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Identify the four current priorities for nursing research under NURSING RESEARCH DEVELOPS KNOWLEDGE

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Angelia Murphy posted Oct 31, 2019 11:39 PM
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“As the demands of high quality nursing care increase and organizations are held accountable for patient outcomes, nursing care must be driven by the best available evidence (evidence based practice), EBP” Coyne, Kennedy, Self & Bullock, (2018). It is important to encourage nursed and nursing students to use evidence based practices early on in their careers. However, they need to be introduced to evidence based practice research and they must be presented with the opportunities in order to be able to put it into practice. Many nursing students shoe very little interest in EBP research and place most of their focus on establishing their clinical skills that will be used to provide care to their patients. Coyne, et al., (2018) reports that having a strong foundation in nursing research is essential for nursing students and practicing nurses to be able to provide high quality nursing care as well as to spark their interest in doing nursing research. Most if not all nursing students seeking an undergraduate degree have had some form of exposure to evidence based research within their classes and programs. Nursing research can help nurses and nursing students in many ways such as increasing their engagement in work while increasing their confidence in their ability to apply evidence based research. EBP can be the link between nursing research and clinical practice by adding relevance to the matter. This will also aid in improving the clinical practice of nursing students and nurses. Nursing research will also expand the knowledge base that nurses have to draw from.
This writer does agree with the four current priorities for nursing research listed on the NINR’s website. I agree that nursing research helps to develop knowledge to build the scientific foundation for clinical practice for nurses, prevent diseases and disabilities, manage and eliminate symptoms caused by illness and enhance the end of life and palliative care provided by nurses to the patient. These research initiatives can be translated into evidence base practice in the emergency department, were this writer currently works, because they help this writer and co-workers understand the disease process. These initiatives also help to give a scientific foundation for emergency department nurse by allowing nurses to have the knowledge needed to provide evidence based practice such as the best ways to treat patients who have suffered a trauma, stroke, seizure, myocardial infarction and so on. Through evidence base nursing research nurses in the emergency department can assist in the management of many different disease processes and illnesses to help eliminate the causes so that most people seeking care can be safely discharged home. It also allows for appropriate discharge education to be taught and given via handouts to the patients. Nursing research has also help to develop the best ways to care for not only the patient at the end of their life, but the family who may be at bedside in the emergency department.
Reference:
Coyne, B., Kennedy, C., Self, A., & Bullock, L. (2018). A comprehensive approach to undergraduate nursing students’ research experience.
Journal of Nursing Education, 57(1), 58-62. doi:http://dx.doi.org/10.3928/01484834-2018102-12

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NaTasha Rodriguez posted Oct 30, 2019 8:41 PM

The National Institute of Nursing Research (NINR) website identifies four current priorities for nursing research. The first priority states that nursing research develops knowledge to “build the scientific foundation for clinical practice” (NINR. (n.d.)). I completely agree with the importance of this priority. Nursing has come so far from the days of using soap and water to disinfect and clean wounds or medical areas. Nursing today is based off of evidence-based practice which lets us know that what we are doing with our patients has been proven by well-designed studies and proven to be the best approach to clinical practices. Through constant research the field of nursing continues to grow.
The second priority states that nursing research develops knowledge to “prevent disease and disability” (NINR. (n.d.)). I agree with this priority as well. Constant research goes into preventive medicine to help combat diseases. With continuous research scientist are able to learn how diseases work and how to treat these diseases. It can be seen through history how this priority has made a difference. Diseases that used to plague our nation, such as, measles, mumps, and rubella, or polio have been almost eradicated due to the formation of vaccinations that were developed through research. This also stands true for disabilities. Forty years ago, those with any mental disorder were classified as mentally retarded. Due to research over the years these mental disorders are able to be classified separately such as Autism or Attention Deficit Disorder (ADD). These mental disorders are now able to be treated accordingly depending on characteristics and behaviors. The study of Autism has come so far, and it has been noted that early intervention and programs such as applied behavioral analysis (ABA) yield the best outcomes. This would not available without research!
The third priority states that nursing research develops knowledge to "manage and eliminate symptoms caused by illness" (NINR. (n.d.)). I also believe this to be true. Nurses are the ones that interact with patients the most. We see their pain and we try to alleviate as much as possible. With nursing research, we are able to determine the best ways to manage patients’ symptoms, whether it be through medication management, or a mixture of medications and therapies. Both ways require research to determine the best way to treat our patients that has proven results backed by scientific evidence.
The last priority states that nursing research develops knowledge to "enhance end-of-life and palliative care" (NINR. (n.d.)). Although I agree that nursing research allows this and despite scientific evidence, I have seen so many families choose their own path to allow their loved one to pass on. Death, although it is inevitable, is something many fear to face. I see this a lot working in a subacute ventilator facility. Many families, despite all the scientific evidence, go against what research states. But with research we are able to educate patients and families on their choices and make our patients comfortable and allow them to pass with dignity.
Working in a ventilator facility where all your patients are dependent on mechanical ventilation to keep them alive, you often see ventilator associated pneumonia (VAP). In a research article from the Journal of Evaluation in Clinical Practice there was an article on Improving Reliability of Clinical Care Practices for Ventilated Patients. In this article it was founded that many cases of VAP were due to the fact that although they were providing the appropriate care for the patient, “what they weren’t doing was measuring how effectively they did it” (Pinto, et al., 2010). The research, such as what occurred in this study, allows facilities like the one I work at to use this evidence and make the necessary changes to measure our compliance with the care we give in order to decrease the occurrences of VAP. The research helped to build the scientific foundation for clinical practice and helped to prevent the occurrence of VAP. Examples like this show the importance of nursing research and how it shapes all areas of nursing.

References
NINR. (n.d.). Retrieved from https://www.ninr.nih.gov/.
Pinto A, Burnett S, Benn J, Brett S, Parand A, Iskander S, & Vincent C. (2011). Improving
reliability of clinical care practices for ventilated patients in the context of a patient safety
improvement initiative. Journal of Evaluation in Clinical Practice, 17(1), 180–187. https://doi.org/10.1111/j.1365-2753.2010.01419.x
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Discussion Question:
Why is there increasing emphasis on nutrition and exercise for middle aged and aging families? Why is it more significant than 30 years ago?

Aging Gracefully

Cheryl Eaddy posted Oct 30, 2019 5:26 PM
As the healthcare environment continues to see that populations are living longer with multiple health concerns that possibly could be avoided by healthier lifestyles. By the year 2040, 80 million older adults which will be 20% of the population will need health services, Bickley, (2017). It must be a priority for healthcare professionals to be educated and provide resources to promote health during the middle-aged years. Having an understanding as a health professional and making knowledge available to patients and their families about what is normal in each stage of life will assist everyone on ways to start and maintain good health. To help keep balance in life two areas of concern are nutrition and exercise. Health professionals must listen to older adults, then promote lifestyle choices that are obtainable and will provide the best results to keep balance for healthy living, strengthening muscles and bones with routine exercising, Bickley, (2017).
As people continue to age at some point in their life decisions are made by these individuals that if they can put off telling family members and clinicians about the physical and mental challenges that they encounter daily, it will keep them in control over their life and decisions made. It is so important for all patients to trust and be able to depend on their health providers to take the time, ask the right questions and perform the correct screening tools to capture the true picture of an individual’s health status. Clinicians that have special training in taking care of the older adult and their many unique life challenges can help patients except that their bodies will continue to change, but life can still be rich, enjoyable and healthy. If nutritional balance can be maintained throughout the aging process that will help lessen mental and physical disabilities or slow the process down. “Regular exercise can help normalize some aspects of age-related mitochondrial dysfunction, in turn improving muscle function. Good nutrition, especially adequate protein intake, also helps limit and treat age-related declines in muscle mass, strength, and functional abilities. Nutrition in combination with exercise is considered optimal for maintaining muscle function, Deutz, Bauer, Barazzoni, Biolo, Boirie, Bosy-Westphal… (2015). Eating well-balanced protein meals can fuel energy to exercise, which can decrease muscle and bone weakness. Active older adults will normally spend less time alone and feeling depressed and more time spent with love ones, finding ways to stay healthy while making sure their health needs are met when appointments are made with health providers. Nutrition and exercise are so important today because 30 years ago 22% of adults 65 and older were labeled overweight, today it continues at a rate of 38%, Bickley, (2017).
References
Bickley, L., S. (2017). Bates’ Guide to Physical Examination and History Taking. Twelfth Edition. Philadelphia, PA.
Deutz, N., Bauer, J., Barazzoni, R., Biolo, G., Boirie, Y., Bosy-Westphal, A., Cederholm, T., Cruz-Jentoft, Krznaric, Nair, Singer, Teta, Tipton, & Caldern, (2015). Protein intake and exercise for optimal muscle function with aging: Retrieved from doi: 10.1016/j.clnu.2014.04.007
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Matthew Benner posted Oct 29, 2019 4:32 PM

This is my wife’s response every time I order death by chocolate when we are out to eat. As usual, she is correct. That’s because aging is linked to a variety of changes, including nutrient deficiencies, decreased quality of life and poor health outcomes. Aging is linked to a variety of changes in the body, including muscle loss, thinner skin, and less stomach acid. Some of these changes can make you prone to nutrient deficiencies, while others can affect your senses and quality of life. For example, studies have estimated that 20% of elderly people have atrophic gastritis, a condition in which chronic inflammation has damaged the cells that produce stomach acid (Russell 2001). Low stomach acid can affect the absorption of nutrients, such as vitamin B12, calcium, iron, and magnesium (Sipponen 2015).
Another challenge of aging is a reduced need for calories. Unfortunately, this creates a nutritional dilemma. Older adults need to get just as much, if not more, of some nutrients, all while eating fewer calories. Fortunately, eating a variety of whole foods and taking a supplement can help you meet your nutrient needs. Another issue people may experience as they age is a reduction in their body’s ability to recognize vital senses like hunger and thirst.
The changes are not exclusively biologic changes. Environment and population changes can attribute to some of the challenges. A projected doubling in the global population of people aged ≥60 by the year 2050 has major health and economic implications, especially in developing regions. Burdens of unhealthy aging associated with chronic noncommunicable and other age-related diseases may be largely preventable with lifestyle modification, including diet. However, as adults age, they become at risk of “nutritional frailty,” which can compromise their ability to meet nutritional requirements at a time when specific nutrient needs may be high.
Health care systems play a key role in integrating nutrition care for older individuals across primary, acute, subacute, chronic care, and home settings. Primary care refers to the initial care contact with a health provider where many health problems are addressed. As part of a primary care regimen, nutrition screening and dietary assessment are integral to the prevention and diagnosis of many conditions common in older adults, such as CVD, gastrointestinal conditions, diabetes, unexplained weight loss, and cancer. Due to the increased vulnerability of this life stage, a greater focus on dietary intake may be warranted during routine care (Bonilla 2016).
In general, it is possible that dietary requirements shift with the dysregulated metabolisms of many age-related chronic disease states beyond those discussed in this review. Many chronic, age-related disease states, including CVD, chronic obstructive pulmonary disease, type 2 diabetes, and cancer, which incur even greater challenges to nutritional management in older adults. However, evidence supports the idea that all age-related disease states may benefit from careful attention to nutritional adequacy and a healthful diet. Finally, an integrated health system infrastructure is crucial to ensure quality nutrition care for the aging population. Incorporating nutrition evaluations and services into preventative care for aging adults within standard wellness practices is central to avoiding and minimizing the effects of the nutrition-related disease.

References
Bonilla C, Brauer P, Royall D, Keller H, Hanning RM, DiCenso A. (2016). Interprofessional dietary assessment practices in primary care: a mixed-methods study. J Interprof Care; 30 (6),77–82.
Russell, M. (2001). Factors in Aging that Effect the Bioavailability of Nutrients. The Journal of Nutrition, 131, (4), 85-93
Sipponen, P., & Maaroos, H. I. (2015). Chronic gastritis. Scandinavian journal of gastroenterology, 50(6), 657–667.
Leaders vs. Managers

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Monika Klimas posted Oct 31, 2019 7:23 PM

Everywhere I have worked for the past eleven years has drilled into the heads of their works, “The patient always comes first.” In my opinion, this is the biggest lie in healthcare when it comes to institutions and management. Workers at the bedside such as CNA’s and nurses, do for the most part, live this phrase. In addition, good healthcare leaders also live by this phrase. On the other hand, managers do not, they live by budget management. Leaders work with and for their team, managers work for the institution. Leaders care about patients and employees, managers care about upper management, owners, and shareholders. And most importantly, I agree with Baker (2014) “Leadership is doing the right thing. Management is doing things right.”
The patient comes first is todays healthcare standard, patient centered care is another way of describing the standard. Managers believe in putting the patient first if it’s budget friendly. Understaffing causes higher mortality rates yet staffing continues to be low on the priority list. Nurses have now come to expect to be short-staffed on every shift. Short-staffed units, short staffing in homecare, short-staffed long-term care facilities, are no longer the exception, but the norm. Managers are no longer concerned about the patient’s safety or their staff’s ability to safely care for patients. Leaders care about the patient’s safety and staff safety; they will work along their staff to ensure safe workplace.
Managers are concerned about producing income that satisfies upper management, shareholders or owners. They will cut staffing, cut needed supplies, cut education, to ensure the budget, that is set by people who don’t work at bedside, is satisfied. Leaders will fight to increase funds to provide the above. Leaders work alongside their staff and understand what it takes to provide excellent patient care.
Lastly, managers do things right, leaders to the right thing. Managers will quote policy and procedure, even when it is not the most beneficial to the patient or their staff. Managers will stand behind policy and procedure, even if being told by their employees that it doesn’t work. Leaders will listen to their employees; they will research and consider alternatives. They will add additional staff when needed, even if the “staffing chart” does not call for additional staff. They realize that patient acuity is not considered when staffing charts are created.
Positive aspects of managers are that they create strategies and implement procedure to support the vision of the institution. According to Baker (2014), managers are excellent at turning strategies into operations. They take the vision of institutions and create strategies to implement the vision. Managers also create and implement budgets so that institutions prosper financially. Employment wouldn’t be available if the company goes broke.
Leaders are great at keeping moral high, and staff retention. Keeping staff saves money by saving money that would otherwise be spent on training and onboarding new employees. Leaders take employees opinions and feelings into account (Baker, 2014). The Moral Leadership concept focuses on leaders being caring, honest, fair, and socially responsible toward their employees and patient care (Weiss & Tappen, 2015).
In conclusion, managers and leaders have similar roles, they are responsible for the success of their departments. Differences are they way they approach these responsibilities. Managers are focused on budget and the happiness of upper management. Leaders approach with focus on the care and responsibility to their employees and patients.
References
Baker, Edward. "Leadership and Management-Guiding Principles, Best Practices, and Core Attributes." Journal of Public Health and Management and Practice, vol. 20, no. 3, 2014, pp. 356-357., doi:10.1097/phh.00000000000063.
Weiss, & Tappen, (2015). Essentials of nursing leadership and management. Philadelphia: F.A. Davis Company.
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Michelle Armstrong-Cook posted Oct 31, 2019 7:57 PM

Managers and leaders share many of the same qualities. Both are highly motivated, have to focus and are goal-driven. However, there are some differences between the two. Managers are focused on company processes, protocols, and tasks; getting the job done. Leaders are more focused on a vision of how to improve a company’s culture. For example, a nurse manager may be focused on assessments and treatments that need to be completed each shift to assure that the hospital is paid by insurance companies. The manager directs others, team leaders and, charge nurses to make sure the company’s objective of maintaining income and the following governance, and protocol are completed. “ The essence of management is getting work done through others (Weiss & Tappen 2015).” A leader understands the company’s culture and focus but has the vision to make the process more efficient for staff and the consumer. Leaders may develop a vision of how to make the completion of assessments easier to complete by developing an assessment that is less cumbersome but addresses all required areas.
So what are some of the differences between managers and leaders? The first difference is that managers tell people what to do, and leaders tend to guide a team, and participate in the process, also. Second, managers control everything. Leaders engage the team, empowering the team, and relinquishing some control to the team members. Third, managers care about the tasks, numbers, and bottom line. Leaders, on the other hand, care about the team and work environment.
The disadvantages of the way managers operate include alienating some staff due to their preoccupation with task completion, and not considering the individuals the staff that is completing the tasks. A second disadvantage to managers is the use of control and micromanagement that can decrease morale, through the lack of providing staff autonomy, and a voice in the process of completing tasks.
The disadvantages of “leaders” can revolve around the loss of vision and inspiration. Sometimes leaders can lose sight of the vision and lose the inspiration to guide others. The team may then lose inspiration without the guidance of the leader, and the vision may be lost, or put on hold. Also, leaders that have not planned or thought through a vision may overwhelm and frustrate the team; again leading to a vision that is not instituted due to a loss of steam, and frustration.
Last both leaders and managers have the motivation to guide and get the tasks done. And both set standards that drive the vision or the task.
Reference
Weiss, S. S. Tappen, R. M. (2015). Essentials of nursing leadership and management. F. A. Davis. Philadelphia, PA.

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