Interventions for Ventilator Associated Pneumonia

Interventions for Ventilator Associated Pneumonia Ventilator associated pneumonia is defined as pneumonia developing in persons who have received mechanical ventilation for at least 48 hours (Shi et al., 2010). It is a major threat to critically ill patients receiving mechanical ventilation (Feider, Mitchell, Bridges, 2010) and it is the most common complication of patients in Intensive Care Units (Soh et al., 2011). Nosocomial pneumonia is caused by bacteria that colonize within the oral cavity of patients in the ICUs (Ewig et al., 1998). Bad oral health is pivotal in the pathogenesis of this harmful complication (Blot, Vandijck Labeau, 2008). Thus, good oral hygiene measure has a critical role in preventing the spread of these bacteria from the oral cavity to the lower respiratory tract thereby reducing the chances of nosocomial pneumonia (McNeill, 2000 cited in Abidia, 2007). There are a couple of interventions which are recommended to prevent Ventilator – Associated Pneumonia. The Institute of Healthcare Improvement suggested the VAP bundle of interventions in preventing Ventilator Associated Pneumonia. (Fields, 2008) In addition to these interventions, oral hygiene care is a nursing intervention that may also help prevent ventilator-associated pneumonia (Feider, Mitchell Bridges, 2010). Evidence shows that comprehensive oral care is an effective preventive strategy to reduce the risk of ventilator-associated pneumonia in patients receiving mechanical ventilation (Cutler Davis, 2005). There are a lot of research studies supporting oral hygiene care in reducing VAP cases among mechanically ventilated patients. In the study of Mori et al., (2006), the incidence of VAP was significantly lower in patients who received oral care than the patients who did not. Similarly, Fields’ (2008) study showed that VAP rate dropped to zero within a week of beginning the every hours tooth brushing regimen in the intervention group. Another study shows that pneumonia, febrile days, and death from pneumonia decreased significantly in patients with oral care (Yoneyama et al., 2002). Various methods and equipment in providing oral care for intubated patients were also studied. Toothbrushes and topical antimicrobials (Binkley, Furr, Carrico McCurren, 2004; Grap, Munro, Ashtiani Bryant, 2003), oral decontamination (Bergmans et al., 2001) and oropharyngeal decontamination with 0.12% Chlorhexidine Gluconate oral rinse (Shi et al., 2010; Tantipong, Morkchareonpong, Jaiyindee Thamlikitkul, 2008; Koeman et al., 2006; Houston et al., 2002; Genuit, Bochicchio, Napolitano, McCarter Roghman, 2001; DeRiso, Ladowski, Dillon, Justice Peterson, 1996) were found to be effective in reducing the bacteria in the mouth and in reducing the incidence of VAP. The AACN (2010) came up with a comprehensive oral hygiene program for patients in critical care and acute care settings who are at high risk for ventilator-associated pneumonia. This includes brushing teeth, gums and tongue at least twice a day using a soft pediatric or adult toothbrush; providing oral moisturizing to oral mucosa and lips every 2 to 4 hours; and using an oral chlorhexidine gluconate (0.12%) rinse twice a day during the perioperative period for adult patients who undergo cardiac surgery. The routine use of oral chlorhexidine gluconate (0.12%) in other populations is not recommended at this time. These interventions are supported by the existing evidence of oral hygiene. Past research studies have focused on assessing the oral care knowledge, attitude and practices among ICU nurses. Studies had shown that ICU nurses lack sufficient knowledge on oral care (Jordan, Badovinac, Ã…  palj, Par, Ã…  laj PlanÄ ak, 2014; Chan Hui-Ling Ng, 2012). The methods used to provide oral care were also found to be varied between nurses in the same unit (Soh et al., 2011; Chan Hui-Ling Ng, 2012). Moreover, the oral care currently provided in ICUs may be ineffective in eradicating dental plaque and respiratory pathogens that may cause VAP to ventilated patients (Binkley, Furr, Carrico, McCurren, 2004). There was also existing discrepancies between reported practices and policies on oral care provided to intubated patients (Feider, Mitchell Bridges, 2010). Though oral care is perceived to be high priority in mechanically ventilated patients, difficulties, problems and barriers still exist in providing the care (Rello et al., 2007; Feider, Mitchell Bridges, 20 10; Soh, Soh, Japar, Raman Davidson, 2011). These challenges include mechanical barriers and equipment issues, perception on the importance of oral care and empathy to patients’ discomfort by nurses, altered patient sensory perception and discomfort, and communication problems. (Berry Davidson, 2006) The existence of variation in oral care practices, the ineffective provision of oral care and the lack of sufficient knowledge of ICU nurses warrants a standardized protocol or guideline that is based on existing evidence. (Soh et al., 2011; Lin, Chang, Chang Lou, 2011) In the past years, Evidence – Based Practice (EBP) is gaining its momentum in the healthcare sector. It has been the focus of discussions and research in the medical field. Its importance to the medical practice has been evident and thus encouraged to be integrated in the practice. However, translating evidence into clinical practice remains a big challenge at the moment. Significant gaps between what is known to improve health, and what is done to improve health is evident (Holmes, Scarrow Schellenberg, 2012). These gaps maybe caused by unawareness or unfamiliarity of clinicians to EBP guidelines or recommendations; or the clinicians disbelief towards the EBP recommendations; or the clinicians personal opinion on the recommended management; or the clinicians’ perception that the guideline is too complicated or difficult to use in their own practices; patient-related factors; and the mentality that altering established practice is often difficult. (Pierson, 2009) Evide nce – based guidelines for providing oral care to patients in mechanical ventilators were formulated by international organizations, but, not all intensive care unit nurses are knowledgeable about it. Past study indicated that nurses lacked the evidence-based knowledge to deliver proper care (Chan, Lee, Poh, Ng Prabhakaran, 2011). In addition, a study also showed that ICU nurses did not follow procedures and steps recommended by current evidence-based practice (Lin, Chang, Chang Lou, 2009). Various knowledge translation strategies such as opinion leaders, audits and feedback, small group consensus, provider reminder systems, incentives, clinical information systems, and computer decision support systems can be utilized to integrate EBP into the clinical world. These knowledge translation strategies should be attempted and researched in clinical setting and should be used to further improve clinical practice. (Ganz et al, 2013) Therefore, the focus of this current research is to translate knowledge of Evidence based oral care practice guideline for mechanically ventilated adult ICU patients to clinical practice using a provider reminder system strategy. Further, it will determine the effect of the provider reminded system strategy in improving the Evidence – Based oral care practices for mechanically ventilated patients among ICU nurses. Provider reminder system is one of the Quality Improvement (QI) strategies. Example of provider reminder system includes reminders in charts for providers, computer – based reminders for providers, and computer – based decision support. (Hughes Hughes, 2008)

Hockey: Nutrition and National Game Essay

Despite the ever-growing popularity of cricket, Hockey has managed to still be the National Game of India. The peak time of Indian hockey team was from 1928 to 1956, when it brought all the six consecutive Olympic gold medals home that were held during those years. Hockey was chosen as the National Game because of the team’s unparalleled distinction and matchless talent at the time. During the phase, India had played 24 Olympic matches and won all of them scoring 178 goals and conceding only 7 goals. The only other achievements of the team later that are worth mentioning are the gold medal in the 1964 Tokyo Olympics and the gold medal in the 1980 Moscow Olympics. The black magic Indian touch and their ball juggling feats have become almost extinct now. Perhaps we need better coaches, more finances and facilities and more practice on Astroturf, which has a faster surface than the grass, where Indians have to practice. It will be a good idea to train the talented children in hockey right from school level, providing them the necessary funds, training and facilities to preserve the Indian glory. Today all the people are interested in playing games such as cricket, football in our country. But people are not showing interest in the game hockey. since hockey our national game. most of the schools and colleges are having ground only for foot ball and cricket. not for hockey. some people wont do no the captain of the hockey game. Not go so far in India study channel there is no category for our national game hockey. So this must be changed . I am not mentioned that playing cricket and foot ball is not a wrong thing but at the same time please give the same importance to the game hockey. There are also subtyoes of hockey have been introduced- like field hockey, ice hockey, roller hockey, street hockey etc. Hockey is a family of sports in which two teams play against each other by trying to maneuver a ball or a puck into the opponent’s goal using a hockey stick. In many areas, one sport is generally referred to simply as hockey. The word hockey itself is of unknown origin, although it is likely a derivative of hoquet, a Middle French word for a shepherd’s stave. [3] The curved, or â€Å"hooked† ends of the sticks used for hockey would indeed have resembled these staves. Junk food Junk food is a derisive slang term for food that is of little nutritional value and often high in fat, sugar, salt, and calories. [1][2][3] It is widely believed that the term was coined by Michael Jacobson, director of the Center for Science in the Public Interest, in 1972. [4] Junk foods typically contain high levels of calories from sugar or fat with little protein, vitamins or minerals. Foods commonly considered junk foods include salted snack foods, gum, candy, sweet desserts, fried fast food, and sugary carbonated beverages. [5] Many foods such as hamburgers, pizza, and tacoscan be considered either healthy or junk food depending on their ingredients and preparation methods. [citation needed] The more highly processed items usually falling under the junk food category. [6] What is and is not junk food can also depend on the person’s class and social status, with wealthier people tending to have a broader definition while lower-income consumers may see fewer foods as junk food, especially certain ethnic foods. Despite being labeled as â€Å"junk,† consuming such foods usually does not pose any immediate health concerns and is generally safe when integrated into a well balanced diet A study in 2008 suggested that junk food consumption alters brain activity in a manner similar to addictive drugs like cocaine and heroin. [9] After many weeks with unlimited access to junk food, the pleasure centers of rat brains became desensitized, requiring more food for pleasure. After the junk food was taken away and replaced with a healthy diet, the rats starved for two weeks instead of eating nutritious fare. [10] A 2007British Journal of Nutrition study found that female rats who eat junk food during pregnancy increased the likelihood of unhealthy eating habits in their offspring. [11] A report published in the Journal of the Federation of American Societies for Experimental Biology suggests that babies of mothers with a high-sugar and high-fat diet while pregnant are more prone to junk food themselves. The study was conducted on rats and suggests that pups â€Å"whose mothers eat excessive amounts of high-fat, high-sugar junk foods when pregnant or breastfeeding are likely to have a greater preference for these foods later in life. â€Å"[12] Junk food can be appealing for a variety of reasons, including convenience, price and taste. For children, who do not always understand the health consequences of their eating habits, junk food may appear especially appetizing. However, regularly consuming fattening junk food can be addictive for children and lead to complications like obesity, chronic illness, low self-esteem and even depression, as well as affecting how they perform in school and extracurricular activities.

Inchoate Offences A Type Of Crime - 908 Words

Inchoate Offenses What an inchoate offense is a type of crime completed by taking a punishable step towards the commission of another crime. The basic inchoate offenses are attempt, solicitation, and conspiracy. The crime allegedly intended is called the target offense. Except for conspiracy, inchoate offenses merge into the target crime. This means that if the defendant is prosecuted for the target crime, attempt and solicitation cannot be charged as well. However, both conspiracy to commit a crime and the crime itself may be charged as defined by Cornell University law library (2015). Failed or incomplete efforts to commit criminal misconduct. Also called preparatory or anticipatory crimes. Punished as crimes even though no major injury takes place (Roberson, 2012). Inchoate crimes merge only when directed to commission of the same crime. Inchoate crimes are typically treated as a lesser offense than the substantive crime. In a significant departure from common law tradition, the Code provides for punishment of the inchoate offenses at the same level as the substantive crime, with the exception of crimes that carry a maximum penalty of life imprisonment (felonies of the first degree). [MPC  § 5.05(1)] A judge has the authority to dismiss a prosecution of an inchoate offense, or to impose a sentence for a crime of a lower degree than is otherwise allowed, if the defendant s conduct was so inherently unlikely to result in a crime that neither he nor his conductShow MoreRelatedThe Function of the Judiciary Within the Constitution of the United Kingdom2659 Words   |  11 PagesThe Function of the Judiciary Within the Constitution of the United Kingdom If miscarriages of justice occur, then not only is the defendant treated very unjustly, but also society (including the victims of crime) has not been accorded the gains in terms of safety, retribution and possible rehabilitation which should flow from an accurate conviction. The question requires us to examine the possible failings, which arise from the personnel by which justice is administeredRead MoreSpousal Compellability? Support for Marriage or Complete Myth2201 Words   |  9 Pagesviolence against the other spouse4. Arguably, the institution of marriage5 is no longer worthy of such protection and now represents an unjustified intrusion into the search for truth. As such, due to the increased public demand6 to address certain crimes and the rising levels of judicial discontent, the law has developed in such a way to grossly undermine the protection afforded to spouses in criminal proceedings. Despite its criticisms7, the spousal privilege was once well founded on numerous rationales

Global Opportunities for Turkey Essay - 1583 Words

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