Patient Management in Nursing - Literature review Example

Article 1 About The Article:The article, ‘How graduate nurses use protocols to manage patients’ medications’ by E.Manias, R.Aitken and T.Dunning was published in the ‘Journal of clinical Nursing’ in the year 2005. Manias and Aitken are senior faculty members in the in University of Melbourne and Dunning is a director of endocrinology and diabetes Nursing Research in St.Vincent’s hospital. Together, the authors have huge experience in the field of nursing which makes the investigation trustworthy. The study was conducted in Australia. Aims And Objective: The aim of the investigation was to study if the protocols in the medication management activities were being followed properly by the nurses. Method : The qualitative methods like ‘observation’ and ‘interview’ were used in the investigation. This gave the study an in depth look at the topic being investigated. Study Setting: The study was conducted in the Melbourne metropolitan university teaching hospital. Ethical Consideration: The approval was received from the hospital and university ethics committees to conduct the study. The nurses and the patients were informed in advance that they are going to be observed during the period of study and written consent was taken from them. The method of study was explained to the nurses and the patients in detail. It was also informed that they will be intervened if they were found committing error in any procedure. No information was hidden from them and hence, the study followed the ethics properly. Sampling Method: The sampling method was utilized to select those participant graduate nurses of different ages who had experience of working in different clinical settings following different responsibilities. This assured a broad outlook to the study. The best thing was that the nurses who participated in the study were working on ‘full time’ basis in the patient care which increased the scope of quality of the project and the sample. Appropriateness Of Sample Size: Even though the number of participants was only 12, the qualitative nature (interview and observation) of the study made it possible to give an in depth look at the protocol procedures of the setting. However, it would have been better if the number was more. Results: There were lots of faults found in the following the protocol procedure. Carelessness was observed in identifying patients as the nurses said that they knew the patients too well to look at the identifying tags on wrist (Manias, Aitken & Dunning, 2005, p.940). Also, on a protocol of double checking of the medication before administration, it was observed that this protocol is followed only 80% of the time (Manias, Aitken & Dunning, 2005, p.940). It was observed that a serious error was prevented in the administration of medication because of gap in the double checking protocol (Manias, Aitken & Dunning, 2005, p.940). This shows how important it is to double check the medication. Also, the protocol of safe storage of medication was followed 90% of time and the nurses said that they had to keep the patients unattended with their medications as they had other duties to do (Manias, Aitken & Dunning, 2005, p.941). Relative Strength : The interviews with the nurses were conducted in a quiet room which provided privacy. Also, they were not only asked about the protocol but also how they make decision regarding the medication practices. The interviews were interactive and hence, there was a scope for clarification and reflection on what was being discussed. Moreover, this also increases the possibility of understanding the essence of matter as the interviewee gets a chance to explain the reason behind the actions and clarify the misunderstandings if any. Relative Weakness: The sample size of the study was the only weakness. Application In Nursing Practices: By revealing life threatening errors in some situations during protocol observation, the study helps in realizing how important it is to follow the protocols 100% of time even if the nurses feel that they know what they are doing. Protocols like identifying patients or double checking the medication seems unimportant after some time, but it is extremely important to follow it as life of a patient depends on it. Conclusion: The overconfidence and ‘I know’ attitude of the graduate nurses can work as an obstacle in following the protocols that are designed for the medication management. Even though the protocols seem unimportant, they should be followed each and every time the medication is administered to the patients. Article 2 About The Article: The article “An investigation of medication information transfer and application in aged care facilities in an Australian rural setting” by D.Pierce and G.Fraser was published in year 2009 in the ‘Journal of Rural and Remote Health Research’. The authors are affiliated with University of Melbourne and hence, have experience in the field of study. This study was conducted in Australia. Aims And Objective: The aim of the investigation was to study the way in which the medication information about the patients is communicated when they are admitted to age care facility. Also, the investigation aimed at studying how the patients are administered the prescribed medication after admission and to see if the fist dose is delayed in the facility. Ethical Consideration: The regional health services approved the research ethics. Method: The methods used were ‘observation’ and ‘questionnaire’. With the patient’s permission, the questionnaire was to be filled by senior nurses assigned to the patients. The questions were related to medication information, administration of medicine, staff action to ensure quality and timely care etc. Study Setting: The setting was a residential aged care facility in rural part of Australia. Sampling Method: The observational study was conducted for 3 month period during 2007 which included 22 aged care facilities in the rural Australian setting (Pierce & Fraser, 2009, p.3). The number of questionnaires received was of 59 individual patients from 14 aged care facilities (Pierce & Fraser, 2009, p.3). Appropriateness Of Sample Size: The sample size does not seem enough as out of 22 aged care facilities, only 14 aged care facilities sent the questionnaires. Results: It was found that different pathways like written information, fax from the GP and direct contact through telephone by GP or community pharmacy, are used to communicate the medication information of the patient to the aged care facility (Pierce & Fraser, 2009, p.3). However, it was also found that this pathway is not followed regularly as in the study, 6.77% of the patients were admitted in the facility without any specific medical information from the GP or the community by the time questionnaire was filled by the nurses (Pierce & Fraser, 2009, p.3). The study revealed a gap in following the immediate administration of medication as 20.33% of patients experienced 4 hours delay in administration of medicine and 3.38% patients experienced 7 hours delay in medicine administration (Pierce & Fraser, 2009, p.4). Relative Strength: The strength of the article is that it not only observed and investigated the ways in which the information is transferred but went one step ahead to investigate whether the transferred information was being used properly or not. Relative Weakness: The investigation was based only on the questionnaire. The lack of qualitative method like interview weakens the depth of the investigation. Application In Nursing Practices: The investigation revealed the need for making the medicines available in the pharmacy as soon as the medication information is received. Also, every member of the staff should follow the usual practice of getting the chart signed by the doctor when he visits the clinic and also fill the medicine chart as soon as the information is transferred. Conclusion: The observation revealed that even when the medication information is transferred on time by GP and community, the unavailability of medicine in the pharmacy and no information about the medication on the medicine chart made it impossible for the staff to follow the timely administration of the medicine. Overall conclusion: The investigation found that the gap in timely administration of medicine in aged care facility is not due to lack of information transfer but due to ill equipped pharmacy and variation in usual practices by the staff. This information can be applied to the aged care facility by maintaining a well equipped pharmacy and requiring a staff to follow each and every practice as usual without any variance. References: Manias, E., Aitken, R. & Dunning, T. (2005). How graduate nurses use protocols to manage patients’ medications. Journal of clinical Nursing 14, 935-944. Pierce, D. & Fraser, G. (2009). An investigation of medication information transfer and application in aged care facilities in an Australian rural setting. Journal of Rural and Remote Health Research. 1-7. Retrieved from http://www.rrh.org.au/publishedarticles/article_print_1090.pdf Read More