Topic: Strengths-based nursing & healthcare
Pages: 3, Double spaced
Order type: Assessment
Language: English (U.S.)
Answer the following question: (450 words)
“What benefits do you think a family strengths assessment can have for clinical practice and promoting family health?”
3 – 4 References please
(From the ‘Critical questions and reflections’ on page 107 in Barnes & Rowe text book).
Reply to this post with relevant feedback to their comments (e.g. discuss a point supported by a reference, (approximately 450 words total).
Family-strengths nursing assessments are designed to encourage patients and their family members identify their capabilities and competencies, from their own perspectives (Trivette & Dunst 1990). It is also designed to strengthen the nurse-patient-family relationship. Family-strengths assessment tools are described as being solution-focused, by enabling nurses to help families build on their own resilience (Barnes & Rowe 2014).
McMurray & Clendon (2015) describe family as the filter or mediating structure protecting individual family members within the wider society. Defining family as whoever they say they are, enables a collaborative approach that optimizes the possibility of meeting a family’s needs, and promotes better health outcomes. Contemporary definitions of families, consider them to be diverse and dynamic as a result of social change and progression. Clinicians and policies need to consider that the social concept of the nuclear family has been replaced with step and blended families, couples without children, lone parents, grand-parents families, same sex parent families, and so forth (Barnes & Rowe 2014). Offering family-strengths based assessments and care for many Australian Aboriginal family groups is inclusive of anyone who is accepted as family, and may even include the families’ child and family health workers (McMurray & Clendon 2015).
Family-strengths assessments uncover, discover and provide indications of how to optimize functioning within a family (Gottlieb & Gottlieb 2017). Families are not assessed against guidelines, as the concept of normative criteria disempowers families with social or historical disadvantages (McMurray & Clendon 2015). Trivette & Dunst (1990) explains that every family has strengths, and the importance of family-strengths based assessment and care is to support and enhance strengths, rather than focusing on rectifying deficits. Family-strengths assessments and care are formed by a value-driven approach that has transitioned from traditional, deficit-based models, and is rooted in principles of person/family-centred care and empowerment (Gottlieb & Gottlieb 2017).
Functioning style, can be used to refer to certain combinations of qualities within a family. Some such qualities can include communication abilities that promote positive interactions between family members, having a repertoire of coping mechanisms for dealing with normative and non-normative life events, and the ability of planning for the future but utilizing internal and external family resources. Essentially, family strengths contribute to how individual family members, and also the family as a unit, respond to stress and demonstrate resilience. Whilst the family strengths philosophy is not deficit-based, an assessment can assist clinicians to promote the family acquire new competencies, as well as optimizing existing ones. This will help the family to mobilise their resources to meet their individual and family unit needs. It will also empower the family to feel they have a sense of control over aspects of their life, despite crises they may be experiencing. Ultimately, strengthening family functioning makes families more independent, and less dependent on health care professionals (Trivette & Dunst 1990).
Barnes M & Rowe J 2013, Child, Youth and Family Health: Strengthening Communities, Elsevier Australia, Chatswood.
Gottlieb L & Gottlieb B 2017 Strengths-Based Nursing: A Process for Implementing a Philosophy into Practice, Journal of Family Nursing, vol. 23, no. 3, pp. 319-340, viewed 12 September 2017, < http://journals.sagepub.com/doi/abs/10.1177/1074840717717731?url_ver=Z39.88- 2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed>.
Trivette CM & Dunst CJ 1990, ‘Assessing family strengths and family functioning style,’ Topics in Early Childhood Special Education, vol. 10, no. 1, viewed 24 September 2017, <<http://web.a.ebscohost.com.ezproxy.utas.edu.au/ehost/detail/detail?vid=2&sid=f1acaa12-6b3c-4a81-974b-d93c4e58172e%40sessionmgr4009&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#AN=9602291996&db=asn>.
McMurray A & Clendon J 2015, Community Health and Wellness: Primary health care in practice, Elsevier Australia, Chatswood.
The pioneers of thyroid surgery, Theodor Kocher and Theodor Billroth, developed an acceptable technique of standardized thyroid surgery between 1873 and 1883. By 1920, the principles of safe and efficient thyroid surgery were already established 1. They consist of three basic phases: identification and ligation of vessels, identification and preservation of laryngeal nerves, and parathyroid glands. Basic surgical instruments are not significantly changed; the main innovations are new methods of coagulation and vascular section 1.Bleeding remains one of the major postoperative complications of thyroid surgery, with the potential to cause life-threatening airway obstruction1. Duringthyroidectomy, bleeding can obscure the operative field,making safe dissection of the recurrent laryngeal nerve (RLN),and parathyroid glands difficult. Effective vessel haemostasiscan be achieved by using the conventional clamp-and-tietechnique.Newer techniques of vessel haemostasis hope to bemore rapid while achieving the same effectiveness. Severalstudies have reported the successful use of bipolar vessel sealing systems or the Harmonic Scalpel in shortening the lengthof thyroid surgery and reducing blood loss, while retaining agood safety profile2. Using mechanical vibrations at 55.5kHz, this device is able to cut and coagulate tissues simultaneously. The proposed advantage of using the device over traditional electrocautery include less lateral thermal tissue injury, a lack of neuromuscular stimulation and the avoidance of electrical energy transmission either to or through the patient 2.One of themajor complications of thyroid surgery is hypocalcemia3 . Hypocalcemia observed after thyroidectomy is believed to be related to traumatization of parathyroid glands during surgery as it is anatomically intimately related to thyroid gland and share its blood supply2.Several studies in theliterature show that harmonic scalpels can be usedsafely in thyroid surgery with no increase in the number ofhypocalcemia 3. The incidence of hypocalcemia was 14% in harmonic scalpel group as compared to 42% in patients treated with conventional hemostasis techniques in one of the studies1. The traditional approach of 2-day hospitalization and monitoring of serum calcium levels after surgery is still being used by many institutions worldwide because the nadir of hypocalcemia typically occurs within 48 hours after surgery.(Ref 1- Pattou F, Combemale F, Fabre S, Carnaille B, Decoulx M, Wemeau JL, Racadot A, Proye C. Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World journal of surgery. 1998 Jul 21;22(7):718-24.2-Lombardi CP, Raffaelli M, Princi P, Santini S, Boscherini M, De Crea C, Traini E, D’amore AM, Carrozza C, Zuppi C, Bellantone R. Early prediction of postthyroidectomy hypocalcemia by one single iPTH measurement. Surgery. 2004 Dec 31;136(6):1236-41.My study would compare the incidence of hypocalcemia in patients treated with conventional hemostasis secured with sutures to hemostasis secured with harmonic scalpel. The local data on this subject is very limited and no such study has ever been done in our setup, so results would be used as a standard practice for future.OBJECTIVE:To compare incidence ofhypocalcemia after total thyroidectomy when using the Harmonic Scalpel versus Conventional Haemostasis.OPERATIONAL DEFINITIONS:HYPOCALCEMIA: All patients with a postoperative calcium level below the lower limit of normal range (8.2–10.6 mg/dL) wereconsidered as having hypocalcemia4.HARMONIC SCALPEL: It is a new device that uses high frequency mechanicalenergy to cut and coagulate tissues at the same time2 . It denatures protein by using ultrasonicvibration at 55.5kHz to transfer mechanical energy sufficient tobreak tertiary hydrogen bonds1.CONVENTIONAL HEMOSTASIS:Conventional techniques to secure hemostasis includes the use of classictechnique of tying and knots,bioresorbableligature,and bipolardiathermy1 .HYPOTHESIS:Incidence of post- operative hypocalcemia more in thyroidectomy with conventional hemostasis as compared to hemostasis with harmonic scalpel.MATERIAL AND METHODS:1. STUDY DESIGN: Single blinded Randomized controlled trial.
2. SETTING OF THE STUDY:
3. DURATION OF THE STUDY: Six months
4. SAMPLE SIZE:
Proportion of hypocalcemia = 14%, bond of error= 7%, Confidence level = 95%, Sample size = 94The patients would be randomized in to two groups for conventional hemostasis and harmonic scalpel by computer generated numbers. Patient in group A (n=47) would be treated with conventional hemostasiswhile the patient in group B (n=47) would be treated by harmonic scalpel.
5. SAMPLING TECHNIQUE: Non probability consecutive sampling
6. SAMPLE SELECTION: INCLUSION CRITERIA:• Age more than 18year and less than 40 years• Acceptance to participate in the study (signed informed consent form)• Total thyroidectomy for benign multinodular goiters • Euthyroid patient EXCLUSION CRITERIA:• Concomitant parathyroid disorders• Previous history of irradiation• Cervicomediastinal goiters• Total thyroidectomy with need of lymph node block dissection as in patients with malignant invasive cancer• Previous neck surgery DATA COLLECTION:Patients would be admitted from OPD after they fulfill the inclusion criteria. Detailed history with known co-morbids would be taken, detailed examination and investigations would be done at time of admission. All the data would be collected and noted in proforma. After anesthesia assessment, informed and written consent would be taken pre-operatively. Surgery would be performed by a senior consultant with atleast 5 year post-fellowship experience. Calcium levels would be assessed on the 24 and 48 hours postoperatively. Serum calcium levels of less than 8 mg/dL on atleast two consecutive measurements would be considered as a case of hypocalcemia.
STATISTICAL ANALYSIS:Statistical Program for Social Sciences (SPSS) version 11 would be used to analyze the data. Age will be presented by mean and standard deviation values. Gender and hypocalcemia will be presented by frequency and percentage. Effect modifiers would be controlled by stratification of age and genderand chi-square test will be applied to see the effect of these on outcome variables and P < 0.05 will be taken as significant.
REFERENCES: 1. Ferri E, Armato E, Spinato G, Spinato R. Focus Harmonic Scalpel Compared to Conventional Haemostasis in Open Total Thyroidectomy: A Prospective Randomized Trial. IntJOtolaryngol. 2011;16(1):32-7.
2. Adrienne L, Sam M. Harmonic Scalpel Compared to Conventional Haemostasis in Thyroid Surgery: A meta-analysis of randomized clinical trials. Int J SurgOncol. 2010;58(4):11-19
3. Roberto C, D’Ajello F, TrastulliS.Meta-analysis of thyroidectomy with ultrasonicdissector versus conventional clamp and tie. World J SurgOncol. 2010;8:112
4. Theodosis S, Papavramidis K, Sapalidis N. Ultracisionharmonic scalpel versus clamp-and-tie total thyroidectomy: a clinical trial. Head and Neck. 2010;32( 6):723–727.
5. Basoglu M, Ozturk G, Oren D. The use of Harmonic scalpel in thyroidecrtomies: Clinical experience. Eur J Med. 2008;40:75-78.
6. Miccoli P, Berti P, Dionigi GL, D’Agostino J, Orlandini C, Donatini G. Randomized controlled trial of harmonicscalpel use during thyroidectomy. Arch Otolary—Head Neck Surg. 2006;132(10):1069–1073.
7. Khanzada TW, Samad A, Memon W. Post thyroidectomy complications: the hyderabad experience. J Ayub Med Coll Abbottabad. 2010;22(1)
NAME:AGE:SEX: M / FCR No:Date of Admission:Date of Surgery:Date of Discharge:Method of Hemostasis used: • Conventional • Harmonic scalpelParathyroid safe: Yes /No Post operative Serum Calcium level: 32 and 48 hoursHypocalcemia : Yes: No: