How Affects Recovery - Research Paper Example

Nursing practices on coronary diseases in the UK Introduction Local health communities should review their existing service provision for coronary heart disease risk assessment and prevention – including the use of -relieving devices (beds, mattresses and overlays) for the prevention of coronary heart diseases in primary and secondary care – as they develop their Local Delivery Plans. The review should consider the resources required to implement the recommendations, the people and processes involved, and the timeline over which full implementation is envisaged. It is in the interests of patients that the implementation timeline is as rapid as possible. This is important in the realm of health care, especially when the human aspect is involved in the context of nursing staff. The approach towards management of coronary heart diseases is of utmost importance, as this is one of those medical conditions wherein the treatment circumstances greatly impact the final course of healing. This topic hence entails immense significance and needs to be understood in the context of real-time problems that exist within the treatment mechanism. Statement of the Problem The research goes upfront with the hypothesis that the nursing care system can play a vital role in treatment of patients with coronary heart diseases. This can largely be speculated due to the fact that it is both an internal and an external condition. Though the internal condition can be taken care of by medicines, the external one largely depends upon the physical environment that is available over there. This is important as this acts as a vector for the study, and gives it the needed direction on order to answer the research question. The said topic was chosen because it gives a very nice converging point for a multitude of study areas, namely internal medicine, external health care, ancillary health services, nursing health care practices and physical atmospheric comforts in healthcare. An all-encompassing issue, this can give an overview about the issue and finally as to what can and is to be doe in the future on this subject. To investigate in detail the aforementioned reason, a number of recent researches on the topic were studied, to evaluate how is this issue being dealt with in real-time. Search engines of the Med-Line and BMJ were consulted for an all encompassing and international perspective on the issue, and the researches subsequently present a very thorough and diverse standing on the subject. Listing of Relevant Literature Following researches conducted on the said topic in the last decade are of significant mention: Coronary heart diseases were once viewed as an inevitable consequence of being infirm and bed-ridden. As it has been recognized that this is not the case, coronary heart diseases have come to be seen much more as an indicator of the quality of care provided, and are consequently high on the political and health agenda. This article provides an overview of the key aspects of coronary heart disease risk assessment and prevention drawn from a variety of national policy documents (Stephen-Haynes, 2004). To study prevalence of coronary heart diseases among functionally impaired patients in the community and evaluate risk factors associated with the development of coronary heart diseases in these patients. Design. Cross-sectional, observational study. Community dwellers served by the Primary Health Care Area of Rincon de la Victoria in Malaga.Participants. All patients included in the Impaired Patient Programme (n=178). Prevalence of coronary heart diseases in our Basic Health Area was 12.9%. The most important sociodemographic characteristic associated with the presence of coronary heart diseases in these patients was the educational attainment of the caregiver. Health variables of the patient were also associated with the risk of developing coronary heart diseases. Results indicate the need of diagnostic protocols with standardised instruments and prevention plans to reduce coronary heart diseases in the community. Longitudinal studies are needed to evaluate interventions in this area (Galvez et al, 2002). A very comprehensive yet lucid representation of guidelines for nursing practitioners (NMC code of professional conduct, 2004, p. 3) states precisely guidelines on the same lines: A registered nurse …in caring for patients and clients …must: respect the patient or client as an individual, obtain consent before you give any treatment or care, protect confidential information, co-operate with others in the team… This clearly goes on to show the emphasis that is laid upon the teaching and training of nurses from the grass-root level. Worth noting are also the factors of ‘confidentiality’ and ‘co-operating with others in the team’. Though a nurse may be professionally quite capable, but unless the feelings of the patient are appropriately empathized with, provisioning of effective health care may be seriously hampered. Not surprisingly, congruent to this is the stance of physiotherapists. In an equally respected brochure by the ‘Chartered Society of Physiotherapists’, it is stated: Physiotherapists agree common goals with the patient, multi-disciplinary team and wider care-givers and family (Core Standards of Physiotherapy Practice, 2005, p. 33). Mutual co-operation for the one cause of humanitarian patient care is henceforth visible from such representations of the manifestos of the health care bodies. All services have to go hand-in-hand in order to provide for the best sustenance of the patient. And this will only be accomplished if the perspective of the patient is fully understood. Especially in the case of the hospitalization of the patient, the nurse has ample opportunity to monitor the behavioral changes in a person with depression. Exchanging notes with the counselor and being in picture with the background of the client would be a great help. The nurse would then have the opportunity to build a rapport, and then gradually build a relationship form where the person in question can rise to a level of conformity. Clear evidence is beginning to emerge that existing interventions for depression may be of value in alleviating the burden of mental disorders across all regions of the world (Crawford, 2004). Nurses, by means of appropriate intervention, can help a person make changes in those stimuli that are causing the condition in the first place. Centuries ago, while the science of medical care was in its technical evolution stage, the prime area of reference was only the administration of health care. However, in today’s world, where the scientific world has come of age in its standing vis-à-vis disease care and prevention, subsidiary issues have emerged that are considered to be of prime importance in the domain of health care. The changes in society and life all around the world have brought about considerable changes in the lifestyles of humanity. Similarly, the profession of health care has seen its development through the ages, and many additional factors like communication skills’ concerns need to be understood better. Fine concludes by admitting, At the end of all of the medical, legal, and ethical argument, it is most important to remember that no matter how certain any of us may be of our analysis, decisions near the end of life should never be easy. We must remind ourselves that true wisdom comes with the acknowledgment of uncertainty and admitting that we cannot know all there is to know (2005). So, for a researcher to have worked in this discipline and to admit that there is a very thin line to cross, one can surely make conclusions about the complexity of the scenario. The effectiveness of treatment often depends on the willpower that the person is able to generate, which is always increased due to environmental factors. While discussing treatment options for depressive patients, it is indicated that associated positive predictors for linkage to primary care included mental health care visits (Grisword, et al, 2005). It is always important to pair the medical treatment with appropriate psychological ones. Mere medicines without positive behavioral reinforcement are likely to further mellow down the social functioning of the patient. Disease management appears to improve the detection and care of patients with depression (Badamgarav, 2003). A nursing professional, if adequately becomes a part of the care giving team for a patient, can provide limitless benefits to the process of healing. A psychiatrist may be interacting with the patient daily, but a nurse is likely to meet the patient several times in a day. The reinforcement that can be provided by this health care professional is in many ways greater than the family of the person. Similarly, the same can have an opposite and dangerous effect on treatment if the nurse does not conform to the emotional frequency of the patient. The patient may retaliate, and would consider the health care party to be adversaries. This in turn would mean that the patient has started to develop negative feelings towards the care providers, which will adversely affect the healing process. This shall make the entire process extremely cumbersome, and actually create a negative impression of nurses. This study aims to provide an insight into wheelchair users' preventative health behaviours with respect to -relief behaviour, perceived risk and attribution of responsibility for preventative health measures. Wheelchair users who are dependent upon a wheelchair for their indoor and outdoor mobility have a long-term risk of developing a coronary heart disease. Of those who responded, 20.8% moved only once an hour and a further 54.7% moved less often than once an hour. This study is part of a wider study investigating the preventative health behaviours of wheelchair users (Stockton and Parker, 2002). Research regarding area care and management in nursing extends back many years, but remains relevant and cited today. With relevant knowledge, midwives can help prevent the development of sores in the maternity setting. Improvements in the appropriate prevention and subsequent treatment and management of sores will benefit women and help save the NHS hundreds of thousands of pounds in treatment and litigation costs (Prior, 2002). coronary heart diseases are a difficult and complex problem, frequently resulting in poor patient outcomes and significantly increased cost of care. This project evolved from a desire to improve the management and subsequent outcomes for persons with spinal cord injury (SCI) who experience coronary heart diseases acquired in the community. The vast body of work related to coronary heart diseases has focused on risk assessment and prevention. A number of issues are identified that relate to funding, diet, attitudes, consistency of care, and low levels of staff interest in coronary heart disease management. This work provides baseline data from which current management practices can be reviewed, revised, and empirically evaluated (Wellard, 2001). In 1998, 89 health care institutions (hospitals, nursing homes, residential homes, and community care institutions) participated in the first Dutch National Coronary heart disease Prevalence Study. It is concluded that participating in the first national prevalence study was a positive experience for the institutions, because agenda-setting took place and most started to plan or implement activities to improve the prevention and treatment of coronary heart diseases (Halfens et al, 2001). Drug errors, hospital-acquired injuries, and patient falls top the list of hospitals most frequent adverse events. Following a serious medical error in 1995, University Community Hospital in Tampa built a data-driven patient-safety program that has led to reductions in all three categories of error (Journal of Clinical Resource Management, 2000). Good nutrition is essential throughout life and often patients have a poor understanding of what a balanced diet comprises. Nurses need to have a good comprehension of malnutrition. Where malnutrition is evident it can be resolved by working with the patient to encourage a healthy diet. One way to improve patient nutrition is by a nutrition audit of patient food. A solution to this problem is to use nutritional tools to highlight nutritional deficiency in a patient's diet not only in hospitals but also in the community and in nursing homes (Russell, 2000). To identify predictors of coronary heart diseases in men with spinal cord injury over a 3-year period. Interviews, questionnaires, and physical examinations were completed in two phases, 3 years apart. Information obtained included demographic and spinal cord injury characteristics; coronary heart disease history; health beliefs and practices; measures of impairment, disability, and handicap; and skin integrity. Phase 1 predictors of coronary heart disease presence at Phase 2 examination were similar to predictors for self-reported coronary heart diseases. Individuals with the identified predictive characteristics are at greater risk for developing coronary heart diseases. These individuals should receive additional interventions to reduce that risk. Potential interventions include more systematic and frequent follow-up, frequent review of coronary heart disease prevention and management strategies, and provision of needed personal assistance and relevant equipment (Garber et al , 2000). A coronary heart disease is an area of localized tissue destruction directly related to prolonged . Once the individual develops an coronary heart disease, assessment of healing is critical to determine the appropriate treatment. Successful treatment depends on the principles of debridement, cleansing, bacterial control, wound dressing, and occasionally, surgical intervention (Ratliff and Rodeheaver, 1999). A large proportion of home care patients present with coronary heart diseases, and many more patients are at risk. Home care nurses have an opportunity to manipulate favorably certain environmental factors that can prevent coronary heart diseases from forming and to develop effective treatment plans for coronary heart diseases once they occur. This article discusses the current practice for coronary heart disease prevention. Next month, a companion article will explore treatment strategies for these wounds (Macklebust, 1999). A questionnaire mailed to all 2,295 members of the Eastern Paralyzed Veterans Association measured 45 potential risk factors for coronary heart diseases. Logistic-regression analysis and Cox proportional-hazards analyses were used to identify the variables that were independently associated with coronary heart diseases. It appears to be a more accurate method of predicting coronary heart diseases than currently used risk assessment scales (Salzberg et al, 1998). Sores remain a significant problem in hospitals and domestic settings, affecting people of all ages, social class and race. Associated complications may be life threatening, e.g. sepsis and osteomyelitis. Other less dangerous, but nevertheless compromising outcomes such as pain, discomfort and low self-esteem and body image can cause personal suffering, and may add extra demand for limited resources. sore risk assessment and classification are discussed, and an overview of nutrition, moving a handling, selecting support surfaces, principles of wound management, and skin care are considered (Culley, 1998). As the population ages and becomes more frail, coronary heart disease prevalence and incidence within specific care settings are being evaluated through outcomes review. This article summarizes the process and outcomes of an ongoing prevalence study at a 300-bed acute care community hospital. After implementation of the Total Quality Management model at our Institution, the prevalence of patients with nosocomial coronary heart diseases was reduced by 83% (Drew and Sacharok, 1998). The need for effective support systems is often overlooked in the community. Through patient assessment is required for the selection of -reducing aids. Patients should be involved in the selection process, and any equipment chosen must be suitable for the home environment (Cowan, 1996). The purpose of this study was to identify factors that resulted in severe coronary heart diseases in a community-based sample of 23 persons with spinal cord injury (SCI). A correlational design was used. Twenty men and three women, 57% with tetraplegia and 43% with paraplegia, participated. Adult participants with an coronary heart disease of 12 weeks' duration or less were recruited from the plastic surgery clinic of a regional SCI center. The findings suggest that educational programs should emphasize more strongly immediate visits to a physician upon detection of an coronary heart disease. Furthermore, such educational models should be assessed for their effectiveness in reducing coronary heart diseases and preventing progression in severity once persons with SCI return to the community (Garber et al, 1996). The purpose of this investigation was to render a more complete understanding of subjective perceptions of coronary heart diseases from the perspective of family dyads, and to study the effect of these subjective experiences on preventive behaviors and coronary heart disease outcomes. Shared care was a pattern of interaction used successfully by family members to prevent coronary heart diseases in patients at risk (Sebern, 1996). This article reviews the etiology, pathology, description, risk factors, prevention, medical and surgical management, and complications of coronary heart diseases. coronary heart diseases, which develop primarily from and shear, are also known as decubitus coronary heart diseases, bed sores, and sores. Areas of ongoing research such as electrical stimulation and growth factors are discussed (Yarkony, 1994). The prevention and management of coronary heart diseases often creates challenging situations requiring specialized knowledge and expert, consistent nursing care. In order to promote coronary heart disease prevention and control costs at a 350-bed community hospital, a Coronary heart disease Prevention Program was developed. An overall decrease in coronary heart disease incidence was found and the documentation of coronary heart disease prevention was improved (Jones, 1993). 135 patients developed coronary heart diseases during four weeks after admission. The weekly incidence of patients with coronary heart diseases was 6.2% (95% confidence interval 5.2% to 7.2%). Although risk assessment scales predict the occurrence of coronary heart diseases to some extent, routine use of these scales leads to inefficient use of preventive measures. An accurate risk assessment scale based on prospectively gathered data should be developed (Schoonhoven et al, 2002). Several fundamental issues around the use of risk scales are highlighted by the article by Schoonhoven et al. These scales are poor predictors of coronary heart disease development, but nurses are encouraged to use them to meet the clinical governance agenda. With changes in demography, earlier discharge from hospital, the threat of litigation, and an ever higher reliance on community services, nurses and clinicians will need more potent evidence to support their management of patients at risk of coronary heart disease development (Franks et al, 2003). Although risk assessment scales for coronary heart diseases predict the occurrence of coronary heart diseases to an extent, strict application leads to inefficient use of preventive measures. Schoonhoven and colleagues used the Norton, Braden, and Waterlow scales to predict the development of coronary heart diseases in hospital patients. In a group of 1229 patients studied over 2190 patient weeks none of the scales satisfactorily predicted the development of coronary heart diseases. Most risk assessment scales are based on expert opinion or literature review and have not been evaluated (British Medical Journal, 2002). Gerben ter Riet and colleagues report a double blind randomised trial of ultrasound treatment and placebo in 88 patients with coronary heart diseases; they found no significant differences between the treatments. They stated: In designing the double-blind study, it was anticipated that ultrasound would double the healing rate of sores. For such a common condition what is needed is a large, pragmatic multicentre (multinational) double blind trial comparing ultrasound treatment (as practised for coronary heart diseases by the individual centres) with placebo. Large pragmatic trials are now common in cancer and other diseases.3 They are the only means to answer important questions such as those posed here (Machin, 1995). coronary heart diseases can have a devastating impact on health and care provision, ranging from patient discomfort and increased healthcare costs to a potential reflection on the quality of care. To evaluate the outcomes of prevention education and skin integrity interventions on the incidence of coronary heart diseases, a multiphase project was initiated in an urban 154-bed regional referral community hospital in Ontario, Canada that provides care to an urban and rural population. The results suggest that education and the implementation of appropriate skin care products and procedures and coronary heart disease prevention protocols may reduce the incidence of hospital-acquired coronary heart diseases (Cole and Nesbitt, 2004). Research Evaluation According to Nine Point Plan of Evaluating Research The specimen research considered here entails, The aim of this research was to establish whether the attitudes and expectations of senior nursing staff might adversely affect patient outcomes in the prevention of coronary heart diseases. The hypothesis was that nursing locus of control affects clinical outcomes in patients. In particular, it affects departmental prevalence of damage. A population of nurses (n = 439) in an acute and community NHS trust were surveyed to test knowledge, control beliefs and value of coronary heart disease prevention relative to prevalence. The research was designed to provide different data against which to test the hypothesis: first, to assess acceptability of nurses' knowledge of prevention and appropriate use of risk assessment and equipment; second, to calculate a mean departmental coronary heart disease prevalence; and third, to measure locus of control and value, which is the focus of this article. There were strong associations between departmental prevalence of coronary heart diseases and attitudes of senior nursing staff. For example, the more that ward sisters believed they could control coronary heart disease prevention, the higher the prevalence of coronary heart diseases in their department. The more that sisters believed that they could not control prevalence, the lower the prevalence of coronary heart diseases. The study shows that failure to account for beliefs, values and expectations of staff could lead to patient harm. It is suggested that it might be counterproductive to put great effort into developing clinical guidelines and refinement of risk assessment methods. The findings have important implications for nursing, and challenge the assumption that nurse leaders are universally beneficial to patients (Maylor, 2001). 1) Aims of the study The aim was to establish whether the senior nursing staff’s attitude may affect the treatment of coronary heart disease patients adversely. The topic was tackled appropriately. 2.) The study and the research design It started with the hypothesis that the nursing locus can affect clinical care because of its sheer proximity to the situation at hand. The hypothesis was exploratory in nature, whereby the result or impact of a particular independent variable (nursing behavior) was sought out on a dependent variable ( coronary heart disease treatment). 3.) Sample in the study A population of nurses (n = 439) in an acute and community NHS trust were surveyed to validate the said hypothesis. 4.) How were the terms defined? The research was designed to provide different data against which to test the hypothesis: first, to assess adequacy of nurses' awareness of prevention and appropriate use of risk assessment and equipment; second, to evaluate an average departmental coronary heart disease incidence; and finally, to measure area of control and impact of the nursing staff. 5.) What counted as data? The accounts, evaluations and retrospective opinionated accounts of the nurses counted as the data. It was largely qualitative in nature and hence subjective in essence. 6) What questions were asked/not asked? The ward nurses were asked evaluative, clinical based and profession related questions pertaining to the treatment and care of coronary heart disease patients. 7) Who did the research? A health care professional conducted the research. 8) What was the theoretical framework? Primarily implicit in nature, the theoretical nature based upon deductive reasoning, and evolved an answer based upon the analysis of the environmental stimuli around the topic statement. 9) How were ethics observed or not observed? Extensive emphasis was not highlighted with regards to ethics, largely because the sample was voluntary, and asked for opinionated responses. It can be assumed with the help of scientific evidence that nursing care, and overall health care methodologies in general within a community can play a vital role in the treatment of patients with coronary heart disease. They demand specialized care in the context of the medication, as well as the physical environment. Precautionary measures are also essential; it generates a mutual relationship between the health care provider and the patient with that ‘extra’ bit that goes into patient care. This goes on to elucidate that idea that leaders are in effect very important of the health care system. As they develop those successful strategies and processes, which are ultimately beneficial for the cause of the human race. Though a variety of researches from all over the world done in the past one year were reviewed, they more or less culminated at the very same stance, which ultimately goes on to prove the initial hypothesis stated in the research question. The fact of the matter is,. That nursing intervention is crucial to the cure of patients with coronary heart disease. Patients heavily rely upon their respective health care providers for support, education and training into how to take care of their respective disease. Another subsidiary lesson drawn from the study was understanding of the research process. It was observed, that it is imperative for any study to be held valid and reliable, a comprehensive stance upon the issue should be followed. This in turn means, that the steps involved in conducting a research must be religiously adhered to. Conclusion This research believes to have established that there is a strong directly proportional link between the health care provided by the community, vis-à-vis the treatment of coronary heart diseases. Nursing staff, health care providers, ancillary health professionals, and the community at large have to play a major role in the successful dealing of the patients with this disease. This was largely attributable to the fact that this disease has both internal and external determinants; though the internal ones shall be dealt with by medications, the external ones are heavily dependent upon how well are the environment stimuli controlled within the health care system. It was also found that the ever changing variables within a system can greatly induce the results found in a research. Therefore, it is imperative, both for the cause of this research and for the sake of research in general, that a standardized research system should be adopted. References British Medical Journal. (2002). Scales do not assess the risk of coronary heart diseases. 3 Jan 2006. . Cole, N. and Nisbett, C. (2004). A three year multiphase coronary heart disease prevalence/incidence study in a regional referral hospital. Journal of Ostomy Wound Management. 3 Jan 2006. . Cowan, T. (1996). -reducing aids for community use. Journal of Professional Nursing. 3 Jan 2006. . Culley, F. (1998). Nursing aspects of sore prevention and therapy. British Journal of Nursing. 3 Jan 2006. . Drew, J. and Sacharok, C. (1998). Use of a total quality management model to reduce coronary heart disease prevalence in the acute care setting. Journal of Wound Ostomy Continence Nursing. 3 Jan 2006. . Franks, P. et al. (2003). Risk assessment scales poorly predict coronary heart diseaseation. 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