Friday, 15 December 2017

Question Of The Day, Mood, Adjustment, and Dementia Disorders
Q. Which statement about somatoform pain disorder is accurate?

A. The pain is intentionally fabricated by the client to receive attention.
B. The pain is real to the client, even though the pain may not have an organic etiology.
C. The pain is less than would be expected as a result of the underlying disorder the client identifies.
D. The pain is what would be expected as a result of the underlying disorder the client identifies.

Correct Answer: B

Explanation: In a somatoform pain disorder, the client has pain even though a thorough diagnostic workup reveals no organic cause for it. The nurse must recognize that the pain is real to the client. By refusing to believe that the client is in pain, the nurse impedes the development of a therapeutic trust-based relationship. While somatoform pain offers the client secondary gains, such as attention or avoidance of an unpleasant activity, the pain isn't intentionally fabricated by the client. Even if a pathologic cause of the pain can be identified, the pain is usually in excess of what the pathologic cause would normally be expected to produce.

Nursing Guides, Nursing Learning, Nursing Tutorials and Materials

All of us have some issues relating to the workplace, patient care, health and wellness within our communities or the healthcare system that we are passionate about and wish we could change for the better. We might believe that it is not within our ability or power to bring about change. However, through well planned and executed advocacy we CAN make a difference while still remaining within the boundaries of professional ethics and workplace policies.

Briefly, advocacy means to act on someone’s behalf. The World Health Organisation defines advocacy within the health care arena as “A combination of individual and social actions designed to gain political commitment, policy support, social acceptance and systems support for a particular goal or programme.”


Nurses are by far the largest group in health care. With their education and exposure to the needs of patients and the community, as well as being recognised as the most trusted and ethical profession, they should be a major force for social change.

Advocacy is also recognised as a core component of the nurse’s role. This is clearly stated in the ICN Code of Ethics for Nurses:

◉ The nurse shares with society the responsibility for initiating and supporting action to meet the health and social needs of the public, in particular, those of vulnerable populations.
◉ The nurse advocates for equity and social justice in resource allocation, access to health care and other social and economic services.

Initial involvement in advocacy need not be a major project; it can be as small as motivating for a suitable breastfeeding room for staff or healthier food choices at the local school canteen. Participation in advocacy initiatives also leads to personal and professional development, including growth in leadership and communication skills, as well as empowerment for all concerned.

The advocacy process

1. Take the initiative

The first step in advocacy is to make the decision to act. This could be you alone or a group who all feel strongly about the problem. The particular issue must be defined and framed as one for which there is a potential solution, within the framework of available support and resources.

Using the above example of the breastfeeding room broad the felt problem might be that staff who want to feed their babies have to use the toilets. The issue is then framed by the need for a clean and comfortable place where staff can breastfeed, given that breastfeeding is the healthiest option for babies and should be encouraged.

2. Gather information

Once the issue has been framed in-depth, research must be done to collect evidence which will help to build a strong, credible case. This information gathering would include the most recent scientific research related to the issue; views expressed by international organisations; the number of people affected and their ideas about the problem and possible solutions.

Research must also include the political context–find out who the people in high places are that make the decisions about priorities, changes in policy and funding. What other influential leaders or organisations could be approached for support? What are others saying and doing about the issue? What coverage is being given to the media – both positive and negative? Who are the possible opponents and what are their points of view.

3. Strategic planning

Once as much information is possible has been collected the next step is to set a goal for the campaign. As for all goals, it should be specific, achievable, have a measurable outcome and a time frame. Smaller institutional or local campaigns might have a short period, whereas, for others, the goal might take years or even decades to achieve (for example, the action against global warming).

Once the goal has been decided on, a strategy can be planned on how to achieve it. This planning is the most important part in ensuring the success of the campaign.

Communication is at the centre of all advocacy – getting the message out there, gaining the support of stakeholders and the public and putting pressure on decision makers.

Stakeholders who will be affected by the action should be involved as soon as possible in the advocacy process, not only for their personal knowledge and experience of the issue but also to get their buy-in and support.

There should be a strong key message with a call to action which should preferably be supported by a visual such as a logo or a “face” on the issue. Specific information packages can then be developed to target different audiences such as the stakeholders and the public; the media; and decision makers. The who, what, why, when, where and how of putting the message out there must be planned in detail.

Where the campaign addresses a community issue, communication through the media will be essential. Win the media over as a partner in the campaign by building a relationship with journalists in the print media, radio and television. Identify a spokesperson for the campaign who will come over well in interviews. Stakeholders who can be talked about their personal experiences can add a compelling human interest angle. Internet-based and social media campaigns are cost-effective and can reach large audiences very quickly but should not be used on their own. Lobbying influential leaders and policy makers, meeting with them and presenting the facts and figures and possible solutions must also be included in the plan.

It is also a good idea to network and form alliances with organisations that have similar goals to provide for information sharing and mutual support. There is always power in numbers.

4. Implementation and evaluation

After careful planning, the campaign is ready to be implemented. This is also the time to be alert and watch the news as it unfolds. With fast action, the campaign message can become newsworthy when linked to relevant breaking news. For example, if the danger of childhood obesity makes the news after a government report is released, it can support the campaign for healthier foods in the school canteen.

There should be continuous evaluation and adjustment of the plan as needed as well as final evaluation at the conclusion of the advocacy campaign.This is essential for accountability, especially where donor funding was involved. How successful was the campaign? What were the strong points and what could have been done differently? Methods used for evaluation will depend on the goal of the campaign. It might be as simple as that the change has been implemented or might require surveys and relevant statistics.

Thursday, 14 December 2017

Question Of The Day, Anxiety Disorders
Q. A nurse notices that a client with obsessive-compulsive disorder washes his hands for long periods each day. How should the nurse respond to this compulsive behavior?

A. By setting aside times during which the client can focus on the behavior
B. By urging the client to reduce the frequency of the behavior as rapidly as possible
C. By calling attention to or trying to prevent the behavior
D. By discouraging the client from verbalizing his anxieties

Correct Answer: A

Explanation: The nurse should set aside times during which the client is free to focus on his compulsive behavior or obsessive thoughts. The nurse should urge the client to reduce the frequency of the compulsive behavior gradually, not rapidly. She shouldn't call attention to the behavior or try to prevent it. Trying to prevent the behavior may frighten and hurt the client. The nurse should encourage the client to verbalize his anxieties to help distract attention from his compulsive behavior.

Wednesday, 13 December 2017

Question Of The Day, Foundations of Psychiatric Nursing
Q. A 28-year-old client with an Axis I diagnosis of major depression and an Axis II diagnosis of dependent personality disorder has been living at home with very supportive parents. The client is thinking about independent living on the recommendation of the treatment team. The client states to the nurse, "I don't know if I can make it in an apartment without my parents." The nurse should respond by saying to the client:

A. "You're a 28-year-old adult now, not a child who needs to be cared for."
B. "Your parents won't be around forever. After all, they are getting older."
C. "Your parents need a break, and you need a break from them."
D. "Your parents have been supportive and will continue to be even if you live apart."

Correct Answer: D

Explanation: Some characteristics of a client with a dependent personality are an inability to make daily decisions without advice and reassurance and the preoccupation with fear of being alone to care for oneself. The client needs others to be responsible for important areas of his life. The nurse should respond, "Your parents have been supportive of you and will continue to be supportive even if you live apart," to gently challenge the client's fears and suggest that they may be unwarranted. Stating, "You're a 28-year-old adult now, not a child who needs to be cared for," or "Your parents need a break, and you need a break from them," is reprimanding and would diminish the client's self-worth. Stating, "Your parents won't be around forever; after all they are getting older," may be true, but it is an insensitive response that may increase the client's anxiety.

Tuesday, 12 December 2017

Q. An 8-year-old child is suspected of having meningitis. Signs of meningitis include:

A. Cullen's sign.
B. Koplik's spots.
C. Kernig's sign.
D. Chvostek's sign.

Correct Answer: C

Explanation: Signs and symptoms of meningitis include Kernig's sign, stiff neck, headache, and fever. To test for Kernig's sign, the client is in the supine position with knees flexed; a leg is then flexed at the hip so that the thigh is brought to a position perpendicular to the trunk. An attempt is then made to extend the knee. If meningeal irritation is present, the knee can't be extended and attempts to extend the knee result in pain. Cullen's sign is the bluish discoloration of the periumbilical skin caused by intraperitoneal hemorrhage. Koplik's spots are reddened areas with grayish blue centers that are found on the buccal mucosa of a client with measles. Chvostek's sign is elicited by tapping the client's face lightly over the facial nerve, just below the temple. A calcium deficit is suggested if the facial muscles twitch.

Monday, 11 December 2017

Nurses, Nursing Professionalism, Nursing Guides

Your level of professionalism as demonstrated by your behaviour and attitudes can be a deciding factor in whether you get that promotion or are passed over for someone else.

Nursing is a profession, but the individual nurse’s level of professionalism develops throughout her career. The professionalism of an individual can be seen on a sliding scale with the new recruit at the one end and the professional ideal on the other. Professional socialisation, through education and practice, begins when the student enters nursing school. The sliding scale also means that all nurses are not equally professionalised with very few, if any, reaching the ideal. The nurse develops professionally throughout her career as she increasingly adopts the professional culture, and demonstrates its norms and values in her daily attitudes, behaviours and practices – both at work and in the community.

What are the norms and values in nursing?

Any culture is made up of standards and values which are transmitted in various ways to socialise the child or the new colleague to a workplace or profession.

Core elements the professional behaviour and attitudes of the nurse are contained in nursing codes of ethics. To be able to apply these concepts in practice the statements should be analysed and discussed, and your practice continuously assessed against these guidelines.

How can I raise my level of professionalism?

By increasingly paying attention to the following eight elements relating to patient care, your development as well as your interaction with colleagues and within the community, you can raise your level of professionalism and your chances of career advancement.

1. Put caring first

Nursing came into being because of the need of human beings for care in times of need. Caring is the nurse’s unique function, and all other professional behaviours are in support this function. The majority of the provisions in the ethical code will be met if the nurse genuinely cares for each patient and accepts the patient as unique, respects his individual rights, and meets all his physical, psychological, social and spiritual needs. This includes respect for dignity irrespective of nationality, race, creed, colour, age, sex, politics or social status.

2. Be professionally responsible and accountable

Nursing is a profession in its right and nurses no longer seen as subservient to the medical practitioner. She is an independent practitioner with the freedom to make nursing care decisions for her patients. In the interests of her patients she should analyse and question, use initiative and take decisions. She can lose her licence is she does not act responsibly and accountably regarding what she has been trained to do. For example, if she executes physician’s orders or prescriptions which she should know from her training to be incorrect instead of questioning them, she is also held professionally liable in the event of problems.

3. Be an advocate for your patient

While advocacy is a relatively new term in nursing, the concept was entrenched in Virginia Henderson’s definition of nursing: “the nurse assists the individual, sick or well, in the performance of those activities… which they would perform unaided if they had the necessary strength will or knowledge”. An advocate acts on behalf of the client and in this role, it is the nurse’s duty to help her client to obtain the health care and other assistance they require when they don’t have the knowledge or ability to act for themselves. Here the client can be an individual patient, family or community. Advocacy must however also be conducted in a professional way and according to acceptable standards.

4. Maintain a good relationship with co-workers

Only the best communication and co-operation between members of the health care team will ensure quality care for the client. The nurse often coordinates this communication as she is the one who spends the most time with the client. Any problems or disagreements which arise between the patient and other members of the team, or between members of the team, should be resolved in a professional manner and never in front of the patient.

5. Maintain patient confidentiality

Every nurse knows this basic human rights principle which is stressed in training and contained in all codes of nursing and medical ethics, and often in professional legislation as well. However, breaches of confidentiality happen daily, often unknowingly in casual conversation. If you listen to conversations between nurses during tea you will often hear discussions which could constitute a breach of confidentiality. There are times when personal information needs to be shared with other members of the team caring for the patient, and the codes of ethics make provision for this.

6. Develop and maintain professional standards

Only nurses can determine professional standards for nurses and nursing care. It is nurses’ responsibility to continually evaluate their own practice against the set standards. Because of commitment to quality patient care the nurse should also strive to continually raise those standards.

7. Maintain professional competence

The best quality of care for the patient is only possible if the nurse accepts responsibility for increasing her professional knowledge and keeping up to date with new developments. She should have an enquiring mind and learn all the time and not limit learning to that required for CPD points for registration. With all the information available on the web, there is no excuse for not reading up on a topic where you have discovered a gap in your knowledge.

The nurse who assigns tasks to other nurses remains ultimately responsible for the care which is provided to clients. It follows then that she also needs to teach subordinates to ensure that they are competent to perform their tasks correctly and according to the accepted standards.

8. Participate in professional affairs

Every nurse should be concerned about and active in promoting the profession and addressing current issues in nursing and health care. Professional groups, including nursing associations or societies representing different nursing specialties, are more successful than individuals in bringing about change through the voice of numbers. Becoming active in professional groups and sharing your expertise can add considerably to your professional development and recognition.
Question Of The Day, Toddler
Q. When assessing for pain in a toddler, which of the following methods should be the most appropriate?

A. Ask the child about the pain.
B. Observe the child for restlessness.
C. Use a numeric pain scale.
D. Assess for changes in vital signs.

Correct Answer: B

Explanation: Toddlers usually express pain through such behaviors as restlessness, facial grimaces, irritability, and crying. It is not particularly helpful to ask toddlers about pain. In most instances, they would be unable to understand or describe the nature and location of their pain because of their lack of verbal and cognitive skills. However, preschool and older children have the verbal and cognitive skills to be able to respond appropriately. Numeric pain scales are more appropriate for children who are of school age or older. Changes in vital signs do occur as a result of pain, but behavioral changes usually are noticed first.

Saturday, 9 December 2017

Question Of The Day, The Nursing Process
Q. A group of nurses has established a focus group and pilot study to examine the potential application of personal data assistants (PDAs) in bedside care. This study is a tangible application of:

A. Nursing informatics.
B. Electronic medical records.
C. Telemedicine.
D. Computerized documentation.

Correct Answer: A

Explanation: Nursing informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice. A specific application of nursing informatics is the use of PDAs in the clinical setting. The devices are less likely to be used to perform documentation or to constitute client records. Telemedicine involves the remote provision of care.




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