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JUL – DEC 2012 VOL-13, NO.2
ROOT CAUSE ANALYSIS: A PROBLEM SOLVING TOOL FOR QUALITY IMPROVEMENT IN HEALTH CARE
*Baby S. Madasami, M. Sc (N)
ABSTRACT
Root Cause Analysis (RCA) is an analytic process designed to help identify the underlying factors that have contributed to or have directly caused a major adverse event or systems failure. The results of a RCA are typically utilized to guide and direct changes to processes, environment, and human behaviour in order to prevent or reduce the probability of such adverse events occurring in the future. It is a popular and often-used technique that helps people answer the question of why the problem occurred in the first place and seeks to identify the origin of a problem. It uses a specific set of steps with associated tools to find the primary cause of the problem, so that you can determine what happened, why it happened, and figure out what to do to reduce the likelihood that it will happen again. In this article, the various steps in RCA, its advantages, disadvantages, and its application in health care settings are discussed using a model and with examples.
Key words: root cause analysis, problem solving, MTO model, concept mapping, quality assurance
*Reader, College of Nursing, CMC, Vellore
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Robert, J. L., (2012). What is RCA? Separating the Tools from the Methodologies. Retrieved from http://www.reliabilityweb.com/art04/what_is_rca.htm
Roussel, L., & Swansburg, R. (2010). Management and leadership for nursing administrators (1st ed.). New Delhi: Jones and Bartlett.
Rustin, B., & Murray, M. (2012). Root Cause Analyses performed in a children's hospital: events, action plan strength, and implementation rates. Journal for Health Care Quality, 55-61. Retrieved from http://onlinelibrary. wiley.com/doi/10.1111/j.1945-1474.2011.00140.x/full
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Victorian Government Health Information. (2011). Root cause analysis and risk reduction action plan summaries. Retrieved from http://www.health.vic.gov.au/clinrisk /sentinel/rca.htm
Wilson, P. F., Dell, L. D., & Anderson, G. F., (1993). Root cause analysis: A tool for total quality management. Retrieved from ASQC Quality Press.http://books.google.co.in/books?id=1yqUOcZnn7MC&printsec=frontcover#v=onepage&q&f=false
Woodward, S. (2006). Learning and sharing safety lessons to improve patient care. Nursing Standard, 20(18), 49-53.
Yoder-wise, P. S. (2007). Leading and managing in nursing (4th ed.). St. Louis Missouri: Elsevier Publication.
PULMONARY THROMBOEMBOLISM: A CASE PRESENTATION
* Jamuna B. S. Rao, M.Sc (N)
** Priyalatha, M.Sc (N)
ABSTRACT
Pulmonary embolism is the migration of a clot or clot from systemic veins to the pulmonary vascular beds. More than 5, 00,000 patients are diagnosed with pulmonary embolism every year. The vast majority die due to failure of diagnosis or without prompt treatment being taken. Nurses play a pivotal role in early identification and collaborative management to rehabilitate the patients. A case study is presented in this article. The patient's clinical presentation, diagnostic measures and management are compared with the book picture.
Key Words: pulmonary thromboembolism, case study, nursing personnel, collaborative management
*Lecturer, Narayana Hrudayalaya, College of Nursing, Bangalore
** Sr. Lecturer, RAK College of Nursing, RAK Medical and
Health Science University, UAE
REFERENCES
Agarwal, R., Gulati, M., Mittal, B. R., & Jindal, J. K. (2006). Clinical profile Diagnosis and management of patients presenting with symptomatic PE. The Indian Journal of Chest Disease and Allied Sciences, 38, 111-114.
Bonow, R. O, Mann, D. L., Zipes, D. P., & Libby, P. (Eds.). (2011). Braunwald's heart disease: A textbook of cardiovascular medicine (9th ed.). Philadelphia: Elsevier Science.
Boon, N. A., Colledge, N. R. & Walker, B. R. (2006). Davidson's principles practice of medicine (20th ed.). Edinburgh: Churchill Livingston Elsevier.
Crawford, M. H., Di Marco, J. P., & Paulus, W. J. (2010). Cardiology (3rd ed). Philadelphia: Mosby Elsevier.
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2007). Nursing care plans (7th ed.). New Delhi: Jaypee publishers.
Ignatavicius, D. D., & Workman, M. L. (2002). Medical Surgical Nursing (4th ed.). Philadelphia: W. B. Saunders.
Joanna, C., Emma B., & Brian G. (2006). Hand Book of Cardiothoracic Surgery. Oxford University Press (online print).
Lewis, S. L., Heitkemper, M. M., Dirksen, S., O'Brien, P. G., & Bucher, L. (2007). Medical surgical nursing: Assessment and management of clinical problems (7th ed.). St. Louis: Mosby's Elsevier.
HEALTH STATUS AND ITS ASSOCIATION WITH SELECTED
SOCIODEMOGRAPHICS AMONG SOUTH INDIAN ADOLESCENTS
* Asha P. Shetty, M. Sc (N)., M. Phil (N)
** Ratna Prakash, M. Sc (N)., Ph. D (N)
*** Nagendra Prakash, Ph. D
ABSTRACT
Adolescence is a period of rapid life changes. India ranks number one in adolescent population in the world. Hence, health promotion of the adolescents is a key challenge to India. In our society health has been conceptualized by many ways including physical, mental, emotional, social, sexual and spiritual well being. A cross sectional survey was undertaken to assess the overall health status of adolescents in terms of physical, mental, social, sexual, and spiritual health. A sample of 1272 adolescents aged 12 to 18 years, was included in a descriptive survey. Physical health status was assessed in terms of body mass index, hemoglobin and blood pressure. Data related to mental, social, sexual and spiritual health were obtained using a self administered questionnaire. The results of the study indicated that based on the overall health status, 8.3% adolescents were in good health status, whereas majority (80%) were in moderate health status and 11.60% were in poor health status. A significant association was found between the overall health status and age, standard of education and socio economic status of adolescents. The study emphasises the need for implementation of innovative strategies for health promotion of adolescents in order to prepare them to be healthy and productive citizens of India.
Key Words: adolescents, rural, urban, haemoglobin, BMI, blood pressure, anemia
*Principal, K. Pandyarajah Ballal Nursing Institute, Mangalore
** Principal, Himalayan College of Nursing, Himalayan Institute, Uttarkhand
*** Professor, Himalayan University, Uttarkhand
REFERENCES
Bose, K., & Bisani, S. (2008). Nutritional status of rural adolescent school children in Paschim Medinipur, West Bengal. Indian Pediatrics, 45 (17), 515-516.
Chaudary, S. M, & Dage, V. R. (2008). A study of anemia among adolescent females in the urban area of Nagpur, India. Indian Journal of Community Medicine, 33(4), 253-245.
de Onis, M., Onyango, A. W., Borghi, E., Siyam, A., Nishida, C., & Siekmann, J. (2007). Development of a WHO growth reference for school-aged children and adolescents. Bulletin of the World Health Organization, 85, 660-667. Retrieved from http://www.who.int/ bulletin/volumes/85/9/07-043497.pdf
Department of Health and Human Services. (2002). 2000 CDC growth charts for the United States: Methods and Development. Mary land: Department of Health and Human Services publication. Retrieved from http://www.cdc.gov/growthcharts/2000growthchart-us.pdf
Deshmukh, P. R., Gupta, S. S., Bharambe, M. S., Dongre, A. R., Maliye, C., Kaur, S., & Garg, B. S. (2006). Nutritional Status of Adolescents in Rural Wardha. Indian Journal of Pediatrics, 73(2), 139-141.
Dubey, A. (2012). Health for adolescent girls. Retrieved from http://www.vigyanprasar.gov.in/Radioserials/4HealthforAdolescentgirls.pdf
Ignatavicius, D. D., & Workman, M. L. (2002). Medical surgical nursing: Critical thinking for collaborative care (4th ed.). Philadelphia: W. B. Saunders company.
Kariyeva, G. K., Magtymova, A., & Sharman, A. (2000). Anemia. Retrieved from http://www.measuredhs.com/ pubs/pdf/FR130/12Chapter12.pdf
Krishna, P., Prasannakumar, K. M., Desai, N., & Thennarasu, K. (2006). Blood Pressure Reference Tables for Children and Adolescents of Karnataka. Indian Pediatrics, 17(43), 491-501.
Mehra, S., & Agrawal, D. (2004). Adolescent Health determinants for Pregnancy and Child Health Outcomes among the Urban Poor. Indian Pediatrics, 41, 137-45.
Mohan, B., Kumar, N., Aslam, N., Rangbulla, A., Kumbkarni, S., Sood, N. K., … Wander, G. S. (2004). Prevalence of Sustained Hypertension and Obesity in Urban and Rural School Going Children in Ludhiana. Indian Heart Journal, 56, 310-314.
Reddy, S. V., & Nagarathanamma, B. (1993). Mental Health status among rural and urban students: A comparative study. Journal of the Indian Academy of Applied Psychology, 19(1-2), 25-30.
Singh, J., Singh, J. V., Srivastava, A. K., & Suryakant. (2006). Health status of adolescent girls in slums of Lucknow. Indian Journal of Community Medicine, 31(2), 102-103.
United Nations Children Fund. (2011). Adolescence: An age of opportunity. New York: UNICEF. Retrieved from http://www.uis.unesco.org/Library/Documents/state-world-children-adolescence-age-opportunity-education-2011-en.pdf.
World Health Organization. (2001). Iron deficiency anemia - Assessment, prevention and Control: A guide for programme managers. Retrieved from http://www.who.int/nutrition/publications/en/ida_assessment_prevention_control.pdf
World Health Organization. (2010). Obesity and public health. Retrieved from http://www.who.int/global_health_histories/seminars/presentation46b.pdf
World Health Organization. (2012a). Adolescent pregnancy. Retrieved from http://www.who.int/mediacentre/ factsheets/fs364/en/index.html
World Health Organization. (2012b). 10 facts on mental health. Retrieved from http://www.who.int/features/factfiles/mental_health/mental_health_facts/en/index.html
QUASI-EXPERIMENTAL DESIGNS
* Vathsala Sadan, M.Sc (N)., Ph.D (N)
ABSTRACT
Researchers need to consider the various challenges while designing a quantitative research study. The methodological challenge is to design a study that will yield gold standard evidence. Nurse researchers test the effect of nursing interventions by using experimental and quasi- experimental research designs. In naturally occurring health care settings, it is often difficult and impossible to conduct a true experiment for ethical and practical reasons. The researchers find it difficult to meet all the requirements of a true experiment which include manipulation, control and randomization. If researchers want to investigate causal relationships in such situations, the quasi experimental designs can be used. It is most frequently used, when it is not feasible for the researcher to use random assignment. The various types of quasi-experimental designs, their characteristics, strengths and weaknesses are presented in this article.
Key Words: quantitative research, research designs, research designs in nursing, experimental designs, quasi-experimental designs, control group designs, time series designs
*Professor, College of Nursing, CMC, Vellore
REFERENCES
Burns, N., & Grove, S. K. (2005). The practice of nursing research: Conduct, critique and utilization (5th ed.). St. Louis: Elsevier Saunders.
Gribbons, B., & Herman, J. (1997). True and quasi experimental designs. Practical Assessment, Research and Evaluation, 5(14). Retrieved from http://PAREonline.net/getvn.asp?v=d&n=14
LoBiondo-Wood, G & Haber, J. (2010). Nursing research: Methods and critical appraisal for evidence-based practice (7th ed.). St.Louis: Mosby Elsevier.
Polit, F. D., & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadephia: Lippincott Williams & Wilkins.
William, R. S. & Rodolfo, G. (2010). Quasi experimental designs. Retrieved from http://onlinelibrary.wiley.com/ doi/10.1002/978047c
ENDOVENOUS LASER THERAPY: A NEW APPROACH
FOR VARICOSE VEIN TREATMENT
* Sonia Abraham, M. Sc (N)
** Vijayalakshmi Kannan, B. Sc (N)
*** Anita K Jeyakumar, M. Sc (N)
**** Reena Santhosh, M. Sc (N)
***** Rachel Deva, B. Sc (N)
ABSTRACT
Varicose veins affect one out of two people above 50 years. They are more common in women than men. Nearly 70% of all women and 30% of men will develop some type of venous disorder due to insufficient blood circulation. The major causes, signs and symptoms, treatment, its complications and prevention of varicose veins are explained in this article. Endovenous Laser Ablation or Therapy (EVLA/EVLT) is an innovative non surgical procedure on varicose vein that offers an attractive treatment against the painful surgical ligation (or stripping) of the vein. It is a minimally invasive procedure with excellent success rate and very minimal complication rate. The indications, contraindications, and complications of this procedure are outlined in this article. It also presents the nursing management of a client who has undergone EVLT, focusing on the pre and intra operative care.
Key Words: varicose veins, endovenous laser therapy, endovenous laser ablation, nursing care
*Reader, College of Nursing, CMC, Vellore
** Charge Nurse, CMC, Vellore
*** Junior Lecturer, College of Nursing, CMC, Vellore
**** Reader, College of Nursing, CMC, Vellore
***** Tutor, College of Nursing, CMC, Vellore
REFERENCES
Almeida, J. I. (2010). What is endovenous laser? Retrieved from http://miamiveincenter.com/endovenouslaser.html
Bhimji, S., Smookler, A., & Aloi, M. (2012). Varicose veins. Retrieved from http://www.emedicinehealth.com/ varicose_veins/page14_em.htm
Black, J. M., & Hawks, J. H. (2009). Medical-surgical nursing: Clinical management for positive outcomes. St.Louis: Saunders.
Dexter, D., Kabnick, L., Berland, T., Jacobowitz, G., Lamparello, P., Maldonado, T., … Adelman, M. (2012). Complications of endovenous laser. Phlebology, 27(1), 40-45.
Elvy, M. (2005). Endovenous laser treatment. Retrieved from http://www.google.co.in/imgres?imgurl=http://www.medicalandvein.com.au/EVLT.jpg
Enzler, M. A., & van den Bos, R. R. (2010). A new gold standard for varicose vein treatment. European Journal for Endovascular Surgery, 39(1). 97-98.
Fauci, A. S. (2008). Harrison's principles of internal medicine. Chicago: McGraw Hill Medical.
Ford, K. (2011). Leg exercises for varicose veins. Retrieved from http://www.livestrong.com/article/404911-leg-exercises-for-varicose-veins/
Ignatavicius, D. D., & Workman, M. L. (2006). Medical-surgical nursing: Critical thinking for collaborative care. Missouri: Elsevier Saunders.
Ihnat, D. M. (2012). Endovenous laser ablation for the treatment of lower extremity chronic venous disease. Retrieved from http://www.uptodate.com/contents/ endovenous-laser-ablation-for-the-treatment-of-lower-extremity-chronic-venous-disease
Lew, W. K. (2011). Varicose vein surgery. Retrieved from http://emedicine.medscape.com/article/462579-overview
Lewis, S. L., Heitkemper, M. M., Dirksen, S., O'Brein, P. G., & Bucher, L. (2007). Medical-surgical nursing: Assessment and management of clinical problems. St. Louis: Mosby.
Memorial care Health System. (2012). Duplex scan. Retrieved from http://www.memorialcare.org/ medical_services/heart-care/venous-duplex.cfm
Monahan, F. D., Neighbors, M., Sands, J., Marek, J. F., & Green, C. J. (2007). Medical-surgical nursing: Health and illness perspective. St. Louis: Mosby.
Sharif, M. A., Soong, C. V., Lau, L. L., Corvan, R., Lee, B., & Hannon, R. J. (2006). Endovenous laser treatment for long saphenous vein incompetence. British Journal of Surgery, 93(7), 831-5.
The free dictionary. (2012). Venography. Retrieved from http://medical-dictionary.thefreedictionary.com/ venography
University of Maryland Medical Center. (2012). Venous doppler. Retrieved from http://www.umm.edu/ diagnosticrad/venous_doppler.htm
Wikipedia. (2012). Varicose veins. Retrieved from http://en.wikipedia.org/wiki/Varicose_veins
Woods, S. L., Froelicher, E. S. S., Motzer, S. A., & Bridges, E. J. (2010). Cardiac nursing. New York: Lippincott.
ALCOHOL DEPENDENCE SYNDROME:
THE SOCIALLY ACCEPTED EVIL
* Harini Srinivasan
ABSTRACT
One of the emerging causes for family and social disharmony is the addiction and dependence on substances, alcohol topping the list. The cost of alcohol includes financial, occupational, spiritual, social and family dysfunction. This article provides an overview of the disease which includes definition, stages, clinical manifestations, diagnosis and management. This is followed by a case study presentation. The main focus of care in this study is the family dysfunction a consequence of this social evil. The unimaginable extent of problems related to alcohol dependence syndrome is highlighted in this case study.
Key Words: alcohol, alcohol dependent syndrome, effects of alcohol, nursing care
*Fourth year BSc Nursing student (at the time of submission)
REFERENCES
Lalitha, K. (2007). Mental health and psychiatric nursing: An Indian perspective (1st ed.). Bangalore: VMG publications.
National Institute on Alcohol Abuse and Alcoholism. (2009). Alcohol alert. US Department of Health and Human Services. Retrieved from http://pubs.niaaa.nih.gov/ publications/aa10.htm
Noren, F., & Lawrence, F. (2007). Psychiatric mental health nursing (2nd ed.). United Kingdom: Delmar publications.
Raney, N. (2012). Diagnostic tools essay. Retrieved from http://creativemindcontrol.wordpress:com/2012/07/22/diagnostic-tools-essay/
Townsend, M. C. (2007). Psychiatric mental health nursing: Concepts of care in evidence (5th ed.). New Delhi: Jaypee publications.
KNOWLEDGE OF POST MENOPAUSAL WOMEN
ON CERVICAL CANCER AND ITS PREVENTION
IN A SOUTH INDIAN SETTING
* Diana Lobo, M. Sc (N)
ABSTRACT
Cervical cancer is the fifth leading cause of death in India. In order to reduce the incidence, women should possess adequate knowledge and understanding about cervical cancer, its causes, signs and symptoms, and the preventive measures. A descriptive research study was conducted in a selected community of Karnataka to assess the knowledge of postmenopausal women regarding cervical cancer and its prevention. Purposive sampling technique was used to select 50 post menopausal women. The data were collected using a structured questionnaire prepared by the investigator. The study findings revealed that majority of subjects (62%) had average knowledge and none of them had good knowledge on cervical cancer and its prevention.
Key Words: cervical cancer, knowledge, postmenopausal women
*Associate Professor, Laxmi Memorial College of Nursing, Mangalore
REFERENCES
Ali, S. F., Ayub, S., Manzoor, N. F., Azim, S., Afif, M., Akhtar, N., ... Uddin, N. (2010). Knowledge and awareness about cervical cancer and its prevention amongst interns and nursing staff in tertiary care hosptitals in Karachi, Pakistan. Public Library of Science ONE, 5(6).
Jubilier, S. J., Blanton, M. F., Blanton, P. D., Zhanq, J., Foster, D., Monk, J., ... Hanshew, D. (1996). Assessment of knowledge, attitudes and behaviours relative to cervical cancer and the pap smear among adolescent girls. Journal of Cancer Education, 11(4), 230-2.
Mohanraj, J., & Vanjeenanthammal, G. (2008). Structured teaching programme improves early detection and prevention of cervix cancer. Nightingale Nursing Times, 30(1), 24-8.
Mutyaba, T., Mmiro, F. A., & Weiderpass, E. (2006). Knowledge, attitudes and practices on cervical cancer screening among the medical workers of Mulago Hospital, Uganda. BioMed Central Medical Education, 1(6), 13. Retrieved from http://www.biomedcentral.com /1472-6920/6/13/
Sharma, P., Rahi, M., & Lal, P. (2008). A community based cervical cancer screening programme among women of Delhi using camp approach. Journal of Advanced Nursing, 35 (1), 86-8.
Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2008). Brunner and Siddhartha's Text book of Medical Surgical Nursing (11th ed.). New Delhi: Wolters Kluwer private limited.
Tharu. (2010). Cervical Cancer. Retrieved from http://m.medindia.net/patientinfo/cervicalcancer-incidence.htm
EFFECTIVENESS OF PLANNED TEACHING PROGRAMME REGARDING ADOLESCENT'S MENTAL HEALTH ON KNOWLEDGE OF
HIGH SCHOOL TEACHERS
* Priyadarshini L. Bhyrappa
** Dorothy D. Theodore
ABSTRACT
Adolescence is a critical period of human development manifested by rapid bio-psycho-social changes demanding a wide variety of adaptations to these changes. Adolescents constitute 21.4% of the total population of India. Many studies report that adolescents are prone for psychosocial problems and mental disorders. The purpose of this study was to assess the effectiveness of a planned teaching programme regarding adolescents' mental health and illness on the knowledge of high school teachers and to determine the association between certain demographic variables and the knowledge of high school teachers. A pre experimental design was adopted. Results revealed that the pre-interventional knowledge mean percentage score of high school teachers was 55%. The planned teaching programme was found to be effective at 0.001 level of significance and no association was found between knowledge and selected demographic variables. The researchers suggest that this form of educational programme should be conducted periodically to improve and update the knowledge of high school teachers.
Key Words: adolescents, mental health, mental illness, teachers
*Lecturer, Narayana Hrudayalaya College of Nursing, Bangalore
** Principal, Narayana Hrudayalaya College of Nursing, Bangalore
REFERENCES
Ahmad, A., Kalique, N., Khan, Z., & Amir, A. (2007). Prevalence of psychosocial problems among school going male adolescents. Indian Journal of Community Medicine, 32, 217-221.
Boyd, M. A. (2008). Psychiatric nursing contemporary practice (4th ed.). New Delhi: Wolters Kluwer.
Family Planning Association of India. (2010). Health camp for adolescent girls in urban slum of Mumbai. Retrieved from http://fpaindiamumbaibranch.blogspot.in/
Kurumatani, T., Ukawal, K., Kawaquchi, Y., Miyata, S., Suzuki, M., Ide, H., … Uemoto, M. (2004). Teacher's knowledge beliefs and attitude concerning schizophrenia. Social Psychiatric Epidemiology, 39, 402-409.
Nizami, A., Aslam, F., Minhas, F. A., Raza, S., Genel, S., & Tetik, B. (2008). Mental health education intervention for training teachers in areas affected by earth quake. Journal of Pakistan Psychiatric Society, 4, 60-62.
Sharma, R., Grover, V. L., & Chaturvedi, S. (2007). Suicidal behavior amongst adolescent students in south Delhi. Indian Journal of Community Medicine, 32, 219-221.
Stuart, G. W, & Laraia, M. T. (2005). Principles and practices of psychiatric nursing (8th ed.). St Louis, Missouri: Mosby.
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