Download File - Kelly Pasch RN

Kelly Price
Nurs 324
1. Purpose: Are isolation precautions effective in preventing the spread of Methicillinresistant Staphylococcus aureus (MRSA)?
2. Information: According to Larson, Cohen, Ross, & Behta (2010), much progress has
been made in preventing infectious diseases, but infections remain a major cause for
mortality and morbidity. Many traditional treatments for common infections are no
longer effective due to the fast-growing problem of microbial resistance to antibiotics.
Larson, Cohen, Ross, & Behta (2010) state “since the 1990s, antibiotic resistance has
increased 1% to 47% in 7 of 9 of the most common microorganisms that cause infection
associated with healthcare” (p. 17).
Larson, Cohen, Ross, & Behta (2010) found that MRSA has been a primary cause of
health care-associated infections in Europe, Asia, Australia, and the United States.
According to the Centers for Disease Control and Prevention (CDC) (2010), the highest
rates of MRSA infections occur in intensive care units (ICUs) of all types. MRSA is a
type of staph bacteria that is resistant to certain antibiotics and is usually associated with
skin infections, but it can cause other infections such as pneumonia. Infection caused by
this bacterium can be fatal to a person. Staph infections, including MRSA can be spread
from skin-to-skin contact, sharing or touching of a personal item contaminated with
MRSA, or touching the surface of a MRSA contaminated item (CDC, 2010).
The current CDC infection control guidelines are developed by HICPAC, Division of
Healthcare Quality Promotion of the National Center for Infectious Diseases and the most
recent guidelines, Management of Multi-Resistant Organisms in Healthcare Settings
2006, provides specific practice recommendations (Larson, Cohen, Ross, & Behta, 2010).
Siegel, Rhinehart, Jackson, & Chiarello (2006) found that Standard Precautions play a
crucial role in preventing MRSA transmission even in facilities that use contact
precautions. The concept of Standard Precautions combines universal and body substance
isolation. Hand washing is an important component of Standard Precautions. Contact
precautions are intended to prevent the transmission of infectious agents such as MRSA.
These agents are transmitted by direct or indirect contact with the patient or the patient’s
environment. A single patient room is preferred for patients who are in contact isolation.
Healthcare personnel caring for patients in contact isolation, such as MRSA, in addition
to hand washing should don gloves and gowns upon entry into the room, and discard
these upon exiting (Siegel, Rhinehart, Jackson, & Chiarello, 2006).
3. Assumptions: It can be assumed that isolation precautions prevent the spread of MRSA
and other infectious diseases. The use of Standard and Contact Precautions can prevent
the transmission of infectious agents from patient to healthcare personnel and vise versa.
It can also be assumed nursing care can play a role in the effectiveness of isolation
precautions by donning the protective equipment and effective hand washing. It can be
assumed that non compliance with isolation precautions by nursing staff and other
healthcare personnel increases the spread of infectious diseases, such as MRSA, thus
increasing morbidity, mortality, and healthcare costs.
4. Data Interpretation: Studies have shown that using isolation precautions such as
Standard Precautions and Contact Precaution prevents the spread of MRSA and other
infectious diseases. In one study, according to Larson, Quiros, Giblin, & Lin (2007),
hospitals with higher implementation of isolation practices and hand hygiene had lower
rates of MRSA and system-wide infection control strategies may reduce antibiotic
resistance rates. Larson, Cohen, Ross, & Behta (2010) found that there is a strong
theoretical rational that indicates barrier precautions such as Contact precautions; the
donning of gloves and gown are likely to reduce the transmission of MRSA infection.
On the other hand, measuring compliance with healthcare personnel and nursing staff
results in a loss of accuracy, due to the fact that behavior changes when being monitored.
Larson, Cohen, Ross, & Behta (2010) state, “a major challenge in assessing the impact of
guidelines is measuring compliance accurately” (p. 20).
5. Concepts/Theories: In theory, the use of isolation precaution prevents the spread or
transmission of infectious disease such as MRSA. The use of Standard and Contact
Precautions prevents the spread of MRSA. If nursing staff correctly applies the
protective isolation equipment and complies with it, the spread of infectious diseases
throughout healthcare facilities will decrease and interrupt the cycle of infection. In
addition, the use of implementation practices such as restrictions on antibiotic use and
prescribing antibiotics reduces rates in antimicrobial resistance (Larson, Quiros, Giblin,
& Lin, 2007). In theory, isolation precautions and restrictions on overuse of antibiotics
can prevent the spread of MRSA and other antibiotic resistant infectious diseases, thus
decreasing length of stay in the ICU, and cost of care.
6. Points of View:
Isolation precautions are effective in preventing the spread of MRSA
and other infectious diseases (Larson, Cohen, Ross, & Behta, 2010). Several assessments
of the relationship between isolation precautions and rates of MRSA show a decrease in
the transmission of the infection. On the other hand, negative affects of isolation
precaution have been documented. Larson, Cohen, Ross, & Behta (2010), found the two
most significant effects are the care and well-being of patients and increased costs.
Larson, Cohen, Ross, & Behta (2010) state, “patients on isolation precautions may be
examined less often by their care providers, receive less care, be more likely to become
depressed or anxious, and, most importantly have more preventable adverse events than
do patients who are not isolated” (p. 20). The cost of isolation precautions and the
duration of time patients are kept in isolation are other concerns. In 2002 in the United
States, cost for equipment for MRSA contact precautions was $101.76 per patient, and
this excludes the cost of a private room and the changes in work processes that occur to
accommodate the patient (Larson, Cohen, Ross, & Behta, 2010). In addition, the
appropriate duration of time patients are kept in contact precautions remains an
unanswered question in the latest CDC/HICPAC guidelines (Larson, Cohen, Ross, &
Behta, 2010). More research and education on the effects of isolation precautions will
aid in achieving better patient outcomes.
7. Conclusion: The meticulous use of Standard and Contact Precautions decreases the
transmission of MRSA and other infectious diseases from patient to healthcare personnel
and vice versa. Unfortunately, according to Larson, Cohen, Ross, & Behta (2010), “little
information or guidance is available for monitoring adherence to or assessing the clinical
impact of guidelines” (p. 20). Nurses and other healthcare professionals must take the
patient’s best interest into their care and comply with the isolation precautions to reduce
nosocomial infections such as MRSA. Major strides have been taken to reduce the
transmission of MRSA in healthcare settings. With research and education on the effects
of adherence to isolation precautions, healthcare professionals can and interrupt the
infection cycle and provide patients with better care and better outcomes, reducing
morbidity, mortality, and healthcare costs
References
Centers for Disease Control and Prevention (CDC). (2010, March 3). Healthcareassociated- methicillin resistant Staphylococcus aureus (HA-MRSA). Retrieved
from http://www.cdc.gov/ncidod/dhqp/ar_mrsa.html.
Larson, E., Quiros D., Giblin T., & Lin, S. (2007). Relationship of antimicrobial control
policies and hospital and infection control characteristics to antimicrobial
resistance rates. American Journal of Critical Care, 16, 110-120.
Larson, E., Cohen, B., Ross, B., & Behta, M. (2010). Isolation precautions for
methicillin-resistant staphylococcus aureus: electronic surveillance to monitor
adherence. American Journal of Critical Care, 19, 16-26.
doi: 10.4037/ajcc2009467
Siegel, J. D., Rhinehart, E., Jackson, M., & Chiarello, L. (2006). Management of multiresistant organisms in healthcare settings. Retrieved from http://cdc.gov/ncidod/
dhqp/pdf/ar/mdroGuidelines.
Grading Rubric for Journals
“Elements of Reasoning”
Possible Points
Points
Earned
10
1. Purpose: Problem/Situation/Question
Clearly Stated
10
10
2. Information/Facts/Data: Collected & Stated
3. Assumptions: State what you presume to know without the
data?
10
10
10
4. Data Interpretation: Assimilates what you have found and
begins to formulate a decision.
10
10
5. Concepts/Theories: States those that are related to the
question and will help arrive at a decision.
10
10
6. Points of View: Considers others positions
10
10
7. Conclusion/Implications/Consequences: States what you
have learned through the elements of reasoning.
8. Used and followed the Rudd article
10
10
10
10
9. Evidence of academic writing: Clear, logical journal
Page limit: Maximum of 3 pages.
10. APA: Correct acknowledgement of sources using APA style
of referencing.
10
10
10
10
100
100
Total possible points
Wow! This was a fabulous journal.
Your research and presentation was excellent. Really outstanding.
Thank you, thank you!!
Self-Assessment of Reasoning
My self-assessment of reasoning skills, I believe have become better since starting the
Bachelors of Nursing Program (BSN) at Ferris State University (FSU). When asked to write
about my strengths and weaknesses of my own critical thinking skills, I look into by own
practice and reflect on certain experiences. Since starting this program, I feel that my writings
have become better, but there is always room for improvement.
There are many definitions of what critical thinking is. The definition of critical thinking
that I like, according to Dowden (2002), states,
To think critically is, among other things, to be fair and open-minded while
thinking carefully about what to do or what to believe. If you are a critical thinker,
you will assess the reasons for and against doing something and then make your
decision on the basis of a fair assessment, not on the basis of your emotions nor
on what your astrology column says nor on whether the person giving you the
reasons is looking you in the eye while sounding sincere (para 5).
From this definition, I can assess my strengths and weakness in my own critical thinking
skills. One area of weakness that I have in my critical thinking skills in my own nursing practice
is that I tend to become emotional when there is a stressful situation such as a code or if I am
taking care of patient who dying. I am working on my emotional impulses, and know I need to
improve on this. I need to put my emotions in check at times and focus on the situation at hand
and assess objectively what is really going on with the patient and not how it is affecting me. A
weakness that I acknowledge in my writing habits is that I struggle with the APA format. I have
to really work hard at citing my references and focusing on the paper and the rubric. I have to
really think about the subject I am writing about and incorporate it into a logical paper. As I
progress through this program, I feel my writing skills will improve. The American
Psychological Association book (2010) and the OWL program at Purdue University have been
quite helpful in the writing of my papers. I frequently have to look up information to help with
citations, and I know throughout this program, more practice with writing will help with these
skills. Another weakness that I have with critical thinking skills is that sometimes I think
superficially. I know this is a major weakness that I must work on. I need to gain better
perspective thinking skills, and put myself in the patient’s shoes and try to see the world and
their situation through their eyes (“Overview of Critical Thinking”, 2009). In these
circumstances, I find myself really trying to objectively look at the situation and imagine myself
in their situation. In addition, I feel that I struggle with the fear of not being good enough in my
practice. I must work on my confidence and believe in my skills, and not look for validation
from others but from what I know and believe in myself.
Aside from my weaknesses of critical thinking, I do believe I possess some strengths.
One strength that I possess is that I am always asking questions and appreciate all of my co
workers feedback and try to apply it to the situation at hand. In addition, I am also honest in all
aspects of my practice. If there is something I do not know, I will try to find the answer and do
understand that there will not always be a definitive answer. Working in critical care, I
frequently take care of many ill patients. I always communicate honestly with the patient and
family. Another strength that I feel I possess is that I try to be organized in my care. I value
organization and prioritize my nursing care in relation to the patient and their situation. In
addition, I am flexible and open to new ideas. I try to look for new learning opportunities in my
field of practice and I am open to all suggestions.
In context to my critical writing skills, I feel that I think critically in regards to the subject
I choose to write about. I pick topics that I frequently am exposed to in my own nursing
practice. I try to write objectively and see from other point of views. I feel that I write strongly
in regards to evidence based practice and use the information to assist in my own practice.
I believe my critical thinking skills will improve throughout the BSN program at Ferris
State University. These are skills are used in every aspect of nursing practice and can
continually be improved. In addition, I feel that one is never complete in improving and
developing their critical thinking skills. These skills not only assist in nursing, but in everyday
life.
Very honest self evaluation. You have so much to offer!
Stay the course…all good things will come to you. It has been a pleasure for me to have you as
student. I wish you well in all your future endeavors.
100%
References
Dowden, Prof. (January 20, 2002). The definition of “critical thinking”. Retrieved from
http:// www.csus.edu/indiv/d/dowdenb/4/ct-def/def-of-ct.htm.
“Overview of Critical Thinking” (November 18, 2009). Retrieved from http://www.
livestrong.com/article/14710-overview-of-critical-thinking.