Write twords replies:

Response 1

Of the resources you are considering for your project plan, what is the biggest challenge you foresee? Why?

My biggest challenge is that the data and resources I have encountered, good and bad, some of the resources are more than 5 years old, and I have searched for new information giving a time frame of 2019-2023. The more I search the more it takes me in different directions and dive deeper into conflicting information by the researchers. Such as Chlorhexidine, is does it help in protecting patients against VAP in the Cardio-thoracic ICU on post-op patients? Yes, it is excellent for Cardio-thoracic patients although not that great for medical ICU patients. Cardio-thoracic patients are only in the ICU for 2- 3 days at best such as Pacemaker, CABG x1, Valve Replacement, and 3-4 days at most for complications such as Aortic Dissection, CABGx4. Medsurgical patients in the ICU may stay for months at a time. These patients are vulnerable to ventilator-acquired pneumonia. The longer in the ICU the higher the rate of other nosocomial infections.

Bardia, A., et al., (2019) “Preoperative chlorhexidine is associated with a significant reduction in postoperative pneumonia after cardiac surgery. This relatively simple intervention was not associated with any adverse events in the studies included in the meta-analysis. Preoperative chlorhexidine mouthwash should be considered in suitable patients undergoing cardiac surgeries” CHX has been widely used in clinical practice for preventing VAP, either as a gel or as an aqueous solution”.

Cruz, J., et al., (2023) “However, a recent systematic review by Klompas et al.11 revealed no significant difference in ventilator-associated pneumonia risk in double-blind studies of non-cardiac surgery patients. Rabello et al.12 also showed inconsistency in a recent overview evaluating 14 systematic reviews and meta-analyses with high-quality evidence. The authors showed that CHX effectively prevented nosocomial pneumonia among adults in Cardio-thoracic ICU but not in other clinical-surgical units”.

References:

Bardia, A., Blitz, D., Dai, F., Hershey, D., Jinadasa, S., , Tikoo, M., & Schonberger, R. B. (2019). Preoperative chlorhexidine mouthwash to reduce pneumonia after cardiac surgery: A systematic review and meta-analysis. The Journal of Thoracic and Cardiovascular Surgery, 158(4), 1094-1100. https://doiorg/101016/jjtcvs201901014

Cruz, J. C., Martins, C. K., Piassi , J. E., Garcia, I. R., Santiago, J. F., & Faverani, L. P. (2023). Does chlorhexidine reduce the incidence of ventilator-associated pneumonia in ICU patients? A systematic review and meta-analysis¿El cuidado bucal de rutina con clorhexidina reduce la incidencia de neumonía asociada al ventilador en pacientes de la UCI? Una revisión sistemática y metanálisis Medicina Intensiva (English Edition), 47(8), 437-444. https://doiorg/101016/jmedine202211002

Response 2

The readings for this week are focused on patient-centered care; what are your thoughts regarding these articles? Which assertions made in the articles do you feel would be most applicable to your area of practice?

This weeks readings were focused upon patient safety and implementing leadership opportunities amongst the staff. In my practice environment, these affect the success and health of our patients each day. Patient-centered care is vitally important for the standardised care we provide as health care professionals. Patient centered care can be defined as, “Care based on balanced relationships between individuals and their health care providers, with the provision of tailored care in consideration of the individual’s status and needs.” (Heo et al., 2023) Through personalised care, nurses can make a difference in the lives of their patients. In the ICU, we take patient-centered care very seriously. In addition, empathy is a great attribute when combined with patient-centered care. “Empathy refers to an understanding of others’ awareness regarding their own experiences.” (Heo et al., 2023) Being aware of how our patients feel during their hospital stay is important for the healing process. Through personalised care, we can modify our interventions and tailor them to our patient individually. In addition to empathy, active listening and self awareness have a known impact when used together. With the combination of these attributes with patient-centered care, we can make a positive change in the health and safety of our patients.

Heo, S. , Haley, B. , Wright, P. , Barone, C. , Anders, M. , Bertulfo, T. & Troyan, P. (2023). Factors Associated With Changes in Patient-Centered Care in Undergraduate Nursing Students. Nursing Education Perspectives, 44 (2), 82-86. doi: 10.1097/01.NEP.0000000000001054.