Effects Of Good Oral Hygiene Health And Social Care Essay

Effects Of Good Oral Hygiene Health And Social Care Essay This paper aims to review the literature surrounding the chosen intervention of oral hygiene. Specifically the effects of good oral hygiene of ventilated patients in a critical care environment. The intervention was selected after the author completed an 8 week placement in an ICU department and to improve evidence-based practice. To retain anonymity the name of the hospital will not be disclosed this complies with the NMC code of professional conduct (2008). It was based on an Intensive Care Unit (ICU) that specialized in the care of level 2 and 3 patients with neurological problems. The majority of the patients on this unit were on advanced respiratory support such as ventilators as well as having with support other vital organ systems. It was noted by the author during the placement that there was a high incidence chest infections. This may have been related to the patients oral hygiene despite the unit adhering to a strict cleansing regime and trust policy/protocols. Firstly, the department adhered to the current recommendations outlined by National Institute for Clinical Excellence (NICE, 2008). NICE states that to reduce the risk of pneumonia in patients on a ventilator patients should be in a semi upright position. Also that some sort of antiseptic is used within the mouth care routine for the patient. These are very vague guidelines and the writer feels further investigation is needed to claify what is best standard practice for mouth care. Intensive care patients have complex oral care needs, inadequate oral care can predispose ICU patients to nosocomial infections such as pneumonia (Ruffell and Admcova, 2008). Ventilator Associated Pneumonia (VAP) is defined as a nosocomical pneumonia that develops in a patient who has been on mechanical ventilary support (intubated) for 48 hour or more (Hutchins et el, 2009), it is a recognised problem in intubated patients, as well as a important cause of morbidity and mortality. In European Prevalence of Infection in ICU study (Vincent et al, 1995) VAP was the most frequent infection accouting for 45% of all infections in ICUs Recent evidence indicates the colonization of the mouth with respiratory pathogens may contribute to VAP. VAP has been associated with increase morbidity, higher mortality rates, increased healthcare cost and longer hospital stays(Hutchins et el,2009).VAP is the leading source of death due to nosocomicalinfection in ICUs (Berry, 2007) Upon reflection, it was observed that there was a high prevalence of VAP on the ward despite the use of high impact interventions such as ventilator care bundles prescribed on the ward. (Saving Lives, 2007) The Health Act 2006 Code of Practice also states that the NHS organisations must audit key policy and procedures for infection control.This included brushing with toothpaste and a small toothbrush, chlorhexidine rinses, suctioning, checking cuff inflation, humidification of and a semi recumbarant positioning. This underpins the rational for selecting the nursing intervention of oral mouth care in VAP prevention. The author felt by reviewing the relevant literature surround the use over mouth care products and associated research the extent to which current literature support or question current evidence based guidelines, could anything else be done to prevent all these infections. Gash defined a literature review as a systematic and thorough search of all types of published literature in order to identify as many items as possible that are relevant to a particular topic (Gash, 2000). Due to the time constraint and the limited number of words allowed the search has been specifically narrowed down and utilised the appropriate and relevant literature. The key words used in the search were oral hygiene and intensive care, with the variants of oral decontamination, mouth care, intubated and mechanically ventilated. The research strategies for selecting literature to review for this paper involved the following databases where searched using EBSCO CINAHL, OVID MEDLINE, Cochrane Library search engines this returned 10224 hits, The search was then narrowed through filtering to only include the core clinical journals or academic papers. The inclusion criteria included research studies and reviews which focused on the oral hygiene in a intensive care setting, articles in this review where published in the last 10 years, focused on adults and written or translated into English. This produced 123 papers, with a search manually finding only 9 that where relevant and will be discussed below. Oral Hygiene effective removal of plaque and debris to ensure the structures and tissues of the mouth are kept in a healthy condition (DOH, 2001). Effective oral health care makes an important contribution to peoples physical, psychological and social well being (Major, 2005). Maintaining oral health in the critically ill patient is imperative in reducing the risk of nosocomial infections and improving patient comfort and discharge outcomes. Critically ill patients are at great risk for poor oral health as many are elderly, undernourished, dehydrated, immunosuppressed, have a smoking or alcohol history, are intubated or on high-flow oxygen, and are unable to mechanically remove dental plaque.(AUS, 2003). Mircoaspiration may occur in patients with a depressed conscience level and reduced cough effort ability, or with a ill fitting or a partially deflated fitting cuff around the endotracheal tube. Critically ill patients lack of spontaneous movement of the tongue movement of the tongue and jaw, infrequent swallowing, and ability to brush teeth because of ventilation equipment as early as 24 hours after ICU admission. (2) Having read through all the research it is evident that studies are contradictory. For example Hutchins (2009) believes the gold standard of oral hygiene is suctioned toothbrushes every four hours followed by Chlorhexidine mouth wash. This reduced VAP by 90% in their study over three years, however can this study be valid as there was no control group or randomization. Furthermore, is research completed in America transferable to the UK. This study was not designed as a RCT but rather as a quality improvement initiative. There was also no numbers of the study size only that all patients ventilated where included over a period of time. Therefore, it could be argued that this study required a sample to measure findings, also completed in America where they have a different a private health care structure and high budgets and funding. Hutchins states the oral hygiene should be completed every 4 hours but The Essence of Care (2001) document emphasises the importance of assessing individu als, in relation to how their oral hygiene can be maintained with its best practice bench mark: All patients/clients are assessed to identify the advice and/or care required to maintain and promote their individual oral hygiene (DOH, 2001). So to do Mouth care on a patient every 4 hours when it needs to be done every hour is unethical, And if the patient only needs mouth care twice a day and your completing every 4 hours this is a waste of nursing time. Maintaining patient safety when administrating mouth care so not to dislodge the endotractcal tube, failing to remove all the toothpaste and mouth wash, putting the patient at risk of aspiration, are all expressed concerns by nurses as concerns when doing mouth care. These reasons as well as patient comfort all influence the nurse to the frequency of mouth care (Berry and Davidson, 2006). Unfortunately, emphasis on the provision of oral care hygiene is allocated as a low priority in nursing duties and student teaching(Berry and Davidson, 2006) although considered to be a basic nursing practice it is relegated to the bottom of the list of duties when caring for a complex intensive care patient. A paper written in 2003 found that Reinforcing proper oral care in education programmes, de-sensitizing nurses to the often-perceived unpleasantness of cleaning oral cavities, and working with hospital managers to allow sufficient time to attend to oral care are recommended.(Furr et el, 2004) Nurse education in oral health practice has remained relatively unchanged for 120 years, and qualified staff lack of adequate knowledge of oral health. In a systematic review (Berry, 20?) sites that nurses in the absence of evidence based guidelines to direct best practice, perform oral hygiene according to individual preferences and historical patterns. These are normally a combination of product availability and nurses previous experience. But the NMC The Code Standards of Conduct, Performance and Ethics (NMC 2008): You must deliver care based on the best available evidence of best practice., although nurses are unclear about what is the best practice, there are many unclear studies and vague guidelines when it comes to Oral hygiene.. The benefits of oral decontamination in reducing VAP have been reviewed in a recent meta-analysis published by the British Journal of Nursing (BJN) This is a peer reviewed journal meaning that to publish within it, others of the same standing have read and agreed with its findings (LoBiondo and Wood, 2002). Toothbrushes/ Mouth swobs The use of the toothbrush in the mechanical removal of plaque, even in the intubated patient, has been proven to be superior to the swab,(AUS)(10) although electric toothbrushes are preferable, their cost, size and the potential for cross-infection limits their use AUS, (2003). Hutchins et al, (2009) research an icu where they had a ventilator bundle that included the use of suction tooth brushes. Swob sticks have been reported as ineffective in removing debris between the teeth and gum borders (Berry at el, 2007) although it was suggested that the use of foam swabs soaked in Chlorhexidine if a toothbrush is considered inappropriate. Although some research shows that mouth swobs should never be used due to them falling apart in the mouth (?)studies indicate that swabbing is the preferred method of oral care in the ICU (Furr et el, 2004) Tooth brushing with a child sized brush is superior to form swobs in removing dental plaque and bacteria in nurse administered oral care (Furr et el, 2004) Mouth wash Although few have been tested in the critical care population, the mouth care rises include chlorhexidine, sodium bicarbonate, hydrogen peroxide and potassium permanganate In a study conducted by Chan (Chan et el,) published in 2007 they found that the oral decontamination of vented patients using antiseptics is associated with a lower risk of VAP(Chan et el, 2007) but they did not reduce mortality or duration of mechanical ventilation or stay in hospital. Although in (Panchabhai et el, 2009) found that use of chlorhexidine did not reduce the amount of VAP compared to the control group, although both groups had reduced numbers of infection, but it did reduce the length of ICU stay. This may have been because they used potassium permanganate as a control rather than a placebo, also when the study was in progress periodic briefing of ICU nurses regarding the importance of mouth care and regular supervision and auditing where done so may have contributed to the decrease of VAP and length of stay. Chlorhexidine is the most investigated and recommended oral care product for preventing VAP.(Senol et el, 2007), although not all studies have found this. There have been reported cases of allergic reactions to Chlorhexidine. (?) Chlorhexidine may also cause brown discolouration to the teeth. (?) . Other ways of helping reduce are To reduce the incidence of VAP incline the head up to 35 percent, interruptions to sedation and the use of subglottic suctioning of secretions. Patients are also but on Tazocine Senol et el (2007) describes that an organised approach to VAP prevention can reduce the rate of VAP. A ventilator bundle is a group of interventions for the intubated patient found to be effective in the reduction rate of VAP. This included elevating the head, sedation vacations, prophylaxis for peptic ulcers and DVT thrombosis. At present there is a review in China underway that is look at Oral hygiene care for critically ill patients to prevent ventilator associated pneumonia, for the Cochrane library. Unfortunately at the time of writing this hasnt come to print (Shi et el, 2010) Berry et el (2007) systematic review concluded need more research Conclusion As indicated in (Marra et el, 2009) to control VAP in the ICU, it is not sufficient to implement 1 measure, or even an ventilator bundle, but rather it requires a culture change involving the entire ICU team. The writer feels that rather than just good oral hygiene to prevent VAP, The ventilator bundle seems to have good results. Education for all ICU nurses, prescribed mouth care products, and valid and reliable assessment tools are needed. The Writer feels that the reading and the literature search have extended their understanding of the key concepts, theories and methodologies surrounding oral decontamination, they have an increased awareness and knowledge and understanding of mouth care and are in a better position to make an informed choice about what practice to use.

I Am Proud to Be An American Soldier Essay -- I Am Happy To Be A Soldi

The United States has long been known for having a military presence that few would dare to challenge. The catalyst has not been in having billions in defense funds, it has not been in having huge weapons of mass destruction, it is the heart and spirit of the soldier. I am very proud to be a part of this long and proud tradition of upholding the ideals set forth in the U.S. Constitution. It is something that I would recommend to all willing and able college students. It instills a sense of pride and satisfaction that is matched by no other. As a soldier, there are many options as far as what type of soldier you wish to be. It is similar to choosing a career in the civilian world. The first step in this process is choosing your military branch. There are four main branches in the military; the Army, Navy, Air Force, and Marines.   Ã‚  Ã‚  Ã‚  Ã‚  The Army is the branch that I chose. The Army is the largest branch, in terms of the number of soldiers, with an impressive five hundred thousand soldiers on active duty, five-hundred thousand in the Reserves, and three-hundred thousand in the National Guard. The Army is responsible for the majority of land combat in a War. These soldiers are also trained to occupy other countries if necessary (Iraq, Afghanistan, and Mogadishu.) In peace time, the Army’s main deterrent of other country’s aggression is its large presence throughout the world. There are deployed soldiers in over one-hundred countries at any certain time, along with huge ship...

The Great Gatsby’s American Dream

The Great Gatsby's American Dream Corrupption â€Å"There are those, I know, who will reply that the liberation of humanity, the freedom of man and. mind, is nothing but a dream. They are right. It is. It is the American Dream. † (Archibald MacLeish). This quote talks about how the American Dream is only a dream. The American is a life of personal happiness and material comfort, and is traditionally sought by the individuals in the U. S. It is only a fantasy. Author F. Scott Fitzgerald shows a great example of the causes and affects the American Dream has on people during the 1920s in his novel, The Great Gatsby.Fitzgerald explains that the American Dream is unattainable through the characters and their actions and the symbolism throughout the novel. In the novel Fitzgerald indicates that the American Dream is unachievable through Gatsby’s unrealistic image of the dream. Gatsby has been in love with daisy for years and spent his life proving that he was worthy enough fo r her to leave her husband and take him back. Gatsby believed money could substitute for time: â€Å"Can’t repeat the past? [†¦]why of course you can[†¦] I’m going to fix everything just the way it was before[†¦]shell see†(Fitzgerald 117).Although Gatsby recreated his past environment with money, he could not recreate the past feelings that were destroyed by time. Gatsby’s dream is bigger than himself. Critic Casie E. Hermanson writes: â€Å"it is the attempt itself and the firm belief that he can achieve the impossible that makes Gatsby more than the sum of his reality† (Hermanson 78). Gatsby’s dream was more than his own reality. It was too big of a dream for him which is why he was not able to achieve it. After Gatsby’s was killed nick realizes that Gatsby’s dream of the East Egg was not all that it was set out to be.Nick says: â€Å"After Gatsby’s death the East was haunted for me like that, distorted beyond my eyes’ power of correction† (Fitzgerald 185). Nick later on in the novel realizes that Gatsby’s dream of the east was corrupt and it wasn’t as great as it was thought to be. Gatsby’s dream was not achieved, his dream killed him. Gatsby’s great American Dream was bigger than reality itself which is why it was not possible to achieve it. Fitzgerald uses lots of symbolism in his novel to get across the idea that the American Dream is not attainable. One of the symbolisms that Fitzgerald uses to symbolize the American Dream is Gatsby’s big mansion.Fitzgerald writes: â€Å"The one on my right was a colossal affair by any standard – it was a factual imitation of some Hotel de Ville in Normandy, with a tower on one side, spanking new under a thin beard of raw ivy, and a marble swimming pool, and more than forty acres of lawn and garden† (Fitzgerald 9). Gatsby’s mansion symbolizes that the American Dream causes p eople to spend money irresponsibly and to live selfish lives. Materialism seems to be everything people think they need to achieve the American Dream which is why it is not possible to achieve it.Fitzgerald also uses the Valley of Ashes to symbolize the American Dream not being possible to achieve. Fitzgerald writes: â€Å"This is the valley of ashes – a fantastic farm where ashes grow like wheat into ridges and hills and grotesque gardens, where ashes take the form of houses and chimneys and rising smoke[†¦]of men dimly and already crumbling through the powdery air† (Fitzgerald 27). Fitzgerald uses the Valley of Ashes to symbolize the result of everyone’s pursuit of the American Dream and their pursuit of wealth. It is filled with ashes like it’s been burnt out and is filthy.It represents societal decay and is basically a dumping ground for everyone who has failed at achieving the American Dream. In the novel Fitzgerald always describes Daisy with l ight like she’s angelic. Critic Casie E. Hermanson writes: â€Å"Daisy is dressed in white and associated with light and sunshine throughout the novel [†¦] Gatsby’s own devotion to her has a permanence that Daisy cannot live up to , yet Gatsby seems committed to an idea of Daisy that he has created rather than to the real woman she is† (Hermanson 77). Daisy is always bright and described with light in the novel, which symbolizes Gatsby’s image of her that he has created.In his mind she is angelic and perfect and bright. But she is not the woman he thinks she is. She is far from being an angel. The symbolism that Fitzgerald used in the novel shows that the American Dream does not lead to any success. Fitzgerald’s novel The Great Gatsby is based around the immorality of the characters and how the unrealistic American Dream causes it. Gatsby’s American Dream causes him and Daisy to act immorally. â€Å"As he left the room again she got up and went over to Gatsby and pulled his face down kissing him on the mouth† (Fitzgerald 122). Gatsby’s dream is Daisy, who is one of the most immoral characters in the novel.As soon as Tom, Daisy’s husband, leaves the room Daisy cheats on him by kissing Gatsby. Gatsby’s Great American Dream was causing Daisy to be immoral and cheat on her husband. The American Dream is only causing immorality in the characters’ lives because it is so unrealistic and unreachable to Gatsby. Gatsby needed wealth to achieve his dream, eventually Tom figures out how he really got his wealth. â€Å"I found out what your ‘drug stores’ were. [†¦] He and this Wolfshiem bought up a lot of side-street drug stores here and in Chicago and sold grain alcohol over the counter [†¦] I picked him a bootlegger the first time I saw him†(Fitzgerald 139).Gatsby’s only way of achieving his dream and winning back Daisy’s love is by becoming wealt hy, so he became a bootlegger. Which is why Daisy chose Tom instead of Gatsby, it was a safer pick. Gatsby’s American Dream was so unrealistic and bigger than himself that he had to resort to immoral crime to try and achieve it. Not only does Gatsby create his own American Dream, but he recreates his whole past with lies to make his dream attainable. While Nick, the narrator of the novel, was getting to know Gatsby he caught him in his own lies when Gatsby told him that it took him three years to earn the money for his mansion. I thought you inherited your money†Ã¢â‚¬ ¦Ã¢â‚¬ I did old sport [†¦] but I lost most of it in the big [†¦] panic of the war. † (Fitzgerald 95). Nick was surprised when Gatsby claimed that he earned the money to buy his house because Gatsby had preciously told Nick that he lived off of the money he inherited from family. Gatsby’s American Dream is not only causing him to commit crimes and try and steal a married woman from her husband, it also causes him to live a lie and make everyone around him believe his lie of a life.The American Dream is causing all of this immorality because it is not realistic and it is nothing more than a fantasy. Fitzgerald’s, The Great Gatsby, indicates through its characters and their behaviors and through the symbolism in the novel that the American Dream is unrealistic and cannot be achieved. From Gatsby’s unrealistic, bigger than himself image of the dream and the crimes and lies that he goes through to attempt to achieve the dream and from the immorality and the other characters actions it is indicated that the American Dream is nothing but a dream.It cannot be achieved especially not with the unrealistic images that Gatsby and some of the other characters create in their minds about the dream. The topic of the American Dream is still important in the real world because it sets a goal. Although sometimes the goal for people to work hard for. It gives peop le a purpose or something to dream of and try and work hard to achieve. Of course it is sometimes highly unlikely that a person will achieve the dream but it gives a sense of hope or something to look forward to.

Change By John P Kotter - 1164 Words

Introduction The definition of change according to the Webster dictionary is â€Å"to become different or to make someone or something different.† John P Kotter writes that change is always about â€Å"changing the behavior of people† (preface XII) Kotter explains that change is a concept that is used by organizations to restructure or improve their business behavior. Many companies find it difficult to initiate change due to the lack of motivating employees or leaders. In his book, Kotter proposes an eight stage process that could help organizations that are looking for change. Discussion The Eight important stages of change by John P. Kotter Stage one: Establishing a Sense of Urgency In this stage Kotter shares business stories of successful companies that increased urgency to spark a change. He explains that there are four behaviors which could prevent change. Behaviors like â€Å"complacency, immobilization, self-protection, you-can’t-make-me-move deviance, and pessimistic attitude that leads to constant hesitation.† (Kotter and Cohen, p17) These four negative elements have to be approached carefully because if they are not the employees wouldn’t not have any sense of urgency to perform any changes. 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