Nursing Research Problem Essay Example for Free

Nursing Research Problem Essay Infections are a common cause of both morbidity and mortality in premature infants; examples of infections include necrotizing enterocolitis (NEC) and sepsis (infection of the bloodstream). Infections in premature infants result in prolonged ventilation, prolonged hospitalization, and higher medical costs, and can cause neurodevelopment impairment (Manzoni et al., 2009). The use of high-potency antibiotics can lead to resistant strains of bacteria and potentially damage the infant’s liver and/or kidney function. Within the past decade, research has turned from finding treatments to finding methods to reduce infections. Breastfeeding and human milk has been well supported through research to provide immunity and positive outcomes for preterm and full-term infants. Breastfeeding and human milk provides nutritional, gastrointestinal, immunological, developmental, and psychological benefits to preterm infants and plays an important role on their long-term health and development (Callen Pinelli, 2005). The components of breastmilk that support immunity include lactoferrin, lysozymes, interferon, and sIgA antibody (Callen Pinelli, 2005). Specifically, lactoferrin (LF) is an iron-binding glycoprotein found not only in breastmilk, but also in saliva, tears, and other bodily secretions; LF has biological functions which include immunomodulatory, antimicrobial, and antioxidant effects, and inhibits growth of pathogenic bacteria, fungi, and viruses (Yen et al., 2009). The described functions of LF support the protective role in immunity. The purpose of this investigation is to determine the effects of oral lactoferrin supplementation on reducing infections in preterm infants. Nature of Problem and Importance to Nursing Practice A nosocomial infection is described as an infection that is acquired after 48 hours of hospital admission (Rodriguez et al., 2010). In neonates,  a late-onset infection is defined as an infection obtained after the perinatal period (Manzoni et al., 2009). Nosocomial infections include infections of the gastrointestinal tract (necrotizing enterocolitis, NEC), blood stream (sepsis), and lung (pneumonia). The effects of an infection in a preterm infant can lead to â€Å"poor growth, adverse long-term neurological sequelae, increased length of hospital stay, and a substantial cost to families, hospitals, and society† (Rodriguez et al., 2010, p. 207). The risk of nosocomial infections increases with the decreasing birth weight and gestational age, and roughly 21% of very low birth-weight (VLBW) infants will encounter a late-onset infection (Stoll et al., 2002). The most common gastrointestinal infection in premature infants is NEC, affecting 2.6% to 28% of VLBW infants (Lin et al., 2005). NEC is widely considered as a multifactorial disease, with no specific pathogenesis; three major factors have been proposed: the presence of a pathogenic organism, the challenge of enteral feeding, and altered enteric mucosa integrity (Lin et al., 2005). NEC is â€Å"characterized by necrotizing injury to the intestine that requires antibiotic treatment and, in severe cases, surgical intervention† (Brooks et al., 2006, p. 347). Reduction of infections in preterm infants is of high priority and active research is being performed to find safe preventative measures, improve patient outcomes, and decrease hospital length of stay. Lactoferrin is an iron-binding protein found in mammalian milk and is important in innate immune host defenses (Manzoni et al., 2009). Partial digestion of LF in the stomach produces peptides called â€Å"lactoferricin† that contain more potent antimicrobial activity (Yen et al., 2009). Human colostrum contains more LF than breastmilk, saliva, tears, or other mucosa linings in the body. Studies have been performed to determine bovine or porcine LF effect on prevention of infection in mice and rat pups; conclusions showed a reduction in â€Å"the frequency of bacterial infections in the GI tract while promoting the growth of Lactobacillus and Bifidobacteria species, which are generally believed to be beneficial to the host† (Yen et al., 2009, p. 591). Bovine, porcine, and human LF molecules are similar, and bovine and porcine LF has been reported to show higher antimicrobial activity compared to human LF (King et al., 2007). In 2001, the US Food and Drug Administration declared bovine lactoferrin generally recognized as safe  (CFSAN, 2001). Bovine or human LF can be given as a formula additive, breastmilk additive, or given to patients by swabbing of the mouth, either actively feeding or with nil per os (NPO) statuses. Research studies have now been performed on the effects of bovine or porcine LF on prevention of infections in VLBW and preterm infants, and LF shows to be a promising agent of prevention. Evidence-based Practice Question Evidence-based practice (EBP) is defined as â€Å"a practice that involves clinical decision-making based on the best available evidence, with an emphasis on evidence from disciplined research† (Polit Beck, 2008, p. 753). Nursing practices are changing in the NICU to include swabbing of the infants mouth with colostrum every six hours to assist in prevention of infection and improve feeding tolerance. The following question is developed to determine the outcomes of infection prevention by LF in preterm infants: Does the supplementation of LF decrease the occurrence of nosocomial infections in preterm infants? Conceptual/Theoretical Framework The studies reviewed did not mention a conceptual or theoretical framework pertaining to the relationship of the subjects investigated. A conceptual model of nursing, Levine’s Conservation Model, can be utilized in applying the methods investigated to provide care and prevention of infection in preterm infants. Levine’s Conservation Model is focused in promoting adaptation and maintaining wholeness using the principles of conservation (â€Å"Current Nursing,† 2010). The model guides the nurse to focus on the influences and responses at the organismic level and accomplish the goals of the model through the conservation of energy, structure, and personal, and social integrity (â€Å"Current Nursing,† 2010). Conservation of energy in preterm infants is necessary for appropriate growth, and is achieved by adequate rest and nutrition; fighting an infection in preterm infants results in NPO status and irritability, thus expending energy. The conservation of structural integrity means to prevent physical breakdown and  promote healing, and is the consequence of an effective immune system (â€Å"Current Nursing,† 2010). The technique of LF supplementation and its potential preventative outcome on infection helps the patient conserve energy and structural integrity. Variables and Findings Manzoni et al. (2009) performed a prospective, multicenter, double-blind, placebo-controlled, randomized trial examining whether oral supplementation with bovine LF alone or in combination with Lactobacillus rhamnosus GG (LGG) reduces late-onset sepsis in 472 VLBW infants. The independent variable of this study is the supplementation of bovine LF or LGG and the dependent variable is the occurrence of infections in VLBW infants. The study randomly allocated infants into three groups; groups consisted of a control group (n = 168, infants supplemented with a placebo) and an experimental group (n = 153, infants given bovine LF alone and n = 151, infants given bovine LF with LGG). The main outcome measured the first episode of late-onset sepsis (sepsis occurring after 72 hours of birth); all tests were two-tailed, and P .05 was considered statistically significant (Manzoni et al., 2009). When stratifying for birth weight, Manzoni et al. (2009) noted a significant decrease in late-onset sepsis in extremely low birth-weight (ELBW, birth-weight 1000g) infants (P = .002 for bovine LF v. control and P = .002 for bovine LF plus LGG v. control) whereas it was not significant in infants weighing 1001 to 1500 g (P = .34 for bovine LF v. control and P = .07 in bovine LF plus LGG v. control). Overall, the results showed a significant decrease in the occurrence of infection in VLBW infants in the experimental groups versus the control group (P = .002 for bovine LF v. control and P .001for bovine LF plus LGG v. control) (Manzoni et al., 2010). A double-blind, placebo-controlled pilot study examined the impact of bovine LF supplementation to bottle-fed infants (King et al., 2006). The participants included 52 infants between the age of 0-4 weeks of age, ≠¥34 weeks of gestational age, and ≠¥2000 g, and who were strictly bottle-fed. The infants were randomized in a double-blind fashion; the control group  received a small dose of bovine LF and the experimental group received a higher dose of bovine LF (King et al., 2006). The independent variable is the supplementation of the higher dose of bovine LF and the dependent variable is the impacts observed in the first year of life. The outcomes measured included diarrhea, upper respiratory infection (URI), acute otitis media (AOM), and lower respiratory tract infection (LRTI). The infants were examined six times throughout the year on the measured outcomes. The results showed a significant decrease in the occurrence of LRTIs in the experimental group than in the control group (P 0.05) (King et al., 2006). Even though this study did not include preterm infants 34 weeks, the effects of bovine LF are still apparent in the protection against infection. Yen et al. (2009) performed a study to examine the effects of porcine LF as a selective decontamination of the digestive tract (SDD) regimen in neonatal mice. Transgenic mice were generated to express porcine LF; the neonatal mice fed from the transgenic mice and were then challenged with pathogens to evaluate in vivo antimicrobial activity of porcine LF (Yen et al., 2009). The control group contained mice that were fed normal milk and the experimental group contained mice that were fed the porcine LF (Yen et al., 2009). The independent variable is the transgenic mice with porcine LF supplementation and the dependent variable is the antimicrobial activity observed. The outcome measures included the growth rate of the mice pups, the state of the intestinal tract mucosa, and the circulating cytokines (Yen et al., 2009). Yen et al. (2009) concluded that the experimental group of neonatal mice showed a significant reduction of severity of illness (P .01), a significant inhibition of microbial survival in the intestinal tract (P .01), and a significant decrease in the number of bacteria cultured (P .05) than in the control group. The authors proposed that porcine LF is an ideal natural SDD regimen for the prevention of nosocomial infections in critically ill patients (Yen et al., 2009). Conclusion Research has proven the high incidence of a nosocomial infection and its adverse outcomes in a preterm infant. The efforts of research have changed  to finding a method to reduce or prevent nosocomial infections in preterm infants. Human colostrum is best in supplying the infant with LF to fight infection, but other methods of supplying LF are being studied. Research has recently proven that the supplementation of bovine LF has decreased the occurrence of infections in VLBW and preterm infants. Future research should include a larger, neonatal population specifically targeting VLBW and/or ELBW infants and the effect of LF supplementation on prevention of NEC. Further studies are needed to determine the dosing, duration, and type of LF (bovine, porcine, or human) that will be most effective in the prevention of infection in preterm infants without causing adverse effects or intolerance (Venkatesh Abrams, 2010). References Brooks, H. J. L., McConnell, M. A., Corbett, J., Buchan, G. S., Fitzpatrick, C. E., Broadbent, R. S. (2006). Potential prophylactic value of bovine colostrum in necrotizing enterocolitis in neonates: an in vitro study on bacterial attachment, antibody levels, and cytokine production. FEMS Immunology and Medical Microbiology, 48, 347-354. doi:10.1111/j.1574-695X.2006.00151.x Callen, J. Pinelli, J. (2005). A review of the literature examining the benefits and challenges, incidence and duration, and barriers to breastfeeding in preterm infants. Advances in Neonatal Care, 5(2), 72-88. doi:10.1016/j.adnc.2004.12.003 Current Nursing. (2010). Levine’s four conservation principles. Retrieved on September 23, 2010 from http://currentnursing.com/nursing_theory/Levine_four_conservation_princples.html King, J. C., Cummings, G. E., Guo, N., Trivedi, L, Readmond, B. X., Keane, V., †¦ de Waard, R. (2007). A double-blind, placebo-controlled, pilot study of bovine lactoferrin supplementation in bottle-fed infants. Journal of Pediatric Gastroenterology and Nutrition, 44(2), 245-251. Lin, H., Su, B., Chen, A., Lin, T., Tsai, C., Yeh, T., Oh, W. (2005). Oral probiotics reduce the incidence and severity of necrotizing enterocolitis in very low birth weight infants. Pediatrics, 115 (1), 1-4. doi:10.1542/peds.2004-1463 Manzoni, P., Rinaldi, M., Cattani, S., Pugni, L., Romeo, M. G., Messner, H., †¦ Farina, D. (2009). Bovine lactoferrin supplementation for prevention of late-onset sepsis in very low birth-weight neonates. The Journal of the American Medical Association, 302(13), 1421-1428. Retrieved on September 4, 2010 from http://jama.ama-assn.org/cgi/content/full/302/13/1421 Polit, D. E., Beck, C. T. (2008). Nursing research generating and assessing evidence for nursing practice (8th ed.). Philadelphia: Lippincott Williams Wilkins. Rodriguez, N. A., Meier, P. P., Groer, M. W., Zeller, J. M., Engstrom, J. L., Fogg, L. (2010). A pilot study to determine the safety and feasibility of oropharyngeal administration of own mother’s colostrum to extremely low-birth-weight infants. Advances in Neonatal Care, 10(4), 206-212. Stoll, B. J., Hansen, N., Fanaroff, A. A., Wright, L. L., Carlo, W. A., Ehrenkranz, R. A., †¦ Poole, W. K. (2002). Late-onset sepsis in very low birth weight neonates: the experience of the NICHD neonatal research network. Pediatrics, 110(2), 285-291. Retrieved September 9, 2010 from http://pediatrics.aappublications.org/cgi/content/full/110/2/285 US Food and Drug Administration, CFSAN/Office of Food Additive Safety. (2001). Agency response letter: GRAS notice (No. GRN 000077). Retrieved on September 23, 2010 from http://www.fda.gov/Food/FoodIngredientsPackaging/GenerallyRecognizedAsSafeGRAs/GRASListings/ucm154188.htm Venkatesh, M. P., Abrams, S. A. (2010). Oral lactoferrin for the prevention of sepsis and necrotizing enterocolitis in preterm infants. Cochrane Database of Systematic Reviews, Art. No.: CD007137 (5). doi:10.1002/14651858.CD007137.pub2 Yen, C., Lin, C., Chong, K., Tsai, T., Shen, C., Lin, M., †¦ Chen, C. (2009). Lactoferrin as a natural regimen for selective decontamination of the digestive tract: recombinant porcine lactoferrin expressed in the milk of transgenic mice protects neonates from pathogenic challenge in the gastrointestinal tract. The Journal of Infectious Diseases, 199, 590-598. doi:10.1086/596212

George Orwells Animal Farm Essay -- George Orwell Animal Farm Essays

George Orwell's Animal Farm Mollie- Represents the rich and noble of Russia at the time (esp. the Czar and his family). Those who fled Revolutionist Russia, because they had had a better life beforehand, and were un-willing to accept change. The messages that Orwell is trying to express through Mollie are directly opposite to the actions which are displayed through Benjamin. Although they were both unwilling to accept change, their actions were very different. The message that Orwell is conveying through Mollie is that you shouldn't just quit because things get tough. Quotes- 'Mollie, the foolish, pretty white mare.' page2 'Will there still be sugar after the rebellion?' page10 'Mollie refused to learn any but the six letters that made up her own name.' page20 'In the end, however, she was found hiding in her stall with her head buried among the hay in her manger. She had taken flight as soon as the gun went off' page27 First page and a 1/4 of chapter five, page 28 Benjamin- No direct character link to the Russian revolution, but very closely linked to the members of the older generation who were suspicious of the revolution, and set in their ways. They had found that life was hard, whatever happened, and so did nothing to try and change it. Benjamin is the original stubborn mule, he is not fooled by Napoleons propaganda, or the promises that life will be better for him. He knows that life is tough, and nothing will ever change that. However, Orwell is trying to communicate that you shouldn't always say nothing, that when you really feel for a cause (e.g., Benjamin with the death of Boxer) you should always speak out. Quotes- 'Benjamin was the oldest animal on the farm, and th... ...the public, the government can control the country a lot easier. There are still examples of such extreme propaganda which have gone on in the recent past. For example, the Gulf war in the early 1990's escalated so quickly, mainly due to conflicting propaganda. The government of Iraq were telling it's public that the Europeans were on Kuwait's side, and that they were only doing it so that they could have Kuwait's oil. The Europeans didn't realise why having the land that Kuwait owned was so important to the people of Iraq. Another message conveyed by Orwell through Squealer is that everyone should have freedom of speech. By progressing the novel so that the animals eventually become slaves of the pigs, and don't have a say in their lives, Orwell is expressing his view that if only the strong get their voice heard, the weak will eventually loose out.

American History II

One of the wonders of the modern world is the influx of modern ideas and the continuing improvement of the quality of human lives. The contemporary society caters to the innovations on the lifestyles and needs of people. Due to the inevitable changes in the needs of people and the creations of their productive and innovative minds, they develop dwellings that fit people’s needs. As a result, cities have been created and are continuing to grow with the process of industrialization and modernization. Cities render various advantages to its settlers. One of its main advantages is the promotion of commerce.The degree of civilization and knowledge existing in a country can be estimated through the proportion of the population living in the towns and cities. In cities, the different aspects of the city is developed and improved. There are also people offering the same trade and services. Thus, there is infinite rivalry, which leads to improvement (Dana, 1848). Cities were originally founded by individuals who congregated for the purpose of national protection and defense. However, in countries with well established governments, men only resort to settling in the urban due to its advantages.The high scale and affluence of the business transactions in cities could not be found elsewhere. Furthermore, the subdivisions of employments offer various fields of exercise in different skills and talents (McCulloch, 1852). As a result, cities became the center of political and economic freedom. In the medieval era, cities were concentrated by entrepreneurs who profited from the restrictions of the lords and the vassals. Nowadays, cities are also the center of the political and economic arena (Lachmann, 2002). The development of cities also has negative implications.The increasing concentration of the population in cities tends to congest the dwelling and cause little social and economic mobility. High concentrated places are also characterized by poverty due to the numer ous structural factors in the urban environment (Gilbert, 2004). In addition, the standard of living becomes low, and people are having a difficult time in seeking for employment due to the numerous people seeking for jobs. Urbanization also poses a threat to the environment, industries and factories continue to grow and come out that may bring substances and elements noxious to our environment (Gilbert, 2004).Due to the growing problems brought by urbanization and congesting cities, the U. S. government began its attempts to address these problems through the implementation of various programs which aim to help the citizens in the cities. They improved their healthcare and social welfare to help people without homes and employment. They also strengthened the laws which aim to protect the people and the environment in the noxious effects of urbanization. References Dana, W. B. (1848). Merchants' Magazine and Commercial Review. New York: Published At 142 Fulton Street. Gilbert, M. A. (2004, April). More than job creation: A case study of empowerment zones and opportunities for economic mobility (Abstract). Paper presented at the annual meeting of the The Midwest Political Science Association, Palmer House Hilton, Chicago, Illinois. All Academic. Retrieved August 11, 2008 from http://www. allacademic. com/meta/p83598_index. html. Lachmann, R. (2002). Capitalists in Spite of Themselves. New York: Oxford UP. McCulloch, J. R. (1852). A Dictionary, Practical, Theoretical, and Historical, of Commerce and Navigation. London: Longman, Brown, Green and Longmans.

The Lesson Essay - 1134 Words

Social classes are a dividing system for people of a nation or country, and have existed for as long as history can date back. In the past, it has designated people to certain categories that determined the opportunities and privileges that they could receive. In the past, the social class a person belonged to was determined by which one he or she was born into, and this label generally stuck to someone for life. In more recent history, broadened opportunity has opened up an escape for those stuck in the lower classes. The social class a person is born into has become a starting point in life, and where somebody ends up is decided by his or her determination. In Toni Cade Bambaras â€Å"The Lesson,† the theme is about learning that a†¦show more content†¦This realization excites Miss Moore because she always tells the children that where they are is who they are, but it does not have to be like that. Sylvia shows that she has learned that she can break away from her social class when she says that nobody will beat her at anything. Bambara also uses the character of Sylvia, to develop the theme in â€Å"The Lesson.† Throughout the story, Sylvia boasts a rebellious and disrespectful attitude. As narrator, she describes the setting of the story to be â€Å"back in the days when everyone was old and stupid or young and foolish and me and Sugar were just right...† (60). Much of what Sylvia thinks or does displays the feeling that she is better than everyone else, such as laughing at Miss Moores appearance, terrorizing the West Indian kids, and taking their hair ribbons and money (60-61). She always wants to escape Miss Moores lessons; she feels that it is not fair for her to be stuck being bored with Miss Moore on a day that should be spent swimming (61). The trip to F.A.O. Schwarz furthers Sylvia anger towards Miss Moore because she is exposed people who possess more than her. 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