Tuesday, March 11, 2008

Nursing Revolution

The end of the 19th Century closed with infectious diseases unchecked by modern antibiotics. Fighting the scourge of diseases emerged the nurse, whose primary weapons were hygiene and sanitation. The new century has dawned with a new scourge of "superbugs" mutated and resistant to our modern arsenal of antibiotics.

Because of the enormous risk to patients and health care workers, as well as the cost of nosocomial infection, nurses must learn from the past to develop improved isolation, hygiene and education strategies to address the growing spread of MSRA and other anti-infective resistant organisms. The nurse's role as a frontline healthcare provider allows the nurse a number of opportunities and strategies to address the issue. Three low cost nurse strategies to address the issue include 1.the use of single use plates, trays, spoons, serving ware for MSRA/isolation patients. 2. The improved sanitation and documentation of MSRA room cleaning including charts, accucheck machines, and reusable equipment anywhere MSRA patients are located. 3. the creation of a hospital wide educational campaign, focusing on consistent isolation procedures from patient contact to discharge.
Staphylococcus aureus is a common bacteria, Methicillin-resistant Staphylococcus aureus (MSRA) is a strain that has acquired immunity to anti-infective agents. Although MRSA has been around for years, only recently have these infectious “superbugs” come to public attention. The healthcare community reaction to this growing health crisis has largely been one of disinterest (Weigelt , 2004). The motivation to adjust the current nursing and healthcare disinterest are both financial and patient focused. In 2005, the average total patient cost of treatment for one MSRA infected patient was over $9,000 (Weigelt , 2004). Combined with recent federal regulations limiting reimbursement for noscocomal infections, the financial burden for treating MRSA infected patients will shift to the health care facility. The World Health Organization (WHO) has estimated that as many as 60% of hospital acquired infections around the world are caused by drug-resistant microbes (Dragon, 2006). Infections from central venous lines account for up to 40% of hospital-acquired bloodstream infections (Dragon, 2006). The Centers for Disease Control and Prevention monitored more than 1,200 ICUs from 1992 and 2003, while 36% of Staphyloccus aureus isolates found were multi-resistant in 1992, the figure had risen to 64% by 2003 (CDC, 2006).
The first nursing strategy to combat MRSA is to close the loophole in the hospital isolation room in regards to the food tray, dishware and utensils patients eat from. In many hospitals the same food service items are used and reused for isolation patients and the general hospital population. In theory these trays and dinning ware are sanitized between use, however this system relies on minimally trained minimum wage food service staff to insure proper sanitation is achieved and enforced at all times. Although cost and resource intensive, the safest way to ensure the isolation of patients and prevent the spread of MRSA and other super bugs is to limit or eliminate the use of reusable trays and serving ware in isolation rooms.
Improved sanitation and hygiene is the next strategy in eliminating the spread of nosocomial infections within the health care facility. By documenting and verifying the sanitation of susceptible items on hospital floors with isolation patients, the chain of infection can be disrupted. Charts, Accucheck machines, hand washing stations, and anything that could touch those items are possible vectors of transmission. Routine and documented sanitation of these items and any surface they could come in contact with should be cleaned and recorded (CDC, 2007). Increased sanitation training with an emphasis on "superbugs" should be initiated hospital wide. With the profusion of electronic gear at the bedside, all offering hand-touch sites from which MRSA can spread, basic hospital cleaning should take a higher priority for infections like methicillin-resistant Staphylococcus aureus (Dancer, 2007). From nurses and doctors to food service staff and janitors the entire staff needs to be focused on eliminating the threat of nosocomial infection. As managers of patient care and the Health Care providers with the most patient contact, nurses can play a vital role in overseeing the cleaning and sanitation of the healthcare facility.
Lastly, a nurse led educational program needs to be developed to coordinate and ensure that isolation patients are handled properly from first contact to discharge. To often a laise faire attitude develops in regards to isolation procedures and MRSA. Transport personal such as EMT and other first responders need to be notified prior to transport of isolation patients so that proper isolation procedures can be taken while transporting MRSA infected patients. A recent study of a large urban ambulance fleet found 48% of ambulances were positive for MRSA (Roline, 2007). To limit financial liability and improve communication with these pre/post care providers, routine admin and discharge testing should be performed to verify that the receiving and discharged patient did not acquire MRSA while at the hospital. This can also be used as a tool to monitor and aide first responders by alerting them to the need to sanitize their vehicles/gear before and after a particular patient. Furthermore, admin/discharge testing can be used to monitor trends in MRSA infected patients.
The founders of nursing faced unsanitary hospitals without the aide of antibiotics. Today we face a similar scourge of bacterial infections with dwindling options to fight off these infectious agents. The answer to our dilemma lies in the history of nursing. By improving our isolation, sanitation and hygiene procedures, the spread of MRSA and similar “superbugs” can be slowed and even stopped. Let us look to history as we face the modern challenge of antibiotic resistant bacteria. It cannot be necessary to tell a nurse that she should be clean, or that she should keep her patient clean,–seeing that the greater part of nursing consists in preserving cleanliness (Nightengale, 1859). Thru improved hygiene, sanitation, and nursing education, the threat of MRSA and the other "superbugs" can be overcome.

Isolating MRSA infected patients is an effective intervention to prevent the spread of nosocomial MRSA infections within a hospital; however a complete isolation is an expensive proposition.

The first disadvantage is the cost/inadequate insurance coverage of the patient population. Single use disposable plates, trays and serving ware is expensive in relation to the standard reusable hospital trays, plates and serving ware. The added cost of these isolation protocols may not be covered by many current insurers. (Elixhauser, 2007). Ultimately the financial burden is passed on to the health care consumer in the form or higher hospital bills for the uninsured and higher medical insurance rates for the insured.

The second disadvantage is the enormous environmental impact using so many more disposable items will create. Although patient safety is a priority, a hospital does not exist in a vacuum, and faces the same environmental issues as the real world. Disposable plates, trays, and serving ware will need to be disposed of as hazards waste and likely incinerated like most bio-waste. The incineration of this additional waste created will negatively impact the hospitals pollution production. The current political environment of state and federal governments limiting industrial CO2 and other pollutants will impact the hospital of the future and may interfere with the drive to isolate patients from MRSA.

Admissions into US hospitals are generally via 3 routes: transported to the ED via EMS, self transported to the ED (walk ins), and scheduled admissions (non-ED). Patients admitted to the ED via EMS transport face the greatest risk of acquiring a nosocomial MRSA infection. A recent study of a large urban ambulance fleet found 48% of ambulances were positive for MRSA (Roline, 2007). Walk-ins to the ED are the next greatest at risk, as a large number of potentially infected patient mingle in the waiting room and in the ED. This melting pot of patients makes the ED the gateway for MRSA to enter the hospital, and the primary vector of hospital borne MRSA infections. The second intervention to minimize the spread of hospital acquired MRSA is to transform the ED into an isolation unit and assume all patients are carriers of MRSA. By applying MRSA isolation protocols in the ED the spread of MRSA within the ED and throughout the hospital can be reduced.

The primary disadvantage of admission/discharge testing is inadequate insurance coverage / cost. The cost of turning an MRSA testing for every patent that enters and leaves the hospital is significant. (Elixhauser, 2007). ().Who will pay for the additional testing? A large portion of urban hospital patients have little or no insurance and routine MRSA testing may not be covered for insured patients. Further complicating the issue is the cost of success. As more patients are identified as MRSA carriers, more patients will be treated for MRSA increasing costs further. More patients in the general hospital population would be treated with expensive isolation protocols, and expensive anti-infective treatments.

The second disadvantage of admission/discharge testing for all patients is the socioeconiomic impact. Hospitals in high density low socioeconiomic areas will be disproportionally affected by the increase cost of admission / discharge testing. Depressed socioeconomic communities have increased risk factors the spread of MRSA including IV drug use, homeless populations, and a larger percentage population without medical insurance. These large urban hospitals face increased cost with less income to offset those costs. The financial reality is that the hospitals most needing MRSA testing is least able to afford it.

A third disadvantage is shifting the “MRSA blame” to pre/post hospital care providers such as EMS and nursing homes (Roline, 2007). While admission/discharge test may protect the hospital from nosocomial infection related cost increases, pushing the blame on to pre/post hospital care providers such as EMS and nursing homes only shifts the cost to vital partners that can ill afford the additional costs as well. Recent Medicare rule changes that eliminate payments for nosocomial infection place the financial burden of MRSA onto the entire system. It would be a bleak future indeed to have a pristine MRSA free hospital but have no EMS to bring the patients to us and no nursing homes to discharge our patients to. Clearly shifting the financial burden around will only reduce our ability to address the MRSA conundrum.

Centers for Disease Control and Prevention (2007). Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. Retrieved November 4, 2007 from http://www.cdc.gov/ncidod/dhqp/ar_mrsa.html

Centers for Disease Control and Prevention (2006). Management of Multidrug-Resistant Organisms In Healthcare Settings. Retrieved November 4, 2007 from http://www.cdc.gov/ncidod/dhqp/ar_mrsa.html

Dragon, N (2006). Fighting today's superbugs: infection control at the forefront. Australian Nursing Journal, 14(2), 16-9. Retrieved October 29, 2007, from Proquest

Forsha B. (2007). Best-practice protocols: Reducing harm from MRSA. Nursing Management, 38(8), 22-27. Retrieved October 29, 2007, from Proquest

Hall, S (2007, February). Infection control: implementing principles in primary care. Practice Nurse, 33(3), 47-51. Retrieved October 29, 2007, from Proquest.

Nightingale, F (1860). Notes on nursing: What it is, and what it is not. New York, NY: D. Appleton and Company.

Roline, C (2007). MRSA colonization in ambulances: Are you taking proper precautions?. Retrieved November 4, 2007, from EMS Responder.com Web site: http://www.emsresponder.com/web/online/EMS-Education-and-Training/MRSA-Colonization-in-Ambulances/5$5711

Weigelt, J, Itani, K, Stevens, D, Lau, W, Dryden, M, & Knirsch, C (2005). Linezolid versus vancomycin in treatment of complicated skin and soft tissue infections. Antimicrobial Agents and Chemotherapy 49, 2260-2266. Retrieved October 29, 2007 from http://aac.asm.org/cgi/content/full/49/6/2260

DeLoach,, C (2007). Pollution prevention workshop for the healthcare industry. Retrieved February 1, 2008, from WRPPN Web site: http://www.wrppn.org/hospital/azhospitalp2.cfm

Steiner, C., Elixhauser, A., Schnaier, J. The Healthcare Cost and Utilization Project: An Overview. Effective Clinical Practice 5(3):143–51, 2002.

Elixhauser, A, Steiner, C.(2007) .Infections with Methicillin-Resistant Staphylococcus Aureus (MRSA) in U.S. Hospitals, 1993–2005. HCUP Statistical Brief #35. July 2007. Agency for Healthcare Research and Quality, Rockville, MD. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb35.pdf

Cantlon, (2007).Significant pathogens isolated from surgical site infections at a community hospital in the Midwest. . American Journal of Infection Control. Volume 34, Issue 8, Pages 526-529.


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Tuesday, March 4, 2008

Crohn's Disease

Crohn’s Disease is a life-long, debilitating form of Inflammatory Bowel Disease (IBD) that can cause many complications. Like most autoimmune diseases, these complications and unpleasant symptoms may be unpredictable and difficult to control, which can cause a sense of powerlessness and lead to depression. A. Lei Correa

Because Crohn’s Disease affects mental as well as physical health, the nurse promotes wellness by thoroughly educating the patient on the disease process of Crohn’s Disease, nutrition and pharmacological management, and uses specialty skills to provide care and emotional support using a holistic approach.
The most common and initial indicators of Crohn’s Disease are fatigue, diarrhea, abdominal pain, gastrointestinal bleeding, and weight loss. These symptoms may also be present in patients with other forms of IBD, therefore thorough assessments and specific diagnostic testing is extremely important to avoid misdiagnosis. Since Crohn’s Disease is most often autoimmune (the body tissues attacking itself), patients may experience a multitude of other complications and exacerbations including arthritis, osteoporosis, anemia, malnourishment, fistulas, renal and hepatic disorders, vision problems and sensitive skin, just to name a few. Rayhorn and Rayhorn (2002) explain that this disease does not always effect just the bowel, “Internal organs, the eyes, blood, skin, and the musculoskeletal system are all potential targets for the devastating effects of this disease, known collectively as extraintestinal manifestations, or EMs”.
Gaining knowledge of Crohn’s Disease is the first step to remission. Patient education is one of the most important aspects of nursing; what is told to the patient about the disease and what to expect, and how well that information is understood will determine the patients’ self-perception, self-care, and choices in regards to disease management. The nurse educates the patient according to their learning ability, and (with permission of the patient to protect health information) educates family members who may be taking on the role of care-giver. An individual experiencing the unpleasant signs and symptoms of Crohn’s Disease is not necessarily eager to learn, and the nurse prepares for this by providing resources, pamphlets, and other reading material so it is convenient for the patient when they are ready to soak in more information. The age of the patient is also a factor. The patient should be informed of support groups in their area and can also be referred to the Crohn’s and Colitis Foundation of America (http://www.ccfa.org) (Rayhorn, 2003). Providing information with pictures will of course make it easier to visualize that which cannot be seen. The severity of the patient’s condition should be clearly understood, as well as warnings of potential problems.
Nutrient deficiency is a complication that should constantly be monitored because it can occur during flare-ups or while the patient is in remission. A significant amount of calories and carbohydrates for energy, and adequate hydration every day is absolutely vital in maintaining optimal health. Nutrient absorption is decreased in patients with Crohn’s Disease because the intestines do not function as well as in a healthy individual. Patients will become aware of the type of foods that will irritate their bowels and which foods are well tolerated. According to a webpage created by the New York Methodist Hospital, foods that have irritation potential include raw vegetables, alcohol, simple sugars, and caffeine because they are associated with inflammation. Other inflammatory foods are fruits with a lot of sugar such as grapes, watermelon or pineapple (2002). Sometimes medications can be the culprit for malnutrition. For example, Prednisone is a common drug for Crohn’s Disease patients, but it can cause osteoporosis, and therefore is treated with calcium and Vitamin D supplementation. Iron deficiency is also common, but oral iron supplementation is often not tolerated in patients with Crohn’s Disease and would then iron delivered intravenously or by injection. In extreme cases of the disease, enteral feeding can induce remission, as well as TPN in which bowel rest may be required (Jeejeebhoy, 2002).
Such a debilitating disease can cause the patient to feel powerless and depressed. Being a counselor and an active listener can make a drastic difference in the patient’s self-perception and quality of life. Specialty nurses who have become active participants in gastroenterology have made a huge difference in patients with Crohn’s Disease. Specialty nurses can improve disease management on a whole different level than just a practitioner. There is a motivation for change in the healthcare system as we advance and make new discoveries. Kamm & Norton (2002) agree that, “Changes may also come from a real desire to move the focus of healthcare away from an insensitive technological approach to one based on holistic care” (p. 331). Patients can be taught how to self-medicate when they are having a flare-up; this means utilizing home remedies and adhering to pharmacological measures as instructed. This will increase autonomy and decrease clinic visits. Kamm and Norton (2002) also provide evidence showing, “in a controlled study this reduced clinic visits by 30%, decreased the delay between symptom onset and treatment from 4 days to under 24 hours, increased the quality of life scores, and decreased costs” (p. 334). Patients with Crohn’s disease need a high level of nursing care; one that combines holistic as well as technical approaches.
Crohn’s Disease does not follow a predicted cycle of flare-ups and remissions; rather it can be rollercoaster of unexpected events. Patients are experiencing a total loss of control over their bodies and overall health. Uncontrollable bowels and discomfort can be extremely embarrassing and disheartening. The exacerbation of other problems caused by this disease, adds to this disparity. The pain and discomfort the patient experiences can be managed more effectively through proper education, pharmacological/nutritional management, and emotional support. This is an opportunity for nurses to take advantage of their specialty skills while providing a holistic type of care.


Jeejeebhoy, N. K. (2002). Clinical nutrition: 6. Management of nutritional problems of patients with crohn's disease. Canadian Medical Association Journal, 166(7),
913–918. Retrieved January 29, 2007, from PubMed Central Database.
Norton, C, & Kamm, M.A. (2002). Specialist Nurse in Gastroenterology. Journal of the royal society of Medicine. 95(7): 331-335. Retrieved April 22, 2007, from PubMed Central Database.
Rayhorn, N. (2003). Inflammatory Bowel Disease. Nursing, 33(11), 54. Retrieved November 07, 2007, from Proquest Database.
Rayhorn, N., & Rayhorn, D.J. (2002). An in-depth look at inflammatory bowel disease. Nursing, 32(7), 26-36. Retrieved November 07, 2007, from Proquest Database.
What is the Role of Diet in Crohn’s Disease? (2001). New York Methodist Hospital. Retrieved February 05, 2007, from http://www.nym.org/healthinfo/docs/103/doc103diet.html

Intervention 1: Nutrition therapy along with pharmacological Management
Disadvantage 1: Debilitating side effects from necessary drugs.
The immunosuppressive drugs that are necessary for disease remission are life-long, and produce very unpleasant side effects that although the patient is in a state of “remission”, day-to-day life is still difficult. Remicaid (infliximab) is a drug used for the treatment of rheumatoid arthritis, and is used in Crohn’s patients to keep symptoms at bay, maintain remission, and treat rheumatoid arthritis that gets exacerbated by the disease. However, this drug can cause abdominal pain, nausea, vomiting, fatigue, headache, infusion reactions, and drug-induced lupus (Deglin & Vallerand, 2007, p.642). Azathioprine (Imuran) is another immunosuppressant that can cause the same kind of G.I. upset, along with thrombocytopenia, anemia, and hair loss (Deglin & Vallerand, 2007, p. 180). Methotrexate (Rheumatrex) is a heavy duty immunosuppressant that is actually used on cancer patients, as well as severe Crohn’s Disease. This drug can cause anorexia, G.I. upset, nephropathy, anemia, rashes, malaise, hair loss, and hepatotoxicity (Deglin & Vallerand, 2007, p. 772). In addition to any of the mentioned drugs, prednisone is usually used in addition to a chosen drug therapy. This drug can cause depression, muscle wasting, G.I. upset, peptic ulceration, abnormal fat deposits, and cushingoid appearance (moon face, buffalo hump) (Deglin & Vallerand, 2007, p. 323-327). Unfortunately, the Crohn’s patient will likely go through different therapies such as these before finding one that is effective and somewhat tolerable. Physicians use an algorithm of which drugs to try first, and depending on the reactions, what the next step would be (Knutson, Greenberg, & Cronau, 2003).

Deglin, J, & Vallerand, A. (2007). Davis’s drug guide for nurses. (10th ed.). Philadelphia: F.A. Davis Company.

Knutson, D, Greenberg, G, Cronau, H. (2003). Management of crohn’s disease – a practical approach. American Family Physician. 68(4), 707-14, 717-8, 595-7. (CINAHL Accession No. 2004070944)

Disadvantage 2: Unknown underlying G.I. problems preventing remission.
Some patients with Crohn’s Disease may also have other things going on with their digestive tract even before the onset of their disease. They could have just IBS, and therefore diet will be more selective. There is also a strong possibility of the patient having Celiac Disease (glutten-sensitive enteropathy), which would mean even more diet restrictions to take into consideration. Once Crohn’s Disease has been diagnosed, it seems imperative to also screen for Celiac Disease. It is quite common, affecting 1 in 100 to 1 in 300 (Edwards, 2006). Celiac, like Crohn’s, can cause similar symptoms of G.I. upset, so misdiagnoses can be more common than preceived. If a Crohn’s patient adheres to their drug regimen, and still not feeling well, it is difficult to assess if it is just the wrong drug regimen for them or if they actually have Celiac Disease as well and the glutten ingestion is inhibiting remission.

Edwards, M. (2006). Coeliac Disease – an update. Practice Nurse. 31(7), 42-4. (CINAHL Accession No. 2009176315)

Intervention 2: Specialty nursing
Disadvantage 1: Shortage of specialty nurses.
The field of gastroenterology indeed needs more specialty nurses. However, there is a shortage of nurses in general all around the world, as well as in specialties. It is a huge intervention to attempt to recruit individuals into the nursing field, let alone encouraging nurses to further specialize. The ICN conducted a survery and found some reasons why the number of nurses are declining. Nurses are already dealing with high nurse to patient ratios, long working hours, inadequate compensation, and reduced time with patients due to overburdened administration (“Where”, 2007). The ICN has called on the WHO, but the nursing shortage continues to rise.

(2007). Where are all the nurses. Australian Nursing Journal. 15(1), 19. (CINAHL Accession No. 2009645084).

Disadvantage 2: Not enough. Need communication - team medicine.
Crohn’s Disease can cause extra-intestinal manifestations (rheumatoid arthritis, anemia, osteoporosis, ulcers, malnourishment, renal and hepatic disease, etc.). These other diseases, mean other specializing physicians. One patient with Crohn’s Disease, may be seeing a rheumatologist, gastroenterologist, nephrologist, pharmacist, and dietician, as well as their general physician. If these physicians are not actively and accurately communicating, the patient’s health may be in jeopardy. It is suggested that stress can exacerbate Crohn’s symptoms, and Crohn’s symptoms can exacerbate stress. The need to see so many different doctors can be quite stressful, and may even be detrimental if it is not an efficient team. The patient’s stress level, and means of seeing the necessary specialties are not taken into account as much as it should.

Smith G,D, Watson, R, Roger, D, McRorie, E, Hurst, N, Luman, W, & Palmer K,R. (2002). Impact of a nurse-led counselling service on quality of life in patients with inflammatory bowel disease. Journal of Advanced Nursing. 38(2): 152-60. (CINAHL Accession No. 2002073703).span>

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Preventing Malnutrition in the Elderly.

Clint Webster

Preventing Malnutrition in the Elderly

With the increasing number of baby boomers reaching an older age, malnutrition is a serious problem today. Many of these elderly will end up in nursing homes and up to 85% suffer from malnutrition (Crogen, 2006). This is an alarming number of malnourished patients for the Registered Nurse to take on. However, the knowledgeable nurse can aid elderly patients by providing adequate nutrition in a vulnerable population prone to malnutrition, and prevent the resulting problems. Three nursing strategies can include acquiring knowledge on malnutrition risk factors and signs/ symptoms, in order to identify the problem, know how to improve food consumption via different dining atmosphere, and supplement the types of foods the elderly consume by improving taste and nutrient density.
Malnutrition can be managed, but it requires skilled nurses and medical teams. In understanding that elderly malnutrition is a dramatic problem of epic scale today, this issue is not taken lightly by the medical community. Nursing homes are managed by nurses and this is where malnutrition is extremely prevalent. Mortality and morbidity are correlated with malnutrition (Brownie, 2006). Nutrition plays a large role in the severe problem of pressure sores due to protein loss. Adequate nutrition and protein are necessary in helping prevent and heal these pressure ulcers. Malnutrition makes pressure sores more likely and more difficult to heal (Dambach, 2005). The immune system is also hindered by malnutrition and this at risk population is already more susceptible to communicable diseases (Brownie, 2006). Conditions like pneumonia and bronchitis are much more serious in an elderly patient and malnutrition weakens their defenses. Registered Nurses are key in the fight against elderly malnutrition because they give the most direct care to elderly populations, and hence spend the most time with this high risk population. The nurse working with the elderly population should acquire detailed knowledge of malnutrition in order to identify the problem. The Mini Nutritional Assessment (MNA) is one valuable tool at the Registered Nurse’s disposal to judge malnutrition in the elderly. It consists of a survey of the patient’s level of malnutrition. Depending on the extent or score, it will recommend appropriate interventions that the Registered Nurse will implement (Vellas, 2006). Tools like the MNA incorporate many aspects of nutrition in the elderly to objectively identify who is at risk, but nurses still need to understand the process themselves. Knowing that the elderly client has decreased bodily function related to consuming and absorbing nutrients is important. Diminishing taste and smell senses can make food less appetizing than in the past. Dental problems can make consuming foods difficult. Poor fitting dentures can cause difficulty and pain in chewing and swallowing (Crogen, 2006). Factors such as reduced stomach acid and absorption problems can make garnering nutrients from food difficult. These can be exacerbated by the various medications the elderly take (Eliopoulos, 2005). Motor coordination is sometimes affected by medications. Elderly often already have some motor coordination deterioration. Further impairment by medications can hinder them from adequate consumption in limiting their ability to feed themselves (Crogen, 2006). The nurse should be educated on these issues and understand that they influence the clinical manifestations of malnutrition in the elderly. These can include “weight loss greater than five percent in the past month, weight ten percent below or above ideal range, serum albumin level lower than 3.5g/100mL, hemoglobin level below 12g/dL, and hematocrit value below 35 percent” (Eliopoulos, 2005, 202).
With knowledge on aging changes and identifying who is at risk, nurses should implement appropriate strategies to improve nutrient consumption. Elderly clients in nursing homes can be aided by an environment that is suitable for food consumption. The Registered Nurse in these settings can change lighting and table setting contrast to aid elderly nutrition. In one study, researchers found that placing white plates on blue trays laid out on a green table cloth with more evenly distributed light markedly increased nutrient consumption over three days (Brush, 2007). In those patients who eat in their rooms at the hospital or nursing home, it is especially important that unappetizing objects such as urinals and related items are not near or on the dining area. These objects detract from the dining environment (Calverly, 2007). Promoting a proper dining atmosphere is a valuable tool in nursing care of elderly malnutrition.
Improving the atmosphere of the dining experience can help in the nurse’s ability to manage elderly nutrition, but foods the elderly consume are the most important factor in preventing malnutrition. According to Dunn (2007), many foods and strategies for increasing their consumption do not work. Serving smaller more frequent meals does not improve nutrition. Oral supplements are also not very beneficial and often go wasted or conflict with medications. However, fortified foods (foods with added vitamins and minerals) and nutrient dense foods (foods that naturally have large quantities of vitamins and minerals for the amount of calories they contain) have been found to be effective. Fortified foods work best when they taste like their regular counterparts. Nutrient dense foods have been found to be very effective in promoting nutrition (Dunne, 2007). Improving taste is one of the best and simplest ways of improving nutrition. In some cases it is more important that elderly patients simply consume calories. Elderly patients have the same taste preferences as they have had all of their life, and thus low sodium, low fat meals are not always as appetizing as the normal version of a food with naturally high fat and sodium content (Calverley, 2007).
Malnutrition will always be an issue for the ever growing elderly population. It is important that this issue be dealt with correctly in order to prevent pain and suffering, increased healthcare costs, staff burden, and mortality (Brownie, 2006). A knowledgeable nurse can aid elderly patients by providing adequate nutrition in a vulnerable population prone to malnutrition. Nurses should be aware of the risk factors and signs via greater knowledge and insight, implementing strategies to improve food consumption, and offering different food choices to improve the amount of nutrients ingested. These strategies all help to minimize the devastating effects of malnutrition by promoting nutrition.


Brownie, S (2006).Why are elderly individuals at risk of nutritional deficiency?. Journal of Nursing Practice. 2, 115.
Brush, J. A., Meehan, R. A., & Calkins, M. P. (2002). Using the environment to improve intake for people with dementia. Alzheimer's Care Quarterly. 4, 330-339. Retrieved January 9, 2007, from Expanded Academic ASAP database.
Calverley, D (2007).The Food Fighters. Nursing Standard. 22, 20-21.
Crogen, N, & Alvine, C (2006). Testing of the Individual Nutrition Rx assessment process among nursing home residents. Applied Nursing Research. 19, 102-104.
Dunne, J.L., & Dahl, W.J. (2007). A novel solution is needed to correct low nutrient intakes in elderly long-term care residents. Nutrition Reviews. 65. Issue 3, 135-139.
Eliopoulos, C (2005). Gerontological Nursing. Philadelphia, PA: Lippincott Williams & Wilkins.
Vellas, B, Villars, H, Abellan, G, Soto, ME, Rolland, Y, & Guigoz, Y (2006). Overview of the MNA--Its history and challenges. Journal of Nutrition, Health, and Aging. 10, 456-463.

Intervention 1: Improving the dining atmosphere to improve nutrient consumption in elderly.
#1) While it is documented that improving the dining atmosphere will increase nutrition in the elderly, there are obstacles to overcome. One issue is that some elderly in nursing homes are very messy eaters for various health related reasons. This can be a distracting and unappetizing occurrence for the rest of the elderly eating there. Even if the lighting and contrast are adjusted for proper atmosphere, the elderly themselves can end up being a distraction. This can be dealt with by having these individuals in a side room (Andreoli, 2007).
#2) The timing of meals is also important. No matter how nicely laid out the dining atmosphere is, if the meal is during a portion of the day when an individual does not have an appetite, then that person will miss out on a meal until the next one comes around (Jhavari, 2006). This system will prevent a proper dining atmosphere from counting for anything because of poor timing.

Andreoli, N.A., Breuer, L, Marbury, D, Williams, S, & Rosenblut, MN (2007). Serving Culture Change At Mealtimes. MN Nursing Homes: Long Term Care Management. 9, 48.

Jhavari, T. (2006) Enhancing the dining experience in senior living. Nursing Home Magazine. October Issue, 58

Intervention 2: Improving nutrient density of foods, implementing fortified foods, and improving taste will help the elderly improve nutrition.

#1) While these techniques and foods have been shown to work, they do not account for the economic status of the elderly. Some may not have the financial means to afford these services and foods (Holman, 2005). The elderly may have someone else doing the shopping for them if they are not in a home, and this can leave their nutritional options in the hands of the person shopping (Holmes, 2006). Similarly, a common problem can be an elderly person who had a spouse or relative do their shopping for them and they are suddenly no longer capable of shopping. In these instances it leaves those elderly to do shopping on their own or not at all, and if they do end up shopping on their own, their nutritional knowledge could be a new problem.
#2) In other instances the elderly may have a host of issues that deter them from adequate consumption of nutrient. Of these, psychosocial issues such as an elderly person losing a loved one and being lonely can make them disinterested in eating (Holmes, 2006). Many other issues may affect a persons desire to eat as well, limiting nutrition.

Holmes, S. (2006) Barriers to effective nutritional care for older adults. Nursing Standard. 3, 51-54

Holman, R.N., Nicol, M. (2005) Promoting adequate nutrition. Nursing Older People. 17, 31-2


Andreoli, N.A., Breuer, L, Marbury, D, Williams, S, & Rosenblut, MN (2007). Serving Culture Change At Mealtimes. MN Nursing Homes: Long Term Care Management. 9, 48.

Holman, R.N., Nicol, M. (2005) Promoting adequate nutrition. Nursing Older People. 17, 31-2

Holmes, S. (2006) Barriers to effective nutritional care for older adults. Nursing Standard. 3, 51-54

Jhavari, T. (2006) Enhancing the dining experience in senior living. Nursing Home Magazine. October Issue, 58

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Issues challenging obese population.

Many research studies have addressed ways obesity affects the human body biologically, but few have actually highlighted other surrounding issues that affect obese population such as discrimination and lack of accommodation in public places. Therefore, this paper will highlight and address great roles that nurses can play to bring a change in perspective of “other” ignored issues about obesity. Joe Njenga
To make this possible a nurse can implement the following strategies.
1. As health care provider, the nurse can set a good example by not practicing bias and discrimination against obese population.
2. As a manager of a health care organization, the nurse can mobilize resources to ensure equipment like oversized beds, commodes, walkers and wheelchairs are available and ready for use by bariatric patients.
3. A nurse can act as an educator to help in creating public awareness about obesity with the correct perception.
The first strategy is for the nurse to be open-minded, understanding, resourceful and free from bias and discrimination. This can prove to be a big challenge to the body image obsessed society which has done little to help address and solve issues of obesity. Instead, the society has marginalized and labeled obese individuals as lazy, irresponsible and, generally of less worth. As a result, many obese individuals are hesitant to go out in public places like colleges, churches, hospitals and gymnasiums.
A research study found physicians and nurses to be among predominant groups that were most stereotypical about obesity. Physicians associated obesity and other negatively perceived conditions with poor hygiene, noncompliance, hostility, and dishonest. Doctors were less motivated and less optimistic when caring for obese patients because they viewed them as unsuccessful, weak willed and unintelligent. (Puhl & Browell, 2001)Therefore, it is important that nurses set a good example for the rest of the society to follow by caring for obese patients with dignity and an open minded approach. For instance if a bariatric patient requested for bed change and the nurse needed some help to turn the patient she should kindly respond, “Let me get someone to help me” instead of “ You are too heavy I need someone to help me roll you over”.
A second strategy involves the nurse as a manager of a healthcare organization and a patient’s advocate. A nurse can mobilize resources to ensure that facilities and equipment can safely accommodate obese patients. This goal can be achieved by construction of infrastructure that can support the growing obese population such as investing in wider beds that can accommodate weights between 300 and 800 pounds, building wide doorways, purchasing or renting wider wheelchairs, lifts, commodes, gowns, bariatric beds, commodes, and walkers. In addition, hiring more staff to help in safer transfers of obese patients is key to avoid back injuries as, Gallagher (2005) explains “Injuries that result from manual lifting and transferring of patients are among the most frequent causes of nurse related injuries with more than half of strains and sprains being attributed to manual lifting tasks while assisting dependent patients with their mobility needs” (Pg 1). Although this may mean additional expenses, this will serve as a long-term investment as the numbers of overweight patients persistently keep rising.
The third strategy is education of the public. Nurses can change the way the public views obesity through education and enlighten on cause of obesity and surrounding factors. But before the healthcare professionals can educate the public, Maxwell (2005) urges all healthcare professionals to educate themselves and other hospital staff first on ways of being sensitive to the plight of the obese people. In her article Obesity: Pain and Prejudice (2005) she exemplifies, “Don't be like the doctor who told his patient that she would have to be weighed at the zoo” (Pg 4). In comparison to HIV/AIDS epidemic, education about obesity will lead an overall public awareness and change of attitude hence change of behavior. Additionally, early education on obesity is paramount to young children to serve as a preventive measure before they turn into young obese adults by creation of healthy food programs in school such as reduction or eradication of vending machines in schools and promotion of Physical education (Malone, 2005)
After, the nurse sets a good example by not practicing bias and discrimination against obese population, mobilize resources to ensure equipment like oversized beds, commodes, walkers and wheelchairs are available and ready for use by bariatric patients and, educate people to create a public awareness about obesity. This will improve empower and encourage public awareness about obesity with the correct perception and aid obese population to lead healthier lives.
Gallagher, S. ((2005)). Caring for the Child Who is Obese: Mobility, Caregiver Safety, Environmental Accommodation, and Legal Concerns. Batriatric Nursing Surgical Patient care , 1.
Malon, S. (2005). Improving Quality of dietary intake in the school setting. Journal of School Nursing , 21, 70-76.
Maxwell, B. (2005). Obesity: Pain and Prejudice. Medscape General Medicine , 7, 3.
Puhl, R., & Browell, D. (2001). Bias, discrimination and obesity. The NOrth American Associaton for the study of Obesity , 9, 788-805.

Joseph Njenga
NUR 211
John Miller
Research paper

Intervention 1

As a manager of a health care organization, the nurse can mobilize resources to ensure equipment like oversized beds, commodes, walkers and wheelchairs are available and ready for use by bariatric patients

Disadvantage 1
One major disadvantage of this intervention is lack of enough funds to meet the need of this intervention. Limitation in coverage of most bariatric procedures by insurance has done little to improve the situation at hand. With scarce resources that the facilities have to depend on, tight budget cuts in many healthcare facilities have been enforced leaving no room for expansion in provision of bariatric services and purchase or required equipment. In a research study to find ways of predicting cost by a bariatric clinic, Mosti states, “Although bariatric surgery is highly effective for controlling obesity and its complications, it is uncovered by third-party payers in many countries. High cost and unpredictable expenses account for the lack of coverage”

Disadvantage 2
The second disadvantage is multiple stages of managerial approval in many organizations. The more the stages of approval the hard it becomes to approve any policy in an organization; this is because each stage of a policy approval questions the chances of success in implementation of an idea. Although it is essential to assess the chances of success of any policy before investing, this practice discourages creative employees from coming up with good idea that would in fact help the organization grow. For instance in the Wikipedia encyclopedia (Espo, 2007), the Stem cell research has gone over multiple challenges and yet it has not been approved as illustrated:

The bill passed House of Representatives by a vote of 238 to 194 on May 24, 2005.[1], then passed the Senate by a vote of 63 to 37 on July 18, 2006. President Bush vetoed the bill on July 19, 2006.
The House of Representatives then failed to override the veto (235 to 193) on July 19, 2006. In a second trial The bill passed the Senate on April 11, 2007 by a vote of 63-34, then passed the House on June 7, 2007 by a vote of 247-176. President Bush vetoed the bill on June 19, 2007,[2] and an override was not attempted..

Intervention 2

The second intervention is for nurses to educate the public about obesity through creation of the right perception about obesity and factors that can be employed to reduce it.

Disadvantage 1
As a result of the well known fact about nursing shortage, this phenomenon has affected nursing educators too. Andrea (2007) in her article states, “Of the 2900 nursing doctoral students who enroll each year, only 440 graduate. The average age of a new doctoral graduate in nursing was 45.7 years and 6.5% of the graduates were 55 years or older.” She goes on to say that this demographic has done little to improve the situation of the nursing scholarly culture. In return there is a shortage of faculty that is supposed to teach new nurses and the public in general. The few nurses that graduate from nursing school are hence siphoned to more critical healthcare system like the hospitals. This means that community based care that is meant to be the primary mode of prevention has been left with no educators creating a whole new challenge for public education on issues such as obesity.

Disadvantage 2
Unavailability of health care centers, information coupled with public illiteracy has been a major disadvantage for wellness promotion through community education. Nurses who teach on the community level greatly depend on this resource for their service as educators to be effective. Lack of this resource has lead to an increase in health care cost through Emergency department response and chronic diseases such as diabetes and hypertension. Parker( 2005) states, “Widespread problems with health literacy significantly limit effective dissemination and understanding of relevant health information in society, especially among many vulnerable populations where health literacy challenges are especially pervasive” she goes on to explain that an improvement in community healthcare will reduce disparities, cost and quality of care. Therefore a well furnished community health care center can greatly reduce the cost of health care in the long run (Parker, 2005)


Andrea L. Smesny, P. J. (2007). Barriers to Scholarship in Dentistry, Medicine, Nursing, and Pharmacy Practice Faculty. American Journal of pharmaceutical education , 5 (71), 91.
Espo, D. (2007, April 12). Stem Cell Research Enhancement Act. Retrieved Feb 5, 2008, from Wikipedia: http://en.wikipedia.org/wiki/Wikipedia:Text_of_the_GNU_Free_Documentation_License
Mosti M, D. G. (2007, nov 27th). Calculating Surgical Costs: How Accurate and Predictable is the Cost of a Laparoscopic Roux-en-Y Gastric Bypass? Obesity surgery , 1555-7.
Parker, L. G. (2005). Library outreach: overcoming health literacy challenges. Journal of the medical library association , 4 Suppl (93), S81- S85.

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Monday, March 3, 2008

Adolescent: Cervical Cancer and Human Papillomavirus

The staggering rate of cervical cancer caused by the Human Papillomavirus (HPV) is chilling. Researchers are learning more about this disease and discovering successful prevention measures to fight it. Having the tools for disease prevention, health care providers are often challenged by real world obstacles. Tove Finch

Lack of public awareness regarding HPV transmission and at risk populations is limited, vaccine controversies surrounding adolescent girls becoming sexually active, and lack of routine screening increases the risk for cervical cancer each year. Targeting the at-risk population, educating HPV prevention, and advocating for cervical cancer screening are essential nursing strategies to reduce the burden of illness caused by HPV.
According to Cox and the CDC (2006), HPV is the most prevailing sexually transmitted infection responsible for cervical cancer. In the United States, 20 million people are currently infected with HPV, an additional six million people become newly diagnosed and nearly four thousand women die from cervical cancer each year (Cox, 2006). Many young women do not know that being sexually active puts them at risk for cervical cancer because HPV can develop undetected and become transmitted unknowingly (Cox, 2006). Fawcett (2007) supports this by stating, “young girls are particularly at risk because some start having sexual intercourse earlier, have higher number of partners, smoke and fail to use barrier methods of contraception” (p.2). Vaccinations to eradicate HPV are underway, but controversial issues continue over personal and religious beliefs. According to Ritchie (2006), there are varied levels of sex education because of religious and cultural beliefs. Therefore, greater preventative steps need to be taken to reduce the incidence of HPV in the younger population.
One nursing strategy on illness prevention is to target the adolescent at risk population. Providing a holistic approach to adolescent health care by including pediatric reproduction health services will benefit public health as a whole and assure access to the at risk population. Roye, Nelson, and Stanis (2003), support this by stating, “nurses should advocate for the provision of comprehensive reproduction health services in all clinical sites that provide primary care to adolescents” (p.4). This type of standardized quality health care will enable goals to eliminate health disparities among adolescents and permit early primary prevention. The national health promotion and disease prevention goals, Healthy People 2010, will also be promoted by strengthening community prevention and protecting the future health of the adolescent population from cervical cancer caused by the Human Papillomavirus, (Potter, 2005).
While targeting the adolescent at risk population, another key strategy must address educating HPV prevention and transmission. Fawcett (2007) states, “educating adolescents about protection against HPV is a vital part of adolescent health care” (p.5). Cox (2006) adds, “At present, HPV is widespread such that most sexually active individuals will be infected in their lifetime” (p.3). Society needs to change their attitude and eliminate political barriers by including an objective nursing focus on educating parents and adolescents about the prevention and transmission of HPV, thus empowering adolescents to participate in disease control. This education may include topics such as risky behaviors, the HPV vaccine, Pap screenings, condom use, and abstinence. Educating on adolescent behavior and giving informed sexual advice permits comprehensive decisions. According to Bartlett, Davis and Belyea, (2007), in any health-related interactions with an adolescent, failure to inquire about an adolescent's involvement in problem behaviors may result in lost opportunities to educate the adolescent, who may have nowhere else to gain such information. Fawcett (2007) supports this by stating, “sexual health education should be aimed at reducing the risk” (p.4). This strategy also supports Healthy People 2010 goals by promoting healthy behaviors and protecting adolescent sexual health, thereby increasing the quality and years to their life.
In addition to education and immunization, screening by Papanicolaou, (Pap) smear, is an essential strategy that contributes to early detection of cervical cancer (Fawcett, 2007). Nurses need to collect comprehensive patient history and advocate screening services in clinical sites that provide primary adolescent care. Cervical screenings have led to a notable decrease in cervical cancer deaths in the middle age population and adolescents alike (Roye, Nelson, and Stanis, 2003). If sexually active adolescents are not regularly screened for HPV they may develop cancer undetected. Fawcett supports this strategy by stating, “We believe that Pap smear screening of sexually active adolescents remains an important preventive health procedure that is clinically justifiable” (p.5).
Evidence exists showing the link between cervical cancer caused by the Human Papillomavirus and the prevalence of this disease on the adolescent population. HPV is like butter, it spreads, making HPV prevention imperative. Many parents are uncomfortable with the idea that the majority of young people are or have had sex by the time they reach early adulthood. Therefore, advocating for adolescent reproductive health services and promoting protective sexual behaviors like HPV prevention and awareness, is an essential step to lessen the burden of disease. It has only recently become a preventable infection. Every effort must be made to further eradicate cervical cancer and provide greater continuity of adolescent health care.

1. Target the At-Risk Population:
A. Failure to Address Adolescent Reproductive Health Issues:
Even though the number of sexual health clinics has increased, it remains difficult to persuade young women to use them. Many young women are sexually active, but very few visit a clinic for advice or treatment. This may be due to feelings of embarrassment or the lack of awareness of the services available. According to Fawcett, nearly half of American teenagers had engaged in sexual intercourse before graduation which suggests that many young people appear oblivious to health promotion messages (2007). Health care providers, such as pediatricians, are often uncomfortable addressing reproductive health issues with adolescent patients and many will fail to do so (Roye, Nelson, & Stanis 2003). Therefore, important adolescent reproductive health information is being overlooked and not getting through from family members or health professionals alike.

B. Lower Socioeconomic Barriers:
Cervical cancer disproportionately affects women of lower socioeconomic status, poor access to health care, and for those who are uninsured (CDC, 2006). Cultural and socioeconomic barriers to cervical cancer screenings have contributed to a distinct health disparity among African American women nation wide. African American women represent a medically underserved population, therefore more likely to be diagnosed with cancer at a later stage when the chance of survival is limited. Additionally, increased rates of cervical cancer have also been found in women in lower socioeconomic groups who may have limited access to basic health care needs. Moore and Seybold (2007) state, “The overall cervical cancer death rate among African American women is six times that among white women” (p.1). The HPV vaccine is new to the market and is not currently covered by most health care plans. While some insurance companies may cover the vaccine costs, others may not. Due to the lag-time after a vaccine is recommended and before it is covered by health plans many young females will miss the opportunity for prevention. The problem of establishing a safety net care for low-income uninsured and underinsured people is national in scope as the number of uninsured has risen past 43 million (Shapiro, Thompson, & Calhoun, 2006).

2. Educating HPV Prevention and Transmission
A. Personal and Cultural Beliefs:
As with any new immunization, controversy exists regarding the ethical use of the HPV vaccine. While it could be argued that routine vaccinations would decrease the numbers of cervical cancer deaths, many may believe that mandatory vaccine programs, currently being proposed in some states, infringe on parental rights to make wise health care decisions for their children. Additionally, some parents believe the HPV vaccine or seeking adolescent reproductive health services promotes sexual promiscuity. Parents are concerned that by consenting to the vaccine they are giving their child unspoken permission to become sexually active. Likewise, groups that promote abstinence until marriage worry that this vaccination will send a message to young women that sexual activity is safe and will undermine the abstinence message (Moore & Seybold, 2007).

B. Lack of Efficacy Data:
According to the CDC, the duration of protection from the HPV vaccine is unclear, however it is believed the vaccine is effective for at least five years (2006). Dawar, Deeks, & Dobson state that, “There are knowledge gaps, especially about the long-term efficacy, this is not unusual at the outset of any new vaccine” (p.7). In 2006 the HPV vaccine became available to the public and so far no adverse effects have been reported and a detailed post-licensure safety monitoring plan is currently in place. Nearly 100% of the study participants developed antibodies after given the HPV vaccination, but at this time there is no data available as to how long the effects of the drug will last or any long term adverse effects directly related to this drug might be.


Bartlett, R., Holditch-Davis, D., & Belyea, M. (2007). Problem behaviors in adolescents. Pediatric Nursing 33(1), 13. Retrieved October 22, 2007 from Proquest database.
Cox, J. (2006). Epidemiology and natural history of HPV. Journal of Family Practice 15(11), 7. Retrieved April 14, 2007 from Expanded Academic ASAP database.
Dawar, M., Deeks, S., & Dobson, S. (2007). Human papillomavirus vaccines launch a new era in cervical cancer prevention. Canadian Medical Association Journal. 177(5), 456. Retrieved February 4, 2007 from Proquest database.
Fawcett, E. (2007). Cervical screening for under 25’s – evaluating the evidence. Journal of Community Nursing, 21(2), 4. Retrieved October 10, 2007 from Proquest database.
Giarratano, G., Carter, C., (2003). Partners in health: Changing cancer screening disparity among underserved african american women. Journal of Multicultural Nursing and Health. 9(1), 40. Retrieved October 22, 2007 from Proquest database.
Moore, S., Seybold, V. (2007). HPV vaccine. Clinician Reviews. 17(1), 35. Retrieved April 14, 2007 from Expanded Academic ASAP database.
Potter, P., Perry, A., (2005). Fundamentals of nursing, 6th edition. (pp.90-91). St. Louis, Missouri: Mosby.
Ritchie, G. (2006). Strategies to promote sexual health. Nursing Standard. 20(48), 35-40. Retrieved October 23, 2007 from PubMed Central database.
Roye, C., Nelson, J., & Stanis, P. (2003). Evidence of the need for cervical cancer screening in adolescents. Pediatric Nursing, 29(3), 224. Retrieved October 10, 2007 from Proquest database.
Shapiro, L., Thompson, D., & Calhoun, E., (2006). Sustaining a safety net breast and cervical cancer detection program. Journal of Health Care for the Poor and Underserved. 17(2), 20. Retrieved October 22, 2007 from Proquest database.

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Incidence of Tuberculosis and Multiple Drug Resistant TB are on the rise. The popular conception is that this disease, as old as humanity, is under control and being eradicated.

However, among certain disenfranchised and underserved populations, such as drug users, prison populations, HIV patients and refugees from high-risk countries, ripe conditions have led to a breeding ground for TB and MDR-TB. Therefore the nursing community must educate everyone they can, identify and be willing to intervene directly with underserved populations and utilize proper techniques and training.
During the first half of the 20th Century, TB was called " white plague " or "consumption" because it seemed to consume and waste a person from within, having traveled from the lungs to other parts of the body. It is a hardy organism spread in aerosol form by coughing, laughing or sneezing. A person can be a carrier, test positive but be non-contagious. They are not be considered to have TB the disease (Selekman 2006). A combination of at least four “front line” anti-TB drugs is used to prevent resistance to the organism (Kidder, 2003). Failing that, subsequent MDR-TB is treated with other more expensive drugs. Just as important as treatment are some nursing strategies that can be very effective at interrupting the spread of the disease.
Nurses must work hard to educate and dispel the many myths that surround TB. The majority of people believe it has been eradicated, at least in the developed countries. People are often shocked when they hear the diagnosis because they believe it leaves them stigmatized and unclean. They believe that only the down & out get TB, yet people from all social strata get TB. Some believe smoking causes it, or that it is hereditary. Effective education by nurses could overcome barriers such as fear and language and cultural differences. One commonly held belief that is true, is that high-risk groups including inmates, homeless, drug users and certain groups of immigrants are more at risk of contracting TB (Boutotte, 2000).
The second nursing strategy is to identify underserved populations and not only go to the source but be prepared to be flexible in implementing nursing interventions. Prisons and jails are a breeding ground for TB due to overcrowding. In addition there are other circumstances that a nurse should know about that contribute to the non-compliance of therapy. In the US, prisons in California and New York have had epidemics of resistant TB. In some prisons, it was discovered that prisoners would sell their medication or deliberately swap sputum samples. Some actually wanted to be sick to stay in the much nicer conditions that the infirmary afforded with no work duty assigned. Conversely, some inmates, believing it would hinder their release dates, bought clean sputum samples, or bribed poorly paid prison medical staff (MacNeil, 2005). In the prisons of Siberia, which are lacking in proper nutrition and appallingly overcrowded, there is a caste system, with Mafia-like bosses, middlemen and abused under castes, who may be beaten if they don’t hand up the valuable drugs to the bosses (Schwalbe, 2002). Of course Mycobacterium tuberculosis does not differentiate between murderers or petty thieves; nor prison guards and their families. It is equally important for the health of the general population that nurses seek out other disenfranchised groups such as the homeless, drug users and immigrants from certain high risk countries.
Fear of immigration authorities, language and cultural barriers, financial restraints, lack of health insurance and inadequate housing are factors that are often compounded by co-infection with other disease processes such as HIV. The only way to obtain compliance is to actually observe each dose administered (known as DOTS-Directly Observed Treatment Short-Course (Kidder, 2003). Compliance in following the drug regimen to its completion is even more difficult when the patient is transient, literally, such as drug users and the homeless population. Further, there is little incentive to continue the therapy when symptoms disperse and more immediate daily needs take prescedence. Dr. Paul Farmer showed that it was necessary to provide assistance with food and shelter to get better results while he worked With TB patients in Haiti (Kidder, 2003). While it requires extra work to bridge cultural, societal and physical barriers, studies also show a direct correlation to the amount of the care provider’s training and the success of implementing prevention and curative strategies (Khan, et.al, 2006).
What training and special protective measures are required by nurses to implement the third nursing strategy? First there are the basics; nurses should be actively on the lookout for patients with signs and symptoms of TB, particularly in high incidence settings. “Nurses should consider a patient to be highly infectious if he has a productive cough, pulmonary cavitation on a chest X-ray, hoarseness, laryngitis, and acid-fast bacillis (AFB) on a sputum smear, and he is not on an anti-tuberculosis drug regimen” (ICN TB Guidelines, 2004). In most cases, it is reportable to a state agency if there is a strong suspicion of infection. The suspected patient should be isolated and started on anti tuberculin drugs before confirmation of lab work. Instruct the patient to cover coughs and sneezes with a tissue or even to wear a mask. It is important that the tuberculosis (Mantoux / PPD) skin test be used as opposed to the older “Tine” test (four pin pricks), which has been deemed unreliable. Chest x-rays are often ordered as a follow-up. This illustrates the need for specialized training and indeed it is possible to become a TB specialist nurse. The work includes contact tracing to find the original carrier and screening close contacts. Being sensitive is also important as the patient may feel responsible for infecting others. The most important aspect of care is ensuring completion of the prescribed therapy. This may require the nursing support to be individualized and flexible.
It is not too hard to see how TB has spread beyond the breeding pools and into the general population and thus this emphasizes the importance of the nurse’s role in treatment and continuous monitoring. Underserved populations present unique challenges outside the classic nurse-patient model. However with diligence toward public education and one’s own education and training, and a little tenacity and flexibility, a nurse can make a difference with overlooked populations.


Boutotte, J., (2000), AFB isolation rounds: What your nurses need to know,
Nursing Management. 31(9), p 49(3), Retrieved October 11, 2007, from ProQuest database.

International Council of Nurses, (2004), TB guidelines for nurses in the care and control of tuberculosis and multi-drug resistant tuberculosis, Retrieved October 10, 2007, from http://www.icn.ch/tb/guide_chap2.htm.

Khan, K., Campbell, A., Wallington, T., Gardam, M., (2006), The impact of physician training and experience on the survival of patients with active tuberculosis, Canadian Medical Association. Journal, 175(7), p 749-753, Retrieved October 09, 2007, from ProQuest database.

Kidder, T. (2003), Mountains beyond mountains: The quest of Dr. Paul Farmer, a man who would cure the world. New York: Random House.

MacNeil, J., Lobato, M., Moore, M., (2005), An unanswered health disparity: tuberculosis among correctional inmates, 1993 through 2003, American Journal of Public Health. 95(10), p 1800-5 (6), Retrieved October 11, 2007, from ProQuest database.

Schwalbe, N., Harrington, P., (2002), HIV and tuberculosis in the former Soviet Union, The Lance, 360, p 19-20, Retrieved October 09, 2007, from ProQuest database.

Selekman, J., (2006), Changes in the screening for tuberculosis in children, Pediatric Nursing, 32(1), p. 73 (3)

New Verbiage

There are often barriers to any educational nursing intervention but specifically in the realm of teaching about Tuberculosis, several disadvantages are the misinformation that exists and the discrimination experienced. Effective education by nurses must over come myths such as the belief that TB has been eradicated, at least in the developed countries. People are often shocked when they hear the diagnosis because they believe it leaves them stigmatized and unclean. They believe that only the down & out get TB, yet people from all social strata get TB. Some believe smoking causes it, or that it is hereditary. The second disadvantage to education is the fear of immigration authorities, language and cultural barriers, financial restraints, lack of health insurance and inadequate housing are factors that are often compounded by co-infection with other disease processes such as HIV. Dr. Paul Farmer found that education about compliance was highly affected whether you had adequate shelter and food, or to put it another way when you are starving you aren’t so concerned about a missed dose even if it’s free (Kidder, 2003).
In Africa TB rates are high and effectiveness of treatment low. A lot has to do with the linking of TB to AIDS and inherit problems with teaching about that disease process. “Limited funding, governmental indifference or opposition, AIDS stigma, and social discomfort discussing sex were often cited as barriers.
It is not just enough to identify at risk populationsas a nursing invervention. The factors that make them hard to find, diagnose & treat are also factors that make them non-complainant with their treatments. Patients with or at risk for TB face discrimination, often because of its association with AIDS. Also, prison inmates homeless, drug users and immigrants from certain high risk countries are not often policy makers first priorities, if indeed, they are on the radar at all.
In Africa, the stigma of AIDS prevents people from readily seeking help until other disease processes including TB are well entrenched. Additionally wars and famine make a shambles of health care systems the populations become transient.
Prisoners face several of these problems. Often there is little staffing and little sympathy for the care of inmates. With limited resources it is hard to convince policy makers that $ and drugs should be used on this lowest caste of society. There are additional compliance/containment problems that typical nursing interventions are not geared toward. In some prisons, it was discovered that prisoners would sell their medication or deliberately swap sputum samples. Some actually wanted to be sick to stay in the much nicer conditions that the infirmary afforded with no work duty assigned. Conversely, some inmates, believing it would hinder their release dates, bought clean sputum samples, or bribed poorly paid prison medical staff (MacNeil, 2005).

Another problem is that government officials may not wish to acknowledge problems with treatment programs. Conversely government officials may have their own idea of what their own treatment program should look like and be dismissive of foreign intervention or non-profits whom they may feel are “irrelevant or even a nuisance.” (Naidoo, 2001)

Bibliography – New Research

Kelly, C., (2006) Psychological and socio - medical aspects of AIDS/HIV (Programs, resources, and needs of HIV-prevention nongovernmental organizations (NGOs) in Africa, Central/Eastern Europe and Central Asia, Latin America and the Caribbean. AIDS Care, 18(1), p. 12- 21, Retrieved from Proquest database January 30, 2008

Naidoo, K. (2001), The role of the nonprofit sector. In C. E. Koop, C. Pearson & M. Schwarz (Eds.), Critical issues in global health (pp. 406-415). San Francisco: Jossey-Bass.

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Reducing Medication Errors With Technology

Providing patient safety is one of the primary responsibilities within the nursing profession. Medication errors not only threaten the patient, they threaten the nursing profession. Roy Simpson (2005) brings to light that nurses are associated with more patient deaths and injuries than any other healthcare profession. This is related to the total time spent with the patient, a shortage in the workforce and weaknesses in operational practices and protocols (Simpson, 2005). Today’s nurse needs to be able to navigate through these obstacles and rely on other resources beyond the “five rights”. Bar code and point-of-care technologies contribute to verification of the five rights, improve workflow and allow for communication between different disciplines. Studies, such as those by Paoletti, Suess, Lesko, Feroli, Kennel, Mahler and Saunders (2007), show a substantial reduction in medication errors in clinical settings that have employed such technology. Information technology provides the means by which a nurse can reduce medication errors, insure patient safety and safeguard the nursing profession in today’s clinical setting.
The nursing shortage has a direct impact on medication errors in the clinical setting. The shortage has led to longer hours and frequent shifts resulting in additional stress and fatigue. As a result, nurses have been associated with an increase in medication errors within the clinical setting (Simpson, 2005). The five rights of right dose, route, drug, time and patient are dependent on the nurse’s ability to identify inaccuracies at the patient bedside. This system becomes compromised when the user is drained and unfocused. Bar code and point of care technology addresses the human error factor by automating the five rights (Wolf, 2007). The process involves scanning the identifying bar codes of the nurse, patient and the medication to be administered. Information is processed through various software systems accessing the patient’s medical profile and comparing it to physician orders and pharmacy protocol. A contradiction of any of the five rights results in an alert, prompting the nurse to further investigate before administering the medication and preventing a possible error.
As technology grows so has the capability of the nurse to go beyond the five rights. Enhancements are capable of alerting nurses to medications that are contraindicated due to vital signs, allergies and/or lab values. This is especially beneficial when giving cardio glycosides and electrolyte supplements. Indicators can caution nurses when using high-risk drugs, such as insulin and heparin, preventing lethal dosing. Errors associated with look-alike/sound-alike drugs can be avoided with customized comments and warnings (Grissinger & Globus, 2004). Information technology allows healthcare providers to customize systems to address the specific needs and barriers of the clinical setting.
In addition to notifying the nurse of potential problems, point of care technology broadens a nurse’s knowledge base by allowing access to the most up to date information at the patient’s bedside (Simpson, 2005). Medicine is constantly advancing and medications are constantly being introduced, updated or, in some cases, taken off the market. Systems can access data regarding new medications, medication/herbal supplement reactions, and signs and symptoms of adverse reactions. This allows nurses to make more informed decisions, faster, resulting in better patient care (Simpson, 2005).
Errors in charting have contributed to the rise medication errors and patient injuries. Patient care and medication administration is dependant on the accuracy, detail and up to date documentation by all team members. Staffing shortages and unpredictable workflow often require nurses to chart at the end of their shift increasing the potential for error (Simpson, 2005). Bar code, point of care technology allows for the nurses to electronically chart patient care and medication administration in real time at the patients bedside. This reduces the risk of errors associated with handwriting, omission and transcription (Paoletti, et al., 2007). Additionally, the time that is spent charting during a shift (which is projected to consume 13%-28% of a nurses total shift) can be focused back toward direct patient care (Braswell & Duggar, 2006).
Data collected from bar code, point of care technology allows nursing managers and pharmacist to generate reports identifying factors that can lead to medication errors. Nurse managers are able to track compliance and address training or other issues as necessary (Braswell & Duggar, 2006, p.14). Pharmacist can use the data to identify opportunities for improvement in storage strategies for medications in nursing-unit decentralized cabinets, separation of look-alike products and formulation differences within the pharmacy department (Paoletti et al., 2007, p 540). The ability to identify the origin of error is the first step and a proactive resource in bringing about positive change. This results in opening lines of communications between the disciplines in the effort to resolve obstacles that might result in error.
The need to incorporate information technology in the clinical setting can be observed in the Paoletti et al. (2007) study at Lancaster General Hospital. Medical observers reported 188 errors related to medication administration prior to the implementation of electronic medical administration records and bar-code medication administration. The errors included wrong time, wrong technique, wrong dose, extra dose, wrong medication and wrong formulation. It was found that errors were more likely to occur at the point of medication administration because safety nets relied on nurses to remember, identify and resolve discrepancies at bedside (Paoletti et al., 2007, p.538). Moreover, of the 188 errors observed, none of them were reported or identified by staff members. Paoletti et al. (2007) assert that the reporting of errors is dependant on the willingness of the provider to file a report. Many of theses errors may be unknowingly committed or go unnoticed by the provider. One can therefore conclude that the prevalence of medication errors is much higher and a greater threat than once understood.
Facilities that have implemented information technology into their medication administration protocol have seen positive results. Lancaster General Hospital had a 54% reduction in medication errors after implementation (Paoletti et al., 2007). Braswell and Duggar (2006) report that the Spartanburg Regional Health System had error rate reductions as high as 78% after implementing bar code, point of care technology systems. Paoletti et al. (2007) write that subsequent to implementation reports were generated identifying possible and prevented errors. Nursing managers were able to use the data to implement training programs to address areas of opportunity. Pharmacy and nursing communication and collaboration during the implementation phase resulted in improved interdepartmental relationships. The commitment to a safer environment has not only been appreciated by patients and nurses, but has served as a recruiting tool for new nurses.
In summary, information technology has a place at the patient’s bedside and within the nursing profession. As the number of qualified nurses begins to diminish, the reliance on technology becomes greater. Wolf (2007) declares that errors will be reduced with the assistance of technology. Technology complements the way a nurse works by supporting the five rights, improving workflow and enhancing communication. The end result is a safer environment for both the patient and the nursing profession.

a. Intervention #1 Bar-coded medication administration
i. Disadvantage 1. Automation of the five rights leads to a decline in nursing diligence.
In its efforts to make the process safer, the administration of medication with the use of bar code technology can lead to a reliance on the system alone (McDonald, 2006). A nurse must still rely on his or her knowledge base as the primary source for decision-making. Automation can lead to a knowledge deficits in different aspects of the nursing profession. With the demands put on today’s nurse (in terms of staffing issues, patient to nurse ratios and high patient demands), nurses are more tempted to look for shortcuts. Bar coding systems are set in place to support the current protocol of addressing the five rights before administrating medication to a patient. McDonald (2006) asserts that systems can create new kinds of errors if not accompanied by well-designed, well-implemented crosscheck processes and a culture of safety.

McDonald, C. (2006, April 4) Computerization can create safety hazards: a bar-coding near miss. Annals of Internal Medicine, 144(7), 510-516. Retrieved February 1, 2008 from Academic Search Premier database.

ii. Disadvantage 2. Hardware and software systems associated with bar coded medication administration are susceptible to technical issues.
Bar-coded medication administration and its users rely on a wireless apparatus capable of connecting to the main system. When hardware and software systems are unable to communicate, the system, as a whole, becomes ineffective. Elizabeth Mims, nurse consultant for the Veterans Health Administration National Bar Code Medication Administration Joint Program Office, noted that problems with wireless transmission can occur due to steel beams in older buildings, rooms with lead shielding, and closed doors (Traynor, 2004). Additional issues include slow response/download times, equipment problems, missing armbands, and illegible barcodes (Heinen, 2003). Technical issues, and the lack of experience and expertise to overcome them, can be costly, frustrate users, disturb workflow, and jeopardize patient safety.

Heinn, M., Coyle, G., & Hamilton, A. (2003, October). Barcoding makes its mark on daily practice. Nursing Management, 34(10), 18-20. Retrieved February 1, 2008 from Academic Search Premier database.

Traynor, K. (2004, October 1). Details matter in beside barcode scanning. American Journal of Health- System Pharmacy, 61(19), 1987-1988. Retrieved February 1, 2008 from Academic Search Premier database.

b. Intervention 2. Point of care technology and electronic patient charting
i. Disadvantage 1. Although point of care technologies and electronic patient charting can provide great benefits, it is also susceptible to infringement on ones medical condition and/or history. Leah Curtin (2005) stresses that the information contained in these databases offers enormous opportunities for prejudice and financial gain. A patient’s medical record, both past and present, is vulnerable to anyone with ability to bypass the safeguards put in place to protect those records (Curtin, 2005). A patients right to confidentiality, and the process put in place by HIPPA to protect that confidentiality, can all be threatened as information is more readily available to a larger number of people. As Curtin (2005, p 352) asserts, healthcare informatics involves healthcare, ethics and informatics – and its practioners must, for the public’s good, be bound by additional ethical, moral and legal responsibilities.

Curtin, L. (2005, October). Ethics in nursing administration. Ethics in informatics: the intersection of nursing, ethics, and information technology. Nursing Administration Quarterly, 29(4), 349-352. Retrieved February 1, 2008 from CINAHL database.

ii. Disadvantage 2. Access to patients’ charts and medical history is dependant on the compatibility of the systems being used.
It was thought that the information maintained on electronic patient charting and patient data would be easily accessible. Philip Darbyshire (2004) states that the basic function of systems being able to “talk to each other” has been one if its shortcomings. Clinicians get little benefit in a system that cannot communicate and/or integrate with other patient care data bases located in various clinics, hospitals, and labs (Darbyshire, 2004). Information entered in point of care systems and electronic patient charts can only be useful if obtainable. Access to a patient’s complete medical history leads to more informative decision making and better patient outcomes.

Darbyshire, P. (2004). ‘Rage against the machine?’: nurses’ and midwives experiences of using computerized patient information systems for clinical information. Journal of Clinical Nursing, 13(1), 17-25. . Retrieved February 1, 2008 from CINAHL database.


Braswell, A., & Duggar, S. (2006, October). The new look of beside technology. Nursing Management, 37, 14-32. Retrieved November 7, 2007, from Academic Search Premier database.

Curtin, L. (2005, October). Ethics in nursing administration. Ethics in informatics: the intersection of nursing, ethics, and information technology. Nursing Administration Quarterly, 29(4), 349-352. Retrieved February 1, 2008 from CINAHL database.

Darbyshire, P. (2004). ‘Rage against the machine?’: nurses’ and midwives experiences of using computerized patient information systems for clinical information. Journal of Clinical Nursing, 13(1), 17-25. . Retrieved February 1, 2008 from CINAHL database.

Grissinger, M., & Globus, N. (2004, January). How technology affects your risk of medication errors. Nursing, 34(1), 36-42. Retrieved October 31, 2007, from CINAHL database.

Heinn, M., Coyle, G., & Hamilton, A. (2003, October). Barcoding makes its mark on daily practice. Nursing Management, 34(10), 18-20. Retrieved February 1, 2008 from Academic Search Premier database.

McDonald, C. (2006, April 4) Computerization can create safety hazards: a bar-coding near miss. Annals of Internal Medicine, 144(7), 510-516. Retrieved February 1, 2008 from Academic Search Premier database.

Paoletti, R., Suess, T., Lesko, M., Feroli, A., Kennel, J., Mahler, M., et al., (2007, March 1). Using bar- code technology and medication observation methodology for a safer medication administration. American Journal of Health-System Pharmacy, 64(5), 536-543. Retrieved November 3, 2007, from CINAHL database.

Simpson, R. (2005, January). Patient and nurse safety. Nursing Administration Quarterly, 29(1), 97-101. Retrieved November 3, 2007, from CINAHL database.

Traynor, K. (2004, October 1). Details matter in beside barcode scanning. American Journal of Health- System Pharmacy, 61(19), 1987-1988. Retrieved February 1, 2008 from Academic Search Premier database.

Wolf, Z. (April, 2007). Pursuing safe medication use and the promise of technology. MEDSURG Nursing, 16(2), 92-100. Retrieved November 3, 2007, from CINAHL

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Final Research Paper for Megan Dempsey

Measles, also known as rubeola, is a highly contagious, airborne disease transmitted by infected people. Most people live in parts of the world where vaccinations and immunity are a way of life. In six countries, including the United States, measles deaths are at near zero today (Otten, Okwo-Bele, Kezaala, & Brellick, 2003).

A Continuing Need

The Measles Initiative, A Continuing Need

Measles, also known as rubeola, is a highly contagious, airborne disease transmitted by infected people. Most people live in parts of the world where vaccinations and immunity are a way of life. In six countries, including the United States, measles deaths are at near zero today (Otten, Okwo-Bele, Kezaala, & Brellick, 2003). Still, many people around the world do not have access to these vaccinations, and are therefore susceptible to many diseases that have nearly been eradicated in first world countries, such as the United States. The World Health Organization recognized a need to create a new vaccination program to immunize African children and adults against the number one killer of preventable disease in their country, measles. As a united front, the World Health Organization, The American Red Cross, The United Nations Foundation, The Bill Gates Foundation, and The United States Center for Disease Control and Prevention created The Measles Initiative, as a solution for the measles epidemic in effected regions of the world. The Measles Initiative was put in motion to prevent unnecessary deaths of innocent children and adults by the simple use of a $1.00 vaccination. In addition to saving lives, this global vaccination program will help stop the spread of a highly contagious disease, in hopes of eradicating the measles virus for good.
The measles vaccine has been in use for forty years, but it was not until 1974 that global measles vaccination programs were put into effect (Wolfson, 2007). These programs have since been categorized into three phases. The first phase began in 1974, with high hopes of introducing routine measles vaccinations to almost every country in the world. UNICEF then led a universal childhood vaccination program that started the second phase. The second phase started in the 1990’s and continued to 1999 with the administration of one vaccination at 9 months old to children in 47 countries (Elliman & Bedford, 2007). The second phase found failure when school age children were found to contract the disease, due to not responding well to the vaccination at 9 months old. It was in 1999, when the WHO, UNICEF, The Bill Gates Foundation, and The American Red Cross united to create The Measles Initiative to vaccinate children age 9 months to 14 years old. The third phase would involve two vaccinations, at least three years apart, with scientific research showing that two vaccines are more effective than one (Elliman & Bedford, 2007).
The partnership of each group involved in The Measles Initiative is crucial because each group bears a different responsibility. The WHO designs the policies and health guidelines for each country to ensure proper, safe steps are taken during immunization campaigns. UNICEF is the only organization allowed to import the vaccine into most developing countries and has a sophisticated logistics capacity as well as great stature in the country. The CDC provides funding and the technical and scientific information to the campaign. The UN Foundation provides a substantial amount of funding as well as the financial mechanisms necessary to move funds between agencies and to countries. The American Red Cross provides funding and has the network of Red Cross volunteers to do the work, ensuring each child has a chance to be vaccinated. The Bill Gates Foundation provides funding (Measles Initiative, 2006).
With all of these groups coming together, the vaccination of over 80 million children started in Sub-Saharan Africa, an area of the world that was responsible for over half of the worlds measles deaths, causing 45% of vaccine preventable deaths (Otten, Okwo-Bele, Kezaala, & Brellik, 2003). The Measles Initiative would continue all over the world and wherever there was a need, there would be a vaccine against measles. The Measles Initiative set a goal to cut global measles deaths by 90% by 2010 (Measles Initiative, 2006).
In 2005 Otten, Kezaala, Fall, Maresha, Caimes, & Eggers (2005) found that between December, 2000- June of 2003, the average decline in the number of reported cases was 91%. The total estimated deaths averted in 2003 were 90,043. The initiative has been wildly successful and is still in progress. In 2005 the number of reported measles-related deaths around the world was at 345,000, which is a 60% decrease from 1999’s reported number of deaths of 873,000 (Irby, 2005). In continuing with this success, The Red Cross wants to ensure that The Measles Initiative steadily moves across the globe to vulnerable regions like Asia, where measles deaths are the highest outside of Sub-Saharan Africa and to smaller countries such as Pakistan, and Uzbekistan. With theses programs, health workers provide not only measles vaccines, but also insecticide-treated nets for malaria prevention, vitamin A, de-worming medication and polio vaccines (Irby, 2005).
The follow up campaigns have proven to be successful all over the world. And it has even been suggested that receiving the measles vaccine could act as a non-specific immune boost to give added protection against other diseases, but further research is needed to confirm this (Salama, Mcfarland, & Mulholland, 2003). There is still a need to continue with vaccination campaigns in Africa. Between 2003-2005, citizens of Mozambique were ravaged with a measles outbreak. There were 1,676 confirmed cases in just three years (Nshimirimana, et all, 2006). This was from failure to vaccinate enough of the population to prevent the endemic proving the absolute importance that even those in remote areas of the world must be vaccinated due to the virus’s airborne ability to infect. In 2004 and 2005, there were several large outbreaks in the European Region. The outbreaks in Romania and the Ukraine were the source of measles outbreaks in a number of EU countries, countries in which the government had reported that measles were under control (Spika, 2006). This exemplifies that measles can still effect vulnerable and non-vulnerable populations alike.
The necessity to eradicate vaccine-preventable diseases is overwhelming. Many of these diseases are highly contagious and there are no walls to protect us from the infected. Everyday people travel from region to region carrying unknown diseases. Diseases, such as measles, are capable of wiping out at-risk populations where treatment and medications are remote. We are fortunate to have access to vaccines that our bodies respond to with immunity. The measles vaccine, when given in two doses, is nearly 100% effective against the virus, but whether we can totally eradicate the virus with global vaccination is debatable. Eradication is possible due to the fact the virus in monotypic and unable to mutate (Spika, 2006). The lack of an animal reservoir and the fact that this is an acute, not chronic, illness makes eradication possible. The problem still remains that measles is a highly contagious disease, making it necessary to vaccinate every child, including those in remote areas of the world (Spika, 2006).
With continuing measles vaccination programs and with the united support of major health organizations such as UNICEF, the WHO, The American Red Cross, and the CDC, eradicating measles becomes more of a possibility every time a child is vaccinated. The measles vaccination has been shown to save tens of thousands of lives and the need to vaccinate against measles will continue until the final goal of measles eradication is met.
a. Intervention 1 Immunize every child in Africa against Measles
i. Disadvantage 1 It is extremely unlikely that every child in Sub-Saharan Africa will be found by members of the Measles Initiative due to the topography of the country
1. Sub-Saharan Africa’s climate and topography make it extremely difficult to account for its total population. “Despite colonialism, African remains powerfully itself, moulded by its hard environment” (Otten,2003). The problems of finding those in need of medical care are usually compounded by a collapse in basic infrastructure; broken roads and bridges, and continued insecurity (Otten, 2003).. It is difficult to maneuver through the terrain to find tribal groups that are “hidden” from society. The measles initiative would like to vaccinate every child in Africa, but this seems unlikely due to the fact that there are people unaccounted for in a country that is divided by desert, mountains, vast forest and war.

Otten, J. The suffering of millions. (2003, June). New African,(419), 59. Retrieved February 4, 2008, from Platinum Full Text Periodicals database.

ii. Disadvantage 2 There is knowledge deficit amongst some of Africa’s population that the immunization is necessary.
1. Many people In Africa are more concerned with short-term survival than minded to take risks for long-term development. Tribal people in the Congo region live in a warring county, their primary concern is to survive the day. These people have more eminent concerns such as what they are going to eat and drink for the day rather than the need for vaccinations. Knowledge deficit is a problem because they are surviving, but their children are dying from diseases like measles, that could have been prevented from a simple vaccine. It is important to teach the need of vaccinations, not only individually, but also globally, as measles cannot be eradicated unless every individual is immune (Culligan & Welsh, 2001).

Tim Cullinan, James Welsh. (2001). The problems of medical relief agencies. The Lancet, 357(9257), 713-4. Retrieved February 4, 2008, from Platinum Full Text Periodicals database

Intervention 2 Give a booster shot of the measles vaccine to the same children at least three years apart from the time it was first given,
i. Disadvantage 1 Record keeping if Africa is modest due to the socioeconomic status of certain rural parts of the country.
1. Immunization records have been lost or never documented due to the fact that there is little access to computers where most records are stored safely. Paper charting has been lost. especially in tribes where travel is a way of life. This problem has led to errors in documentation of school age children who have or have not received a second booster shot to discourage a measles outbreak during early education. The booster shot is necessary to prevent further outbreaks and spread of such a highly contagious disease. As the child gets older, vaccination records have become more and more obscure (Alan,Lifton,Thai,Kaying, & Hang, 2001), This potentiates the need to vaccinate school age children against measles and other threatening diseased where there are either no documents of incorrect document of the child’s past medical history. In Sub-Saharan Africa, there are few computers and even fewer dollars to provide accurate accounts of medical history (Alan et all, 2001).

.Alan R. Lifson, Dzung Thai, Kaying Hang. (2001). Lack of Immunization Documentation in Minnesota Refugees: Challenges for Refugee Preventive Health Care. Journal of Immigrant Health,3(1), 47-52. Retrieved February 4, 2008, from Research Library database..

ii. Disadvantage 2 African tribes travel due to political unrest, making it difficult to find the children who are in need of a booster shot.
1. Political unrest and a warring state have caused people to leave their homes and communities. . Some of these people go into hiding to escape the consequences of war. This makes it extremely difficult to find those children in need of a second measles shot as well as other vaccinations. The reality of this has shown that the measles epidemic is still a problem in Africa because school age children need a booster to keep them immune from the disease. Aid workers cannot find these displaced children to give them the immunization that are necessary

Richard Dowden (2005, March). To save Africa we must listen to it. New Statesman, 18 (850), 18-20. Retrieved February 4, 2008, from Platinum Full Text Periodicals database.


Alan R. Lifson, Dzung Thai, Kaying Hang. (2001). Lack of Immunization Documentation in Minnesota Refugees: Challenges for Refugee Preventive Health Care. Journal of Immigrant Health, 3(1), 47-52. Retrieved February 4, 2008, from Research Library database. (Document ID: 352546391)
Carlson, L. (2007, March). Immunization update: neonates to adolescents. Nurse Practitioner, 32(3), 49-57.

Fitzpatrick, M. (2007, May 24). An End to the MMR guilt trip for blameless parents. Community Care, Community Care 1674, 23.

Nshimirimana, D., Masresha, B.G., & Maumbe, T. . (2006, September 22). Effects of measles-control activities--African region, 1999-2005 MMWR: Morbidity & Mortality Weekly Reportt
55, 1017-1021.

Otten, M. W., Okwo-Bele, J. M., & Kazaala, R. (2003, May 15). Impact of Alternative Approaches to Accelerated Measles Control: Experience in the African Region. Journal of Infectious Diseases 187, 36-43.
.Richard Dowden (2005, March). To save Africa we must listen to it. New Statesman, 18(850), 18-20. Retrieved February 4, 2008, from Platinum Full Text Periodicals database. (Document ID: 810330381).
Tim Cullinan, James Welsh. (2001). The problems of medical relief agencies. The Lancet, 357(9257), 713-4. Retrieved February 4, 2008, from Platinum Full Text Periodicals database. (Document ID: 69559122).

The suffering of millions. (2003, June). New African,(419), 59. Retrieved February 4, 2008, from Platinum Full Text Periodicals database. (Document ID: 349264441).

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