional support, and advocating change in government policy” (D’Arcy p. 2). Though early intervention is key, “some [patients] refused the medications because the physician would not assure them of its effectiveness, they were doing well at the moment, and the cost was a deterrent” (Ross et al p.7). MS is a disease that needs time and attention right away; however, high costs, ineffective explanations and poor communication practices with practitioners perturb patients from seeking the health care needed.
Intervention #2
The MS Nurse Specialist should begin to develop a therapeutic relationship with the patient, and help patients and their families incorporate the disease into their lives.
Disadvantage #1
Developing relationships with patients can prove to be challenging. Some times nurses will see patients for the first time after the disease has already progressed. Furthermore, “there is often limited time to discuss individual concerns and provide counseling” (Ross p. 3). This means that the nurse must establish a healthy, therapeutic relationship within a limited amount of time and possibly take over care of a patient that has or has not been established with MS treatments. These issues listed above make it difficult for the nurse to help the patient and family come to terms with MS and its effects.
Disadvantage #2
Though it would seem that following the interventions listed above is easy to do, it can prove to be difficult. Establishing the relationships are important to ensure patient adherence and family support. However, in some case adherence is an issue. In Counseling Points, Ross states, “There are signs that indicate patients may not be adhering to therapy. In some cases, patients try to act as if everything is going well or they avoid giving direct answers. It is up to the nurse to be aware of these signs and to be able to assess what is really going on” (p. 6). Therefore, nurses must try to counteract these types of situations with consistent and frequents follow-ups with the patient and their family. This may help with patient adherence and family participation.
References
D’Arcy, C. (2005, Oct). Managing multiple sclerosis: working in partnership: Caroline D'Arcy describes how healthcare professionals can respond to the needs of people with long term conditions such as multiple sclerosis. Nursing Management. 12(6) 32-35. Retrieved on April 3, 2007 from Expanded Academic ASAP database.
Embrey, N. (Feb. 12, 2003). Benchmarking best practice in relapse management of multiple sclerosis. Nursing Standard, 17(22), 38-42. Retrieved May 28, 2007, from the Expanded Academic ASAP database
Fleming Courts, N., Buchanan, E., & Werstlein, P. (2004). Focus groups: The lived experience of participants with multiple sclerosis. Journal of Neuroscience Nursing, 36(1), 42-47. Retrieved April 3, 2007, from the Expanded Academic ASAP database.
Multiple Sclerosis Society. May 23rd, 2007. Retrieved on May 29, 2007 from http://www.mssociety.org.uk/index.html
Ross, A., Costello, K., Kennedy, P., & Pfohl, D., (2005). Managing patient expectations. Multiple Sclerosis: Counseling Points. 1(1). Retrieved April 28th, 2007, from http://www.iomsn.org/pdf/counseling_pts_Vol1_Num1.pdf
Assisted Reproductive Technologies: the Nurse’s Role in Preconception Counseling
Infertility prevents around 6.1 million people in the United States from having children. As a result, infertile couples and individuals often seek to become parents through assisted reproductive therapies (ART). Each client has a different situation, so there are a number of assisted reproductive techniques available to suit their needs. Because assisted reproductive technology is a successful option for managing infertility, nurses must assess and evaluate factors affecting fertility, screen for genetic problems, and educate clients about the reproductive options available depending on each individual situation.
Involuntary infertility affects 10% of reproductive-age individuals. Basic infertility services may be used to treat the majority (85-90%) of infertile males and females, but the remaining 10-15% require assisted reproductive technologies. ART also provides options for individuals with or at risk for transmitting a genetic disorder and those experiencing infertility due to advanced maternal age. Since 1992, there have been over 850,000 ART cycles in the U.S. resulting in over 210,000 children conceived (Jones, 2004, p.116). The most common adverse outcome from ART treatment is multiple births which may lead to complications during pregnancy; though studies have found that many patients seeking ART treatment prefer to have twins or triplets instead of just a single infant (Grainger, Frazier, & Rowland, 2006, p.162). “Experience with and refinement of these technologies continue to increase the likelihood that an infertile woman, man, or couple is able to conceive and give birth to a child through the various technologies now available” (Jones, 2004, p.115).
Nurses are often the first healthcare providers that women encounter for preconception and prenatal issues. Preconception care involves the “assessment of risk factors for having a child with a genetic disorder, providing information about preconception, prenatal testing, and reproductive options to minimize the chance of having children with genetic problems.” Nurses obtain the family, medical, obstetric, and genetic history, physical examination, and laboratory results which provide vital information for determining risk factors. Once the risk factors have been assessed, appropriate lifestyle modifications (ex. diet, medications, environments) can be made to optimize preconception and prenatal care (Shapira & Dolan, 2006, p.143).
Nurses provide appropriate preconception and prenatal care, education, and medical counseling for those with known genetic problems to decrease the risk of complications or genetic disorders. Genetic screening of both parents is helpful in diagnosing risks for transmitting a genetic disorder. Around 85-90% of repeated pregnancy loss is due to genetic problems. If one or both parents are carriers of a genetic disorder, or have a genetic disorder themselves, preimplantation genetic diagnosis (PGD) is a very effective option. PGD involves determining the sex and chromosomal make up of an embryo produced through in-vitro fertilization. One benefit of this option is knowing the genetic health of the embryo before it is implanted, therefore eliminating the decision of whether to terminate or not if a genetic condition was found later in the pregnancy. It is possible to find out if embryos are affected with disorders such as cystic fibrosis, sickle cell anemia, and Huntington’s disease (Jones, 2004, p.126). Gender selection is helpful when the parents have been screened with either an X-linked recessive, or a Y-linked disorder. Gender selection is also available for non medical reasons and is virtually always accurate (Barad & Gleicher, 2007, p.2).
Comprehensive preconception care requires building a strong nurse/patient relationship and knowledge of the advances in genetics and reproductive health options. It is critical for nurses to use this knowledge to provide anticipatory guidance and encourage clients to think through their options. The most common assisted reproductive options available include the following: in-vitro fertilization (IVF), preimplantation genetic diagnosis (PGD), and intracytoplasmic sperm injection (ICSI) (Barad, 2007, p.3). In-vitro fertilization is a useful option for clients with diagnoses such as: fallopian tube defect, ovulatory disturbance, or idiopathic infertility (Jones, 2004, p.124). Male infertility is a factor in about 40% of couples seeking ART. Intracytoplasmic sperm injection (ICSI) may be used to achieve pregnancy in this situation. Since only one sperm is needed to fertilize the egg, only very small quantities of semen are needed. This method is used for male clients with semen anomalies, congenital or surgical absence of vas deferens, spinal cord injury, impotence, azoospermia, or idiopathic infertility. An established nurse/patient relationship provides psychosocial support and allows the opportunity for nondirective, nonjudgmental reproductive decision making. Care is delivered in a nondiscriminatory manner, protecting and respecting client autonomy, dignity, and rights. Privacy and confidentiality issues are regulated by state, and federal laws and standards of practice by the ANA (Wille, Weitz, Kerper, & Frazier, 2004, p.37). Nurses also provide referrals to other healthcare providers or professional resources such as genetic counselors, support groups, religious groups, or social workers when needed.
There are a number of factors affecting fertility (ex. diet, exercise, medications, work conditions). Nurses identify risk factors, suggest any modifications needed to maximize fertility, and provide appropriate preconception and prenatal care. Since there are a number of options available for clients experiencing infertility, nurses provide information, resources, and support to help clients make the best possible reproductive decisions. Nurses are effective in the assessment of factors affecting fertility, identifying risks for genetic problems, and providing education and support for clients making the reproductive decisions unique to their situation.
References
Barad, D., & Gleicher, N. (n.d.). Treatment options assisted reproductive technology. Retrieved May 6, 2007, from http://www.centerforhumanreprod.com/treatment_assisted.html
Grainger, D. A., Frazier, L. M., & Rowland, C. A. (2006). Preconception care and treatment with assisted reproductive technologies. Maternal and Child Health Journal, 10(7), 161-164. Retrieved May 28, 2007, from PubMed Central database.
Jones, S.L. (2004). The confluence of two clinical specialties: Genetics and assisted reproductive technologies. MedSurg Nursing, 13(2), 114-122. Retrieved April 16, 2007, from Expanded Academic ASAP database.
Shapira, S. K., & Dolan, S. (2006). Genetic risks to the mother and the infant: Assessment, counseling, and management. Maternal and Child Health Journal 10(7), 143-146. Retrieved May 28, 2007, from PubMed Central database.
Wille, M. C., Weitz, B., Kerper, P., & Fraizer, S. (2004). Advances in preconception genetic counseling. Journal of Perinatal and Neonatal Nursing, 18(1), 28-41. Retrieved April 16, 2007, from ProQuest database.
Intervention 1: Nurses must educate clients about the reproductive options available depending on each individual situation.
Disadvantage 1: Options available are changing constantly due to new research and development of new techniques. Clients may have specific clinical questions that are related to what they have seen or heard in the media. “Media coverage of these issues means that members of the public are quickly aware of new developments. Nurses can therefore find themselves confronted with queries on a rapidly changing and highly complex subject (Hitchen, 2008, pg 27).” It is difficult for organizations involved in assisted reproductive technologies to keep up to date with developments in embryonic and reproductive research due to the huge demand for treatments as well as the continual development of new techniques and research (Hitchen, 2008, pg 27).The area of ART is demanding and unique, and requires the development of specialized nursing knowledge and skills in order to provide safe, effective, and appropriate care to women and their partners receiving ART (Payne, 2007, pg 38).
Disadvantage 2: Another barrier to client education may be that the clients are unwilling to make the necessary lifestyle changes to improve fertility (such as smoking cessation, avoiding drugs and alcohol, and hazardous environments) as well as follow the prescribed treatment plan. The treatment cycles are very involved. “Nurses are required to educate women and their partners particularly about the female reproductive cycle and the different treatment options. The latter are regimens that require strict adherence and administration of oral and injectable medications. The dosages vary depending on the results of blood tests taken throughout the treatment cycle (Payne, 2007, pg 38).”
Intervention 2: Nurses must screen for genetic problems.
Disadvantage 1: One disadvantage could be the cost of genetic testing. Heteroduplex analysis costs $260, DGGE tests cost $250-$800, ASO and PTT tests can cost between $190-$450, while sequencing tests can cost $500-$3,000 each. A few reasons for the high cost are that genetic tests are rare, labor intensive, and undergo multiple levels of review. There may be additional costs to you besides the actual cost of the genetic test. These may include any cost for blood draw or specimen collection, Federal Express or other shipping costs, and genetic counseling or physician fees (Toland, 2000, pg 2). Cheaper medical treatment is available abroad, but the quality and safety of such treatments is not monitored (Hitchen, 2008, pg 28).
Disadvantage 2: Clients may not want to make the ethical decision of what to do if they conceive a child with a genetic disorder. Families who learn that they are at significant risk have multiple alternative reproductive options including: donor egg, donor sperm, sperm separation, preimplantation genetic diagnosis, adoption, or avoidance of pregnancy. Prenatal diagnosis is available to allow preparation for having a child with a genetic disorder or termination of the pregnancy. “The psychosocial implications of genetic counseling and testing are often manifold and couples may have difficulty with decisions and options (Wille, Weitz, Kerpner, & Frazier, 2004 pg 29).”
References
Hitchen, L., (2008). Examining issues in assisted reproduction. Practice Nurse 35(1), 27-30. Retrieved May 25, 2008 from ProQuest database.
Payne, D., (2007). The role of nurses working in ART. Australian Nursing Journal 15(3), 38-39. Retrieved May 25, 2008 from ProQuest database.
Toland, A. E., (2000). Genetic testing: Costs of genetic testing. Retrieved May 12, 2008, from http://www.genetichealth.com/GT_Genetic_Testing_Costs_of_Genetic_Testing.shtml
Wille, M. C., Weitz, B., Kerper, P., & Fraizer, S. (2004). Advances in preconception genetic counseling. Journal of Perinatal and Neonatal Nursing, 18(1), 28-41. Retrieved April 16, 2007, from ProQuest database.
Diabetes Complication: the Nurse’s Role in Reducing Diabetic Complications
About 17 million people in America are currently suffering from diabetes. “A significant public health problem, diabetes is the seventh leading cause of death in the United States.” (Black, 2005, p.1244) Because diabetes can cause serious complications such as retinopathy, neuropathy, renal failure, and even death, nurses play a critical role in reducing diabetic complications through holistic care and education. Nurses can prevent diabetes complications in patients by providing diabetes education to newly diagnosed patients, creating a multidisciplinary diabetic control regimen with the patient, nutritionist, and diabetes educator, and calling patients bimonthly to check upon patients’ compliance with diabetes control regimen. Through these interventions, nurses can greatly reduce diabetes complications in patients.
Diabetes mellitus is a “chronic systemic disease characterized by either a deficiency of insulin or a decreased ability of the body to use insulin.” (Kronmal, 2006, p.401) Diabetes mellitus can be divided into either type I or type II. Type I diabetes is characterized by absolute insulin deficiency caused by destruction of pancreatic beta cells. Patients with type II diabetes produce insulin, but their liver and peripheral tissues are resistant to the effects of insulin. As a result of defective insulin utilization, diabetes patients experience decreased glucose utilization, increased fat mobilization, and increased protein utilization. If untreated, diabetes mellitus can cause more serious complications such as coronary artery disease, hypertension, retinopathy, nephropathy, and neuropathy.
Diabetes is a disease that requires a tremendous change in a patient’s life style. Since patients have to live with diabetes for the rest of their lives, it is essential that they are educated early after the diagnosis on what they need to know to improve the quality of their life. The diabetes education nurse can set up a convenient time for the patient, choose a private room, and explain the pathology, clinical manifestations, and complications of diabetes. During this education session, it is important to emphasize to patients that they did not do anything wrong to cause the disease. Glycemic control is directly linked to the patient’s exercise level and dietary regimen, and thus it is easy for patients to think that they have earned the disease. According to the Diabetes Attitudes, Wishes, and Needs (DAWN) study “diabetes distress was common among patients, with 85.2% of them experiencing a feeling of shock, guilt, anger, anxiety, and depression at the time of the diagnosis” (Funnell, 2006, p.155). The study also stated that these psychological distresses lead to poor glycemic control in patients, so it is critical to educate patients and answer any questions they have, soon after the initial diagnosis.
Once the patient has accepted the diagnosis of diabetes, the nurse can coordinate a multi disciplinary approach to create a diabetes control regimen. The multidisciplinary team can consist of a nutritionist, physician, diabetes education nurse, and the patient. This team can decide on measures to keep patients’ glucose level as normal as possible, such as eating a balanced diet, exercising regularly, and administering daily medication. During the meetings, the nurse should act as a patient advocate and actively involve the patient in the decision making process. Since diabetes is a chronic condition, the control regimen “should be individualized to each patient’s goals, age, lifestyle, nutritional needs, activity level, and type of diabetes” (Davidson, 2003, p.2291) to produce optimal outcome. The nurse plays a critical role in creating this individualized regimen by assessing the patient’s needs and what they are willing to do.
Once the diabetes control regimen has been implemented, the nurse can increase patient’s compliance by calling them bimonthly to check their status. Asking a few simple questions such as the patient’s recent glucose levels, recent meals, or last time that the patient exercised, can give a nurse valuable clues about how the patient is doing. Patients also benefit from these phone calls by building a better care relationship with the providers. Patients can utilize this time to ask any additional questions that they came up with or simply express concerns. According to the research study performed by Taylor, et al, (2003) patients who have received the bimonthly calls from nurses “showed significant reduction in blood glucose level, total cholesterol level, and total LDL level.” (p.1063)
Diabetes is a complex disease that requires extensive change in the patient’s life style. Nurses can help the patients adjust to change in their lives by providing diabetes education to newly diagnosed patients, creating a multidisciplinary diabetic control regimen with the patient, nutritionist, and diabetes educator, and calling patient bimonthly to check upon patient’s compliance with the diabetes control regimen. Nurses can help diabetes patients better than any other healthcare team members, since they spend most time with patients. Through careful observation and active listening, nurses can be more attuned to each patient’s beliefs and attitudes toward diabetes and can come up with individualized diabetes control regimens that can effectively reduce complications from diabetes.
Intervention #1
Nurses need to provide diabetes education to newly diagnosed patients.
Disadvantage #1
One problem with nurses providing education to diabetes patient is that nurses have to spend extra effort and time to learn about diabetes. Diabetes is a complex disease that impacts patient’s overall health status. As a result, nurses first have to become knowledgeable about different aspects of diabetes management before they can educate their patients. According to a study in Magson-Robert’s paper, only 38% of nurses responsible for diabetes education had “attended a diabetes study day within the past two years.” Nurses are not mandated to regularly update themselves in diabetes management, and this lack of continuing education can lead to nurses giving invalid or inappropriate advice to their patients.
Disadvantage #2
Some patients might not follow instructions given by the diabetes education nurses, due to the faulty perception that nurses don’t have the authority or knowledge to educate them. In his paper, Martin stated that “authorities seen as credible sources of information are particularly effective as agents of behavior change.” Conversely, patients’ compliance will decrease if the patient views nurses as having no authority. Thus, nurses need to be creative in devising a way to convey their expertise to the patients to increase patient’s compliance.
Intervention #2
Nurses need to call their patients bimonthly to check upon patient’s compliance with diabetes regimen.
Disadvantage #1
One problem that occurs with this intervention is that nurses are so short staffed that they don’t have time to call all their patients bimonthly. Nurses’ workload are heavy as it already is and added responsibility of telephone checks can lead to dissatisfaction of the nursing staffs. According to study done on 43,000 nurses only 34% of surveyed nurses believed that they had enough RNs to provide high-quality care in the facility where they work (Mees, 2008). If the nurses are already feeling like they don’t have enough staffs to provide high-quality care, they will not appreciate any added work, regardless of the benefits that it offers to their patients.
Disadvantage #2
Another barrier to this intervention is that the patient’s might not have adequate socioeconomic means to participate in the program, even if it is offered. For instance, according to Borsky’s research article, Asian Americans were less likely than whites to receive eye examinations, physiological testing, and self – care instructions. This can be attributed to the fact that Asian Americans have the highest rate of uninsurance (6%), compared with white (0.2%), reflecting different work pattern. This socioeconomic status of having no insurance had significant influence on health outcomes for Asian Americans since
diabetes is the fifth leading cause of death among Asians, and the prevalence of diabetes is higher among Asians compared to white population. References
Black, J.M., Hawks, J.H. (2005). Management of clients with Diabetes Mellitus. In Medica-Surgical Nursing (pp.1243-1287). Missouri: Elsevier
Borsky, A..E., Greenberg, L., Moy, E. (2008). Community Variation: Disparities In Health Care Quality Between Health Affairs, 27(2), 538-550. Retrieved May 10th, 2008from ProQuest Smart Search database (1447860551) Asian And White Medicare Beneficiaries.
Davidson, M.B. (August 2003). Effect of a nurse-directed diabetes care in a minority population. Diabetes Care, 26(8), 2281-2291. Retrieved from ProQuest Smart Search database on May 29, 2007. (384283331)
Funnell, M. M. (2006). The diabetes attitudes, wishes, and needs (DAWN) study. Clinical Diabetes, 24 (4), 154-156. Retrieved from ProQuest Smart Search database on May 23, 2007. (1166450571).
Kronmal, R.A., Barzilay, J.I., Smith, L.N, Psaty, B.M., Kuller, L.H., et al. (2006) Mortality in Pharmacologically Treated Older Adults with Diabetes: The Cardiovascular Health Study, 1989–2001. Public Library of Science Medicine 3(10), 400-404. Retrieved from PLoS Medicine database on April 30, 2007. (p.0030400)
Magson-Roberts, S. (2007). The Role of the District Nurses in Diabetes Management. Journal of community Nursing, 21 (3), 10-12. Retrieved May 10th, 2008 from ProQuest Smart Search database (1240618771) Martin, Steve (2008). The Science of Compliance: Believing in an Expert. Practice Nurse, 35(7), 39-40. Retrieved May 10th, 2008 from ProQuest Smart Search database (1470885181) Mee, C.L., Robinson, E. (2003). What’s Different About this Nursing Shortage? Nursing, 33(1), 51-53. Retrieved May 11th, 2008 from ProQuest Smart Search database (276207061)
Taylor, C. B., Miller, N.H., Reilly, K.R., Greenwald, G, et al. (2003). Evaluation of a nurse-care management system to improve outcomes in patients with complicated diabetes. Journal of Diabetes Care, 26 (4), 1058-1064. Retrieved from ProQuest Smart Search database on April 19, 2007. (324968961).
Best Practices in the Mental Health Setting
The general role of a mental health nurse is to provide non-prejudiced and holistic care of the patient. Psychiatric nurses play an important role as members of a multi-faceted treatment team in providing health promotion, assessment of dysfunction, and prevention of further disabilities. Nurses work in collaboration with other disciplines including psychiatrists, physicians, psychologists, and social workers to provide a well-rounded and holistic approach to treatment. Leanne Cowin (2003) points out that the primary nursing care goal is the ongoing development of a therapeutic relationship with the patient.Therapeutic alliances between patients and staff are encouraged to help decrease the ongoing problems of aggressive behaviors displayed by patients on mental health units. As a result, nurses are utilizing the appropriate tools to manage aggressive conditions. Tools include involving patients in psychological therapies, engaging in techniques to manage challenging behavior, and most importantly, building therapeutic relations. Because the emphasis of mental health nursing is on the development of therapeutic alliances, strategically building relationships should create the foundation to handling aggression more effectively. (Duxbury, 2005)In managing challenging behaviors, the utilization of various tools, specifically, cognitive behavioral therapy, will allow nurses to be more capable of carrying out nursing tasks in safer environments. Cognitive-behavioral therapy is a key branch of the psychological therapies used in mental health settings. This type of therapy aims to predict and control behaviors using a variety of methods. It is concerned with the perception and belief systems and changing the way things are viewed to better an outcome. “This treatment approach aims to identify and modulate cognitive, behavioral, and physiological responses to perceived provocation though various treatments.” (Graham, 2005) The ultimate goal of cognitive-behavioral theory is to reduce anger episodes by understanding and observing personal anger patterns and using alternative methods to handling provocation. This approach to therapy generally relies on present experiences as opposed to past ones. It tends to directly reduce symptoms as well as apply strategies designed to build better problem-solving skills.In gaining insight of how patients cope with daily challenges, role-playing assists nurses in comprehending situations patients’ experience. (Hahn, 2006) Participants are encouraged to perceive aggression from an interactional and situative context. Situations consist of moments wherein patients are experiencing paranoid thought, hallucinations, delusions, and states of aggression or anxiety. Nurses also take into consideration that patients have a barrier they are learning to cope with: mental illness. Key skills involving role-playing are the use of communication and presentation toward the patient. Nurses are to demonstrate effective communication through articulating at the level and appropriateness of the patient and situation. Role-playing has been successful in keeping nurses aware of patients’ behavioral patterns.Additionally, proactive actions in observing factors of aggressive behaviors prevent circumstances from becoming uncontainable. It is important to effectively “calm down” an escalating condition and prevent situations. This can be done by moving a patient to a calmer area to assist them in focusing and working with the treatment team to reduce feelings of anxiety or agitation. Nurses can help to “talk out” with the patient to identify possible stressors and triggers and ways to reduce them. Approaching the patient calmly and cautiously and keeping a neutral position is also beneficial to avoiding escalation. Neutral positions help to decrease paranoid thoughts and keeps patients aware of their surroundings. It also helps them to focus on the situation at hand. Neutral positions consist of keeping hands visible and being aware of facial expressions as engagement occurs.Situations involving patients who have displayed threats to safety of themselves or others permit nurses to engage in de-escalation techniques. De-escalation has proven a valuable intervention that is used by nurses to help encounter problems of aggression and violence. By using de-escalation techniques, nurses are more aware of patients who are beginning to escalate and intervene early. To recognize early warning signs and involve the patient in discussions on how to avoid seclusion and restraint best is an extremely valuable exercise if the event allows. Early warning signs of increasing agitation include physical and verbal signs of increasing anxiety, pacing and excessive body movements, as well as an increase in volume and tempo of voice. (Cowin, 2003) De-escalation in combination with problem solving and conflict resolution is an effective, alternative method to keeping safety on the wards. The use of restraint and seclusion should be utilized as a last resort. According to Joy Duxbury (2005), the seclusion of psychiatric patients is viewed as a violation of human rights.As new practices are put into place, the numbers of incidents involving aggressive and violent behaviors decrease. Less restrictive practices, such as de-escalation, help nurses to develop better relationships with their patients. This tool illustrates nurses’ abilities to communicate effectively while keeping the respect of the patient. Utilizing improved judgment and being able to read situations early provides more secure environments for both nurses and patients on wards. Using a combination of all tools maintains and increases autonomy and dignity of patients. This in turn allows for more productive outcomes in maintaining safety and dignity among their patients. Giving patients options to “talk it out” and use of less punitive measures takes nursing forward to finding a therapeutic common ground between patients and the treatment team.Positive connections were found between utilizing tools specified and rates of violent incidents decreasing, enabling psychiatric nurses to work with their patients in a more productive manner. Using techniques such as de-escalation and cognitive-behavioral theory exercises the patients’ ability to use a reality-based sense of coping when discharged into the community. Well-trained mental health nurses can help find critical therapeutic common ground between patients and staff, which can help maintain safety for all on the wards. A new level of effectiveness between a nurse and their patient allows for alternative methods regarding aggression and violence. This team concept of transforming relationships with patients towards a holistic approach leads ultimately better quality lives for patients.ReferencesHahn, S., Needham, I., Abderhalden, C., Duxbury, J., & Halfens, R. (2006) The effect of a training course on mental health nurses' attitudes on the reasons of patient aggression and its management. Journal of Psychiatric and Mental Health Nursing, 13(2), 197-204. Retrieved Janurary 19, 2008, from CINAHL database. (Documentation ID: 2009145056).Duxbury, J., & Whittington, R. (2005) Causes and management of patient aggression and violence: Staff and patient perspectives. Journal of Advanced Nursing, 50(5), 469-478. Retrieved January 25, 2008, from CINAHL database. (Documentation ID: 2005110112).Cowin, L., Davies, R., Estall, G., Berlin, T., Fitzgerald, M., & Hoot, S. (2003) De-escalating aggression and violence in the mental health setting. International Journal of Mental Health Nursing, 12(1), 64-73. Retrieved January 25, 2008, from CINAHL database. (Documentation ID: 2003163724).Graham, G., & Saini, M. (2005) An evidence-based review of psychological treatments of anger and aggression. Brief Treatment and Crisis Intervention, 5(2), 229. Retrieved January 15, 2008, from ProQuest database. (Document ID: 859805811).A. INTERVENTION 1: DE-ESCALATION TO HELP ENCOUNTER PROBLEMS OF AGGRESSION AND VIOLENCEi. Disadvantage 1: There are differences between the views of staff and patients about reasons for aggression and its managementA need for training in how to communicate and facilitate collaboration is implied by patients; mental nursing staff believes the use of de-escalation is successful in preventing the development of violence. Patients, however, were not of this view, which suggests that it may be poorly implemented despite its reported use by nursing staff. While de-escalation is encouraged in training today, it does not address interpersonal difficulties prior to the occurrence of aggression or fundamental and organizational deficiencies. (Duxbury, 2005)ii. Disadvantage 2 – Inadequate training techniques involving de-escalation can lead to ineffective communication between patient and nursing staff furthering agitation and aggressive/violent actionsInexperienced staff managing de-escalation events can increase agitation, which can escalate into violent actions. Communication is key! Staff alternatively turn to non-therapeutic techniques (i.e. seclusion and restraints, PRN medications/ stat IM orders) to “defuse” and “contain” the situation promptly. This approach does not consider the patient’s autonomy and dignity. (Cowin,2003)B. INTERVENTION 2: BUILDING THERAPEUTIC ALLIANCES BETWEEN PATIENTS AND STAFF TO HELP DECREASE THE ONGOING PROBLEMS OF AGGRESSIVE BEHAVIORSi. Disadvantage 1: Difficulties arise with patients who suffer brain injuries and/or are severely illPatients who suffer from traumatic brain injuries have varying degrees of comprehension. TBI often results in lifelong impairments in physical, cognitive, and psychosocial function, even in so-called "mild" cases.” A substantial proportion of individuals who sustain mild TBI also experience "persistent postconcussive syndrome," in which neurocognitive deficits and emotional symptoms persist beyond 12 months' postinjury." The most common psychiatric disturbances following TBI include major depression, anxiety; personality and neurobehavioral changes such as impulsivity and aggressiveness; and substance abuse. (Nelson, 2007)ii. Disadvantage 2: Cultural/Language barriersThough interpreters are present to translate vital information towards recovery from the treatment team to the patient, an aspect of the holistic model is absent. A direct, one-on-one interaction with a patient who has a language barrier and their caretaker is considered necessary towards a more effective recovery. Ethnocentrism plays a role as well in keeping alliances from developing between client and staff. (Alverson, 2007) There is also significant commonality within ethnic groups as there are significant contrasts between ethnic groups in the illness discourse and experiences of illness and of treatment.Nelson, L., Rhoades, D., Noonan, C., & Manson, S. (2007) Traumatic brain injury and mental health among two American Indian populations. Journal of Head Trauma Rehabilitation, 22(2), 105-12. Retrieved May 12, 2008, from CINAHL database. (Document ID: 2009558514Alverson, H., Drake, R., Carpenter-Song, E., Chu, E., Ritsema, M., & Smith, B. (2007) Ethnocultural variations in mental illness discourse: some implications for building therapeutic alliances. Psychiatric Services, 58(12), 1541-6. Retrieved: May 12, 2008, from Proquest database. (Document ID: 2009744297)
Click Here to Read More..Effectiveness of Treatments for Infantile Colic
Teaching a new mother about infantile colic is one of the primary responsibilities of postpartum nursing. Mustafa Aksam (2006) brings to light that infantile colic (IC) is a problem that effects up to 40% of babies. IC presents itself during the first three months of life and usually has its onset during the second week of life (Aksan, 2006). Many parents and caregivers are frustrated by IC especially when they are unable to control or relieve their baby’s pain and crying. A newly discharged mother is overwhelmed by all the changes in her life. Excessive uncontrolled crying of her baby during the day and night may be an additional trigger for postpartum depression (Roberts, 2004). Nurses should insure that all new mothers receive education about the treatments for infantile colic before discharge from the hospital. The result will be that fewer new mothers will return to the hospital with maternal depression.
The nurse educator will provide information about infantile colic to a new mother. According to Donna Roberts (2004), colic is often defined by “The rule of three”: an infant who is healthy and well nourished but crying “for more than three hours per day, for more than three days per week, and for longer than three weeks.” A colicky infant has attacks of high-pitched screaming in the evening with associated motor behavior such as furrowed brow, flushed face, clenched fists, distended and tense abdomen, and the legs drawn up to the abdomen. The loud cry may persist for several hours. It may be terminated when the infant becomes fatigued, or passes feces or flatus (Roberts, 2004). It is most important for the mother to have reassurance that her baby is healthy and the colic is self-limited with a short term effect unless there are other signs and symptoms of illness (Roberts, 2006). E. Rosenthal (2004) states that infant colic is considered by many as “stressful yet harmless” (Rosenthal, 2004).
According to Donna Roberts (2004), the cause of infantile colic remains unclear, and there is no effective medication that may help to resolve this problem without harming a baby. However, nurses are teaching new mothers several effective treatments that show a significant decrease in the time of infant’s crying episodes (Roberts, 2004).
Mustafa Aksam (2006) discusses the study conducted in Isparta Maternity Hospital in Turkey about the effect of oral hypertonic glucose solution in a treatment of infantile colic. In this study, thirty healthy infants with colic were selected and the double blind study with crossover trial was conducted. Two bottles were prepared for each patient: one bottle with 30% of hypertonic glucose solution used for IV injection and another bottle with distilled water. The same patient used one bottle for four days and then used another bottle for four days. All parents were instructed to give 1 mL of solution before each feeding using medicine droplets. The infants were examined in the clinic repeatedly and the parents described the effect of the last treatment on their infants. The study showed that 64 % of the parents reported an improvement in their infant’s condition while using 30 % of hypertonic glucose solution. However, 36 % of the parents also reported an improvement after using distilled water (Aksan, 2006). No one reported any side effect in this study. Since oral hypertonic glucose solution has a significant effect for the treatment of infantile colic, nurses will recommend it for the new mother as a natural, safe, and cheap therapy.
According to one study reported by P. Kearney (1998), lactase is effective in management of infantile colic. Incomplete lactose absorption in the small intestine provides carbohydrates for bacteria, which are present in the large intestine. Those bacteria metabolize lactose and produce hydrogen that causes infantile colic. Adding a few drops of lactase to the milk formula 24 hours prior to feeding the baby, significantly (95% or 1.14 hr/day) decreases crying time for babies with infantile colic. However, there is no effect of adding lactase to formula during the baby’s feeding. It is possible that stomach acid destroys lactase making it ineffective. The study showed that there was no difference in stool of the babies who had lactase or placebo in milk. Also, there were no side effects reported during this study (Kearney, 1998).
According to Sally Wade (2001), two systematic studies found that the infants fed with soya milk formula have less colic than infants fed with standard milk formula. Soy milk formula compared with standard milk formula reduces the duration of crying by 50-75% (Wade, 2001). However another research suggests that infants fed with soya milk formula do not receive important vitamins and proteins that are found in standard milk formula.
Donna Roberts (2004) suggested that herbal mixture containing chamomile, licorice, fennel, and lemon balm is effective in treatment of infantile colic. The mixture should be given to the infant three times a day, 150 mL per dose. However, there is a lack of standardization of strength and dosage, and it is too much for an infant to drink 150 mL of fluid at once. So, the new mother should be cautioned about the use of herbal treatment of infant colic (Roberts, 2004). According to E. Rosenthal (2004), behavioral and environmental modification can decrease infant crying time during the colicky time. Also, E. Rosenthal suggested another herbal mixture called “Gripe Water” which may include cardamom, chamomile, cinnamon, clove, dill, fennel, ginger, lemon ball, licorice, peppermint and yarrow. This product provides relief from flatulence and indigestion, however it has not been scientifically evaluated. Parents should avoid products that are made with sugar and alcohol and are manufactured outside of the US (Rosenthal, 2004).
Donna Roberts (2004) suggested behavior modification treatments for infantile colic. Some infants may reduce or even stop crying if placed near clothes dryer or near the room with a vacuum cleaner turned on that makes “white noise”. “Colic hold” is also suggested, which is a gentle pressure on infant’s abdomen (Roberts, 2004). E. Rosenthal (2004) suggested movements such as gentle rocking motion in a baby swing, in parent’s arms with walking or sitting in a rocking chair, or riding in a car also soothes some babies. Taking a warm bath together not only soothes the baby but also his mother (Rosenthal, 2004).
According to those studies, there are some effective and safe treatments and behavior modifications for infantile colic. If nurses provide the education about infantile colic to the new mothers, it will significantly increase their physical and mental ability to take care of their infants. Nurses prepare mothers to cope with the challenges that their babies will give them. Health care cost will decrease and the baby’s health will increase because mothers will use safe treatments and behavior modifications to treat infantile colic. Fewer mothers will return to the hospital for treatment of post-partum depression as the result of education that nurses will provide to new mothers prior to discharge from the hospital.
Intervention 1. Administering oral glucose hypertonic solutions for infant in treatment of infantile colic.
Disadvantage 1.
Oral glucose hypertonic solution does not affect all infants similarly. According to the study conducted in Isparta Maternity Hospital in Turkey, only 64% of parents reported an improvement in their infant’s condition while using 30% of hypertonic glucose solution. This means that this treatment did not affect positively other 36% of babies (Aksan, 2006). Another study also suggested that oral hypertonic solution does not have the same effect on all newborn babies. In this study only 23 from 36 babies who received one milliliter of oral hypertonic solution experienced relief in pain (Badiee, 2006).
Disadvantage 2.
Another disadvantage is a knowledge deficit. A very small amount of health care workers and parents in US are familiar with this treatment and even a smaller percentage of them use oral glucose hypertonic solution for treatment of infantile colic. The study about how oral glucose hypertonic solution treats infantile colic was conducted in 2006, in Turkey (Aksan, 2006). There is no evidence that this study has been repeated in US and implemented in US health care system yet.
Intervention 2. Soy milk formula compared with standard milk formula reduces the duration of crying by 50-75%.
Disadvantage 1.
One disadvantage of soy milk formula is affected by socioeconomic status. Soy milk formula is more expensive than cow’s milk formula. One Internet store shows that soy milk formula cost two dollars more than cow’s milk formula for the same can size (Diper.com, 2008).
Disadvantage 2.
According to Natalie Reiss, soy milk formula compared to breast milk has another disadvantage. Breast milk reduces the risk of getting infectious and non-infectious diseases in infants. Breast milk also reduces the risk of chronic diseases such as diabetes, cancer, allergies, and asthma in infants. Breast feeding infants also have less risk of becoming overweight compared to infants fed by formula (Reiss, N. 2007).
References
Akcam, M. & Yilmaz, A. (2006, April). Oral hypertonic glucose solution in the treatment of infantile colic. Pediatrics International, 48(2), 125-127. Retrieved February 12, 2008 from CINAHL database.
Badiee, Z. (2006). Pak J Physiol. Oral hypertonic glucose, for analgesia in the premature newborns. 2(2). Retrieved May 5, 2008, from http://pps.org.pk/PJP/2-2/zohrah.pdf
Diapers.com. (2008). Baby Formula/Similac. Retrieved May 5, 2008, from http://www.diapers.com/Shop/SubBrand.aspx?CategoryID=2&CategoryName=Baby+Formula&BrandCode=SM&BrandName=Similac
Kearney, P. Malone, A. Hayes, T. Cole, M. & Hyland, M. (1998, April). A trial of lactase in the management of infant colic. Journal of Human Nutrition and Dietetics, 11, 281-285. Retrieved February 12, 2008 from CINAHL database.
Roberts, D. Ostapchuk, M. & O’Brien, J. (2004, August). Infantile colic. American Family Physician, 70(4), 735-741. Retrieved February 12, 2008 from Proquest database.
Reiss N. (2007, May). New research suggests that breastfeeding babies for at least six months is best. Pediatrics for Parents, 23(5), 2-3. Retrieved May 5, 2008, from Proquest database.
Rosinthal E. (2004, December). Recognizing and treating infant colic. Primary Health Care, 14(10), 45-49. Retrieved February 12, 2008 from CINAHL database.
Wade S. & Kilgour T. (2001, August). Infantile Colic. Clinical Evidence, 323(7310), 437-440. Retrieved January 30, 2008 from Pubmed central database.
Eliminating Apprehension Amoung Nurses Towards End-of-Life Care. Jennifer Dees
Improvement in palliative care can happen with more interest from nurses towards this area of practice. Nurses are the health care providers that spend the most time with the patient and their families, making them advocates for patients who need end-of-life care. Nurses can also change the quality of care that is given. There are many ways to change the concepts of palliative care through both schools, hospitals, and nurses themselves. Since there is apprehension among nurses to provide end-of-life care, nursing schools should promote further education in this area, and allow students more clinical time to build the necessary skills and therapeutic technique to care for patients as well as specific training for caring for the family members, as well as teaching nurses how to deal with their own fears and emotions related to working with patients during their final days.
There are several factors that keep nurses as well as newly graduated nursing students from choosing palliative end-of-life care as their focus in their nursing career. Having little or no exposure to end-of-life care in school is a contributing factor, as well as the increased needs of the patient’s family during this time. Another obstacle is the nurse’s own fears about death and the potential feelings of loss for each patient. When a patient is referred to palliative care, the focus is no longer on curing. Palliative nursing is focused on caring for the patient and making them a comfortable as possible. Caring for a patient during this time involves several emotions and nurses should have training on how to deal with these feelings.
Encouraging nurses to explore this area of nursing is critical. More clinical experience in palliative care is needed. Training for nurses dealing with dying patients is needed as well, in order to recruit new nurses choosing this area of focus. Being exposed to end-of-life care will help nurses deal with apprehension issues, and allow the student to work through their own fears with the dying process. It may also be an enlightening experience as it may be an area some students would never chose until they are exposed to it, and realize it is something they are comfortable with. Exposure in nursing school can be beneficial even if the student does not intend to focus on end-of-life care. Integrating palliative end-of-life care into the daily practice of every nurse, regardless of specialty, can improve healthcare overall (Rushton, 2004). Patients can pass away on any floor of a hospital or nursing home, before they are referred to palliative care. The nurse working with this dying can implement some of the same strategies without specializing in end-of-life care. These strategies can also be implemented if a patient is not dying, such as assisting a family of a patient with an acute or chronic illness. The dying process includes psychological, social, spiritual, physical, and existential aspects. Facing a terminal illness is a stressful experience that affects many aspects of life (Smith, 2005). If nurses could specialize in this area, their focus would be on all of these aspects instead of just one or two (Smith, 2005). Further training in these areas, as well as exposure to dying patients will help the nurse to cope with his/her own apprehension about providing end-of-life care. Including palliative care in nursing schools would enable perspective palliative nurses to adjust to working with a dying client base. Since an important component of palliative nursing is to achieve the trust of the patient, the nurse-patient relationship can be further explored in schools, as well as in hospitals (Chiu, 2003). End-of-life care patient training should also be implemented early in nursing school and continued throughout one’s nursing career. With baby boomers aging, it is evident that end-of-life care will become an important part of nursing (Weigel, 2007).
Because end-of-life care involves caring for the patient’s family as well as the patient themselves, a nurse should keep the family informed and allow them to participate in the care of their loved one. Nurses have the most contact with the patients families, so they play a critical role in assessing the needs of the family during this sensitive time (Brajtman, 2005). Although, the death of the patient is unavoidable, providing sensitive, caring nursing will comfort the loved ones. A nurse should communicate with the family and provide information about the patient’s condition including things a family can do to provide care. Including the family members in the implementation and planning of care of their loved one with alleviate questions and concerns as well as giving them the sense of involvement. Informing the family of what is being done as the nurse performs tasks, i.e. pain meds, and their expected effects will help calm their fears and allow them to know what signs to look for, as well as giving family members the peace of mind that their loved one is comfortable. Nursing schools should implement caring for more than just the patient as curriculum. It is an emotional experience for the patient as well as for the family they are leaving behind. One of the most important things a nurse can do for the family is to listen to their concerns.
Caring for patients who are entering their final days of life is an emotional experience (Weigal, 2007). Nurses are hesitant to care for patients in this state because of the fear of their own emotional experience during the process. The fear of death itself is a factor that makes some nurses concerned about choosing this specialty to apply their skills. The fear of working with the family at such an emotional and life altering time is also an obstacle. As a nurse providing end-of-life care, there is an intense amount of time spent with the patient as well as the family members involved. Some healthcare professionals may find themselves with feelings of hurt and loss with each patient that passes away, because of the bond that was built during the patient’s final days. This is something a nurse working in this area would have to overcome. Hospitals could implement a counseling service as well as support groups for nurses to talk about their experiences and to deal with their emotions throughout these critical times.
There is apprehension among nurses to provide palliative care. Some ways to alleviate their hesitation are having curriculum in nursing schools as well as more clinical time with end-of-life patients. Schools, as well as hospitals should provide additional training for nurses on how to address and care for patients families during end-of-life care, and counseling for nurses individually to assist them in dealing with their own fears and emotions both before they work in palliative and continuing on during their career. One way for schools to consider these suggestions is for current palliative nurses to voice their concerns and advocate for student nurses to be exposed during their education. This is an important area of nursing. Patients deserve the best care possible regardless of the prognosis. Having more, quality trained nurses chose this area of nursing will ensure that.
Intervention 1: Nursing schools should have curriculum and clinical time devoted to end-of-life care.
I: Disadvantage 1 Time constaints
There is a nursing shortage in all areas, and having nursing schools devote more time to certain areas will only prolong the amount of time it takes to produce new nurses. If nursing schools were to implement curriculum with a special emphasis on end-of-life care, the curriculum would need to be updated continually (Dickinson, 2007), further taking up both time and money which are both scarce at this time in nursing education. The entire course may not fit into curriculum causing an extension of time nurses spend in training (Dickinson, 2007).
II: Disadvantage 2 Lack of Teachers
Many faculty feel under prepared to teach, and fail to provide adequate feedback about communication in end-of-life care (Sullivan, 2003). It is also a view that patient’s in end-of-life care offer too few learning opportunities and are not assigned as often (Sullivan, 2003). It is difficult for some medical professionals to teach about something that contradicts what they have been taught, which is to save lives (Sullivan, 2003).
Intervention 2: Hospitals could implement a counseling service for nurses to talk about their experiences and emotions felt about the dying process.
Disadvantage 1: Comforts levels about dying are different with each individual.
Everybody has different views and beliefs about death. Counseling and support groups may not curb reservations about dealing with this issue. Some people can’t be trained to be comfortable with the topic (Dickinson, 2007). Personal attitudes may also hinder ones ability to deal with this type of client.
Disadvantage 2: Funding and staffing for this unit
If hospitals implement counseling services specific for end-of-life care nurses, there would have to be funding and staffing for the unit. Anxiety levels may increase from increased exposure to death (Dickinson, 2007) causing an increased number of counseling sessions. Anxiety in the workplace can also show through in home life.
Reference Page
Brajtman, S. (2005). Helping the family through the experience of terminal restlessness. Journal of Hospice & Palliative Nursing, 7(2), 73-81. Retrieved January 30, 2008 from Expanded Academic ASAP database.
Dickinson, G. (2007). End of life and palliative care issues in medical and nursing schools in the United States. Death Studies, 31: 713-726. Retrieved May 12, 2008 from EBSCO Research database.
Johnston, B., Smith, L. (2006). Nurses’ and patients’ perceptions of expert palliative nursing care. Journal of Advanced Nursing, 54(6), 700-709. Retrieved January 30, 2008 from Expanded Academic ASAP database.
Mok, E., Chiu, P. (2004). Nurse-patient relationships in palliative care. Journal of Advanced Nursing, (48)5, 475-483. Retrieved January 30, 2008 from Expanded Academic ASAP database.
Rushton, C., Spencer, K., Johanson, W. (2004). Bringing end-of-life care out of the shadows. Holistic Nursing Practice, 18(6), 313. Retrieved January 30, 2008 from Expanded Academic ASAP database.
Sullivan, A., Lakoma, M., Block, S. (2003). The status of medical education in end-of-life care. Journal of General Internal Medicine, 18(9), 685-695. Retrieved May 12, 2008 from Pubmedcentral database.
Weigel, C., Parker, G., Fanning, L., Reyna, K., Gasbarra, D., (2007). Apprehension among hospital nurses providing end-of-life care. Journal of Hospice & Palliative Nursing, 9(2) 86-91. Retrieved January 30, 2008 from Expanded Academic ASAP database.
Breastfeeding: the nurse's role
Breastfeeding has been proven to have many positive outcomes for the child. It has been shown to have effects on the child’s intelligence, immunologic development, weight, social development, and overall health. There are many positive results for the mother as well. Because research shows many positive effects of breastfeeding, nurses should include breastfeeding education in both prenatal care and when teaching new mothers. Nurses can implement the following strategies to address this issue: involve lactation consultants in prenatal care, make it policy that lactation consultants are involved in educating new mothers during the immediate puerperium period, and make follow-up home health appointments with nursing standard during the puerperium period.
Historically, the popularity of breastfeeding has had its ups and downs. Like many other things, it has faded in and out of favor by people throughout the years. This partially could have been due to the fact that people didn’t know or fully understand all of the effects of breastfeeding. However, enough is now known about breastfeeding that the benefits are no longer debatable. In every situation (but very few cases) it is the best option for the baby. Not everyone is educated enough about the subject to understand the strong case for doing it. Most people understand it’s good for the baby, but they may not understand just how good it is and the numerous effects it will have on that child throughout its lifetime.
Involving nursing lactation consultants during prenatal care or even prior to pregnancy is extremely beneficial. It helps the woman (or couple) make a more informed choice about breastfeeding. “A woman’s decision about the method of infant feeding is made before pregnancy; thus it is essential to educate women of childbearing age about the benefits of breastfeeding” (Hockenberry, Lowdermilk, Perry, Wilson, Wong, 2006, p. 277). Doing so earlier could make a huge difference. Making comprehensive breastfeeding education a standard part of prenatal care would impact the number of people that decide to breastfeed. Most people at this point know that breastfeeding is good for the baby, but they may need more thorough education by nurses to understand the vast number of ways that it is beneficial for the baby throughout its lifetime.
Having nursing lactation consultants present very soon after birth is also very helpful for the woman. It provides her with the education, support and encouragement that are necessary when beginning to breastfeed. “Mothers often identify support received from healthcare providers as the single most important intervention the healthcare system could have offered to help them breastfeed” (CDC, 2006, p. 1). This immediate education and attention by the nurse lactation consultant would start the woman “off on the right foot” when it comes to breastfeeding. It would give them an opportunity to spend time with someone who is focused solely on the success of their breastfeeding experience. Implementing a policy by the hospital’s nursing committee, which makes it standard practice to have nursing lactation consultants present for education and coaching during the first breastfeeding experience, would make a significant difference in a woman’s breastfeeding experience. Research has shown a “positive relationship between delivering at a hospital that employed IBCLCs (International Board Certified Lactation Consultants) and breastfeeding at hospital discharge” (Castrucci, Hoover, Lim, Maus, 2006, p. 6).
It is recommended by the American Academy of Pediatrics that breastfeeding be done for at least 12 months. Follow-up home health visits by nurses are a great way to help mothers accomplish this goal and a very positive addition to breastfeeding education. Surveys conducted by the CDC in 2004 have shown that 73.8% of babies were ever breastfed, 41.5% were still being breastfed at 6 months of age and 20.9% were still being breastfed at 1 year. “The key reason women stop breastfeeding before the recommended 6-month period is because of perceived difficulties with lactation rather than maternal choice” (Krueger, Sheehan, Sword, Watt, 2006, p. 1). Continuing to provide constant professional nursing support has been shown to increase the number of women who continue to breastfeed, despite experiencing a perceived breastfeeding barrier or lactation crisis. This support, for many women, needs to include education on continuing breastfeeding even after returning to work. The lactation consultants coach women on how to use breast pumps, how to store the milk or anything else that could be a potential breastfeeding barrier. Home health visits by lactation consultants would have a significant impact on breastfeeding duration.
Breastfeeding is extremely beneficial for both mother and baby. Mothers who breastfeed have been shown to have lower rates of some types of ovarian and breast cancers, hip fractures and osteoporosis after menopause as well as other health conditions (U.S. Department of Health and Human Services, 2005). Breastfeeding also helps mothers lose their “baby weight.” Babies who are breastfed have lower rates of asthma, ear infections, SIDS, diabetes, leukemia, lymphoma; the list of benefits for babies goes on and on (U.S. Department of Health and Human Services, 2005). There are societal benefits as well, the greatest being that breastfeeding saves on healthcare costs because breastfed babies need less medical care than those who aren’t breastfed. The three outlined nursing strategies: involving nursing lactation consultants in prenatal care, in the immediate puerperium period and in home health visits during the postpartum period would make a significant impact on the number of women who not only initiate breastfeeding, but also those who choose to continue.
References –
Castrucci, B., Hoover, K., Lim, S., & Maus, K. (2006). A comparison of breastfeeding rates in an urban birth cohort among women delivering infants at hospitals that employ and do not employ lactation consultants. Journal of Public Health Management and Practice, 12 (6), 578-585. Retrieved April 29, 2007 from Expanded Academic ASAP database (A154690153).
Centers for Disease Control. (2006, August). The CDC guide to breastfeeding interventions: Professional support. Retrieved on May 29, 2007 from http://www.cdc.gov/breastfeeding/pdf/BF_guide_5.pdf
Davies, B. & Edwards, N. (2003, September). Breastfeeding best practice guidelines for nurses. Retrieved on May 7, 2007 from http://www.rnao.org/bestpractices/PDF/BPG_Breastfeeding.pdf
Hockenberry, M., Lowdermilk, D., Perry, S., Wilson, D. & Wong, D. (2006). Nursing care during pregnancy. In Maternal Child Nursing Care (pp. 277-278). Third Edition. St. Louis: Mosby Elsevier.
Krueger, P., Sheehan, D., Sword, W., Watt, S. (2006). The impact of a new universal postpartum program on breastfeeding outcomes. Journal of Human Lactation, 22 (4), 398-408. Retrieved May 28, 2007 from Expanded Academic ASAP database (A152872149).
U.S. Department of Health and Human Services, (2005, October). womenshealth.gov: Benefits of Breastfeeding. Retrieved on February 18, 2008 from http://www.4woman.gov/breastfeeding/index.cfm/index.cfm?page=227
Intervention #1 - Involving lactation consultants in prenatal care.
Disadvantage #1 – One disadvantage of this intervention would be cost. It would be a struggle to get insurance companies to cover this in addition to the other things that are covered in prenatal care. And many people would not be able to afford to pay for this out of their pocket or more accurately would not choose to spend their money on this. The only way this intervention could truly be successful is if it was something that was standard for everyone. This intervention is aimed at educating those who aren’t planning to breastfeed and those who belong to groups of people that typically don’t breastfeed. Even though the long-term benefits far outweigh the cost and even though the insurance companies have the potential to save themselves a significant amount of money down the road, convincing the insurance companies of this would not be such an easy sell.
Disadvantage #2 – Another disadvantage of this intervention would be that it would not be able to address many of the problems that arise that cause women to stop breastfeeding. “The key reason women stop breastfeeding before the recommended 6-month period is because of perceived difficulties with lactation rather than maternal choice.” (Krueger, Sheehan, Sword, Watt, p. 1). It would be extremely valuable to start educating parents on the many benefits of breastfeeding as soon as possible, however, because this education happens so early it could not focus on helping mothers solve some of the problems that arise during breastfeeding, mothers that want to breastfeed but end up stopping early because of problems doing it.
Intervention #2 - Making it policy that lactation consultants are involved in educating new mothers during the immediate puerperium period.
Disadvantage #1 - One disadvantage of this intervention would again be cost. It would be difficult to convince insurance companies to cover this in addition to other costs associated with having a baby or convincing hospitals that it’s in their best interest to have a lactation consultant on staff. “The odds of breastfeeding at hospital discharge for a women delivering at a facility that employed an IBCLC were more than 2 1/4 times higher than women delivering at a facility that did not employ an IBCLC.” (Castrucci, Hoover, Lim, Maus, p. 6). Despite the fact that the initial cost would be minimal, I suspect insurance companies would still just view this as another cost, as opposed to viewing it as paying a little now to save big later. The same goes for the hospital, they may not see it as their responsibility to address the breastfeeding issue and therefore a cost that’s not in their best interest to spend.
Disadvantage #2 - Another disadvantage of this intervention would be that most people have made up their minds by then whether or not to breastfeed. If they have decided to breastfeed they would be very receptive to this additional education, however, if they have decided not to breastfeed they would most likely not be very receptive to receiving this education. They may actually perceive it as disrespectful if they have already made their plans known. This intervention would probably not be able to make much of an impact on breastfeeding initiation, but it could potentially effect breastfeeding duration.
Cyndi's final paper
Childhood obesity is on the rise, some would say to epidemic proportions. Something must be done today, and the best defense to this problem is prevention. Preventing children from becoming overweight will assist to reduce the potential problems these kids will experience now and later in life. Because childhood obesity leads to long-term health and social problems, nurses can take a lead role in the prevention of childhood obesity through recognizing and becoming educated on risk factors and using developmentally appropriate strategies for prevention, educating the patient and family on risk factors, problems of obesity, and strategies to make healthy lifestyle choices, and through working with other health professionals to address this multi-faceted issue.
Childhood obesity has been increasing alongside adult obesity. The rate of childhood obesity almost tripled since 1970 (Koplan, 2007). There are many reasons for the increase in obesity, but most can be attributed to lack of activity, amount of television watched, diet, and family attitudes towards eating (MacKenzie, 2000). The health professional failing to recognize the risk factors, inadequate counseling skills, and lack of time with the patients also accounts for unsuccessful prevention (Story, 2002). It is much easier and successful to prevent obesity than to try to treat this disease. Not only is prevention more successful, but the problems associated with obesity can be life-long. Heart issues, diabetes, social stigma, and self-esteem issues are just a few of the problems that can develop with childhood obesity (Ruxton, 2004). Obesity is a national health crisis, and the time to act is now.
For any strategy to work, the nurse needs to be educated on identifying the risk factors for obesity. Some of the risk factors are high birth-weight, overweight parents, socioeconomic status, and more than 1.5 hours TV per day (Ruxton, 2004, p.52). There are standardized criteria for accessing obesity in children. Understanding the criteria used to determine if an adolescent is overweight. For example, on growth charts, a weight at the 85th percentile indicates overweight, and obesity at the 95th percentile, the nurse, with other factors, can determine actual risk (Ruxton, 2004, p.48). If the child is identified at risk for being overweight or already is according to criteria, the nurse can then suggest ways to decrease this risk or at least maintain the risk and the child’s weight. The nurse must know what teaching strategies are appropriate given the patient’s age and gender to be effective. Many parents fail to see their child having a problem with weight or have concern with their lack of activity, which makes the nurse’s job very important in identifying these children at risk.
Nurses need to play a key role in educating the patient and family. Often the nurse spends more time with the patients and family than the doctor or other professional. When the nurse recognizes risk factors in the child, they can teach strategies on preventing obesity. These strategies need to be tailored to where each child is developmentally. For example, parents may be concerned with their toddler being a picky eater and bribe their child to eat more. This can result in the child not being able to regulate their caloric intake. The nurse needs to understand this and educate the parents on other ways to encourage healthy eating by their toddler (MacKenzie, 2000). Another example is educating a pregnant woman or new mother on the importance of breast-feeding and the link between overweight children and being formula-fed. The nurse should provide suggestions for physical exercise. For a teenage boy, this may include encouraging enrollment in a team sport. The nurse is the first line of defense for preventing obesity in children. Because of one obstacle identified as lack of time (Story, 2002), the nurse needs to recognize the need for collaboration to put the education into practice. The nurse needs to address the specific needs of the child, but it is just as important to look at the family unit (Vaughn, 2005).
Collaboration between health care professionals is a must in preventing obesity. The nurse needs to refer patients to a nutritionist if appropriate to help develop healthy eating habits. In addition, the nurse or family can contact the child’s school nurse to address lifestyle choices at school. The school nurse can advocate for the patient by being involved in any behavioral issues that may be developing, or in cafeteria choices. The school nurse needs to ‘act as catalyst for change’ (Harrison, 2004, p.1). The nurse can be an educational resource and teach strategies for making healthy lifestyle choices. The parents’ involvement, as well as siblings, is crucial to successful prevention. Parents need to be educated on risk factors identified in their child and possibly learn themselves what healthy choices to make in regards to diet and exercise. For prevention to work, every aspect of the child’s life needs to work together.
Childhood obesity is a public health issue that can have long-term effects on the child. Waiting until the child is overweight or obese, instead of preventing this problem, is similar to waiting for the car to run out of gas before getting more. Prevention can be effective when the nurse takes the primary role in identifying risks factors and knowing appropriate strategies, educates the patient and family on strategies for a healthy lifestyle, and works with other health professionals in addressing this issue. These three strategies must be established for prevention to work. Successful prevention of childhood obesity starts with the nurse.
Intervention 1: Nurses need to become educated on identifying risk factors and problems of obesity, and able to offer developmentally appropriate strategies for prevention of obesity.
Disadvantage 1: Nurses need to be aware that just looking at BMI will not give an adequate picture of whether the child is at risk for being overweight or obese. You must also look at the child’s ethnicity, gender, age, and physical activity (Henry & Royer, 2004). Standard growth charts should be looked at to see a trend in a child’s pattern, again along with heredity and other factors (Ruxton, 2004, p.48). This requires the nurse to be educated on all types of measures of obesity, and keep up with new and more accurate tools. This can be difficult for the busy nurse, and would require additional and continuing education.
Disadvantage 2: For the nurse to be able to make appropriate suggestions for health lifestyle and activity choices, the nurse must assess where the patient is at developmentally. The nurse would want to suggest and offer strategies that the patient will want to follow and stick to. Also, since lack of time was cited as a main barrier to successful prevention(Story, 2002), you may not get another chance for a year at the patient’s next annual exam to know how they are doing. This is a huge disadvantage, and makes this intervention hard to evaluate.
Intervention 2: Nurses provide education to the patient and family on risk factors, problems associated with obesity, and strategies to make healthy lifestyle choices.
Disadvantage 1: Parents don’t recognize that their child is overweight. According to Dorhan (2002), differing perceptions, especially in low-income mothers, between the primary care provider and the mother on what it means to be overweight. Mothers did not see their children as overweight by the measures of growth charts. To them, having a larger child meant they were well-fed and healthy. In fact 79% of 99 mothers failed to see their children as overweight (Childhood Education, 2003). If parents do not see their children as overweight, no amount of interventions will work, it is crucial to successful prevention of obesity in children. Changing parents attitude is a difficult task, and makes this intervention very difficult to follow through on and be successful.
Disadvantage 2: Need to look at whole family unit, socioeconomic status, and lifestyle not just the patient’s attitude towards eating. One very big disadvantage, especially in today’s economy, and for families in lower socioeconomic status, is the cost of healthy foods. It is a lot cheaper to buy pasta, or that fast food meal, than to spend money of fresh fruits, vegetables, and chicken or fish. Not to mention the cost of milk these days compared to a 2-Liter of soda. The problem is complex, with many causes, from food costs, to convenience fast food, decreased activity time in school, and soft drinks (Feeg, 2004). While the patient may be willing to change their eating, there needs to be a full multi-faceted approach to enabling this child to succeed. For this disadvantage to be overcome, some type of government program needs to exist to reward families for healthier choices.
References
Childhood Education. (2003). Parents’ denial: Most don’t recognize child’s obesity. Childhood Education, 79(4), 228. Retrieved May 5, 2008 from Proquest Database.
Drohan, S. H. (2000). Managing early childhood obesity in the primary care setting: A behavior modification approach. Pediatric Nursing, 26(5), 599-610. Retrieved May 5, 2008 from Proquest Database.
Feeg, V.D. (2004). Combating childhood obesity: A collective effort. Pediatric Nursing, 30(5), 361-362. Retrieved May 5, 2008 from Proquest database.
Harrison, S. (2004). Fill vending machines with healthy food, schools told: school nurses urged to act as 'catalyst for change' in improving children's nutrition.(news). Nursing Standard, 18(1), 6. Retrieved April 10, 2007 from Expanded Academic ASAP database.
Henry, L.L., & Royer, L. (2004). Community-based strategies for pediatric nurses to combat the escalating childhood obesity epidemic. Pediatric Nursing, 21(3), 162-164. Retrieved May 5, 2008 from Proquest database.
Koplan, J.P., Liverman, C.T., & Kraak, V.I. (2005). Preventing childhood obesity. Issues in Science and Technology, 21(3), 57-64. Retrieved April 10, 2007 from Expanded Academic ASAP database.
MacKenzie, N. R. (2000). Childhood obesity: Strategies for prevention. Pediatric Nursing, 26(5), 527-531. Retrieved April 10, 2007, from Proquest Database.
Ruxton, C. (2004). Obesity in Children. Nursing Standard, 18(20), 47-52. Retrieved April 10, 2007 from Expanded Academic ASAP Database.
Story, M.T., Neumark-Stzainer, D.R., Sherwood, N.E., Holt, K., Sofka, D., Trowbridge, F.L., & Barlow, S.E. (2002). Management of child and adolescent obesity: Attitudes, barriers, skills, and training needs among health care professionals. Pediatrics, 110(1), 210-214. Retrieved April 17, 2007 from http://pediatrics.aappublications.org/cgi/content/full/110/1/S1/210.
Vaughn, K. (2005). A Call to Pediatric Nurse Practitioners in Battling the Childhood Obesity Epidemic. Pediatric Nursing, 31(4), 348,344. Retrieved April 10, 2007, from Expanded Academic ASAP Database.