Nurse Staffing Essay Example for Free

Nurse Staffing Essay Adequate nurse staffing for patient care has been a major difficulty in the health care system . Patients’ acuity continues to grow at a fast rate while hospitals continue to struggle with the adequate number for nurse-to-patient ratio, leaving nurses in a very difficult situation while trying to provide the best care possible to their patients. The low nurse-to-patients ratio can be remedied when public and private hospitals realize the negative impact on the outcome of care. This paper will try to point out the negative effects of low nurse-to-patient ratio has on outcome of care. Like other professions that continue to face obstacles, nursing has its own obstacles that it must face from time to time. The world population increases so will the obstacles that nursing will have to face, but good administration can be used to defend the work conditions under which nurses are forced to work. Many studies have been done to point out the problem, with a pile of evidence to support the need to alleviate the burden on the nurses but to no avail. A study conducted in the Chinese hospital by Zhu, You, et al. (2012). Nurse Staffing Levels Make a Difference on Patient Outcomes: A Multisite Study in Chinese Hospitals proved, â€Å"more nursing staff per patient had statistically significant positive effects on all necessary nursing care, nurses’ reports of quality of care, their confidence on patients’ self-care ability on discharge from hospital, patient adverse events, as well as patients’ report of satisfaction (Zhu, You, et al, 2012, p. 266)†. The study was composed of 181 hospitals across mainland China. The sample that was used was 31provinces, municipalities and autonomous regions with level 3 hospitals. To show the strength of the study, the researchers applied statistics to prove their results. As much as the hospitals may not see the need to improve on the nurse to patient problem, the evidence is there. It is something that must be dealt with because it is dangerous to both nurses and patients. Further studies were also conducted on the problem by Nantsupawat A, Srisuphan W, et al. (2011). Impact of nurse work Environment and Staffing on Hospital Nurse and Quality of care in Thailand. This study was to prove the impact of nursing staffing on the work environment, the cause of burnout and the impact on quality of care in Thailand. Research elements was secondary data analysis of 2007 Thai Nurse Survey. The study took place at 13 general and regional hospitals in Thailand using a â€Å"multistage sampling†. Nurses were asked demographic questions about themselves both general and regional hospitals. Results shown the ratio of patient to nurse was 10:1. Nurses who worked in hospitals with fair patient to nurse ratio had less burnout. The study has great significance in nursing practice and can be used as proof to show the impact of high patients to nurses ratio. It was found that nurses in Thailand work environment have high burnout and great dissatisfaction of nurses. Nurse to patient is very low with a total of 1:10 per shift. At times, a nurse ended-up having to care for more patients. The high patients to nurse ratio brought with it adverse outcomes on patients’ care and place the patients at high risk of occurrences such as: mistaken one patient for another, patient falls, medication errors, pressure ulcers, and urinary tract infection. Furthermore, in the study conducted by Cho, June, Kim, et al (2009). Nurse staffing, quality of nursing care and nurse job outcomes in intensive care units. This study measured the proportion number of patients to nurse. As per the authors of the article, â€Å"nurses were more likely to rate quality of care as high when they care for two or fewer patients (odd ratio, 3. 26; 95% confidence interval, 1. 14-9. 31) or 2. 0-2. 5 patients (odd ratios, 2. 44; 95% confidence interval, 1. 32-4. 52), compared with having more than three patients (Cho, June, Kim, et al,, 2009, p. 1729)†. The research use for its design a â€Å"cross-sectional study with survey. Its method included 1365 nurses from 65 intensive care units in 22 hospitals in Korea, using â€Å"A Multilevel logistic regression model†. Two indicators were used, which are the number of patients for each nurse on the ward and the way the staff viewed adequate staffing. The research took place in the ICU units. Hence, the study also reported that in table #4 in the Sole ICU, there were largest number of patient 2. 8 + or – 0. 4 ( Cho, June, Kim, et al, 2009, p. 1733)†. What is proven is that when the ratio of nurses increases and the patient’s one decreases, there is a higher quality of care that takes place on the unit. This study has great significance to nursing and patient care, because nurses here in the U.  S often have similar complaints. In addition, the study from Manojlovich Sidani (2007). Nurse Dose: What’s in a concept. This is a pathway that the authors believed could alleviate the problem of nurse to patient ratio. The study provided an understanding between the link of nursing care and outcome of care. As stated by Manojlovich Sidani (20097), â€Å"by clarifying the conceptual and operational definitions of nurse dose, we offer a unified view of the inter-relationships among variables, with the goal of advancing research on nurse staffing and patient outcome (p. 11)†. With this concept of â€Å"Nurse Dose† future nurse staffing may greatly improve. Furthermore, in the research conducted by Al-Kandari Thomas (2008). Perceived Adverse patient outcomes correlated to nurses’ workload in medical and surgical of selected hospitals in Kuwait. It is understood that the proportion of patient to nurse ratio plays a vital part on the outcomes of care. The study shown that there is clear correlation that exist between the work load of the nursing staff and the outcomes of care. The research elements utilized for this study was â€Å"across-sectional survey conducted between RNs on medical and surgical units in five governmental hospitals. The result shown three major faulty outcomes were reported by nurses from their previous shift which were patients’ complaints and family concerns. The limitation of this study reports were only from the nurses on the units and future researches would need further details (Al-kandari Thomas, 2007, p. 589). It is impossible for nurses to give adequate care and expect good outcomes when nurses are stocked with non-nursing tasks to do. It was found that patients and families and medication miss dose were the two primary outcomes that added on the nurses’ workload. Second, occurrences tend to increase on the units as the workload of the nurses increased, and non-nursing tasks heavily impacted the workload of the nurses in Kuwait. The study shown great relevance to nursing practice, because it shows that hospitals need to employ other people to carry out non-nursing duties on the unit such as clerical work; which would alleviate the workload from nurses responsibilities. Hence, the article Relationships between Registered Nurse Staffing, Processes of Nursing Care, and Nurse-Reported patient outcomes in Chronic Hemodialysis Units by Thomas- Hawkins, Flynn, Clarke (2008) shown the importance of a high nurse to patient ratio in hemodialysis units. The authors reported in hemodialysis units, â€Å"higher RN staffing levels have lower odds of experiencing skipped dialysis treatments (Hawkins-T, Flynn, Clarke, 2008, p. 124)†. The study shows that it is to the benefits of the patients when there is a higher nurse to patient ratio on hemodialysis units because, patient will less likely experience any untoward events that are associated with the side effects of hemodialysis therapy. The study utilized a â€Å"cross-sectional method† for data collection which focused on the hemodialysis patient population. The study demonstrated the importance of having a high nurse to patient ratio in dialysis units. The higher the nurses to patient ratio, the less occurrences the patients will experience during hemodialysis treatment. The research used a type of questionnaire in order to find the most accurate adverse events that took place in the dialysis units. The limitations of this study was conducted with nurses who belong to an organization, the adverse patients’ outcomes were gathered from the nurses’ reports. The findings from this research were as follow: the nurse staffing levels played a significant role on patients’ outcomes during treatment. The ratio between patients and nurses is high, and each nurse had a patient load that consisted of 12 patients and sometimes more. This study has very good relevance to nursing practice due the fact that it shed light on a particular unit because it is a specialized unit. The study also demonstrated the importance of having professional RNs to perform such duties. Nurse staffing levels and Nursing outcomes: A Bayesian analysis, of Finnish-registered nurse survey data by Tero-h, Kiviniemi, et al (2009). Journal of Nursing Management, 17, 986-993. This report pointed out the impact of high patients to nurse ratio have on the nurses and their performance on the unit. Therefore, it is inevitable this kind of nurse staffing would bring negative patients’ outcomes. The design of this study used a survey of date collection from RNs in 46 units at five hospitals. The study found that many elements were contributed to occurrences on the unit such as mortality, failure to rescue, had a very closed correlation to the number of patients to nurse ratio. The study relates significantly to nursing, because it displayed the stress levels that nurses experienced due to heavy patient load assignment. Macphee, Ellis, McCutcheon (2005). Nurse Staffing and patient Safety. The Canadian Health Services Research foundation. This article brought up evidences of events that may occur in relation to lower nurse patient ratio. It is evident that with a lower nurse to patient ratio, patients are at greater risk of adverse outcomes such as increased rate of mortality, nosocomial infections. It is also proven that with a higher nurse to patient ratio, incidents can be greatly reduced. The study utilized sets of data collected from other researches. No specific population group was chosen for this research but the impact of having high patient to nurse ratio were strongly presented. The article displayed its use to the nursing practice with enough substantial facts. Ke-p. (2003) Relationships between Nurse Staffing and Patient Outcomes. Journal of Nursing Research, 11(3). The study was conducted on a medical –surgical unit in Taiwan with analyzed data from a â€Å"descriptive and multivariate inferential statistics†. The rational of this study was to demonstrate the co-relation that exised between high patients to nurse ratio and its impact on patient care outcomes. The results of this study were astounding. It was found that acquired infections, falls, pressure ulcers were the outcome results of inappropriate nurse to patient ratio. This study definitely has very good relevance to nursing practice. Curtin L. (2003). An Integrated Analysis of Nurse Staffing and Related Variables: Effect on Patient Outcomes. Online Journal of Issues in nursing, 8(3), 10913734. In this his study, the author shows a good co-relation between nurse staffing and the outcomes of care on medical patients. He also pointed out an increase in nurse staffing, that was associated with a reduction of 3 to 12 % in occurrences on the hospitals units. (Curtin, 2003). Here again it shows that the greater is the nurse to patient ratio, the better the outcome. Although, this study did not use a specific design, but the analysis it used shows the importance of having a low patient to nurse ratio. Therefore, it is vital for the hospitals to realize the great pain that are imposed on patients and nurses. It is time to remedy the problem. Aiken L. (2010). Safety In numbers: A mandatory minimum nurse to patient ratio improves outcome. Nursing Standard, 24(44). The author reported, â€Å"International Hospital Outcomes Study revealed that in England and the United States, hospitals with higher nurse staffing levels had lower mortality rates, nurse job dissatisfaction and burnout (Aiken, 2010, p. 2)†. The study was conducted in five different countries which survey 22,000 RNs in 604 hospitals in California, Pennsylvania, and New Jersey. It was found that nurse in California and the two other states that are closed to California with similar staffing mandatory rules had decreased their workload subsequently providing better care. Duffield C, et al. (2010). Staffing, Skill mix and the model of care. Journal of Clinical Nursing, 19, 2242-2251 dio: 10. 1111/j. 1365-2702. 2010. 03225. The study design was based on secondary analysis collection of data on selected medical/surgical units in 19 hospitals in South Wales, Australia. The experienced nurses worked during the night while the least experienced nurses worked day or evening shift. The limitation of this study was that skill mix RNs was beneficial to outcomes, but the number of years of experience on a unit were not studied. (Duffield, et al, 2010, pp. 2246, 2249)†. The relevance of this study to nursing was that it shows how a unit can benefit from having different levels of experienced skill nurses give care to patients. Sidani S, Manojlovich M, Covell C. (2010). Nurse Dose: Validation and Refinement of a Concept. Research and Theory for Nursing Practice: An international Journal, 24(3), dio: 10. 1891/154-6577. 24. 3. 159. The study used â€Å"Anonexperrimental, modified survey† a questionnaire was used with four sections that participants used to answer the questions. The targeted population was nurse researchers who are experts in services related to healthcare (p. 163)†. The result of this study shows how important it is for nurses to spend time with their patients to bring an effective outcome. The study shows great significance of this study in nursing. Welton JM. 2007). Mandatory hospital nurse to patient staffing ratios: Time to take a different approach. Online Journal of Issues in Nursing, 12(3). (13p) (52 ref) This article did not show a specific design that was used. The article stressed another component of the problem, the fact that hospitals are being pressured to increase their staffing without any reimbursement. The article presented two arguments one for and the other against the problem. As a result, hospitals diminished their staff from other area which helped them to compensate for the deficit. Although the acuity of patients continue to rise, hospitals failed to increase nurse to patient levels to enable good outcomes. Currie V, Gill V, et al. (2005). Relationship between quality of care, staffing levels, skill mix and nurse autonomy: Literature review. Journal of Advanced Nursing, 51(1) 73-82. Using a â€Å"cross-sectional analysis design and magnet hospitals, the article poke through between the problem of patient to nurse ratio and the level of occurrences such as, mortality and failure to rescue. The findings were that units with higher nurse to patient ratio experienced lower occurrences. Yes, the article did prove its significance into nursing and patient care. In conclusion, studies are not always conclusive on a particular problem or issue. Further studies are often needed to shed new light on the problem. Hospitals have their parts to play in order to bring a higher nurse to patient ratio to fruition. It still remains that nurses have the responsibility to provide safe and effective nursing care to their patients, regardless of the environment. As a reminder, nursing is a humanistic profession, and its aim has always and will continue to focus on human needs, without regard to ratios. Nonetheless, nurses own it to themselves to be steadfast and never to soften their stand on their demands. Nurses to patient ratio is of utmost importance in the health care and patient outcomes depend on safe nursing staff. It is undeniably true that most professions are facing their own obstacles, and nursing is no different. Nursing has its own obstacles that it has been fighting and must continue to fight for, but a higher nurse to patient ratio is a must win fight, because the end result will be good patients’ care.

Classification Essay - Cats :: Classification Essays

There are three types of domestic cats: indoor domestic cats, outdoor domestic cats, and indoor-outdoor domestic cats. Though these cats would look very similar if they were clean and sitting next to each other, they would also be very different. Indoor cats are generally very clean, since they do not have to work for their food. The excess time allows them to clean and pamper themselves on a daily basis. The fact that they are usually fed on regular intervals makes an indoor cat overweight. The cats know that they can sleep all day and still get fed once or more times a day. Also, since the cats do not work for their food, they lose their exercise time. It makes it impossible for them to burn off any extra calories they may have gotten. This type of cat generally likes a lot of human contact, since humans are the ones who pamper and feed the cats. They are use to this contact, which makes them not scared of humans. For the most indoor cats, a person does not have to worry about getting a disease from them, since the cat probably is taken to the veterinarian on a regular basis. Outdoor cats usually are pretty scraggly looking. The fact that they have to work for all of their food causes them to get more dirty and does not allow them the time to clean themselves everyday. They are much skinnier and are in much better shape. These cats are awake all day long looking for food and avoiding the everyday obstacles of an outdoor cat. This allows them to get plenty of exercise, but not always enough food. Outdoor cats are not usually people friendly. They are not around humans, so that they do not depend on humans enough to be friendly with people. It is probably a good thing that these types of cats do not like a lot of human contact, since more outdoor cats unlike indoor cats have not had their shots. This does not insure that they are free from diseases, so a person does not know if this cat has a disease or not. An indoor-outdoor cat is a combination of the previous two types of cats. These cats are also generally clean looking cats that are semi-dependent on humans for their food.

Baby Development

This paper provides an in-depth look at the findings of an Adult Attachment Interview (AAI) with a toddler’s parents in combination with an intricate observation of the same child. Throughout the course of this paper, it is interesting for the reader to compare and contrast the strong Chinese culture at play within this family to that of their own heritage. The observation of the child was naturalistic meaning there was no contact or attempt to alter the activities by the observer and it lasted thirty-minutes with each minute’s findings noted separately on the enclosed table.The AAI consisted of eighteen questions which are intended to provide a sense of understanding of the parent’s experience with their own mother and father while when used with the observation of the child can help to offer a clearer picture of their parenting. There are three definitions of each, parents and children, which can be used to categorize them. These include for the child: secure, insecure-ambivalent, and insecure-avoidant; and for adults: secure-autonomous, dismissing, and preoccupied.The supporting statements that categorize each of these definitions have been carefully considered in determining which rightfully defines the parents and child in this particular case. Commentary Section During the thirty-minutes that the infant, Kevin, was being naturalistically observed in his parents’ home, a vast majority of his activity revolved around self-stimulation with toy cars with very little interaction with his mother who was also present.Of the three categorizations for an infant—secure, insecure-ambivalent, and insecure-avoidant—I would have to say, based on the short amount of time spent with him, that Kevin showed more signs of being a secure child. This conclusion comes from monitoring his activity and interactivity with his mother in combination with things that were said and his mannerisms. The observation began with Kevin’s mot her introducing three toy cars of differing sizes making the young boy incredibly excited.She obviously brought the toys in order to make the child happy, which shows that she is caring. Kevin was unable to verbally communicate clearly. However, the noises that he did make seemed to be joyful and very animated, mostly â€Å"ya, ya. † Initially, Kevin showed slight hesitation in his ability to play with the toy car and his mother, upon instantly recognizing this, got up from the sofa and selected a car to demonstrate to him a fun way to use the toy.In doing so, to further substantiate my feeling that he is a secure child, he made no fuss at her grabbing a toy and was perfectly happy with her showing him what to do. Some children in this situation may have thrown a tantrum feeling insecure as though the parent was going to take the toys away or control the activity in some way. About fifteen minutes or so into the observation Kevin begins knocking on the floor with the cars. Hi s mother informs him of the elderly lady living below the apartment and how she does not like when he makes such loud noises.Ignoring the lengthy explanation he continues to knock out of lack of comprehension. His mother stands and once Kevin sees that her facial expression is one of displeasure he immediately stops knocking as the visual is something that he is able to recognize. As if the child is checking to see whether or not his mother is terribly upset, he goes to her clutching all three of the toy cars against his chest and says â€Å"ma, ma. † She responds with a smile and a â€Å"yes, honey?† He instantly giggles as he realizes that he is not in trouble but was merely scorned for his action at the time. Seeing as how he went to his mother right after the minor incident shows me that he is comfortable enough with her to run back to her immediately after she scolds him. Their relationship appears to be one of happiness and understanding for one another’s needs and wants. Kevin’s mother was born and raised in Xi’an, which is the capital city of Shanxi province located in northwest China.When she was younger, she explains that both of her parents worked full-time, her mother as an accountant and her father for the Chinese government. She was not the only child; she also had a sister who is two years her junior. She graduated from the Xi’an Institute of Foreign Language and came to the United States to attain her MBA when she was twenty-three years old. She describes her parents as being extremely busy throughout most of her childhood as far back as she is able to remember, but she does not see it as being a problem with their relationship.She describes her mother as the kind of person she would like Kevin to think of her as when he is older: intimate, warm, casual, relaxing, and caring. Every free minute that she had available was spent with her and her sister. Based upon the way that Kevin has responded to his mo ther’s discipline throughout the course of the observation, it seems as though he does not suffer from what psychologist Kagan refers to as behavioral inhibition, which often leads to anxiety in later years.In his research, he has acknowledged the fact that per attachment theory, an infant, in this case Kevin, will become bonded to his mother or whoever provides care to him on a daily basis within the first year. It is, though, the â€Å"individual differences in the secure versus insecure quality of attachments [that] have been observed, resulting from differences in the caregiver's availability and responsiveness to the infant and the degree of reciprocity between the infant and the caregiver† (Shamir-Essakow, Ungerer, and Rapee, 2005).Kevin’s mother has vowed to take traumatizing experiences of her past and avoid putting her child through them so that he can develop into a more secure toddler and eventually adult. One of the questions asked of Kevin’s mother during the Adult Attachment Interview (AAI) was about a time that she remembers being separated from her mother, whom she stated she was closest to growing up. She told me of a time when her mother went away for business when she was almost seven years old.She and her sister waited outside everyday while their mother was away, hoping that she would return soon. Finally, when she did come back she cooked a large meal for the entire family as a way to make up for her absence. Seeing as how this is something that left a lasting impression on her, it seems that she displayed some separation anxiety while her mother was away, but since her mother returned rather than abandoning her it is highly likely that any future trips caused her and her sister far less stress.Knowing how her mother leaving negatively affected her and her sister at such a young age it is probably unlikely that she will accept any requests for leaving Kevin for an extended period of time, at least until he is o ld enough to understand that she will be coming home. Although he does seem secure overall, he did show great affection toward his mother and it is apparent that she would be greatly missed should she leave. As far as her disciplinarian responsibilities with Kevin, she takes cues from her parents. In the interview, she stated that her parents were never threatening whether it was in a joking or serious manner.Yet, she mentioned that her confidence and self-esteem levels are lower than she would like and attributes that aspect of her adult life to the lack of compliments and praise received by her parents as a child. During my observation, when Kevin repeatedly knocked the cars onto the floor, his mother was stern but not condescending or threatening whatsoever. She simply gave him a look to let him know that she was not happy with his present behavior and he stopped out of an obvious subconscious respect for his mother’s wishes.This is an insecurity that she had as a child th at she is trying not to pass down to Kevin. By communicating with him and interacting with him she is definitely not displaying characteristics of a parent who would be considered preoccupied or dismissing. In Mahler’s object-relational theory of child separation-individuation, he explored this sort of relationship between parents and their children and looked further down the road to disclose the affects it would have on them in adolescence.From his work on the subject, others have determined that it is ultimately the way that an individual is able to learn how to balance â€Å"closeness and distance in interpersonal relationships appears to have implications for a host of adjustment and psychosocial outcomes, including self-esteem, quality of family relationships, success in peer relationships, and level of depression and anxiety† (Holmbeck and Leake, 1999). These are all aspects of developmental life that can be either negatively or positively affected at early stag es in Kevin’s life should his mother do too much to avoid a natural separation.It is difficult to balance and control actions in parenting so that a child grows up to be an independent, self-sufficient adult who is able to recognize and pass on similar traits to their children and so on. There is no doubt that a parent who is constantly dismissing their child or is clearly preoccupied a majority of the time will have negative effects on their child at some point later on in their life. This can be seen in the way that Kevin’s mother’s parents dealt with her in certain situations. Granted, after returning from the business trip she made up for her absence in the eyes of her children, an underlying cut was perhaps made.Furthermore, the lack of compliments and praise has obviously made an impression on her into adulthood. Young people are very perceptive, much more than adults give them credit for. Though their actions may not reveal the hurt and slight damage that is being caused, in the long run it may be apparent and those actions blamed after-the-fact. Kevin’s mother has taken these deficiencies and altered them to suit her desires as a parent. Based on her experiences, she has come to realize that her child needs as much physical contact as possible; including kissing, hugging, and just being held.However, the difficulty comes in balance, if Kevin is coddled too much it may also negatively affect him later in life making him into an extremely dependent adult who constantly craves attention and lacks the self-sufficiency to handle grown up problems on his own. However, praise comes with little consequences as long as discipline is fairly and consistently provided. She has come to realize that praising Kevin on a regular basis when he does things that she would like to see him doing leads him to continually act in such a manner in the future.In the interview she mentioned how overprotection has affected her and vows to allow Kevin t o be exposed to the realities of the world around him to better prepare him for life on his own, which is ultimately what parenting is all about. Overall, this project was an extremely beneficial experience for me. It helped me to learn how insecure parents can sometimes raise an insecure child who becomes a far more secure and autonomous parent raising a secure child based on their own experiences growing up in combination with their cultural background.This is revealed as truth in research developed by Ainsworth that found â€Å"that maternal behavior toward the infant is the critical determinant of infant attachment† (Lowinger, Dimitrovsky, Strauss, and Mogilner, 1995). When he grows up, he will have a much more positive relationship with his mother than perhaps his mother has with her own. The future appears to be bright for little Kevin who has seemingly found a healthy balance between freedom and dependency.

Communication Essay - 2481 Words

Interpersonal Communication Essay Communication is the first instrument that humans used in their process to socialize, interact with others and can be defined as the process of sending information about our though, opinions, feelings to another person . Why we communicate? We communicate to know each other, to find out about others emotions, to change information, to convince others to understand our point of view and build relations. Interpersonal communication is the most important form of communication and is the most used. People cannot avoid this type of communication, and their social relation depends on their ability to engage in a conversation with others... Interpersonal communication is the process that†¦show more content†¦It has been estimated that their can be a 60% loss of meaning in the transmission of messages from sender to receiver, hence it is no surprise that most companies find that communications is at the root of a lot of there problems. We have to be aware of all the potential sources of communication in order to avoid these barriers in the future. There are 5 main barriers to communication the first is Physical barriers. They are often due to the nature of the environment. As an example, the natural barrier which exists if staffs are located in different buildings or on different sites it will make it harder for them to communicate with each other. Likewise, poor or outdated equipment, particularly the failure of management to introduce new technology, may also cause problems. Staff shortages are another factor which frequently causes communication difficulties for an organisation. Whilst distractions like background noise, poor lighting or an environment which is too hot or cold can all affect peoples morale and concentration, which in turn interfere with effective communication. The second barrier I would like to talk about is Language barriers. 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