Hospital Acquired Pneumonia Discussion: Organizational Policies and Practices to Support Healthcare Issues
Quite often, nurse leaders are faced with ethical dilemmas, such as those associated with choices between competing needs and limited resources. Resources are finite, and competition for those resources occurs daily in all organizations.
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For example, the use of 12-hour shifts has been a strategy to retain nurses. However, evidence suggests that as nurses work more hours in a shift, they commit more errors. How do effective leaders find a balance between the needs of the organization and the needs of ensuring quality, effective, and safe patient care?
In this Discussion, you will reflect on a national healthcare issue and examine how competing needs may impact the development of polices to address that issue. Hospital Acquired Pneumonia.
To Prepare:
• Review the Resources and think about the national healthcare issue/stressor you previously selected for study in Module 1. NOTE: The national healthcare issue/stressor I addressed in module 1 is “HOSPITAL ACQUIRED PNEUMONIA. So, you are going to use this topic to answer questions related to this discussion.
• Reflect on the competing needs in healthcare delivery as they pertain to the national healthcare issue/stressor you previously examined. Hospital Acquired Pneumonia
Post an explanation of how competing needs, such as the needs of the workforce, resources, and patients, may impact the development of policy. Then, describe any specific competing needs that may impact the national healthcare issue/stressor you selected. What are the impacts, and how might policy address these competing needs? Be specific and provide examples.
Required Readings
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Author. Retrieved from https://www.nursingworld.org/coe-view-only
Note: Review all, with special attention to “Provision 6” (pp. 23–26) Hospital Acquired Pneumonia.
Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 6. doi:10.3912/OJIN.Vol23No01Man06. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Nursing-Cost-Containment.html
Milliken, A. (2018). Ethical awareness: What it is and why it matters. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 1. doi:10.3912/OJIN.Vol23No01Man01. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Awareness.html Hospital Acquired Pneumonia
Hospital-Acquired Pneumonia
Description of the National Healthcare Issue/Stressor
Hospital-acquired pneumonia (HAP) refers to pneumonia that a patient develops within a hospital setting after at least 48–72 hours after being admitted (Pássaro et al.; 2016). HAP is the second leading hospital-acquired infection and cause of death among critically sick patients. HAP is allied to an elevated rate of mortality and morbidity, as well as increased healthcare costs (Torres-García et al., 2019). According to Min et al. (2018), the incidence of HAP worldwide is 5–20 cases per 1000 admissions. The high prevalence of HAP indicates the need to address the issue.
In my healthcare organization, HAP is common among patients in the ICU, and notably patients who are mechanically ventilated. Similarly, the rate of HAP is also relatively high in patients within the medical-surgical ward and the general ward. In the organization, HAP in all units leads to an increased rate of morbidity and mortality, longer period of hospital stays, as well as increased costs for both the patient and the organization. This is consistent with other organizations where hospital-acquired infections like HAP are associated with a high mortality rate, a prolonged period of hospitalization, as well as higher healthcare costs (Pássaro et al., 2016) Hospital Acquired Pneumonia.
In the organization, the rate of HAP is particularly high among older adults, patients in the ICU, as well as patients with prolonged use of antibiotics and glucocorticoids. The high incidence of HAP among patients with lengthy use of glucocorticoids is allied to the reduced immunity that makes individuals susceptible to infections. Similarly, long-term use of antibiotics is a major risk factor for hospital-acquired pneumonia due to resistance to antibiotics. In my healthcare organization, HAP is associated with an increased rate of mortality, admission to the ICU, and an increased period of hospital stay. Besides, the organization, being a government agency, spends a lot of money on financing the treatment and care of HAP.
Summary of the Two Articles
According to Brett et al., (2019), HAP is allied to elevated morbidity and mortality rate and also increased medical costs. HAP is also a leading factor for transfer to the ICU and results in a prolonged hospital stay. Risk factors associated with HAP include advanced age, a longer period of hospital stay, being a male, dysphagia, numerous comorbidities, as well as chronic obstructive pulmonary disease (Brett et al., 2019). Brett et al. (2019) further indicate that poor oral hygiene causes a buildup of dental disease, which is a significant risk factor in HAP. Accordingly, Brett et al. (2019) explain that improved oral hygiene is effective in decreasing the rate of HAP. Other strategies that can reduce the rate of HAP include early mobilization, effective hand hygiene, proper management of dysphagia, and prevention of viral infections (Brett et al., 2019) Hospital Acquired Pneumonia.
Again, Deng et al. (2019) explain that HAP is a very common hospital-acquired infection and a leading cause of death among hospitalized patients. Multi-drug-resistant organisms (MDROs) are attributed to the numerous cases of HAPs, and particularly within the ICU and emergency departments (Deng et al., 2019). Wide usage of broad-spectrum antibiotics is attributable to bacterial resistance, one of the risk factors for HAP.
Strategies used to Address HAP
The study by Brett et al. (2019) demonstrates that interventions such as improved oral care, increased movement, and mobility, as well as dysphagia management, are effective in preventing HAP. The study indicates that improved oral care is an important modifiable risk factor for HAP. Comprehensive oral care facilitated by nurses is effective in preventing HAP as it prevents the buildup of dental plaque, which is a significant risk factor in HAP.
Increased mobilization is also an intervention that can be used in preventing HAP, especially among patients with acute ischemic stroke. The intervention involves turning the patient from “supine position to right and left lateral resting position” after every two hours and passively mobilizing the four limbs. This intervention is effective in reducing the rate of HAP. The mobilization intervention also integrates pre-operative patient education, breathing exercises, as well as pre-operative physiotherapy (Brett et al.; 2019). Brett et al. (2019) further explain that proper management of dysphagia and particularly among post-stroke patients, is essential in reducing the rate of HAP. This intervention includes nurses screening patients for dysphagia and implementing the appropriate interventions. The reason is that dysphagia is the leading cause of aspiration pneumonia. After all, food or liquids can enter the airway when patients have difficulties in swallowing and hence introduce bacteria to the lungs. Therefore, effective management of dysphagia can prevent aspiration pneumonia Hospital Acquired Pneumonia.
Preventing and treating infections caused by multi-drug-resistant organisms can go a long way in preventing HAP (Deng et al., 2019). Long-term use of antibiotics is a significant risk factor for HAP as a result of organisms’ resistance to antibiotic therapy. Interventions used to address the issue of multi-drug resistance include relieving the inflammatory reactions among patients, improving organisms’ clearance, reducing the period of mechanical ventilation, treating patients’ immunity, and increasing the success rate of ventilator weaning (Deng et al., 2019).
References
Brett M, Russo P, Cheng A, Andrew S, Rosebrock H, Curtis S, Robinsion S & Kiernan M. (2019). Strategies to reduce non-ventilator-associated hospital-acquired pneumonia: A systematic review. Infection, Disease & Health, 24(4), 229 – 239. Hospital Acquired Pneumonia.
Deng, D., Chen, Z., Jia, L, Bu J, Ye M, Sun L, Gen Y, Wen Z, Chen G & Fang B. (2019). Treatment of hospital-acquired pneumonia with multi-drug resistant organism by Buzhong Yiqi decoction based on Fuzheng Quxie classical prescription: study protocol for a randomized controlled trial. Trials, 20(817).
Min, J. Y., Kim, H. J., Yoon, C., Lee, K., Yeo, M., & Min, K. B. (2018). Hospital-Acquired Pneumonia among Inpatients via the Emergency Department: A Propensity-Score Matched Analysis. International journal of environmental research and public health, 15(6), 1178. https://doi.org/10.3390/ijerph15061178.
Pássaro, L., Harbarth, S. & Landelle, C. (2016). Prevention of hospital-acquired pneumonia in non-ventilated adult patients: a narrative review. Antimicrob Resist Infect Control, 5(43 (20).
Torres-García, M., Pérez Méndez, B. B., Sánchez Huerta, J. L., Villa Guillén, M., Rementería Vazquez, V., Castro Diaz, A. D., López Martinez, B., Laris González, A., Jiménez-Juárez, R. N., & de la Rosa-Zamboni, D. (2019). Healthcare-Associated Pneumonia: Don’t Forget About Respiratory Viruses. Frontiers in pediatrics, 7(168) Hospital Acquired Pneumonia.