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Disseminating Evidence

Disseminating Evidence

Student’s Name

Institution

Disseminating Evidence

A Summary of strategies for disseminating the results of the project to key stakeholders and to the greater nursing community

The project results will be disseminated through published reports. However since most nurses do not catch up with relevant practice through one report, the project coordinators will publish as many reports as possible to ensure that each nurse reviews about 18 reports per day. Good practices in patient care are pegged on the dissemination of the most recent evidence. Without credible evidence to underline practice, nurses more often than not find themselves aggravated for being incapacitated in the provision of the best likely care (Kohn and Donaldson, 2010).

Education

The translation of research findings into practice could take up to two decades, to ensure that this does not happen; the project coordinators will use educational forums to teach patients and nurses on the relevance of the project’s findings as regards the development of the new staffing matrix to positively impact overall delivery of health care to the patients. The project coordinators will seek to maintain skill levels through habitual and progressive professional development. These will have to be related to initiatives such as the skills and knowledge framework, as well as appraisal procedures, where nurses will be appraised by the patients on the quality of delivery of health care (Polit and Hungler, 2006).

The Education of Nurses

The effective outcomes of the project’s findings will have to mirror the need to involve nurses still in training institutions in order to successfully impress them on the significance of evidence based practice relative to effective clinical outcomes (Kohn and Donaldson, 2010).

Time Management Skills

To ensure that the successful dissemination of the project’s findings does not take two decades as has been the case in the past, nurses will have to be taught time management skills. The project coordinators will introduce educational platforms for nurses to specifically be imparted with skills necessary for reading, critiquing and disseminating research (Polit and Hungler, 2006).

Current Systems

In order to successfully disseminate the project’s results to key stakeholders and the greater nursing community the project coordinators will make use of the existing systems to monitor the effectiveness of the clinical outcomes and evidence based practice. This will relate with the use of link forums and specialist knowledge that are already being supported by the hospitals in the district (Kohn and Donaldson, 2010).

Communication

The project coordinators will monitor the lines of communication between nurses and patients to ensure they are evaluated and robust. Since this relates to individual responsibilities and organizational influence all stakeholders will have to identify their roles while appreciating the role played by others. This will in the end ensure that the project’s results are successfully disseminated to key stakeholders and the greater nursing community (Polit and Hungler, 2006).

The Profession of Nursing

The project coordinators will ensure that Nursing as trained in institutions becomes more academic without losing the sight of what it is all about. For instance through patients’ appraisal mechanisms and continued professional development nursing would be made to be fundamental to clinical outcomes and evidence based practice (Kohn and Donaldson, 2010).

Conclusion

The potential to gain high level evidence to impact on the quality of care received by patients necessitates a commitment from nurses and all health stakeholders. It is only through exhibiting commitment for disseminating and supporting clinical outcomes and evidence based practices can the health care system salvage the trust it initially had from members of the public. By committing themselves to communicate their latest clinical outcomes and evidence based practices nurses be able to increase their self esteem, morale and reduce their frustration for having been incapacitated in the past in their efforts to provide the best care to their patients.

References

Polit DF, Beck CT, & Hungler B.P. (2006.) Essentials of Nursing Research: Methods, Appraisal and Utilization (Fifth edition), Lippincott Williams & Wilkins, Philadelphia PA.

Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (Eds.). (2010). To error is human: Building a safer health system. Washington, DC: National Academies Press.

Disseminated intravascular coagulation (DIC)

Health and Medicine

Name

Institution

Health and Medicine

Disseminated intravascular coagulation (DIC)

DIC is a condition that is life threatening as it prevents normal blood clotting in human. Though it is a rare condition it might cause hemorrhage throughout the body which may lead to organic failure, shock and death1.

The body’s natural ability to control blood clotting fails to function well in DIC, leading clumping and small blood vessels all over the body get clogged. Clotting excessively causes damage in organs, destroys blood cells, and also makes blood not to clot normally by depleting the supply of platelets and other clotting factors. This condition causes profuse bleeding both internally and externally.

It is not easy to diagnose DIC as it is a very complex condition.DIC does not have a single test for its. In most cases, several tests are repeatedly done over a period for accurate diagnosis. An individual, who experiences excessive bleeding or clotting, may have DIC. Confirmation of DIC can be done by measuring amounts of platelets, prothrombin, fibrinogen and other substances that may affect clotting1.

The tests used to diagnose DIC

D-dimer test measures fibrin, a substance that is released during break up of a blood clot. This test determines whether a person’s blood clotting is normal. In people with abnormal blood clotting, D-dimer levels are always higher.

The next blood test is Prothrombin time (PT/INR) which is done to see how long blood takes to clot. For blood to clot and stop bleeding (coagulation), a dozen of blood proteins are needed. Among several clotting factors produced by the liver is Prothromblin, a long prothrombin time can be a sign of DIC.

Blood smear test is done by smearing a blood drop on a slide staining it with dye and observing through a microscope. Then a record of platelets, the number, size and shape of red blood cells and white blood cells is taken. Blood cells of people with DIC often look damaged.

Next is Fibrinogen test, testing for fibrinogen a protein that plays part in blood clotting. Measurements are taken to check how much fibrinogen is in the blood. A low fibrinogen level happens when the body uses fibrinogen faster than it can make. People with low fibrinogen may be having DIC.

Finally,complete blood count is also done. It involves counting red blood cells and white blood cells from a taken blood sample. DIC cannot be diagnosed by CBS results; this only provides information to aid a doctor main diagnosis. (Drop in platelets count may be caused by DIC)

The tests and their significance

An emergency department received a 37yr old man who had one week history of chills, fever and productive coughs after he became febrile and disoriented. He was found to have purpura, epistaxis, and hematuria on examination. A platelet count of 17,000 cells/micro liters, a white cell count of 42,000 cells/microliters with a shift to the left, a prolonged prothrombin time to 16.5 seconds, a prolonged to 63 seconds of an activated partial thromboplastin, the level of fibrinogen was below 100 mg/dL and the concentration of fibrin degradation products was elevated, this was shown by laboratory test taken. Kidney injury with a serum creatinine level 3.1 mg/dL was shown by metabolic panel. Schistocytes and confirmed thrombocytopenia was revealed by peripheral blood smear. Pleural effusion too was a revelation by the chest radiograph, which was revealed to be an empyema on further evaluation. A surgical consult was obtained for pus drainage and chest tube placement after the patient was admitted to the intensive care unit. To control his bleeding, administration of cryoprecipitate, platelets concentration, and fresh frozen plasma was done; the treatment of infection was started by broad-spectrum antibiotics. His coagulation parameters slowly recovered the next day, and subsequent clinical course was uneventful.

Significance of the test results

The tests results above indicate a complex DIC syndrome and both thrombosis and hemorrhage secondary to underlying conditions are involved. The recognition of underlying conditions in a patient with clinical manifestation of thrombosis or bleeding (or both) and confirmation by repeat measurement of coagulation parameters play a role in diagnosis. The underlying condition can be corrected by mainstay of treatment. Stabilization of the patient in cases with active bleeding can be done by blood component replacement. In certain conditions where thrombotic manifestations predominate, heparin use can be considered though it is controversial (e.g., purpura fulminans, solid tumors, hemangiomas, dead fetus syndrome) 2.

Liver Disease

The liver sever various critical function many bodily functions from protein production and blood clotting to cholesterol, glucose and iron metabolism. The liver can be affected by a variety of illnesses. Occurrence of cirrhosis happens when the normal liver cells are replaced by scar tissue resulting from chronic liver disease. The particular liver disease treatment depends on its specific cause. To evaluate the functionality of the liver, a series of special blood tests can often be done3.

First is Serum bilirubin test which measures the level of bilirubin in the blood. Bilirubin is excreted in the bile and produced by the liver. An elevation of bilirubin levels might indicate an obstructed flow of bile or liver inability to process bile. Serum alkaline phosphatase test measures the level of alkaline phosphate. Many tissues have alkaline phosphate; it is highly concentrated in the liver, biliary tract, and bone. Performance of the test can be done to assess functioning of the liver and detection of liver lesions which may cause obstruction of biliary, tumors or abscesses.

Alanine transaminase (ALT) test checks the level of alanine aminotransferase that is released into the bloodstream after the liver cell is damaged acutely. The performance of the test is to assess liver functions, or evaluation of treatment in acute liver disease like hepatitis. Serum albumin test, on the other hand, determines the level of albumin is in the blood.

Prothromblin time (PT) test measures the time it takes blood to clot whereby prolonged clotting is an indication ofliver disease. Tissue damage in the liver is done through Lactic dehydrogenase test which can facilitate liver disease diagnosis. The 5’-nucleotidase test, which measures 5’-nucleotidase level helps diagnose diseases associated with cholestasis. Elevated levels of 5’-nucleotidase is an indication of liver disease.

Mitochondrial antibodies test targets primary binary cirrhosis, chronic active hepatitis, and other certain autoimmune disorders (which are antibodies), while Aspartate transminase (AST) test targets the levels of aspartate transaminase that is released in the bloodstream after a heart or liver problem. After acute liver cell damage, this enzyme is released into the bloodstream.

Serum alpha-1 antitrypsin test (A1AT) is done to test the levels of alpha-1 antitrypsin in blood. It identifies a rare form of emphysema in adults and rare form of liver disease (cirrhosis) in children and adults. The last test is Alpha-fetoprotein test which detects fetal tissues and tumors, since the two produce alpha-fetoprotein.

Practicality of the test and test score significance

A 22-year-old man patient who is HBsAg(+), HBeAg(+), anti-HBe(-), with a HBV DNA of 71.5 million copies/mL this is approximately 14 million int. Unit/mL and a persistently serum ALT ranging from 20 to 30 int. unit/L(upper limit of normal 40 int/L). He had a normal essential liver biopsy. This would not be treated at this time although his HBV DNA level is high. He has no significant inflammation on liver biopsy and serum ALT that is normal as he is young this is a prediction of low probability of HBeAG seroconversion in both nucleos/tide analog and peginterferon. Though serum HBV DNA level in patience can be decreased by antiviral therapy, no evidence has been shown that treating this patient will improve clinical outcome at this stage. This patient will need continuous treatment for several years or even decades to derive clinical benefit given this low rate of HBeAg seroconversion less than 5% after one year of treatment.

For feasible achievement of this goal, it must be balanced against the risk of drug resistance. There is a possibility that a patient may undergo spontaneous HBeAg seroconversion upon the next few years, Hence the patient has to be followed up and re-examined ALT every 3 to 6 months. In case his ALT becomes more than two times normal, the monitoring of the patient must be more frequent and treatment should commence if no observable changes are recoded in six weeks. For patients above 45 years, with the same high HBV DNA level, the biopsy would be run and a consideration treatment if HBV DNA level persists high or if there is moderation/severe inflammation and/or advancement of fibrosis on biopsy.

References

1. Wallach, J. B. Interpretation of diagnostic tests. Philadelphia: Wolters Kluwer Health/Lippincott Wiliams & Wilkins; 2007.

2. Pagana, K. D., & Pagana, T. J. Mosby’s diagnostic and laboratory test reference. St. Louis, Mo: Mosby; 2013.

3. Friedman, L. S., & Keeffe, E. B. Handbook of liver disease. Philadelphia, PA: Elsevier/Saunders; 2012.

Disruption of Attachment Due to Separation & Loss

Disruption of Attachment Due to Separation & Loss

Author

Institution

Introduction

The importance of family cannot be gainsaid as far as the growth and development of an individual is concerned. It tends to shape the individual and has a bearing on the traits, values, likes and preferences that he or she has in life. Needless to say, separation of an individual from his or her family has devastating effects on their psychosocial development. Studies show that disruptions of bonding and attachment can have adverse impacts on the psychological and emotional development. In fact, family loss and separation experiences have been shown as risk factors for the development of problems with one’s mental health both in childhood, as well as adulthood. While temperament, experiences and biology play crucial roles, children who have experienced interruptions in relationships with their families, caregivers or parents are a higher likelihood to incorporate compromised mental health. The trauma associated separation and loss mainly depends on the circumstances within which the separation or loss has occurred. In instances where a child is separated from his family or permanently loses it through care placement, the chronic nature of the separation, the age of the child, as well as the trauma with which it is associated are shown to significantly determine the impact of the separation on the psychological or mental health of the child. Volumes of literature have been written, and numerous movies produced trying to depict the impact of separation or with their main theme as family loss and separation. This is the case for the 2002 movie Rabbit Proof Fence.

Set in the 30’s, the movie revolves around the lives of two sisters Molly and Daisy and their cousin named Gracie. It was at a time of social and political unrest when Aborigine kids would be forcibly separated from their parents and taken to white families, who apparently could bring them up. After being brought up in the detention centres, they would be married off to white people so as to eliminate this ‘unwanted race”. The three girls were captured and taken off to the Moore River Settlement Camp. However, they made a daring escape from the camp and followed a 1500 mile Rabbit Proof Fence that acted as their guide on the route home. They never managed to reach back home to their parents as Gracie was tricked that her mom was waiting for her at a train station, after which she was recaptured while looking for the mother. At the epilogue of the movie, Molly informs the audience that Gracie is dead and outlines varied episodes of recapturing, as well as separation from her kids.

Varied loss events have been illustrated in the film. At the beginning, the three girls are taken away from their mother and grandmother, as well as the place that they called home. They are taken to Moore River Settlement Camp where they undergo physical and emotional torture.

Once they decide to escape, an Aboriginal traveler sets them up for recapture, in which case they are separated again. Gracie is recaptured after she goes to meet her mother at the train station ash she had been lied to that the mother was waiting for her.

Other episodes of separation are outlined at the epilogue of the movie, where Molly States that she and her two daughters were taken back to the settlement camp. However, she managed to escape from the camp with one daughter (Annabel), in which case she separates from one of them. Later on, Annabel was taken away from her when she was only three years old, a separation from which Molly has never set her eyes on her daughter again.

However, the first episode of separation sticks out as the most traumatic for the children. They have already established a relationship with their parents and guardians, a bond that is severed by the separation. It is worth noting that the three kids are in different stages of growth. Daisy and Gracie are aged 8 and 10 respectively, in which case they are in the latency stage of psychosocial development. Molly is 14 years old, falling under the adolescence, a time when she needs to gain her own identity. Studies show that the children at the latency stage would have low self-esteem and self-confidence in the event of separation from their parents. They are also bound to distrust everybody. However, children at the adolescent stage tend to be relatively independent. This does not undermine the fact that they would also have low self-esteem and even be unable to form friendships and even socialize with others. They would also be angry at the “outside world” and become impulsive, an aspect that is seen with Molly when she crafts the plan to escape from the camp.

On the same note, the trauma and grief of separation seems to have hardened Molly to the outside world. Scholars note that children in that age are bound to be independent. In instances where they are facing any hindrance from their parents, they are bound to become rebellious in an effort to assert their independence. This is the case for Molly who wishes to assert her independence to the hostile world that has attempted to shape her destiny and incarcerate her in a camp against her wishes.

In addition, such separation breeds mistrust of other people in children. They tend to label the outside world a foe that cannot be trusted, in which case they would have problems adjusting in the outside world. Molly and the other girls have this problem and find it hard to adjust to life in the camp or even socialize with other Aboriginal kids in the camp. Instead, such kids tend to stick to what is familiar, as seen in the case of Daisy and Gracie who cling onto Molly once they get to the camp. This is also seen when Molly comes up with the plan to escape from the camp. Daisy is reluctant to follow Molly stating that she already liked it there. This is because she has already established some element of familiarity with the camp and is fearful of what the unfamiliar world to which Molly wants to introduce her holds.

Scholars note that the effects of such separation would be compounded in instances where such kids are subjected to multiple episodes of separation, as is the case for Molly, Daisy and Gracie. However, this trauma can be rectified by allowing the kids to grow in a relatively stable environment, where they gradually learn to trust the people around them. The advantage in this case is that they are kids, yet to explore much of the outside world, in which case they are bound to come across varied episodes that would restore their confidence in the outside world, as long as they are not under any pressure from any quarter.

Attachment refers to the emotional and social relationships that children develop with individuals who are significant in their lives. This process is composed of interactions between the child and his primary caregiver, starting at birth and assisting the child in the intellectual development perceptions organization, logical thinking, conscience development, self-reliance, development of coping mechanisms, as well as the formation of intimate and healthy relationships. Varied elements of attachment are identified. When the girls are separated from their guardians (mother and grandmother), they become extremely distressed, as shown by their cries of anguish and their determination to be reunited with their primary caregiver. Their determination to go back shows that they had an extremely healthy attachment with their caregivers, a notion that is cemented by the joy they exhibit after being reunited. In Molly’s case, it is evident that her character is a testament to the attachment that she has with her parents. She takes the position of a mother or guardian when they are separated from their parents while acknowledging that she was the oldest of the three and was, therefore, in charge of their security. In addition, positive attachment is seen to have shaped the relationship she creates an emotional bond with the two younger girls choosing to make a daring escape from the camp so as to save them. It is worth noting that her emotional attachment to her mother and granny is what drives her during the long journey home, despite the challenges and the traps. The trust that she had learnt from her parents had imbued a sense of security in her, in which case she looks at the world as secure. This is what drives her to seek help from strangers after escaping from the camp despite the fact that she knew that her captors were after them. These girls exhibit no element of insecure attachment to their primary caregivers. In fact, they strive to get back to their primary caregivers, driven by their strong, secure and emotional attachment, a fact that is cemented by the excitement that they exhibit when they see them again.

Molly in the developmental (Eriksonian) stage of middle childhood

Molly is 14 years old as at the time of the film, an adolescent stage characterized by a desire for one’s own identity vs. role confusion. At this stage, an individual’s development is dependent on the actions of an individual, in which case the person must struggle to find his true identity and negotiate social interactions. Adolescents at this stage start developing strong affiliations, as well as devotion to friends, causes and ideals. In their effort to find their identity, they are bound to be highly aggressive, and exhibit extreme physical strength. These aspects are clearly evident in Molly’s case as seen when she captures a wild animal, as well as her confidence in getting back to her people.

In my opinion, Molly negotiated the adolescent stage as a highly emotive, physically energetic, as well as aggressive child trying to establish her true identity. Her defiance even in the face of danger from her captors could be interpreted as one of the efforts she makes to establish her true identity. It is worth noting that this assertion becomes her character, as seen in the prologue where she recounts that she was recaptured and taken in the same detention camp and managed to escape by following the same rabbit-proof fence. In essence, she has established her identity as a non-conformist, something that she carries on to her adulthood. In fact, she states in the prologue that she is never going back to “that place”. This non-conformist attitude is also seen at their time of escape, when Daisy tells her that she already likes it in the camp, to which Molly tells her that that is not their home.

It is worth noting that, during the first time of her capture with her sisters, she was aged 14 years old. The developmental stage of middle childhood is characterized by high levels of emotions, aggression, self-absorption, as well as preoccupation with oneself as the adolescent would be beginning to have a sense of self (Caye et al, 1996).

In addition, scholars note that individuals in this stage are faced by the need to reestablish their boundaries for themselves, something that is usually done in a potentially hostile world. This is evident in Molly’s life right from the time of capture. The society has determined that she should become “white” or adopt their ways, something that she detests and chooses to run away from the camp in spite of the difficulties that lie ahead. She has determined that she wants to adopt the ways of her people and strives to follow up on this aspect.

Role of aboriginal culture in Molly’s life in the context of human behavior and the social environment

The ethnic background of an individual was thought to have little or no effect on the behavior of an individual. In fact, the behavior of a child used to be interpreted in the context of religion, gender and other factors (Crain, 2011). However, recent literature and studies have cemented the role that society plays in shaping the behavior of a child. Scholars note that not only does an ethnic group’s culture affect the development of an individual or child, but it also determines the kind of treatment he or she receives (Crain, 2011). In cases where the ethnicity of an individual is the basis for his or her being shunned away or being discriminated, the individual would be resentful, as well as aggressive. In most cases, such people tend to congregate into protective groups (Caye et al, 1996). Evidently, the Aboriginal society has influenced Molly’s behavior in a tremendous way. It goes without saying that the aggressiveness even in the face of difficulties are the result of the betrayal that she has gotten from the society, which has failed to accept her as she is and instead forced her to change and become more white.

In addition, she must have learnt about the importance of family and community at large. She was brought up in an environment where everyone looked after the other people, as seen by her behavior of caring for Daisy and Gracie. In fact, she seems to have stepped in her caregivers’ shoes when they are captured and looks after Daisy and Gracie, not to mention the fact that she takes it as her responsibility to rescue them and deliver them home. This is a behavior that she learned from her community as imparted to her by her primary caregivers.

On the same note, Molly is unwilling to let go of her culture and beliefs as demanded by the assimilation programs. She strongly believes in acknowledging and accepting one’s culture, something that she has learnt from her community. Evidently, these aspects have been imparted in her through her attachment to her parents and caregivers. Attachment theory mainly concentrates on the bond that exists between parents and their kids. It could explain the devotion and determination that Molly has towards her people and in getting herself and the siblings back to the parents that she knew.

References

Caye, J., McMahon, J., Norris, T., & Rahija, L. (1996). Effects of separation and loss on attachment. Chapel Hill: School of Social Work, University of North Carolina at Chapel Hill.

Crain, W (2011). Theories of Development: Concepts and Applications (6th ed.). Upper Saddle River, NJ: Pearson Education