Infection Control

At the hospitals that I have worked their policies for infection control is that we are to prevent the spread/transmission of infections to other patients, staff, and the hospital environment. To accomplish this it is sometimes necessary to place patients in isolation precautions. Isolation precautions could indicate that we have to isolate the patient and move them to a private room this is normally always done. There are occasions where the infected patient is in with another patient, and to make sure that there is no further spread of contamination we isolate the patients together. When a patient is isolated we use signs at there door entrance indication what type of precaution is needed and what equipment is to be used. Before and after entering and exiting a room you need to wash your hands. Washing your hands is the best practice to help prevent the transmission of infectious disease.

There are 3 different types of Isolation Precautions:

1. Contact Isolation- gloves, gown- transmitted by touch
2. Airborne Isolation- gloves, gown, goggles, mask - transmitted in the air
3. Droplet Isolation- gloves, gown, goggles, mask - transmitted in the air if within 3 feet of patient and contact

The more common bugs that we isolate patients for in the hospitals are Methicillin Resistant Staphylococcus Aureus (MRSA), Vancomycin Resistant Enterococcus (VRE), clostridium difficile (C-DIFF). We screen every patient that walks in the door for MRSA and VRE by doing swabs to all open areas on the skin, their nairs, and their rectum. C-Diff is screened by sending a sample of the patients stool to the lab, you would only test a patient if they were having loose watery stools. Infection control has stepped up their qualifications for isolation because of the SARS outbreak, it is always better to be safe then sorry!

For more information please visit:

Ross Memorial Hospital http://www.rmh.org/content/view/393/280/
Peterborough Hospital http://www.prhc.on.ca/Site%20Map/Patient%20and%20Visitor%20Info.aspx

Empowering the Chronically Ill

As Laffrey (1995) noted, health care professionals cannot empower clients; empowering must come from clients themselves. What professionals can do is remove obstacles and facilitate opportunities for clients to empower themselves. Eighty percent of people in Ontario over the age of forty five suffer with some type of chronic condition; of those seventy percent suffer from two or more chronic conditions. Chronic diseases are accountable for an estimated thirty three percent of our health care costs (Ontario Telehomecare Network). Because of the rapid aging of the population and the greater longevity of persons with many chronic conditions the number of persons with chronic illness is at a astonishing high (Wagner).The government has initiated several different projects to help the chronically ill manage at home. These projects enable people with chronic illness to live independently, but is also cuts down on the cost of health care. There are five particular programs that I believe have decreased the amount of hospital admissions, and emergency room visits and they are: Telehealth, Telehomecare, Telemedicine, e-Health, and Electronic Health records.

• Telemedicine allows patients with chronic illnesses to receive care in a home or community setting by being able to communicate with their health care professionals via teleconferencing, and provides support for the patient (What We Do, 2008).


• E-health gives patient and health care provider the technology to educate, support, and detect any health changes. E-health has many great programs it helps prevent duplication of services and allows patient and the provider access to health information (E-Health Technologies and Canada).


• Electronic Health Records are records that are electronically stored by health care professionals; they can be accessed by the patient or anyone who has permission to do so (Government of Canada).


• Telehealth is a number that anyone can call twenty four hours a day, seven days a week for advice from a registered nurse (Public Information-Telehealth Ontario, 2006).


• Telehomecare gives the patient the support and information needed to be able to manage their activities of daily living (Ontario Telehomecare Network).

Not only has technology increased delivery of services but it has substantially increased the quality of life in clients who use the services all around the world enabling them to live at home independently.

Communication Barriers Perceived by Older Patients and Nurses

In Korea a communication-barrier questionnaire was developed to examine patient, nurse, and the environmental factors that can affect the communication between nurses and the elderly. They chose 100 elderly patients that had to be within the following criteria:

• >60 years of age
• Hospitalized for greater then 2 days
• Alert and orientated
• Able to communicate verbally
• No medical history of dementia (Park, E., Song, M., 2005).
  

They had also chosen 136 nurses to complete the questionairre. The nurses and the patients were recruited from the same hospital units. After completing this 50-item communication barrier questionnaire, they determined that the nurses had scored higher on patient-related communication barriers. The patients believed, that the communication barrier should be more focused on nurse-related rather then patient related. In order for nurses to achieve a more efficient communication barrier they need to be educated. Understanding the patients perception of communication barriers should be included in both basic and in-service nursing education. Patient-related communication barriers do not normally change, because it is the result of illness or aging. Effective nursing approaches such as: making sure the patient has the appropriate prostesis, should be adopted to compensate for patient-related barriers (Park, E., Song, M., 2005).

Elderly Abuse

I have witnessed several different types of abuse while working in nursing homes. When you here about elderly abuse the first thing that comes to your mind is physical abuse. Unfortunately abuse can take many forms. College of Nurses of Ontario (2005) ackowleges six types of abuse and they include:

• Physical abuse - is when someone strikes a client or causes discomfort
• Oral abuse - is when the care giver is shouting at, or insulting a client
• Emotional abuse- could be as simple as mistreating a family member
• Sexual abuse - can be inappropriate touching
• Financial abuse - is to accept money from a client
• Neglect

In all that I have witnessed neglect is one of the most common types of abuse. I believe this is related to the nursing shortages in our Provence, and the management of some of the nursing homes. I have been put in situations where I have witnessed abuse and had to intervene. There are many steps to the reporting of a staff member when it involves the abuse of a client, you need to follow the protocol of your employer and use the guidance of the College of Nurses of Ontario (CNO). The CNO (2002) states that:

• As Nurses we are accountable for reporting to the appropriate authority any
  health team member or colleague whose actions or behaviors toward clients are unsafe or unprofessional, including physical, verbal, emotional, and/or financial abuse; and reporting sexual abuse of a client by a regulated health professional to the appropriate regulatory college as legislated by the Regulated Health Professions Act.

You can find more information of the Regulated Health Professions Act at http://www.cno.org/docs/ih/42007_misconduct.pdf

Virtual Communication in Nursing

Email has become a asset tool for communication in several hospitals. The use of email has enabled us to receive education information, and keep us in touch with all the programs available to us in the hospital. As employees we are able to log on to our network and communicate with anyone who has access. Being able to email our managers about specific problems not only saves us time, but saves them time to. To be able to have that open communication with our colleagues creates a safer and more respectful environment. Hospitals networks include information on our policies and procedures, educational information sessions with dates available for in class discussion, and even what is for lunch down in the cafeteria. If any policies of the hospital have changed they are able to email the changes to us, and then we can use safer practices. Nursing knowledge and skills change every day. I have found that email has increased my awareness and kept me informed with many of these changes which has made me a better nurse.

One Step At A Time

As time goes on I look in the mirror and I ask myself, have I accomplished all that I want in life? I look deep within and find that I want more from myself and I know I will be able to do this one step at a time. My name is Lisa and I am a nurse, I have decided to increase my knowledge and skills by going back to school to achieve my BSCN. Am I crazy at this age or this stage in my life? Most would say yes, but I believe that you can achieve anything that you put your mind to.