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Nursing Practices

Hygiene and nutrition control are of the paramount importance in health care organizations, especially health care organizations with older inpatients. In fact, aged people are more susceptible to the negative impact of their environment, various infectious diseases and other health care problems, which can be provoked by poor nutrition or hygiene. In such a situation, one of the major goals of nurses and health care professionals working with elderly people is to provide them with safe environment, prevent the risk of catching an infectious disease or development of some health problems, because these people can suffer from complications, which may lead to the lethal outcome in the most severe cases. At the same time, the creation of the safe environment means the provision of elderly people with good nutrition, regular cleaning, etc. However, in addition to the work of nurses and medical staff on the creation of safe environment, it is also necessary to inform elderly people on basic rules and hygienic norms in order to minimize the risk of the development of serious health problems. In this respect, it is also important to remember about the necessity of control over the medical staff and patients since without an effective system of control, all the efforts of health care professionals, including nurses may be inefficient.
At this point, it is possible to refer to the problem Maria Schwarzkoph has faced. Obviously, this problem is very serious since such symptoms as stomach cramps and diarrhea can be symptoms of an infectious disease, which may affect not only Maria Scharzkoph, but also other patients. On the other hand, such symptoms clearly indicate to the fact that Maria Schwarzkoph has got her health problems because of the poor hygiene or probably malnutrition. Consequently, it is necessary to pay more attention to hygiene in the facilities and nutrition of patients.
First of all, it is necessary to start with the strengthening the infection control in order to minimize and prevent all possible risks of the development of some disorders or infectious disease. In fact, the personnel working with patients, as well as all people who contact with patients, for instance, visitors who call on patients, including friends or relatives, should be informed on the existing risks to the health of the patients. In all probability, visitors and people who do not have a medical education will need instructions from the part of the personnel in order to teach them the basic hygienic norms and rules. Being informed about possible risks to the health of patients, people will be more aware of the possible effects of their actions or inactions leading to the violation of basic hygienic norms within the facility.
At this point, the effective system of the infection control should rely on the checking system which can prove that all the visitors and the personnel are informed about basic hygienic and anti-infectious norms and rules. What is meant here is the fact that it is necessary to introduce special instructions where all basic hygienic norms are listed. A visitor or a health care professional, or any other person, who enters the facility, should carefully read the instructions and, if necessary, get additional information from the health care professional, a nurse, for instance, who is responsible for the spread of these instructions. On getting all the information a visitor, health care professional, or any other person, should sign the instructions which will prove that he is informed and conscious of possible effects of the violation of the basic hygienic norms. It is important to make a person responsible for his actions and while signing the instructions he read, a visitor or health care professional agrees with his responsibilities. Consequently, if he violates the hygienic norms certain actions can be undertaken in his regard. For instance, a professional working in the facility can be transferred to another facility, where he can perform less responsible work or even fired if his actions led to very negative effects, such as the spread of an infection within the facility involving many patients. As for visitors, such as relatives of patients they can be limited in their access to the facility.
In addition, it is necessary to pay more attention to the hygiene and infection control within the facility that may need more efforts from the part of the personnel working within the facility. To put it more precisely, it is necessary to establish a strict control over the personnel who have access to the dirty utility. In fact, it is necessary to ensure that they will have an opportunity to protect patients from the spread of any infection which may be spread from the dirty utility. In practice, this means that people will need to wash their hands and ensure that their clothes is absolutely clean or, if necessary the clothes can be changed, in a special room, next to the dirty facility.
Furthermore, the personnel as well as patient should focus on the maintenance of hygiene in WCs, which are next to rooms. It proves beyond a doubt that the ignorance of basic hygienic norms and unclean WCs can be the major source of infectious diseases and health disorders, leading to stomach cramps or diarrhea. Consequently, the personnel should ensure that WCs are perfectly clean and absolutely safe for inpatients. Naturally, all other rooms and areas within the facility should be in perfect order and clean too. This is particularly important in relation to the dining room since it is another place where the risk of catching an infectious disease or other health problems is particularly high. At this point, it is worth changing the dining room and providing each patient and each person attending the dining with a separate table in order to minimize the risk of spreading an infection.
In addition, the ward and staff should work with patients in order to strengthen control over hygiene and infection prevention. What is meant here is the fact that elderly people often have problems with adequate following the established rules, including rules related to hygiene. Often they do it unconsciously because of poor memory abilities, for instance, which naturally expose elderly patients to the risk of catching an infectious disease or other health problem because they fail to follow basic hygienic norms and rules. To inform inpatients on these norms and rules and to maintain hygiene in the facility, it is necessary to provide patients with instructions concerning the basic principles of their behavior in the facility (Miller, 2003). In fact, the personnel, including nurses, should constantly inform patients and remind them about the importance of hygiene and about the necessity to follow the established rules strictly. At this point, it is possible to develop special reminders for elderly patients. For instance, it is possible to place special leaflets or posters where the basic rules and norms of hygiene are written or printed in a clear and comprehensible way, including simple pictures or signs, which inform patients how they should behave and what they should do.
Along with the strict observance of basic hygienic norms and rules, nutrition is another important factor that can facilitate infection control and prevention of various health problems or, in contrast, deteriorate the health of patients. Also, it is necessary to remember that the personnel is also exposed to the risk of catching an infectious disease, especially nurses who contact regularly with patients (Longstreth, et al, 2006). On analyzing the nutrition of patients, it is important that the nutrition was balanced. In other words, patient should receive a sufficient amount of vitamins, microelements, minerals and other elements essential for the normal functioning of human body. In fact, the balanced nutrition, rich in vitamins, strengthens the immune system of patients and, therefore, decreases the risk of the development of various health problems. On the other hand, patients should not over-consume vitamins, which are mainly concentrated in fruit and vegetables. It is very important to develop an individual diet for each patient. The diet for either patient should be carefully prepared and a nutritionist developing the diet should take into consideration not only the age of patients but also their health problems, peculiarities of their constitution since either patient has unique needs.
Furthermore, the technology of cooking is also of the utmost importance. It proves beyond a doubt that if terms of storage of products or their cooking are not followed, the dishes consumed by patients are likely to bear dangerous elements, bacteria which may cause such disorders as diarrhea as well as serious infectious diseases, such as salmonellosis (Ryan and Ray, 2004). As a result, the health of patients can deteriorate consistently.
The problem of Marie Schwarzkoph reveal the existence of the problem of poor hygiene since stomach cramps and diarrhea are likely provoked by some bacteria which may lead to the development of an infectious disease. In order to decrease the risk of the further development of infection it is necessary to identify clearly what the problem actually is. This means that it is necessary to examine Marie Schwarzkoph in order to diagnose whether she has an infectious disease or not. After that it is possible to start treatment depending on the outcomes of the examination. In order to ease her sufferings at the moment, it is possible to use diazepam to decrease stomach cramps. In addition, it is necessary to replace fluid lost because of diarrhea. The medicaments that can be used are loperamide and bismuth subsalicylate (Alam and Ashraf, 2003). Anyway, it is highly recommended to isolate Marie Schwarzkoph for the moment.
Thus, taking into account all above mentioned, it is possible to conclude that hygiene and infection control are extremely important in health care organizations, especially if they deal with elderly patients. The high susceptibility of these patients to various diseases implies more efforts from the part of the personnel to maintain hygiene in the health care organization. At the same time, it is not only health care professionals who should observe the basic hygienic norms and rules, but it is also patients and all people who enter the facility.

Alam N.H. and Ashraf, H. (2003). "Treatment of infectious diarrhea in children". Paediatr Drugs 5 (3): 151–65.
Kasper, D.L., et al. Harrison's Principles of Internal Medicine. New York: McGraw-Hill, 2005. ISBN 0-07-139140-1.
Longstreth, G.F. et al. (2006). "Functional bowel disorders". Gastroenterology 130 (5): 1480–91.
Miller, S.C. et al. (2003). “Hospice Enrollment and Pain Assessment and Management in Nursing Homes.” Journal of Pain and Symptom Management. 26:3:791-799.
Ryan, K.J. and Ray, C.G. (ed.). (2004). Sherris Medical Microbiology, 4th ed., New York: McGraw Hill.
Schiller, L.R. (2007). "Management of diarrhea in clinical practice: strategies for primary care physicians". Rev Gastroenterol Disord 7 Suppl 3: S27–38.
Sloane, P.D. et al. (2003). “End-of-Life Care in Assisted Living and Related Residential Care Settings: Comparison with Nursing Homes.” Journal of the American Geriatrics Society, 51:1587-1594.


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