2bPhD

Try Bandura's theory of self-efficacy, however he is psych and not nursing. If you are looking for a mid-range nursing theory check out... Smith, M., Lierhr, P. (2003). Middle Rante Theory for Nursing. NY: Springer. Most of these theories, however focus on direct patient care. If you want a theoretical framework that works for any situation, go with Bandura. Nursing research is utilizing this theory more and more, and Smith has a chapter on it. Also, look at the theories that other people have used with research on your topic. That is always a good way to go. Hope this helps. :rolleyes:

It is part of our program, however students must pass a pharm exam before they can give meds in clinical.

Ask the senior nurses for advice and help.

Wow, there is some really good stuff here. I have read every word. I just finished a semester as a clinical instructor with my first group of students. I know that a few of them are lurking on these boards and I would love to hear their input . [your grades have already been posted so your comments will not count against you].

God put that piece of skin there for a reason! We just don't know what that reason is.

Ursala, you can do a cost effectiveness analysis on any intervention. It is not my bag and has always been challenging to me. If you are in administration, why not look at a topic that directly relates to what you do every day? You could look at training new staff or enhancing job satisfaction. I'm sure if you searched pubmed you would find something interesting. Try nurses and burnout. That seems to be a hot topic.

Cape - I know what you mean. I have had the same thing happen to me. In one facility where I was working it seemed like there were 2 or 3 people who had the majority of the "skin discolorations". We were able to get the attending physician to document in her chart and diagnose her with senile purpura. This helped in our defense. Another person was sent to see a dermatologist who documented that the discolorations were not due to trauma and that they would be chronic. It is a shame that we spend so much time in LTC dealing with things that are really unimportant that we don't have the time that we need to address real issues.

I feel your pain. I know how those 15 page incident reports can be. I have some information that may actually help. Remember that the concern is that the bruise may have resulted from mistreatment, however I have found that many people refer to every purple spot on someone's skin a bruise. There is a difference. A bruise is a layman term often used for contusion which is swelling, discoloration, and pain that results from an injury. The edges of a contusions are usually smooth. Contusions can result from mistreatement and should be investigated. Ecchymoises is a blue/purple discoloration on the skin that is caused by extravasation of blood into the SQ tissue that occurs when vessel walls are fragile. Ecchymoises usually has irregular edges. Ecchymoises is common in the elderly because of thin skin, especially when they are taking anticoagulants or steroids and occurs with minimal trauma to the skin. Sometimes just a little bump will cause this. Purpura is a small blue/purple spot that occurs when there is a hemorrhage into the tissues. Older adults often have purpura (sometimes called senile purpura) due to fragile blood vessel walls that rupture without trauma. Differentiate between the three and tell the staff to avoid using the term bruise as it can be misleading. Investigate bruises but just document ecchymoises and purpura. If you have a patient who gets a lot of either of these, get a derm consult to confirm that it is a skin disorder and not from trauma. Hope this cuts down on the paper work.:)