Improving Nursing Care For The Elderly With Delirium Nursing Essay

Improving Nursing Care For The Elderly With Delirium Nursing Essay Delirium, characterized by a change in cognition and a disturbance in consciousness, is a common problem that nurses encounter when caring for the elderly. Approximately half of hospitalized patients are older than the age of 65, and 56% of these patients will either have delirium on admission, or will acquire delirium during their hospital stay (Dahlke and Phinney, 2008). If left untreated, delirium can lead to harmful outcomes, changing the lives once had by elderly individuals. The following represents an example of an older adult acquiring delirium during her hospitalization: Ms. Cotes, age 77, is in hospital after a knee replacement surgery due to osteoarthritis. She developed a UTI in hospital and required opioid pain medication for back neck pain. Her discharge to a rehabilitation facility is on hold because of new issues. She has tried to leave her room on her own and seems to forget about her operation. She says that the staff is stealing her clothes and the food is poisoned ; she refuses to eat or drink. Prior to hospitalization, Ms. Cotes lived at home, worked as a volunteer, was a keen gardener, and played cards often at the seniors center. Her home was immaculate. Studies show that one of the major reasons why delirium is still a common issue in the older adult population is the lack of efficient care given by the nurses (Dahlke and Phinney, 2008). According to nursing theorist, Jean Watson, the artistic domain of nursing emerges as transpersonal caring-healing modalities which correspond to providing comfort measures, helping the cared-for to alleviate pain, stress, and suffering, as well as to promote well-being and healing. (Cara, 2003). By focusing on the case study of Ms. Cotes, the application of Watsons caring theory will allow nurses to give efficient care to patients with delirium by promoting effective healing, and to help decrease the risks of acquiring delirium in the future. First, one of Watsons assumptions states that caring promotes self-knowledge, and self-healing processes and possibilities (Cara, 2003). It is important to care for Ms. Cotes through engaging in health promotion and teaching her about her health in order to achieve wellness and healing. Also, according to Watson, the nurses creativity contributes to making nursing an art (Cara, 2003). Nurses can come up with a variety of nursing interventions t o help Ms. Cotes with her difficulties of delirium and help her heal. Last, it is important for nurses to acknowledge the elderly population and avoid negative attitudes towards them; instead, nurses should apply Watsons theory by being authentically present, and enabling and sustaining the deep belief system and subjective life world of self and the one-being-cared-for. (Cara, 2003). As a result of applying Watsons caring theory into a practice, nurses can provide efficient care to clients like Ms. Cotes who are suffering from the negative outcomes of delirium. One of Watsons assumptions states that caring promotes self-knowledge and self-healing processes and possibilities (Cara, 2003). To apply this assumption, nurses can give care to clients like Ms. Cotes through engaging in health promotion and teaching them about their health in order to achieve wellness and healing. An important step in order for a nurse to give care is to know about the clients conditions and how to prevent it from becoming worse. Dahlke and Phinneys (2008) study shows that nurses lacked the knowledge to efficiently care for older adults with delirium; as a result, nurses often found themselves intervening in ways that contradicted the best interests of the older adults in their care. To prevent the development of delirium in elderly patients, nurses must be equipped with the skills and knowledge to identify and assess for delirium. The reduction on the incidence of delirium can be obtained through meticulous assessment and early recognition of symptoms. (Feazah, 20 08). The first step to prevent delirium is to identify the risk factors that lead to it. In the case of Ms. Cotes, several factors were presented which may have caused her to develop the disorder. For instance, her knee replacement surgery played a major role in the acquisition of delirium because it led to her attaining a UTI, an infection known to induce delirium (Feazah, 2008). A knee replacement surgery would have kept Ms. Cotes immobile for a long period of time, resulting in urine incontinence and the use of urinary catheterizations, both a leading cause of UTI. To prevent the risk of attaining the infection, it is highly important for nurses to assess after a set period of time, whether an indwelling urinary catheter is still indicated for the patient (Bernard, 2012), to decrease the risk of attaining a bladder infection. Moreover, care can be given by promoting health by informing Ms. Cotes about the risks of urinary catheters and the importance of urinary continence, so tha t she will have self-knowledge and will be self-informed of the possibilities of wellness and healing. Another risk factor of delirium in the case of Ms. Cotes is the use of opioid medication for her back neck pain. Nurses should minimize the dosage of pain medication to help reduce the symptoms of delirium: Opioid use has been associated with delirium in several large prospective studies in hospitalized patients. Some data suggest that the risk of opioid-induced delirium is dose relatedà ¢Ã¢â€š ¬Ã‚ ¦ (Alexander, 2009). By attaining knowledge of associated risk factors, and applying Watsons theory of caring by sharing data with the client in order for them to be self-knowledgeable and self-informed on healing possibilities, nurses will be able to provide effective care to patients with delirium. Also, according to Watson, the nurses creativity contributes to making nursing an art (Cara, 2003). Nurses can come up with a variety of nursing interventions to help Ms. Cotes with her difficulties with delirium and help overcome the disorder to decrease her hospital stay. For example, nurses can be creative by applying Watsons 6th carative factor in practise: a caring environment preserves human dignity, wholeness, and integrity; they offer an authentic presencing and choice. (Cara, 2003). A nurse can apply this carative factor by altering the environment to suit the needs of Ms. Cotes, aiding in the healing process. There are a number of creative ways in which a nurse can perform therapeutic environmental modification to help reduce the risk of delirium episodes. A nurse can: Modify Ms. Cotes environment by keeping the physical environment consistent and by maintaining routines; provide continuity of staffing for accurate assessment of her health status and consistent care; involv e family in care and providing frequent orientation to promote a sense of well-being; using a no-restraint or least-restraint policy to reduce worsening of delirum; promote familiarity such as the encouragement of using personal items; create well-lit surroundings; maintain appropriate room temperature; and reduce noise levels on the unit (Gillis Macdonald, 2006). According to Gillis and Macdonald (2006), nursing environmental interventions focuses on balance between sensory deprivation and sensory overload, and between patient independence and supportive care. The balance of rest, exercise, and consistent nursing designates nursing as a science and an art. By maintaining balance in the environment of Ms. Cotes, the application of Watsons caring theory of a healing-environment is achieved. Watson discusses how the healing space or environment can expand the persons awareness and consciousness and promote mindbodyspirit wholeness and healing. (Cara, 2003). Therefore, by applying Wa tsons theories, nurses should be creative by modifying the environment of the delirius elderly, and to provide routine care to promote wellness and healing success. Lastly, it is important for nurses to acknowledge the elderly population and avoid the negative attitudes towards them. Instead, nurses should apply Watsons theory of being authentically present, and enabling and sustaining the deep belief system and subjective life world of self and the one-being-cared-for. (Cara, 2003). In order to give efficient care to patients like Ms. Cotes, nurses must understand that delirium is an acute illness, not the elderlys personality. It is noted that nurses who believed confusion was normal in older adults would be less likely to recognize symptoms of delirium as a medical emergency requiring their attention and intervention. (Dahlke and Phinney, 2008). Dahlke and Phinneys (2008) study also showed that nurses perceive delirious elderly as children who require babysitting, and consequently a burden in their work. Furthermore, nurses fail to provide efficient care when they focus on collecting physical data while ignoring the subjective experiences of the client. Watson suggests that when collecting physical data about the patient, nurses should inquire about his mind and spirit as well (Cara, 2003). She strongly believes that spirituality upholds a foremost importance in our profession. In fact, she ascertains that the care of the soul remains the most powerful aspect of the art of caring in nursing. (Cara, 2003). In the case of Ms. Cotes, a nurse can enter her phenomenal field by asking her a number of questions about herself such as life experiences, bodily sensations, spiritual and cultural beliefs, and goals and expectations (Cara, 2003). This method of transpersonal caring may encourage Ms. Cotes to share her life story, and help her to find harmony and meaning to her life crisis. Therefore, it is important for nurses to disregard the negative attitudes towards clients with delirium and provide care by being authentically present. In conclusion, nurses can provide delirious clients with efficient care utilizing Watsons theories: promoting care by engaging in health teaching to allow clients to be become self-informed and self-knowledgeable of healing possibilities; providing nursing care artistically through creative interventions like therapeutic environmental modification; and by disregarding negative attitudes towards the elderly and providing transpersonal caring by being authentically present. Certainly, by using Watsons caring theories, nurses can provide efficient and effective care to the elderly with delirium, and allow them to reach harmony, wellness and healing.

Childcare Unit 7 Play

Te Whariki Te Whariki is the Ministry of Education's early childhood curriculum policy statement. Te Whariki is a framework for providing children's early learning and development within a social cultural context. It emphasises the learning partnership between teachers, parents, and families. Teachers weave a holistic curriculum in response to children's learning and development in the early childhood setting and the wider context of the child's world. This curriculum defines how to achieve progress towards this idea for learners in early childhood learning environments.It is about the individual child. Its starting point is the learner and the knowledge, skills, and attitudes that the child brings to their experiences. The curriculum is also about early childhood settings. Learning begins at home, and early childhood programmes outside the child’s own home play a significant role in extending early learning and in laying the foundations for successful future learning. There a re four broad principles at the centre of the early childhood curriculum. Empowerment – The early childhood curriculum empowers the child to learn and grow.Holistic Development – The early childhood curriculum reflects the holistic way children learn and grow. Family and Community – The wider world of family and community is an integral part of the early childhood curriculum. Relationships – Children learn through responsive and reciprocal relationships with people, places, and things. The strands and goals arise from the four principles. The whariki is woven from these four principles and from the following five strands, or essential areas of learning and development.The principles and strands together form the framework for the curriculum. Each strand has several goals. Learning outcomes have been developed for each goal in each of the strands, so that the whariki becomes an included foundation for every child’s development. Strand 1: Well-being The health and well-being of the child are protected and nurtured. Goals Children experience an environment where: †¢ their health is promoted; †¢ their emotional well-being is nurtured; †¢ they are kept safe from harm. Strand 2: Belonging Children and their families feel a sense of belonging. GoalsChildren and their families experience an environment where: †¢ connecting links with the family and the wider world are affirmed and extended; †¢ they know that they have a place; †¢ they feel comfortable with the routines, customs, and regular events; †¢ they know the limits and boundaries of acceptable behaviour. Strand 3: Contribution Opportunities for learning are equitable, and each child’s contribution is valued. Goals Children experience an environment where: †¢ there are equitable opportunities for learning, irrespective of gender, ability, age, ethnicity, or background; †¢ they are affirmed as individuals; they are encouraged t o learn with and alongside others. Strand 4: Communication The languages and symbols of their own and other cultures are promoted and protected. Goals Children experience an environment where: †¢ they develop non-verbal communication skills for a range of purposes; †¢ they develop verbal communication skills for a range of purposes; †¢ they experience the stories and symbols of their own and other cultures; †¢ they discover and develop different ways to be creative and expressive.Strand 5: Exploration The child learns through active exploration of the environment. Goals Children experience an environment where: †¢ their play is valued as meaningful learning and the importance of spontaneous play is recognised; †¢ they gain confidence in and control of their bodies; †¢ they learn strategies for active exploration, thinking, and reasoning; †¢ they develop working theories for making sense of the natural, social, physical, and material worlds.

Mathematics, Education, and Computer Innovation

The introduction of the graphing calculator has changed the structure of teaching and learning mathematics. This made it possible for everybody to receive the benefits of a computer-generated visualization without the high cost of a computer. These graphing calculators over the years have lowered in cost, became easier to use, and are more portable. The next generation of graphing computers has arrived with the recent introduction of the Texas Instrument TI-92. This relative inexpensive calculator will allow more high school teachers to teach an area mostly untouched, computer symbolic algebra and computer interactive geometry, because it has not been practical or possible. The TI-92 is merely the beginning of the new revolution of hand-held computing tools. The next challenge mathematics teachers are facing is the teaching of traditional paper-and-pencil symbolic algebra skills. This task has been made obsolete by the more accurate and faster computer symbolic algebra algorithms. Students can get a far better illustration of important concepts and applications of mathematics with these new hand-held tools than with the traditional paper-and-pencil task. The paper-and-pencil task and other traditional skills must still be acquired, but students should spend less time acquiring it. More emphasize must be put on computing tools. Students should take advantage of the computer technology to become powerful and thoughtful â€Å"problem solvers.† The process of changing from traditional methods to a more computer-oriented environment has to be met by the education and mathematics community. Educators should have textbooks that better represents the new technology. Teachers need to be more technology literate. The mathematics community must dispel the image of â€Å"doing mathematics† with the traditional paper-and-pencil method. These reforms can better teach students important skills needed for the future. The use of technology in mathematics will give students an advantage mathematics and related technology. Students will need that advantage if they wish to compete in the twenty-first century. This article stressed very important issues educators, teachers, and the mathematics community must face. The reform will change the course of mathematics in school and elsewhere. As a student, I am very concern about the future of mathematics. My future plans will revolve around mathematics and technology. I understand the need to continue using the paper-and-pencil methods, but computing tools should be added to the current criteria. The future will be technologically intense and very competitive. Graphing calculators have enhanced mathematics and I think the new powerful computing tools will do the same for the next generation. These hand-held computers are inexpensive and contain very powerful and versatile computer software. This could be the computer for all mathematics students.

Buddhist Meditation Practice And Buddhism - 1072 Words

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