Pressure Sore Prevention: Sexual Function in Women after Urinary Incontinence and/or Pelvic Organ Prolapse Surgery

Introduction

The research paper has an aim of determining the way through which the sexual function in women is affected when they undergo urinary incontinence surgery or/and the surgery of the pelvic organ prolapse. The PICO question for the research is, ‘what are the effects that women incur when they undergo urinary incontinence surgery or/and the surgery of the pelvic organ prolapse. Research shows that approximately 64% of women who are sexually active and applying to the departments of urogynaecology are incurring sexual dysfunction effects (Čadková, & Huvar, 2017). As a result, this research paper is important as it draws the attention about the continuation of the sexual function even if one undergoes urinary incontinence surgery or/and pop surgery. It also promotes the attention of improving the sexual function following incontinence or prolapse treatment. Furthermore, it is essential in providing counseling on the potential development pertaining the postoperative sexual function.

Summary of the Nursing Quantitative Research Article
From the quantitative research article, it is seen that pelvic organ prolapse surgery is accompanied by sexual function effects that vary from one another. The pelvic reconstructive type of surgery that is mainly done for the purpose of correcting the prolapse, it causes some effects to the sexual function as a result of the reasons like urinary incontinence fear, vaginal canal becoming narrow, physiological axle changes of the vagina, decrease in lubrication and also dyspareunia reasons (Dilek, et al. 2013). Another fact realized from the article is that pelvic organ prolapse problem and urinary incontinence problem are the kinds of problems that are hidden. It was also realized that every woman who undergoes urinary incontinence surgery records an improvement in the storage symptoms and in the incontinence symptoms and positive effects observed in their sexual life.

Reliability

This refers to the accuracy of the instruments that are used in the research (Cant, et al. 2013). Homogeneity reliability is observed on the distribution of the women who have undergone surgery in regards to their sexual intercourse frequency in the period of preoperative and the sixth month of postoperative. In this case, no statistical difference was observed. On the behavioral status of the women in the group of UI, we find that there was no any significant recorded in the preoperative period and in the sixth month of the postoperative period. This is an illustration of stability reliability. For the group of women in UI + POP level, also no significant difference was recorded which shows equivalence reliability.

Validity

This is the extent to which a given concept is accurately measured in the research (Cant, et al. 2013). The first case we look at this case is content validity. We find that the research has covered all the contents respect to the title of the research which proves that there is the continuation of sexual function following a UI surgery or a POP surgery. Also, the research shows that urinary incontinence problem and pelvic organ prolapse problem are hidden problems illustrating construct validity. When figuring out the conducted randomized trials and then comparing them with the SUI surgical techniques, the urination difficulties were less recorded in the TOT level. This is a good illustration of criterion validity.

Strength and Weakness of the Quantitative Research Article
The quantitative research article is relevant to the title as it draws an attention to it and provides an essential awareness to the health professionals. As per the research, the health professionals are supposed to assess the urinary incontinence effects and/or the pelvic organ effects, do an evaluation and a comparison of the results following a surgical treatment or before it. The major weakness is that the research only made a follow up of women up to 6 months following the surgical treatment. This can be considered to be such long enough in fully recovering and figuring out whether the sexual function has a possibility of changing.

Clinical Practice Guideline
One fact realized in the clinical practice guideline is that anatomic outcomes are not in a position of all the adequate information required pertaining the safety and the efficacy of pelvic reconstructive surgery. This is because its clinical significance is limited. Secondly, pelvic surgery is capable of affecting the sexual function as a result of pain, the introitus narrowing, clitoris denervation and body image change. Furthermore, there are other factors that are capable of affecting the sexual function quality like the age of the women, the availability of her partner, the health of the women, and her psychosocial factors (Mørkved, & Bø, 2013).

There is a record of sexual function improvement if there parallel improvement of incontinence. This is normally realized in women following an SUI surgical correction at the 6-month after a process of surgery. This is as a result of less loss of urine and less urine leakage during sexual intercourse. Moreover, research shows that the women who have passed urinary incontinence surgery or pelvic organ prolapse surgery have high chances of suffering the effects of recurrence. This condition is normally observed amongst the old women whereby the risk of experiencing pop surgery or the pelvic organ prolapse surgery is around 11% up to the age of 80 years. Furthermore, it is realized that a number of postoperative complications that are also common can be avoided by giving the preoperative management, postoperative management, and the intraoperative management the special attention (Jha, 2017).

Conclusion

The research paper has achieved its main of determining the way through which the sexual function in women is affected when they undergo urinary incontinence surgery or/and the surgery of the pelvic organ prolapse. From the quantitative research article, it is realized that the symptoms of the urinary tract affecting the women are improved and their associated sexual function changed in a positive way at the sixth month following the urinary incontinence surgery and/or the pelvic organ prolapse surgery. As per the results found, provision of counseling services concerning the potential growth of the postoperative sexual function including the associated possibility of sexual function impairment for the category of women who are undergoing pelvic organ surgery or/and urinary incontinence surgery.

Recommendations
A preoperative assessment for the women who are undergoing pelvic organ prolapse surgery or/and urinary incontinence surgery is required to come with a detailed history of the main and the minor symptoms that are likely to affect them. Also, it must entail the respective defecatory type of symptoms and the related sexual function. Furthermore, a counseling related to the functional outcomes that are detailed and preoperative is required to be offered to the patients who are about to undergo pelvic organ prolapse surgery and/or urinary incontinence surgery.

Delivery of Nursing Care

Introduction


Nursing care models can be defined as the conceptual outlines and methodologies that are used by nurses to carry outpatient care. Also, the models stipulate the theoretical frameworks about the people, their surroundings as well as the duties of nurses. The nursing care models vary from one health care institution to another depending on the patients as well as the settings of the facility. Furthermore, the model of care that is utilized in a particular facility represents the work environment as well as the clientele. Nurses often refer to the models to guide them on matters education as well as during the processes of healthcare delivery.


The nursing care model I observed


A couple of weeks ago, I went to a healthcare facility that is located a few kilometers from our church. According to my observation, I concluded that the nursing care model that was in use was the team nursing model of care. The reason for this is that while in the facility I observed that the health care professional worked in groups to deliver care to a group of patients who were admitted to the inpatient department. Each group of professionals was made up of a nurse in charge who was also the leader of the group nurse of and their assistants.


The role of the nurse in charge/group leader was to assign patients to the nurses in the group. Moreover, the group leader also sought to be informed about the patients in the department and even the plans of healthcare delivery to those patients. The responsibility of the nurses who were the members of the group was to work together with their assistants to deliver healthy care to the patients who were assigned to them. I noticed that the nurses delegated duties that fell within their qualifications and areas of expertise to their assistants.


When a patient is admitted to the facility, I observed that the team of healthcare professionals would gather and review information concerning the patient. The patient information is obtained from the nurse in charge of admissions and also by looking at the patient's file. It is also in this instance that the team leader/nurse in charge assigns roles to the nurses concerning the care of the patient. The nurses develop a plan of care and inform their leader/nurse in charge.


During my visit, I also noticed that the nurses communicated to their assistants all the details concerning the patients to enable them to care for the patients and prevent any errors from occurring. The same thing also happened during the change of shifts. The nurses could communicate to the ones who were taking over from them things like the medications given to the patients the vital signs that were being kept under observation as well as all the other necessary details about the nature of the patient as observed during the shift. Sometimes, a nurse could call to request to be allowed to take a day off due to sickness. At this instance, I discovered that the team leader assigned the duties that were supposed to be accomplished by the absent staff and for that reason, the process of patient care was not interrupted.


Review and summary of sources regarding team nursing


According to the Australian Journal of Advanced Nursing, The team nursing model was developed in 1950 as a result of the changes in the nursing skill mix (Australian Journal of Advanced Nursing). The article also highlights the requirements needed for a successful team nursing model of care. Among the conditions are an exceptional leadership and proficient communication skills that will make it possible to place the caregivers into groups that are led by the nurses in charge and to enable them to cooperate to ensure the delivery of quality care for the patients.


Furthermore, the article provides a lot of insight into the importance of teamwork in healthcare delivery. Some of the benefits include the fact that the healthcare professionals tend to be more productive while working in groups than when they are working alone.


Furthermore, errors are reduced, and there is an improvement in the quality of patient care. In this regard, the nurses are more satisfied with their work which enables the facilities to retain them. The nurses benefit from the improved relationships they build with their colleagues which allows them to share duties and also gives them the opportunity to work together. The patients are also satisfied because of the continuity of safe and quality care that they receive. Nevertheless, the journal also draws attention to some of the issues and challenges of team nursing model of care. The problem is the lack of enough preparation to work in teams, and also some nurses have cited the fact that they are overworked because of unfair allocation of duties by team leaders.


The team leaders also complain of increased responsibilities as well as confusion of roles among the group members. Indeed this is a challenge because while observing the facility I visited, I realized that some team members had more workloads than the others which could a times lead to protests and dissatisfaction among the members of staff. Despite the challenges, the journal indicates that there has been an improvement in both the patient and nurse satisfaction.


The international journal of Evidence-based healthcare states that since the implementation of the team nursing model was marked decrease in the number of medical errors recorded. The reason for this is that the patient is assigned to more than one health care professional each with unique skills. In addition the plan of care is reviewed by the nurse in charge and all the caregivers of a given patient are required to stick to it. Moreover, during a change in shifts the nurse who is handing over provides the details of the condition of the patient under his or her care to the nurse who is taking over. Besides, according to the journal the novice nurses have an increased chance to learn from the experienced members of the group which helps them improve their performance.


Review and summary of resources regarding primary nursing care model


The article by Jennifer Neisner and Brian Raymond : Nurse Staffing And Care Delivery Models, is very intuitive concerning the primary nursing model of care. According to the article the model was developed as an alternative to the team nursing model with the aim of improving the quality of care and nurse’s satisfaction 2017. Also, the article states that in this type of care one nurse (registered nurse) is responsible for caring for a patient from the time of admission to the time of being discharged. Also, with this model, if the registered nurse is absent, an associate nurse stands in for him or her until they return. In other words, the registered nurses do not work in shifts. Instead, they are required to care for the patient during the entire period that they are admitted to the hospital.


Another article about primary nursing care model is the journal of clinical nursing which indicates that the implementation is focused on providing the patient with individualized health care by the same nurse from the time the patient arrives at the inpatient department to the time they leave. In this model of care, there is continuity in the patient care because the same nurse is responsible for the patient throughout their stay in the hospital.


How the current nursing care model is being implemented


During my visit to the healthcare facility that uses the team nursing model of care, I was able to make observations about how it is being applied. The team leader/nurse in charge was always engaging the team members to ensure that the model of care was meeting the set objectives. Also, I realized that the composition of the team was designed in a way that could provide the inclusion of individuals who had expertise regarding patient care and those novice nurses who learned a lot from their senior colleagues.


Furthermore, the team members could develop the plan of care which could be thoroughly reviewed during group meetings which took place before the beginning of shifts. It was during these meetings that the team leader gave feedback regarding the plan of care. The feedback included the recommendations for change that could improve the quality of care. Communication between the team members and their patients was also paramount during the implementation. I would recommend the patient-centered nursing model of care which refers to providing care for a patient in a way which is helpful and meaningful to them. In this model, the caregiver explains to the patient everything they need to know about their condition as well as prognosis.


Additionally, they listen to the patient to find out their needs and preferences regarding the treatment plan. This is done in recognition of the fact that every individual's needs and values are unique and also concerning the preferences of the patient. Involving the patient in the treatment process enables them to receive quality care and also improves their safety because they understand the treatment plan and are updated on the prognosis of their condition.


The family members are also involved, and the patient receives both physical and emotional support from their caregivers. Staff satisfaction will be improved because of improved treatment outcomes and the development of positive relationships between the nurses and the patients.


Conclusion


The nursing care models are theoretical guidelines that are used as points of reference by the health care professionals while providing care for the patients. The models of care vary from one hospital to another depending on the types of patients they receive, the staffing as well as the capacity of the facilities. The different nursing models of care that are mostly used include team nursing, primary care, functional care as well as the patient-centered model of care.

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Four Reasons Why students study Nursing.

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• It exciting career, fast paced profession

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• It's a n opportunity to positively give to the community and patient

If you ask your nurse buddy's why did you choose the shitty career of taking care the most vulnerable people in the world"sick"?" They will mostly respond by telling you' I really wanted to help people, become their friends, confidence and a trusted adviser when all their hope is crumbling down. "
Most nurses are empathetic, kind and they are special kind of people you don't come across anywhere.

• It is a flexible kind of a job

Nursing is flexible, sustainable profession. There is more than one hundred different specialties in the world of nursing. It is a career that will last a lifetime!! As a nurse, you can relocate to any part of the globe and be as much as comfortable as you have been in your native neighborhood.
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Feasibility of Reducing Hospital Readmissions Proposal and Importance of Communication

Introduction

Intensification of strategies to reduce hospital readmissions characterise most of clinical practices. Discharge of patients in the cardiac unit can help to cut the increased hospital readmissions. Delayed discharge of patients in the cardiac department leads to increased readmissions. Currently, discharge of patients is done through verbal or written methods. The method is ineffective since some patients face challenges in reading and understanding the instructions. However, giving comprehensive instructions via video will help to enhance discharge of patients. The video instructions must enforce follow up, the significance of medication compliance, establishing outpatient schedules, medication reconciliation and assessment of patient’s needs. However, video discharge instructions require resources and proper communication to determine its feasibility and acceptability.

Discussion

Skilled and qualified human resource is one of the tangible resources needed to reduce hospital readmissions through video discharge instructions. The human resource helps to offer education and training to patients and carries out follow up .Additionally, the program would require financial resources to purchase the video gadgets, pay the actors implementing the program. Moreover, intangible resources would include goodwill from the hospital management which would ensure complete and continuity of the program.

Investing in video discharge programs to reduce hospital readmissions will result in high return on investments of the above resources. Several improvements are anticipated from the program. There will be increased efficiency in the provision of care services to patients particularly discharge services. Further, better teamwork among health workers and patients a well as increased patients satisfaction also increases.

Communication is critical for convincing the management to allocate the necessary resources. Communicating the impact of the program such as reduced rehospitalization and efficient healthcare delivery will help the decision makers consider investing their funds and time in the project . The presenter has to show qualitative and quantitative evidence to make the corporate consider the project. Further, communication through discussions and brainstorming sessions will help the decision makers understand the problem of hospital readmissions. The presenter should help the management understand how the program will help them avoid penalties associated with increased hospital readmissions.


Conclusion

Several interventions exist to reduce hospital readmissions. Video discharge instructions become more efficient than verbal or written instructions in reducing hospital readmissions among cardiac patients. The reductions in hospital readmissions attribute to enhanced communication, improved care and medication safety.


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