Paper Example on Effective Nursing Practice for Norovirus

Introduction

Norovirus inflection (NoV) is a major health issue worldwide. The virus is the leading cause of acute gastroenteritis with statistics indicating that it accounts for more than 90 percent of all viral gastroenteritis. In Australia, approximately 1.8 million cases of NoV infection are reported each year (Ong, 2013). The continued increase in the number of new cases places a huge economic burden on Australians. Based on the 2016 prices, the national cost of treatment for Australians as a result of acute gastroenteritis was AUD$359 million (Barker et al., 2018). Although the virus affects all age groups, older patients (at least 65 years) account for the majority of the hospitalizations and deaths (Ong, 2013). Given the high hospitalizations and death rates, understanding the risks faced by older patients can help design appropriate interventions to reduce the social and economic burden of acute gastroenteritis.

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The Norovirus

What is Norovirus?

Norovirus is a highly contagious viral infection which causes gastroenteritis-a disease of the stomach and intestines. NoV often manifests itself as a brief, self-limited illness with an incubation period of 12 to 48 hours. Some cases of NoV infection may take 4 to 6 days to manifest themselves while others take longer than days. The onset of the disease is characterised by nausea, vomiting and abdominal cramps though the most common symptom is non-bloody diarrhoea which occurs in 90% of the cases (Ong, 2013). Outbreaks of NoV infections occur at any time of the year but episodes are much more common during the winter (New South Wales Government, 2018).

Symptom and Transmission

NoV infections occur both in hospitals and community settings. The NoV infections can spread through person-to-person contact (e.g. shaking hands with someone who has been sick), direct contact with the stool of a person infected with the virus, and contact with objects contaminated with the virus. Other modes of transmission include food, water, and inhaling of infected air particles (New South Wales Government, 2018; Ong, 2013). The modes through the virus are transmitted make it a difficult pathogen to control.

Risks for Older Patients

Research has shown that older patients face a higher risk of contracting the NoV infection. For instance, older persons have age-related immunosenescence which makes them more vulnerable to infections. Further, the presence of comorbid conditions creates extended symptoms for older patients. Moreover, elderly residents have a higher likelihood of staying longer in long-term care facilities (LTCFs). LTCFs are common conditions for outbreaks of norovirus infection because, in these facilities, elderly residents share rooms and touch common surfaces which increase the risk of infection (Chen, Hall, & Kirk, 2017). The risk of transmission is also increased by the institutionalized confinement that characterises elderly care facilities.

Infection Control Precautions in a Residential Aged Care Facility

Hand washing is an important control precaution against NoV. For medical staff, it should be done after an invasive procedure, contact with patients, and after touching body fluids of residents and contaminated equipment (Queensland Government, 2018; Ong, 2013). According to the Queensland Government (2018), it is necessary to wash hands as hands are the predominant mode of cross transmission of infections. Washing hands removes salient NoV pathogens acquired by recent contact with residents, equipment or dirty surfaces.

Wearing protective equipment can also reduce risk of infections. Before touching the skin, mucous membranes, body fluids, blood and secretions, the nursing staff must wear gloves. The gloves must be changed and discarded between given tasks to avoid transmission since NoV is a highly contagious infection. The rationale for this is that gloves reduce the chances of transmission of infections through contact (Queensland Government, 2018). However, it is should be noted that the obligation to change and discard gloves between tasks does not eliminate the requirement to wash hands.

Residential Aged Care Facility

Cleaning the hospital environment can control infections. Hospital surfaces and health equipment must be cleaned using detergents and water as per the instructions of manufacturers (NHMRC, 2013). Since aged residents face a higher risk of contamination in healthcare facility settings, cleaning removes pathogens from surfaces that come in contact with residents and care providers.

Safe handling of food mitigates the risk of NoV spreading. NoV spreads through food and water. Safe food handling is critical since older people are more susceptible to food-borne diseases. The emphasis on food handling is based on the finding that tiny contaminated particles of air carrying the virus easily affect food in hospital settings though food can also be contaminated at the source (NHMRC, 2013). This should be supported by educating residents about food safety.

Assessment and Nursing Care

Pressure injury assessment is vital in the case of Mrs. Charini Tamang to reduce the risk of the NoV spreading. Pressure injuries are considered preventable yet the prevalence rates in Australian hospitals go as high as 30 percent (Latimer, Gillespie, & Chaboyer, 2017). In the case of Tamang, her ability to respond to pressure related discomfort is critical for effective communicate with nurses as they seek to administer appropriate interventions against the Norovirus infection. Assessment on the extent to which the skin is exposed to moisture is pivotal as well. Dampness provides a favorable environment for the transmission of NoV (Ong, 2013). As such, doing an assessment would help the caregivers to move the patient from damp locations/settings to avoid contamination of the skin with NoV.

Assessment of nutritional status is an important procedure for securing the safety of patients. Older patients are considered nutritionally vulnerable because age predisposes them to a nutrient deficiency as a result of a decline in energy requirements. The deficiency reduces the body's ability to deal with stressors (e.g. a bout of diarrhoea as evidenced in the case Tamang), making them vulnerable to infections (Starr, McDonald, & Bales, 2015). Thus, findings from screens on nutritional decline can help medical officers to tailor care in a manner that is effective in dealing with risks such as pressure injuries and falls which are predisposing factors for nosocomial infections. The assessment may also help caregivers to make decisions about giving patients food supplements to facilitate recovery (Victoria State Government, 2018).

Sensitivity to the culture of patients is a common nursing practice meant to improve the quality of healthcare outcomes. Tamang is Nepalese and professes Buddhist faith. Religious beliefs and practices impact on how patients respond to treatment as well as on their perceptions about service delivery. Awareness of culture promotes collaboration with residents thereby enhancing patient-centred care (Jo Delaney, 2018; Freeman et al., 2014). The rationale for this assessment is to enable nurses to develop respect for the views and wishes of people like Tamang in order to avoid situations where clinical decisions are based on stereotypes.

Interdisciplinary Team

Having a social worker and physical therapist can improve the quality of care to Tamang. Research has found that integrated care enables health workers to meet the social and health needs of older patients (Spoorenberg et al., 2015). In the case study, involving a social worker is necessary to assist in facilitating family support to Tamang with a view to meeting the social needs of the patient. The social worker can also act as a link between the nurses and the families, making all stakeholders pool their resources together for the benefit of the patient. Such collaboration is likely to improve not only the quality of service delivery but also the overall well-being of the patient.

In the same vein, older patients are likely to be frail and living with many chronic conditions which require rehabilitation through physiotherapy. Thus, a physical therapist is essential in Tamang's case to enable the patient to enhance her mobility and relieve the abdominal pain. According to the study done by Shakib et al. (2016), a multidisciplinary approach to elderly care improves survival rates among older patients with multimorbidity. The study findings suggest that providing nursing care alone cannot meet the needs of older patients.

Conclusion

Norovirus is a contagious pathogen responsible for the overwhelming majority of all viral gastroenteritis in Australia and around the world. The virus manifests itself in nausea, diarrhoea, vomiting and abdominal pain. Transmission modes include food, water, and physical contact with persons or surfaces contaminated with the virus. As a standard practice, it is essential that risk assessment is done to design to appropriate medical interventions for older patients such as Tamang. Pressure injury assessment is vital to determine the risk exposure of patients to infections through skin contact. Nutritional assessment allows health workers to establish the vulnerability of the patient to infections as well as make decisions on giving food supplements to the patient. Cultural risk assessment allows medical teams to provide patient-centred care and promotes collaboration between the patient and medical staff. For Tamang, it is imperative that treatment involves an appreciation of her Buddhist beliefs and cultural background of Nepalese people. Besides assessing the risk of patients, adopting a multidisciplinary approach involving nurses, social workers, and physical therapist can significantly improve health outcomes of patients.

References

Australia National Health & Medical Research Council. (2013). Infection prevention and control in resident and community aged care. Retrieved from https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/d1034_infection_control_residential_aged_care_140115.pdf

Barker, S. F., Zomer, E., O'Toole, J., Sinclair, M., Gibney, K., Liew, D., & Leder, K. (2018). Cost of gastroenteritis in Australia: A healthcare perspective. PLOS ONE, 13(4), e0195759. doi:10.1371/journal.pone.0195759

Chen, Y., Hall, A. J., & Kirk, M. D. (2017). Norovirus disease in older adults living in long-term care facilities: Strategies for management. Current Geriatrics Reports, 6(1), 26-33. doi:10.1007/s13670-017-0195-z

Freeman, T., Edwards, T., Baum, F., Lawless, A., Jolley, G., Javanparast, S., & Francis, T. (2014). Cultural respect strategies in Australian Aboriginal primary health care services: beyond education and training of practitioners. Australian and New Zealand Journal of Public Health, 38(4), 355-361. doi:10.1111/1753-6405.12231

Jo Delaney, L. (2018). Patient-centred care as an approach to improving health care in Australia. Collegian, 25(1), 119-123. doi:10.1016/j.colegn.2017.02.005

Latimer, S., Gillespie, B. M., & Chaboyer, W. (2017). Predictors of pressure injury prevention strategies in at-risk medical patients: An Australian multi-centre study. Collegian, 24(2), 155-163. doi:10.1016/j.colegn.2015.11.005

New South Wales Government. (2018). Norovirus. Retrieved from http://www.health.nsw.gov.au/Infectious/factsheets/Pages/norovirus.aspx

Ong, C. W. (2013). Norovirus: A challenging pathogen. Healthcare infection, 18(4), 133-142. doi:10.1071/hi13016

Queensland Government. (2018). Residential aged care facilities infection management. Retrieved from http://bsphn.org.au/wp-content/uploads/2018/03/Infection-Management.pdf

Shakib, S., Dundon, B. K., Maddison, J., Thomas, J., Stanners, M., Caughey, G. E., & Clark, R. A. (2016...