Strategies to Prevent Inadequate Delivery of Nursing Care - Research Paper Example

Research proposal: Strategies to prevent inadequate delivery of nursing care in the first 24 hours for stroke patients Name: Course: Tutor: Date: Research proposal: Strategies to prevent inadequate delivery of nursing care in the first 24 hours for stroke patients Introduction Every day in most countries, there is a recorded number of people who suffer from stroke. Stroke is one of the diseases that cause death in most countries. It is also the main cause of severe physical disabilities among adults. The numbers of people affected by stroke every year are daunting for health care planners, managers and clinical staff (NHS, 2007, p. 7). The good news is the strong evidence that proves that provision of organized social and health care improves the health of those affected by stroke. The proper health care also reduces the risk of another stroke happening to other people. The challenge is to find strategies that prevent the inadequate delivery of care for patients within the first 24 hours of recognition. The strategy will aim to provide proposals to improve stroke care in both the community and hospitals. It is important that the care of stroke recognize the specific need of the patients at different stages. It is also important to recognize that proper care should be provided for patients who have just suffered the disease. The first 24-hour treatment is important (NHS, 2007, p. 8). It is also important to understand disease impact on friends and family of stroke survivors. The disease can be a life-changing event for caregivers and family and hence must be fully acknowledged. The survivors of stroke often have problems, in addition to the symptoms of, the disease. This requires careful clinical assessment for the problems to be detected. Significant variables of research include the level of stroke severity versus the time the treatment is provided. The changes that are evident in a patient include changes in balance, vision, taste, hearing and touch. The person could have problems with identification of places or persons. The potential significance of the study to the nursing practice includes: Improve the primary prevention and awareness of stroke Improve the rapid access, to appropriate and suitable medical management Create awareness for the health care providers on the importance of primary care Review rehabilitation services that can be provided to maximize chances for earlier stroke specialist rehabilitation Definition of terms Stroke – this is usually thought of as a weakness mostly of the leg or arm on one side of the body. Stroke can be mild or severe which may cause death or physical disability. NHS – National Health Service. This is a shared name of funded healthcare systems Caregivers – these are people who provide care to adults, children or parents with special medical needs. Some can be family members or paid to provide care. Literature review Stroke is the third of the most widespread causes of deaths. It is also a frequent cause of disability in adults. It is usually associated with tremendous cost burden that the society is experiencing. Some strokes are ischemic while some are caused by subarachnoid or intracerebral hemorrhage (Caulfield & Wijman, 2008, p. 345). Immediate death is high, and about 20% of those affected die within 30 days. For the survivors, recovery takes a long time. The suggested frameworks for considering the effect of stroke on a patient include pathology or diagnosis which operates at the level of the organ system or organ, impairment or signs and symptoms which operates at the whole body level, disability or activity limitation and participation restriction which affects the roles of the individual or social position (NHS, 2010, p. 1). There are several domains of participation and activity, which provides a focus for rehabilitation attempts. The domains include domestic life, mobility, learning and applying knowledge, communication, major life areas, general tasks and demands, self-care, interpersonal relationships and interactions and community, civic and social life (NHS, 2010, p. 2). Within the framework, the therapy aims to optimize the individual’s participation, activity and the life quality. It also aims to minimize the distress of caregivers. Patients affected by stroke are emergency patients. The patient is diagnosed and treated emergently. Management of strokes requires timely organized care. This is because response time is very critical in the initial treatment. Therefore, this necessitates educational campaigns that provide awareness of stroke symptoms and the need for quick response (Reddy, Moroz, Edgley, Lew, Chae & Lombard, 2009, p. 1). Nursing interventions that should be placed as the highest priority in helping a patient with early signs of stroke include stabilizing the patient. After stabilizing, the first triage of potential stroke victims is made. Background information is collected to get an estimate of the time since the symptoms first appeared. Airway, breathing and circulation are managed. Time is very important, and the patient should be given the necessary treatment immediately. The treatment is completed, and the patient monitored for oxygenation, vital signs and cardiac signs. The patient should then be transferred to the ICU as per the protocol. Within the first 24 hours of hospitalization, there are indications for admission into the ICU. The indications include the need to intensify respiratory monitoring, inability to protect the airways, neurological monitoring, the need for intensive cardiovascular monitoring, sedation, nutritional support, immobilization, standard of care and the need to maintain blood chemistries (Barker, 2008, p. 544). It is generally known that chances of survival for those affected by stroke are increased through maximization of early multidisciplinary rehabilitation. Their independence in the home setting can also be increased if the rehabilitation is the proper setting. The use of stroke units in the first 24 hours encourages independence and increases the chances of survival. The possibility of survival lies in the rapid treatment of the secondary complications that are likely to occur following stroke. It also lies in the speedy diagnostic procedures performed (Mehrholz, 2012). The 24-hour treatment includes a CT scan and diagnostic neuro sonography. The stroke units are important since they perform thrombolysis and determine the sign for invasive therapeutic procedures. This helps to clarify the causes of stroke and helps monitor the patient intensively in order to detect complications early enough and treat them (Mehrholz, 2012). Stroke units have essential monitoring beds that make possible the continuous monitoring of respiration, blood pressure, heart rate, oxygen saturation, temperature and ECG. Nursing effort and mortality is reduced in patients who are treated using stroke units than those treated in non-specialized wards. Mobilization of patients with stroke within the first 24 hours is very vital. This is because it is an effective way to avoid deep vein thrombosis. The patients who have mild impairments should be released almost immediately. Those with deficits should be mobilized within 24 hours. The initial steps of mobilization include walking short distances, standing and transfer to a chair. Measures should be put in place, to avoid falling (Adams, Hachinski & Norris, 2001, p. 500). The degree at which the patient will require assistance will depend on the presence of co-morbid diseases and the patient’s impairments. The first stages of mobilization include checking of the blood pressure. Neurological symptoms could be aggravated is blood pressure drops suddenly. Prevention can be done through the use of heparin, aspirin, mobilization, danaparoid, low molecular weight heparins, pneumatic calf compression devices and long-term prevention (Ham, 2007, p. 479). Heparin is beneficial to patients who are at their first stages of stroke. Aspirin at doses of 160 to 325 mg per day is also effective in the treatment. Stroke rehabilitation begins instantaneously the patient is admitted to hospital. It is an active process that focuses on six main areas (Ham, 2007, p. 480). The areas include: Recognizing, preventing and management of co-morbid illnesses and medical complications Providing training for the purpose of maximum independence Facilitating maximum adaptation of the family and patient and psychosocial coping Preventing secondary disability by encouraging community reintegration including recommencement of the family, home, recreational and vocational activities Enhancing life quality in view of residual disability Recurrent stroke prevention, and other vascular conditions, for example, myocardial infarction. This occurs with increased frequency in patients with stroke. Maximal success in rehabilitation is assured if the patient is medically stable, has the ability to learn new information, and is motivated. The rehabilitation setting depends on several factors. The factors include physical endurance, degree of impairment, tolerance to therapy, and involvement of caregivers. Prevention of stroke complications during the initial stages such as pressure ulcers, pneumonia, and constipation and so on will enable maximization of the attainment of rehabilitation goals and minimization of recovery time (Ham, 2007, p. 480). Therapy for the patients should be commenced as soon as possible after the beginning of symptoms. The therapy should be done in parallel with the monitoring of such issues as vomiting, headache and acute hypertension. It is necessary to do the monitoring so that a computed scan of the brain can be done (Aschenbrenner & Venable, 2008, P.616). The scan is only done immediately the symptoms mentioned are noted. Nursing care within the first 24 hours will enable the identification of the organ at risk. It will also ensure that the disease is not confused with other brain conditions that mimic stroke. The identification will help in the reverse of the symptoms in a manner that will result in fewer strokes (Lindley, 2008, p. 8). Assessments should be done frequently specifically with 24 hours to identify if the attack has led to a permanent stroke or not. The earlier detection of symptoms, the greater the imperative to begin thrombolytic therapy. The older patients are often at a greater risk with the use of thrombolytic treatment (Williams, Flanders & Whitcomb, 2007, p. 143). Research questions What should be done for suspected stroke? What nursing interventions should be placed as the highest priority in helping a patient with early signs of stroke? What clinical manifestations would a nurse expect to find during the assessment of a patient with stroke? What strategies are important in curbing inadequacy in delivery of nursing care? Research problem There have been cases of inadequacy in delivering care for stroke patients within the first 24 hours. Response time is very important when handling patients with stroke. Time is critical especially for initial treatment. This is especially if the symptoms being realized do not provide enough evidence that the disease is indeed stroke. Patients with stroke present themselves for emergency or urgency for treatment. It is for this reason that management of stroke should be done in a timely and organized manner. It is also for this reason that strategies have to be formulated to help prevent inadequate delivery of nursing care in the first 24 hours for stroke patients. The research will be conducted in a hospital where the number of stroke patients will be recorded. The amount of time taken to attend to a patient will be noted. Those who are attended to using stroke units will be compared to those treated in the non-specialized wards. The result will proof the importance of timely, organized care for stroke patients. Contextual factors include environmental and personal variables. The variables refer to each stroke patient and access to health care. Environmental variables include the external attributes such as family support, healthcare resources and social attitudes. Personal factors are the internal attributes such as sex, co morbidities and background. All dimensions should be considered to avoid overestimation or underestimation. The specific aims of the research are to resolve: The steps to perform when handling a patient with stroke The strategies to use to prevent the inadequate care in the first 24 hours The steps that provide a clear and helpful way forward for stroke care Methodology This is concerned with design implementation, and how the research is carried out. The chosen method determines the quality of the data set created. It specifies when and how to collect data, construction of data collection measures, identification of the sample or test population, choice of strategy for contacting respondents, selection of statistical tools and presentation of findings. Quantitative methodologies perform a deductive test from existing knowledge. The test is done through developing a hypothesized relationship and proposed outcomes for the research. Qualitative methodology performs inductive tests (Charoenruk, p. 2). There is no quantifying or counting of findings instead, a description is made in the language employed during the research process. The research will utilize the quantitative research methodology. The method is chosen because it produces legitimate scientific answers. Because of the hard data used, action will be generated, and changes suggested will take place (Charoenruk, p. 3). A simple random sampling method will be used for the study population. Patients will be chosen randomly to be incorporated in the study. The chosen patients will represent the rest of those suffering from stroke. The main advantage of the chosen method is the increased likelihood that the findings can be generalized. Interviews and questionnaire will be used. Questionnaire can be posted hence no direct contact will be required with patients and nurses (Charoenruk, p. 4). Interviews will require that contact exist between the researcher, patients, and staff. Methodology will cover all area including sampling techniques, data collection, and research design and data analysis. Research design This is a master plan of the study to be carried out. The purpose of a research design is to make certain that the data required is collected economically and accurately. It is important because it provides a framework, which guides the collection and analysis of the data. The research at hand will utilize the descriptive research method. The reason for the choice is that the method will yield descriptive data. It takes a population sample at one point in time and describes the changes that occur in that period (Elahi & Dehdashti, 2011, p. 3). Descriptive research is proper because of the presence of such objectives as characteristics of a physical and social phenomena and the determination of the frequency of occurrence. There is also the degree to which the variables identified are associated. The reason for choosing descriptive research design is because of the advantages inherent in it. Data is often already available and hence it is inexpensive and efficient to use. It is also appropriate because very few ethical considerations or difficulties exist (Grimes & Schulz, 2002, p. 147). This means that it is not very restrictive in terms of how the data will be collected. Population and sampling plan The target population is patients and nurses in a hospital of choice. The nurses will provide the records patients who are brought in with stroke. Those with adequate resources afford to admit their people for stroke units. There they will be given specialized treatment in a timely and organized care. Those without many resources admit their people in the non-specialized wards. The wards do not have special devices necessary for the treatment of stroke. Such patients are likely to suffer permanent stroke or even die because of the situation. The sampling plan will involve simple random sample that was chosen. Each sampling unit has equal probability of being chosen to represent the rest of the population (Walfish, p. 4). Each unit is selected in an independent manner. The sample uses basic statistics that are estimates and standard error estimates have to be adjusted for the other methods of sampling. If the sample size is increased, the precision of the sample estimate is increased. Taking a large sample will mean that the sample mean is closer to the population mean. Increasing the sample size will also decrease the standard error of the estimate. The recruitment strategy that will be used will be to establish a criterion for number, location and sampling method. The location here will be the hospital, where the number allocation will be done according to precedence. The subjects included will only be those who suffered from stroke and admitted to the hospital within 24 hours. Consultation will be done, with the nurses, to identify potential recruits. Respect and responsiveness will be exercised at all times. The steps to follow in the sampling procedure will include a definition of the population. The population is defined in terms of time, units, extent and elements. The sampling frame is specified before the sampling unit is specified. Here, the method of selecting the elements to be included is stated. The sample size is also determined as well as the sampling plan. The place and field for sample selection is also selected. A practical example concerning the hospital will look like this: Step 1: Definition of the population The population consists of: Elements = patients Units = Hospital ABC patients Extent = all patients registered within 24 hours Time = date of registration Step 2: Sampling frame specification A printout of all the patients registered within the first 24 hours of the day of study is obtained. This is done through the help of the nurses. Step 3: Sampling unit Only patients suffering from stroke and registering within 24 hours will be included in the study. Data collection and procedures This is where data to be used in the research will be gathered. The purpose of gathering information is to record, make important decisions about issues and pass the information to others. Quantitative data collection instruments include questionnaires and standardized measuring instruments. Procedures are the processes of collecting data over the instruments proposed (Punch, 2006, p. 53). The methods employed included interviews and self-administered paper and pencil questionnaires that were done in the hospital. Patient Information was obtained on a one-on-one interview with the child. The questions included their experience in the specialized wards for those admitted in the stroke units. The same was done for those in the non-specialized units. What we sought to know was if there was adequate delivery of care, from the nurses. How timely and organized the care was, immediately they were admitted in the hospital. All the information was recorded and kept confidential. Nurses The nurses will be given a questionnaire from where they will be given enough time to complete them. Procedures and materials were developed to maximize the inclusion of all subjects. The questions will seek to inquire about the availability of nurses in the hospital. Through this, we can conclude about the issue of adequate provision of care. Nurses are required to answer all questions without bias. The questionnaire will be posted or collected on the next visit. Reliability is the extent to which the questionnaire and any other measurement procedure produce the same results. The results will be the same on repeated trials (Miller, p. 1). Validity is the extent to which the research instrument measures what it is supposed to measure (Miller, p. 3). Validity and reliability of data collected is ensured through the inclusion of adequate sample size. An adequate sample size will ensure that data is valid. The participants should be sufficient enough to represent the target population. Numbers and coding of subjects should be counter checked for consistency. Validity and reliability will also be improved, through the use of various methodologies, to measure the same phenomenon. Reliable data produce stable results. Data analysis The process of data analysis includes the decision on the appropriate analysis to conduct, preparation of data for analysis and summary of results. The data are expressed in numerical terms, in which the values could be small or large. It is a systematic application of statistical tools. It helps describe facts, develop explanations and test hypothesis. One of the approaches that are best suited for this research is the analysis of differences that exist between the two sets of patients. The analysis will be based on the difference patients who are attended to within the first 24 hours and those who are not. Some may argue that if the disparity is large enough, statistical tests are not necessary (Kohlmann & Moock, p. 95). However, in cases of small and moderate differences, a question of whether the observed effect has occurred by chance or nor arises. Statistical tests are suitable for such situations. Statistical tests are tools used to distinguish between the results obtained by chance and those that cannot be explained by chance. Statistical tests compare observed results with the standards that are expected based on the dataset. Initial requirements of data analysis include identification of levels of measurements that are associated with the data. The levels include nominal, ordinal, interval and ratio. Nominal data involve basic classification of data. In the hospital, nominal data will be in the form of female or male. An arbitrary value is then assigned to both, for example, female=0, male= 1. For ordinal data, a logical order is assigned. Here, the differences are not constant. Example is the wards in the hospital that can be categorized as specialized and non-specialized. For interval data, it is continuous and has an order. Example is the satisfaction of patients on the delivery of care in the hospital. The satisfaction can be ranked on the scale of 1-5. Ratio data is continuous, ordered and has a natural zero. Once the levels have been identified, data are presented using tables where records are entered. The tabulated information will then be summarized through the use of a chart. Patient Number Response time Probability for Occurrence of complications 001 30 minutes 0 002 40 minutes 0 003 5 hours 0 004 2 days 1 005 3 days 1 The rules about data analysis include; the researcher should look at the data and think about it. This includes asking oneself what it is they want to really know. Estimation of the central tendency of the data is done. Central tendency can be something like an average. Exceptions to the central tendency are also observed. Ethical considerations Ethics is doing what is legally and morally right while carrying out the research. Consideration of ethical issues will make ethical decisions much easier. Ethical issues have to be considered when carrying out any research. The process of conducting research is in itself a problem. Timing, funding, and accessibility may pose challenges and impose problems. Ethical concerns are available in every step of the research process. Ethical concerns may include conflict of interest, harm, and risk. Conflict of interest needs to be handled with care because points out questions of benefit, trust, power and reliance. The researcher will have to consider if the study may cause harm to the respondents. In the case, that risks are involved, methods and measures should be put in place, to stop them from happening (Punch, 2006, p. 57). Some researches involve direct contact with the respondent especially for this case study. Whether the research will cause harm should be greatly considered. Harm can be social, physical or psychosocial. The line of questioning could inflict some psychosocial harm to the patient. Social harm results from release of information that should have been released. Another ethical concern is privacy. Some countries have granted citizens the right to privacy. It is for this motive that the researcher should consider this as a main concern. It is ethically right to avoid examining people who do not want any information about their lives disclosed. Participation in the research should be voluntary. This means that patients should be ready and willing to disclose their information. The same applies for nurses; they should be ready to disclose information about the hospital without fear. Plagiarism is also an ethical issue that must be considered (Punch, 2006, p. 57). Presenting ideas that are not our own is avoided, and if included, proper citation will be done. We also strive to present bias-free writing that does nor oppress or discriminate against any group being referred to in the study. The ethical research criteria should be followed. The criteria include protecting confidentiality, being objective, using integrity, and avoiding harmful research. Confidentiality and privacy of information should be maintained (Ellen & Singleton, 2008, p. 440). This can be accomplished through legal and physical protection. Data obtained should be protected, and access limited to those authorized to do so. Official misuse is avoided through legal protection. A data management plan should be created which will cover how data will be collected and generated. It will also cover how data will be stored, its ownership and controls. It will cover how data will be managed and distributed (Weaver, p. 10). It will also cover regulatory mechanisms as well as data security measures. It will include how access will be provided, roles and responsibilities of researchers and the sustainability of the data. Data should be managed according to contractual, legislative, administrative and legal requirements. 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