Transforming Nursing Leadership and Practice

Transforming Nursing Leadership and Practice Order Instructions: Identify a leadership or practice issue. briefly outline the issue you have chosen to discuss and justify your choice.

Identify a journal that may be interested in publishing a literature review about your chosen issue and provide a rationale for your choice of journal. Clearly, describe the steps that are required in the process of developing a literature review on your topic.
Use the following structure as a guide:
1.Introduction :
Introduce the leadership issue or area of practice change, justify your choice of topic and provide an overview of your paper.
2.Background :
Make a clear statement about the relevance and importance of your topic to nursing.
Using scholarly literature, provide background information about your topic and challenges associated with your leadership or practice issue.
3.Choice of journal and process of developing a scholarly paper:
Using the information and reading from your learning modules for guidance, provide a comprehensive rationale for your choice of the journal and discuss the step involved in developing a paper for publication.

Transforming Nursing Leadership and Practice Sample Answer

Transforming Nursing Leadership

Introduction

The nursing profession exposes the employee to a host of leadership and management issues that they need to be aware of and take into consideration from time to time. Though the nursing role is often protected from interference by persons in leadership positions, the minimal aspects of human resource management such as performance evaluation and welfare issues call for leadership in nursing practice. Every nurse often gets urgent calls that they are not prepared for psychologically and at times the outcome of a medical trial or treatment does not turn out as expected and as professionals, it is devastating (Brown, 2016). Leadership and management ensure that the nurses are well taken care of and remunerated so that they can offer the optimal results expected of them. However necessary the medical services are, a nurse needs to lead a normal life so as to distinguish the mindset at work from the mindset at home.

Management and hospital leadership ensure that there are free transitions between nursing shifts and that the nursing staff is indeed adequate. A lot can go wrong and indeed, a lot does go wrong from time to time when shift management is not properly handled. It is often nurses that bear the burden of responsibility when it comes to the care of patients. However, it is often a concern when the health of these nurses is at risk. Managers and hospital leaders thus need to guarantee that there are no circumstances that will inconvenience the nurse or the patient in the course of their treatment (Anderson, Malone, Shanahan & Manning, 2015). It is the role of management, for instance, to assess the psychological and physical state of nurses from time to time to guarantee that their health status allows them to work. This is because; the caregiver role that many nurses play hardly allows them to demonstrate any emotion, problem or weakness to their patients. Management is aware of this and has to consistently ensure that the welfare of the nurses is guaranteed. This paper is going to discuss the inefficiencies in nursing leadership and their impact on the nursing working environment.

Inefficiencies in Nursing Leadership and management

Nursing leadership is not always effective. There are concerns about the ability of nursing leaders to make accurate ethical and efficacy decisions from time to time. Such concerns arise when trauma situations arise and a myriad of emergency cases are admitted at the hospital. The ability of the nurse leader to maintain their composure and manage the human resource in the wake of potentially life-threatening situations is almost always realized among the most unnerved of nurses. For instance, when emergency victims are rushed to the hospital institution, there are concerns over the level of injury they are exposed to and the nature of care they require, including aspects such as prepping for surgery and getting the right equipment and personnel at the right time and place. Such issues at times mark the difference between life and death for the nursing staff. Leadership must thus make very first and accurate decisions to save a life, which is a paramount duty in the medical profession.

Exposure to contamination is a concern in the nursing environment. Management in the nursing profession needs to create an environment where nurses can freely treat patients without risking being infected. The provision of safety equipment at all times must thus never be compromised. Critical working equipment such as gloves and gas masks go a long way to protect the medical staff in a hospital especially where contagious airborne diseases are diagnosed (Malone, 2016). Contamination has been experienced in previous treatment trials such as the SARS and Swine Flu viruses. The need for care by the treatment professionals often trounces the risks they face at the working environment. Management and proper leadership of nurses thus bridge the gap between the call to serve mankind and the exposure to risk. In the need to control disease spread, nurses often expose themselves to hazards that are potentially lethal to their health. Management needs to protect these employees from exposing themselves to such dangers since this exposure to diseases is a concern they have to face every now and then.

Contaminated equipment is also another concern hospital leadership and management has to deal with. In many countries across the world, there are very few hospitals and insufficient medical personnel to handle patients. This is the reason why hospital beds are at times shared and some of the basic equipment that needs to be applied by one patient ends up being used by several. There may also be insufficient sanitary equipment to clean medical equipment after use. Direct contact with patients in these circumstances is often inevitable rather than accidental. Nurses end up contacting diseases and basically becoming exposed to harsh working conditions as a result. For some of these professionals, working in these environments is not a matter of choice but rather a duty and a necessary evil they have to endure. This is why it is necessary to ensure that nurses are not exposed to such working conditions.

Regulations to minimize exposure

In many nations across the world, there is a regulatory mechanism or framework to ensure that medical professionals are in situations where they can perform at their optimal. It is up to the hospital leadership and management to ensure that these regulations are followed and met with optimal standard actualization. However, demanding the assignment is; the hospital leadership is required to offer them basic sanitary provisions to prevent exposure to contamination and contracting infectious viruses from the patients. It is a basic concern that the person offering the medical skills and services in an institution be protected from the medical hazards within their environment (Andrew & Mansour, 2014). Regulation such as minimal hygiene standards in a hospital is very critical in the event the hospital is facing health concerns from their own sanitation concerns. It is important to ensure that hospitals that do not comply with basic requirements are indicted so that they do not expose the rest of society to these health issues. Hospitals need to be establishments where diseases are treated; not contracted.

The United States Department of Health works with the Occupational Safety and Health Association (OSHA) to guarantee health standards within working environments and the safety of nursing and other medical professionals. This makes it possible for nursing professionals to maintain a fairly healthy living style despite being in near-exposure situations every day. The organization also runs periodic medical tests on the nurses to assess their psychological situation from time to time. This is in order to guarantee the safety of the patients they treat from time to time. It is vital that while there are measures to check whether the nurse is in their right state of mind; more effort is made towards ensuring that they are given the right counseling and encouragement as they perform their noble assignments (Barr & Welch, 2012).

Changes to improve nurse employee safety

Lack of proper leadership in a hospital environment can be very detrimental to medical personnel. For instance, the recent Ebola virus spread in West Africa demonstrated how medical conditions and the state of healthcare safety in some countries are very wanting. Due to the lack of proper leadership among local government health ministries, many nurses were infected with the Ebola virus. Some even, unfortunately, succumbed to it. This is often the concern when the government cannot have proper management of medical agencies involved to guarantee proper safety of the nurses. The government thus exposed most of these nurses to the health hazards they faced due to their incompetent leadership (Kear & Ulrich, 2015). There are many other situations where the exposure of nurses to medical risk situations is a need that the organizations need to take care of yet fail to do so. There need to be more standards and the guarantee of the same to ensure that medical professionals are always guaranteed of their safety while at work.

Leaders in the nursing profession need to be at the forefront of realizing better ways to improve common practices. Medical professionals can also give their input regarding the necessary changes that can be done in order to guarantee better working environments. A lot of research is done in the medical profession concerning how to treat new infections and curb the spread of bacteria and viruses. However, little is done to confront the issue of occupational safety (Coben & Weeks, 2014). It is vital that there be research units dedicated to the institution of realizing better healthcare across the globe. Better healthcare can, however, be guaranteed if the health of the healthcare giver; the nurse is not at risk. This is why research in such fields is a concern that needs to be addressed from time to time and ensured where it lacks.

Transforming Nursing Leadership and Practice Conclusion

While technology has boosted medical practice extensively over the last few decades, the issue of nursing leadership is still a concern. Medical professionals often face situations where their health risk is a concern. Management needs to be aware of these concerns and treat nurses like employees who deserve a lot of care since their contribution to society is indeed very significant. There is a need to have nurses and other persons in the profession protected from contamination while at work. It is also necessary to protect the patients in hospitals from unhygienic exposure (Kangasniemi, Vaismoradi, Jasper & Turunen, 2013). This can only be done if the hospital leadership is aggressive in making the hospital environment better. Organizations that handle healthcare regulation have to be on the forefront to guarantee that health and safety in hospitals and other medical care facilities guaranteed.

Transforming Nursing Leadership and Practice References

Anderson, J., Malone, L., Shanahan, K., & Manning, J. (2015). Nursing bedside clinical handover – an integrated review of issues and tools. Journal Of Clinical Nursing, 24(5/6), 662-671.

Andrew, S., & Mansour, M. (2014). Safeguarding in medication administration: understanding pre-registration nursing students’ survey response to patient safety and peer reporting issues. Journal Of Nursing Management, 22(3), 311-321.

Barr, J., & Welch, A. (2012). Keeping nurse researchers safe: workplace health and safety issues. Journal Of Advanced Nursing,68(7), 1538-1545.

Brown, G. (2016). Averting Malpractice Issues in Today’s Nursing Practice. ABNF Journal, 27(2), 25-27.

Coben, D., & Weeks, K. (2014). Meeting the mathematical demands of the safety-critical workplace: medication dosage calculation problem-solving for nursing. Educational Studies In Mathematics, 86(2), 253-270.

Kangasniemi, M., Vaismoradi, M., Jasper, M., & Turunen, H. (2013). Ethical issues in patient safety: Implications for nursing management. Nursing Ethics, 20(8), 904-916.

Kear, T., & Ulrich, B. (2015). Patient Safety and Patient Safety Culture in Nephrology Nurse Practice Settings: Issues, Solutions, and Best Practices. Nephrology Nursing Journal, 42(2), 113-123.

Malone, B. R. (2016). Professional Issues. Intimidating Behavior Among Healthcare Workers Is Still Jeopardizing Medication Safety.Nephrology Nursing Journal, 43(2), 157-159

Pneumonia Research Paper Available

Pneumonia

Order Instructions

Read the following articles:

Lisy, K. (2014). Chest physiotherapy for pneumonia in children. The American Journal of Nursing, 114(5), 16. doi:10.1097/01.NAJ.0000446761.33589.70
Makic, M., Rauen, C., Jones, K. and Fisk, A. (2015) Continuing to challenge practice to be evidence based. Critical Care Nurse, 35(2), 39-50. doi:10.4037/ccn2015693

Certain practice habits continue to be used despite the availability of research and other forms of evidence that should be implemented to guide practice interventions. CPT is often prescribed for children with pneumonia, asthma, bronchiolitis, and atelectasis following surgery or mechanical ventilation.

Initial Discussin Post::

What is the expected outcome when implementing CPT?
What are the risks of performing CPT? Do the risks outweigh the benefits?
Is the practice of CPT supported by evidence? Are there safe, alternative interventions that the RN can implement to achieve the same outcome as performing CPT? If so, identify at least one.
Base your initial post on your readings and research of this topic.

*FORMATTING AND STYLE FOR WRITTEN ASSIGNMENTS:
*APA style is required for the writing assignments.

The body of your initial post to the discussion question must:
Contain a minimum of 250 words. References, citations, and repeating the question do not count towards the 250 word minimum.
• Contain at least one (1) current professional nursing reference.
o A current professional nursing reference is from current (five [5] years old or less) professional sources published in the United States.
o Sources such as Wikipedia, Medicine Net, nursing blogs etc. are not professional nursing resources and do not count towards the one (1)reference minimum.

Required:
Textbooks for this paper:
Brunner and Suddarth’s textbook of medical-surgical nursing**
• Chapter 23: Management of Patients with Chest and Lower Respiratory Tract Disorders (sections on “Atelectasis”, “Acute Tracheobronchitis” , “Pneumonia”, “Aspiration”, “Pleurisy” and “Pleural Effusion”, “Acute Respiratory Failure”,” Acute Respiratory Distress Syndrome” and “Chest Trauma”)
• Chapter 24: Management of Patients with Chronic Pulmonary Disease (sections on “Chronic Obstructive Pulmonary Disease” and “Plan of Nursing Care – Care of the Patient with COPD” )
Pharmacology**
• Chapter 41: Drugs for Lower Respiratory Disorders
Nursing Diagnosis Guidebook
• Use your chosen Nursing Diagnosis Guidebook to review the nursing diagnoses specific to the content covered in this module
Maternal and child health nursing**
• Chapter 40: Nursing Care of a Family When a Child has a Respiratory Disorder(sections on “Aspiration”, “Bronchial Obstruction”, “Bronchiolitis”, “Pneumonia”, “Atelectasis” and “Pneumothorax” only)
Web Based and Other Professional Resources:
• Chest physiotherapy for pneumonia in children (2014)**
• Continuing to challenge practice to be evidence based (2015)
• CDC guidelines for the pneumococcal vaccine

***Required Materials and text book for Nursing 211 course.

Textbooks (Chapter numbers and titles may differ in subsequent editions of a given textbook. If your edition is different, use the Table of Contents in the textbook to locate the appropriate chapters to read):

Hinkle, J., & Cheever, K. (2014). Brunner and Suddarth’s textbook of medical-surgical nursing (13th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

Kee, J., Hayes, E., & McCuistion, L. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). St. Louis, MO: Elsevier.

Nursing Diagnosis Guidebook
A pocket-size nursing diagnosis guidebook of your choice that is no more than one edition old, that includes NANDA International-approved nursing diagnoses, definitions, defining characteristics, and possible nursing Interventions.

Pillitteri,A. (2014). Maternal and child health nursing: Care of the childbearing & childrearing family (7th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

Web Based and Other Professional Resources:

American Heart Association. (2014). American Heart Association issues e-cigarettes recommendations.

Jenerette, C. M., Brewer, C. A., & Ataga, K. I. (2014). Care seeking for pain in young adults with sickle cell disease. Pain Management Nursing, 15(1), 324-330 7p. doi:10.1016/j.pmn.2012.10.007

Johnson, M. and Pennington, N. (2014). Adolescent use of electronic cigarettes: An emergent health concern for pediatric nurses. Journal of Pediatric Nursing. doi:10.1016/j.pedn2014.11.006

Lisy, K. (2014). Chest physiotherapy for pneumonia in children. The American Journal of Nursing, 114(5), 16. doi:10.1097/01.NAJ.0000446761.33589.70

Mahon, S. Screening for breast cancer: Evidence and recommendations. (2012). Clinical Journal of Oncology Nursing, 16 (6), 567-571. doi10.1188/12.CJON.567-571

Makic, M., Rauen, C., Jones, K. and Fisk, A. (2015) Continuing to challenge practice to be evidence based. Critical Care Nurse, 35(2), 39-50. doi:10.4037/ccn2015693

Mayer, D. K. (2012). Anatomy of a drug shortage. Clinical Journal of Oncology Nursing, 16(2), 107-108.

McKeever, A. E., Bloch, J. R., & Bratic, A. (2013). Drug shortages and the burden of access to care: A critical issue affecting patients with cancer. Clinical Journal of Oncology Nursing, 17(5), 490-495. doi:10.1188/13.CJON.490-495

Purbaugh, T. (2014). Alarm fatigue: A roadmap for mitigating the cacophony of beeps. Dimensions of Critical Care Nursing; 33 (1), 4-7.

Stevens, S. (2015). Preventing 30-day Readmissions. Nursing Clinics of North America, 50 (Transformational Tool Kit for Front Line Nurses), 123-137. doi:10.1016/j.cnur.2014.10.010

Wilson, B. H., & Nelson, J. (2015). Sickle cell disease pain management in adolescents: A literature review. Pain Management Nursing, 16, 146-151. doi:10.1016/j.pmn.2014.05.015

American Cancer Society

CDC guidelines for the pneumococcal vaccine

Drug Shortages page of the Food and Drug Administration website

Pulmonary Hypertension Association

SAMPLE ANSWER

Question 1

Chest Physical Therapy (CPT) is a technique that helps patients breathe more freely and receive more body oxygen. It is based on the theory that when particular back and chest parts are percussed, transmission of shock waves occurs through the chest wall. This in turn loosens the airway secretions. CPT has been used commonly in children with pneumonia. In a well-positioned, the secretions flow into the upper airways and then cleared through deep breathing techniques and coughing. The outcomes of CPT implementation include improved respiratory efficiency, elimination of respiratory secretions, changes in breath sounds, increased blood oxygenation as measured by ABG sampling, and improved chest X-ray findings.

Question 2

Some of the risk factors that have been associated with CPT include pulmonary hemorrhage, vomiting and aspiration, injury or pain to the ribs, spine or muscles, dysrhythmias, bronchospasms, and occasions of acute hypotension in some patients. CPT does more harm than go to the patient.

Question 3

There is no evidence that supports the use of CPT in evacuating mucus from the peripheral lung regions. Registered nurses have been challenged to evaluate their practice and embrace clinical practices that are evidence-based into their daily practice. Newer and safer interventions have been introduced in clinical practice to aid in curbing the adverse effects of CPT (Lisy, 2014). The interventions include Active Cycle of Breathing Technique (ACBT), autogenic drainage, forced expiratory technique (FET), and positive expiratory pressure (PEP). An interview like ACBT aids patients with respiratory conditions in clearing sputum by loosening and moving the sputum from the airways. Conversely, in PEP patients breathe against a resistance to force air behind the mucus and help it move from the air walls.

Reference

Lisy, K. (2014). Chest physiotherapy for pneumonia in children. The American Journal of Nursing, 114(5), 16. doi:10.1097/01.NAJ.0000446761.33589.70

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Implementation of the IOM Future of Nursing

Implementation of the IOM Future of Nursing Order Instructions: Benchmark Assignment: Implementation of the IOM Future of Nursing Report

View Rubric Details:

In a formal paper of 1,000-1,250 words, you will discuss the work of the Robert Wood Johnson Foundation Committee Initiative on the Future of Nursing and the Institute of Medicine research that led to the IOM report, “Future of Nursing: Leading Change, Advancing Health.” Identify the importance of the IOM “Future of Nursing” report related to nursing practice, nursing education and nursing workforce development. What is the role of state-based action coalitions and how do they advance goals of the Future of Nursing: Campaign for Action?

Explore the Campaign for Action webpage (you may need to research your state’s website independently if it is not active on this site): http://campaignforaction.org/states

Review your state’s progress report by locating your state and clicking on one of the six progress icons for education, leadership, practice, interpersonal collaboration, diversity, and data. You can also download a full progress report for your state by clicking on the box located at the bottom of the webpage.

In a paper of 1,000-1,250 words:
1. Discuss the work of the Robert Wood Johnson Foundation Committee Initiative on the Future of Nursing and the Institute of Medicine research that led to the IOM report, “Future of Nursing: Leading Change, Advancing Health.”
2. Identify the importance of the IOM “Future of Nursing” report related to nursing practice, nursing education and nursing workforce development.
3. What is the role of state-based action coalitions and how do they advance goals of the Future of Nursing: Campaign for Action?

Summarize two initiatives spearheaded by your state’s Action Coalition. In what ways do these initiatives advance the nursing profession? What barriers to advancement currently exist in your state? How can nursing advocates in your state overcome these barriers?

A minimum of three scholarly references is required for this assignment.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

Please Note: Assignment will not be submitted to the faculty member until the “Submit” button under “Final Submission” is clicked.

*******RUBRIC*********

Benchmark Assignment: Implementation of the IOM Future of Nursing Report

1
Unsatisfactory
0.00%

2
Less than Satisfactory
75.00%

3
Satisfactory
79.00%

4
Good
89.00%

5
Excellent
100.00%

80.0 %Content

5.0 % Provided an original summary of the key messages of the IOM report, Future of Nursing: Leading Change, Advancing Health. Any specific references should be cited.

Did not attempt to provide a summary of the key messages of the IOM report, Future of Nursing: Leading Change, Advancing Health, or failed to cite specific references to the IOM report.

Provided a skeletal summary of the key messages of the IOM report, Future of Nursing: Leading Change, Advancing Health. Some of the specific references to the IOM report were cited or were done incorrectly.

Demonstrates a moderate knowledge of the subject. Recognizes the basic ideas. Misinterprets evidence on the committee’s initiative.

Demonstrates good knowledge of the subject. Correctly describes the committee’s initiative. Justifies some of the impacts on the Future of Nursing.

Provided an original summary of the key messages of the IOM report, Future of Nursing: Leading Change, Advancing Health. References specific to the IOM report were properly cited.

15.0 % Identify the role of the Robert Wood Johnson Foundation Initiative and the American Association of Retired Persons on the Future of Nursing Campaign for Action and the State-Based Action Coalitions

Does not demonstrate knowledge of role. Fails to identify the impact of the Robert Wood Johnson Foundation Initiative on the Future of Nursing.

Demonstrates minimal knowledge of the subject. Does not adequately visualize or justify the work of the Committee of the Robert Wood Johnson Foundation Initiative on the Future of Nursing.

Demonstrates a moderate knowledge of the subject. Recognizes the basic ideas. Misinterprets evidence on the committee’s initiative.

Demonstrates good knowledge of the subject. Correctly describes the committee’s initiative. Justifies some of the impacts on the Future of Nursing.

Demonstrates full and deep knowledge of the subject. Develops and explains an informed position on the committee’s initiative, integrates and justifies the impact on the Future of Nursing

15.0 % Identify the importance of the IOM FON report related to the nursing workforce

Does not demonstrate knowledge of the concept or its role. Fails to identify the importance of the IOM FON report related to the nursing workforce.

Demonstrates minimal knowledge of the subject. Does not adequately visualize or justify the importance of the IOM FON report related to the nursing workforce.

Demonstrates a moderate knowledge of the subject. Recognizes the basic ideas. Misinterprets evidence on the importance of the IOM FON report related to the nursing workforce.

Demonstrates good knowledge of the subject. Correctly describes the importance of the IOM FON report related to the nursing workforce.

Demonstrates full and deep knowledge of the subject. Develops and explains the importance of the IOM FON report, integrates and justifies the importance of the IOM FON report related to the nursing workforce.

15.0 % Discuss the intent of the Future of Nursing Campaign for Action

Does not demonstrate knowledge of the concept or its role. Fails to identify the intent of the Future of Nursing Campaign for Action.

Demonstrates minimal knowledge of the subject. Does not adequately visualize or identify the intent of the Future of Nursing Campaign for Action.

Demonstrates a moderate knowledge of the subject. Recognizes the basic ideas. Misinterprets evidence on the intent of the Future of Nursing Campaign for Action.

Demonstrates good knowledge of the subject. Correctly describes the intent of the Future of Nursing Campaign for Action.

Demonstrates full and deep knowledge of the subject. Develops and explains the intent of the Future of Nursing Campaign for Action, integrates and justifies the intent of the Future of Nursing Campaign for Action.

15.0 % Identify the rationale of state-based action coalitions

Does not demonstrate knowledge of the concept or its role. Fails to identify the rationale of state-based action coalitions.

Demonstrates minimal knowledge of the subject. Does not adequately identify the rationale of state-based action coalitions.

Demonstrates a moderate knowledge of the subject. Recognizes the basic ideas. Misinterprets evidence on the rationale of state-based action coalitions.

Demonstrates good knowledge of the subject. Correctly identifies the rationale of state-based action coalitions.

Demonstrates full and deep knowledge of the subject. Develops and explains and identifies the rationale of state-based action coalitions and justifies a rationale for state-based action coalitions.

15.0 % Discuss one state-based action coalition and two initiatives

Does not demonstrate knowledge of the concept or its role. Fails to identify one state-based action coalition and two initiatives.

Demonstrates minimal knowledge of the subject. Does not adequately identify one state-based action coalition and two initiatives.

Demonstrates a moderate knowledge of the subject. Recognizes the basic ideas. Identifies but misinterprets one state-based action coalition and two initiatives.

Demonstrates good knowledge of the subject. Correctly identifies one state-based action coalition and two initiatives.

Demonstrates full and deep knowledge of the subject. Develops and explains the one state-based action coalition and two initiatives, integrates and justifies one state-based action coalition and two initiatives.

15.0 %Organization and Effectiveness

5.0 % Thesis Development and Purpose

Paper lacks any discernible overall purpose or organizing claim.

Thesis and/or main claim are insufficiently developed and/or vague; the purpose is not clear.

Thesis and/or main claim are apparent and appropriate to the purpose.

Thesis and/or main claim are clear and forecast the development of the paper. Is descriptive and reflective of the arguments and appropriate to the purpose.

Thesis and/or main claim are comprehensive; contained within the thesis is the essence of the paper. Thesis statement makes the purpose of the paper clear.

15.0 %Organization and Effectiveness

5.0 % Paragraph Development and Transitions

Paragraphs and transitions consistently lack unity and coherence. No apparent connections between paragraphs are established. Transitions are inappropriate to purpose and scope. The organization is disjointed.

Some paragraphs and transitions may lack logical progression of ideas, unity, coherence, and/or cohesiveness. Some degree of organization is evident.

Paragraphs are generally competent, but ideas may show some inconsistency in the organization and/or in their relationships to each other.

A logical progression of ideas between paragraphs is apparent. Paragraphs exhibit a unity, coherence, and cohesiveness. Topic sentences and concluding remarks are appropriate to the purpose.

There is a sophisticated construction of paragraphs and transitions. Ideas progress and relate to each other. Paragraph and transition construction guide the reader. Paragraph structure is seamless.

15.0 %Organization and Effectiveness

5.0 % Mechanics of Writing (includes spelling, punctuation, grammar, language use)

Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice and/or sentence construction are used.

Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, and/or word choice are present.

Some mechanical errors or typos are present but are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.

The prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.

The writer is clearly in command of standard, written, academic English.

5.0 %Format

2.0 % Paper Format (1- inch margins;12-point-font;double-spaced;Times New Roman, Arial, or Courier)

The template is not used appropriately or documentation format is rarely followed correctly.

The template is used, but some elements are missing or mistaken; lack of control with formatting is apparent.

The template is used, and formatting is correct, although some minor errors may be present.

The template is fully used; There are virtually no errors in formatting style.

All format elements are correct.

3.0 % Research Citations (In-text citations for paraphrasing and direct quotes, and reference page listing and formatting, as appropriate to assignment)

No reference page is included. No citations are used.

The reference page is present. Citations are inconsistently used.

The reference page is included and lists sources used in the paper. Sources are appropriately documented, although some errors may be present.

The reference page is present and fully inclusive of all cited sources. Documentation is appropriate and GCU style is usually correct.

In-text citations and a reference page are complete. The documentation of cited sources is free of error.

100 % Total Weightage

New York Action Coalition

The Future of Nursing New York State Action Coalition is the driving force for the implementation of the Institute of Medicine recommendations in our state. We are working with diverse stakeholders to create and model innovative solutions that will lead to healthier communities, with nurses leading the way.

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New York Action Coalition

Fostering Interprofessional Collaboration in Health Care

Collaboration is the cornerstone of success in any team. Interprofessional collaboration is one of the trademarks of several highly successful health care innovations. When nurses collaborate as equals with other health care providers, patient outcomes and quality of more

Issues: Fostering Interprofessional Collaboration, Locations: New Jersey, New York,

Transforming Nursing Education

More highly educated nursing workforce needed to provide more complex patient care, experts say. Many registered nurses (RNs) start—and finish—their post-secondary education with an associate degree in nursing (ADN). But health care experts want more nurses to see more

Issues: Transforming Nursing Education, Locations: National, New York, Texas, Wyoming,

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Susan Apold

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New York University College of Nursing

Debbie Stamps

Chief Nursing Officer
Newark-Wayne Community Hospital

Implementation of the IOM Future of Nursing Sample Answer

Benchmark Assignment: Implementation of the IOM Future of Nursing Report

With over 3 million practitioners, the profession of nursing forms the largest section of the US’s health care workforce. Nurses play a central role in assisting patients in realizing the objectives of the Affordable Care Act, legislation that forms a wide range of health care overhaul since the creation of Medicare and Medicaid. However, some obstacles have hindered nurses from effectively responding to the ever changing clinical settings as well as an evolving health care system. These challenges include a shortage of nurses, technological changes, and the shortage of educational opportunities for nursing. These barriers need to be addressed so that nurses can be in the best position of leading change and advancing health.

Work of RWJF Committee Initiative

Robert Wood Johnson Foundation (RWJF) in conjunction with the Institute of Medicine (IOM) established a major initiative that has served as a guide in the future of nursing. RWJF partnered with IOM in conducting a study and developed a report meant to transform the future of nursing. The IOM committee through this study determined potential challenges that were facing the nursing profession and compiled a report on the modifications in institutional policies at the local, state, and national levels. RWJF through the IOM’s study committee reviewed innovative models of nursing education and care delivery and provided solutions that could be used to improve the quality of care delivery at an affordable cost.

RWJF established the initiative of the “Future of Nursing” that examined the potential of promoting the quality and accessibility of care through the use of nursing-led solutions. The report had recommendations geared towards determining significant roles for nurses in planning and executing an effective and efficient health care system.

Some of the recommendations that were highlighted in the report include an examination of innovative solutions associated with the delivery of care and nursing education with a focus on nursing and the provision of patient care. It was also recommended that the nursing faculty should be expanded, the capacity of schools increased, and nursing education be redesigned in order to ensure that it produces a sufficient number of well-prepared nurses that are able to meet health care demands. Fineberg & Lavizzo-Mourey, (2013) state that clinical and community care in the US has become more complex. Therefore, the education provided should equip nurses so that they can make important decisions linked to care for frail patients and work with sophisticated, life-saving technology. The report also pointed out that the role of nurses within the context of the health care workforce, future technology, nursing shortage, and societal issues should be re-conceptualized. Nurses are called upon to collaborate with different health care professionals and coordinate care across different settings. Moreover, the committee proposed that for improved patient outcomes to be realized, the health care sector should attract and retain competent nurses in different care settings such as acute, primary care, ambulatory care, long term care, public, and community health.

The RWJF used the report in its extensive communication in conjunction with the IOM. To support the initiative, the RWJF sponsored a team of experts who discussed the issues raised by the IOM committee. The IOM also played a vital role in the development of the report. For instance, it provided evidence-based proposals to clinicians, private stake holders as well as the general public and provided independent, objective, and technical advice to policymakers. Additionally, the IOM ensured that the recommendations that were developed had an agenda that was clearly defined with an action plan that was properly formulated.

The Importance of the IOM Report

The recommendations provided by the IOM in report center around the vital intersection between the actions of the nursing workforce and the health care needs of different people across the lifespan (Reed, 2015, November). They are meant to promote the efforts of improving the health of the people of US through contributions of nurses. They have an impact in various nursing aspects such as;

Nursing Practice

Nurses have a great potential of leading innovative strategies tailored towards improving the health care system. However, a number of state regulations limit the scope of nursing practice. Depending on the state, regulations on the scope of nursing practice of a RN may deny or limit prescriptions of medications, admission of patients, assessment of patient conditions, and evaluation of tests. However, the IOM report insists that nurses should provide care to the full extent of their education and training. This has promoted delivery of quality care as nurses provide necessary care with a little limitation of the potential.

Nursing education

Through the report, profound changes were introduced in nursing education both before and after receiving a license (Keating, 2014). This resulted in the betterment of nursing education which has ensured that the current and future generations of nurses provide quality, patient-centered, safe, care across settings. Nurses have also been encouraged to act in response to the demands of the ever-changing health care sector by attaining higher levels of education and training.

Nursing workforce

To address the issue of a nursing shortage, the implementation of the IOM report has led to the entry of a greater number of nurses with a baccalaureate degree early in their life. The report has also resulted in the transformation of the practice environment through a balance of skills and perspectives among nurses and other health care providers.

Role of State-Based Action Coalitions and the Future of Nursing

States in the US have formed state-based coalitions that are aimed at enhancing the implementation of the proposed IOM recommendations. These coalitions mobilize stakeholders in the health care sector in order to promote the development of a clear plan of action. The state of New York has been in the frontline in shaping the future of nursing practice. For instance, it has adopted an initiative that is geared towards promoting nursing education for it to be in line with set standards necessitate so that is can meet the complex nature of the health care sector (Campaign for Action, 2014). The initiative also proposes that nurses should take up leadership roles in the promotion of the health care system. The objective of this initiative is to make sure that nurses know their roles as leaders and the public acknowledges the competence of nurses when promoting strategies. The state of New York has also built a strong and highly-competent nursing workforce. These initiatives have given the state’s nurses the opportunity of contributing actively in the promotion of care delivery.

The state of New York has been barred by barriers which limit proper advancement of IOM recommendations. One such barrier is the shortage of nursing workforce. This has resulted in overworking of the nursing leading to job burnout which in turn prevent delivery of quality patient care. It is also important to note the insufficient of nursing workforce has also resulted in an increase in hospitalization cases. Nursing advocates can play a central role in ensuring that the IOM recommendations are achieved. For instance, the advocates can engage actively in decision making processes that will introduce transformational policies in the health care sector. The barrier of nursing shortage can be addressed through increasing admission of undergraduate nursing students and increasing nursing schools. The policies should also target nursing education so that it can enlighten the nurses on how to deliver quality care despite the myriad of challenges facing the health care sector.

Implementation of the IOM Future of Nursing Conclusion

The US has the potential of transforming its health care sector and nurses should contribute majorly in this transformation. The IOM report has been essential in the health care sector as it calls on nurses to play a central role in America’s increasingly multifaceted health care system. Moreover, nurses have been urged to adopt leadership roles in all care settings so that they can satisfy the demands of the evolving health care. The health care delivery competencies has enabled nurses to examine the likely evolution of the health care sector, evaluate their career goals, and determine what should be done to achieve the set objectives. Some of the interventions that have been put forward include advancement of academic education, continuing education, as well as certification. These advancements have been necessary in equipping nurses with appropriate skills for tackling the challenges they encounter. However, the efforts of improving the organizational conditions not only rest solely on nurses but also on health care organizations, the government, insurance industry, and professional associations. Collaboration of these diverse parties will help in ensuring that the health sector offers affordable, seamless, quality care that is easily accessible.

Implementation of the IOM Future of Nursing References

Campaign for Action. (2014). Transforming nursing education. Retrieved from http://campaignforaction.org/transforming-nursing-education/

Fineberg, H. V., &Lavizzo-Mourey, R. (2013). The future of nursing: A look back at the landmark IOM report.

Keating, S. B. (2014). Curriculum development and evaluation in nursing. Springer Publishing Company.

Reed, J. (2015, November). Creating a Culture of Health: Opportunities for Public Health Nursing to partner with State Action Coalitions. In 143rd APHA Annual Meeting and Exposition (October 31-November 4, 2015). APHA.

The Current Transformations in Health and Social Care

The Current Transformations in Health and Social Care Order Instructions:

The Current Transformations in Health and Social Care Sample Answer

Introduction

This paper evaluates the aspect of change in health and social care setting.

The Current Transformations in Health and Social Care

Economic factors, operational framework, policy setting, and knowledge are highlighted as the core drivers of this change. Moreover, the paper evaluates not just the challenges brought about by this change but also its impact, and suitable service response mechanism. When it comes to essential principles of change management, PowerPoint presentation is employed. Furthermore, planning of changes, monitoring process, the plan for determining current transformations, social care policy and benchmarks for measuring change are discussed.

1.1Main factors that lead to change

Change refers to the transformation from the current state to a preferred future state. The cycle of change is never ending in our organization. Some welcome and enjoy uncertainties it comes with it; others fear change because they think that something valuable will be lost, and they feel that change will bring unnecessary stress (Brown & Jones 2012). In health care and social services, care is about those who provide the service and those who need the service. People are receptive to impacts of change such as managers have to establish how changes will deliver intended care within the organization.

The main reason why change is always constant is that stimuli of change, as well as other factors that drive change, are economic factors, social factors, operational factors, change in policy, and technological developments.

Economic factors

The cost of health services has been on an upward trend in spite of, the increased financing in the sector. For this reason, there is a need to reduce the expenditures of the current services while looking for cost-efficient ways of delivering the services in the future. Of concern is to ensure that the skills of the existing workforce are up-to-date and specialization has to be enhanced. Besides, cost reduction has to be maximized through the use of private and nonprofit, supplies (Hayes 2014). The rising user expectation also has to be addressed. This is because as roles develop, information becomes readily available meaning that a large group people will be able to quickly access the available information leading to more informed citizens on the services available.

Availability of information leads to a more informed choice. In other words, people will be in a position to analyze the risks involved, the value of treatment provided, and learn the long-term effects of the treatment method that they have chosen. This affects the demand for certain services and institutions depending on how people view them. In a social point of view, consumers are encouraged to be active and choose how their needs will be met. This has been made possible through the provision of means for people to directly purchase services, meaning that intermediary parties have been eliminated. This option is boosted by the increasing number of individuals who understand their rights and what they are entitled to.

There is also an increase in the roles of women, and the globalization of the medical sector has led to a changing workforce. These changes mean maintaining existing working patterns will be difficult to maintain. It also means that new ways of working will be created based on different career structures and patterns of recruitment. The mixed economy will also contribute to social care change. This is further enhanced by the shift of authorities towards direct service provision. This method has enabled a shift towards efficiency and economy. Furthermore, it has led to the emergence of improved regulation due to improved knowledge, skills, and training leading to long term changes.

Knowledge

With expanded knowledge, improved medications and new ways of doing things, expansion and improvement of services have been achieved. In areas such as drugs, the rate of change is slowing, while new discoveries are increasing. However, given the rising costs of healthcare, the expectation is that with the new developments and technological advancements, it will create new demand for available resources. Innovations will strengthen or improve existing institutions. Expansion of clinical know-how boosts changes in health care. This is because increased specializations lead to improved healthcare and expand the range of roles leading to the development of new working opportunities.

Development of information technology has allowed professionals to search and present advice without the need for a face-to-face consultation. Social care service provision widens staff groups which are providing specialized knowledge and skills. This leads to expansion of expectations, responsibilities, and requirements for new competencies and training. Improved technology has led to new methods for storing and delivering information. The emergence of the internet has enabled people to do certain tasks online; thus, reducing the need for the involvement of specialized staff. This gives them more time to concentrate on more complex care and management duties. Also, this has led to an increased number of individuals responsible for their care.

Operational Framework

Operating environment is also starting to change. For instance, the patient’s choice of where to be treated may undermine the financial position of health care provision centers. Likewise, the introduction of the private sector will, in the long run, affect the existing trusts and provide new opportunities for service delivery.

Policy Environment

Given the new regulations by the government aimed at improving performance, new ways of working and delivering care are evolving. Roles are changing as well as management and organizational structures. The need for improved performance occasioned by financial constraints is also bringing about change (Brown & Jones 2012). This is due to increased innovations in service delivery meaning that there is a continual change in professional roles. Policy changes are also reducing demarcation lines between different professional boundaries, making it much easier to effect changes. Increasing emphasis on interdependence has led to improvement in joint performance through joint monitoring and evaluation.

1.2Challenges and main factors of change

Inadequate capital affects final project outcomes owing to the costs related to the provision of social care service such as hiring new staff, acquiring new equipment, training, and staffing costs are significant challenges for health care provision. Staff resistance or difficulty in adapting to changes is difficult since workers are accustomed to certain ways of operating (Payne 2014). Switching to the new system could be very challenging to them. Political pressure can also compel the institution to achieve set targets.

The changing nature of healthcare comes with challenges and prospects. Staff training and the need for continued professional development are some of the challenges. Furthermore, maintaining quality health care and ensuring the safety of patients, requires extended care and meeting demands for integrated services. To reduce these challenges, there is a need to increase the workforce, proper planning, and proper governance to enhance collaboration between administrators and medical providers

Several opportunities will also come along health care transformation. The increase in skills depths provides advantages and serves to make use of skill mix and expertise in the team. This method also ensures proper staff utilization through identification of specialized knowledge and skills leading to proper utilization of resources (Kadushin & Harkness 2014). Better patient outcomes and more focused patient services, opportunities for development, and job satisfaction will be realized.

2.1Strategy and principles for assessing current changes

Making transformations in an organization involves the determination of the changes that worked and those that never worked; thus, leading to improvements. Therefore, it is expected that one collects data before, during and after the implementation to help measure the progress based on the set goals (Cameron & Green 2015).

Recognize the variables to be estimated and the data required. This relates to the kind of information to be analyzed such as staff attitudes, perceptions et cetera. Secondly, decide the best tools for data collection and develop the best ways to collect them. Thereafter, choose the best tools depending on information required such as the need to know staff attitudes by analyzing members of staff through individual interviews or groups.

Training the personnel is important in developing methods to allow for valid, reliable and accurate data collection. The information gathered should be organized not just in a systematic way, but by considering the purpose, and technique for efficient data collection. The data is then analyzed to understand the scale, nature, and the cause of a problem.

2.2. The impact of recent changes

Owing to improved health care standards, and increase the population will be experienced leading to congestion. This change will occasion improvement of transport systems due to the changing demands. The increase in the number of young people requiring social and health care will exert pressure on the providers of social amenities (Brown & Jones 2012)

Owing to the improved standards of living, higher wages are demanded to provide for the increased cost of living. This also means an additional charge for personal care. Improved health care means improved well-being and improvement of the quality of life. This is associated with the delivery of high-quality primary care, better access to medical services, improved patient participation through tailored services, and continuity of attention.

Moreover, this will also lead to improved skills while making services available within the community. Collaborative working means provisions of full range services while utilizing available resources, getting access to a larger population leading to improved income generation; hence; increased profitability.

2.3. The effects of the current change in health and social care

Organizational transformations can lead to improved efficiency. This can be achieved by meeting set goals. All agencies should strive to be more efficient following modifications. This is connected to the utilization of available resources to attain the desired output. It also refers to resources utilized by a firm to generate the desired productivity. Efficiency in organizations maximizes resources during production without wastage (Bourke et al. 2016)

Reduction in cost-benefit is geared toward overall cost reduction. Benefits or outcomes should be more than costs incurred to achieve that end. Whether the organization aims to make profits or not, the total cost should be balanced with the outcome of the service so as to be viable. Referral in health care refers to the process of transferring patients from a low cadre hospital to a high cadre hospital for further treatment. This referral rates can be used to measure the effectiveness of a hospital based on the number of referrals done to a high cadre hospital vs. the number of cured patients (Kadushin & Harkness 2014).

This is often done through restructuring and training to improve their skills and technical know-how. The time the patient waits to be attended to is a significant method to evaluate the impacts of changes in a health facility. Minimal waiting time indicates speedy patient care administration and by extension faster service delivery and timely intervention.

2.4. Suitable Responses to recent changes

There should be improved employee participation through the creation of employment opportunities. The management should conduct proper staff training on different technologies. There should also be a change in the structure of the Directorate; new employees should be hired to handle the increased work occasioned by improvements and introduction of new facilities. There should also be a change of equipment to handle new developments meaning new manpower should be hired to manage or train staff on how to handle new equipment (Cameron &Green, 2015). There should also be a change in service delivery and communication owing to improved facilities.

Local authorities should ensure that people are advised correctly to make good decisions about care and support and the range of available support providers. They should also promote caregivers, children, and families.

3.1. Fundamental principles of change management using Power Point Presentation

3.1.1 Address the “human side” systematically.

Any transformation creates issues touching people. New jobs will be set up new skill and capabilities will be required. Dealing with such changes requires the involvement of leadership, engagement of key stakeholders and leaders.

3.1.2 Start at the Top.

CEO is seen as the main point as everybody looks to him for strength, support, and direction. Leaders should, therefore, embrace new challenges so as to motivate the rest of the institution. The executives should work together to get the best success.

3.1.3 Involve Every Layer.

Changes affect all sections in the organization and as such training must align individuals to the mission and vision of the organization with the bid of making change happen.

3.1.4 Make the Formal Case.

Legal case allows for the creation and alignment of leadership. This is achieved through confronting reality, developing a faith that the company has a healthy future, and provides a clear roadmap that will guide behavior and decision-making.

3.1.5 Create Ownership.

Leaders should accept responsibility in all areas under their control. This achieved by involving people in all the processes and reinforcing by use of incentives and rewards.

3.1.6 Communicate the message.

Communication provides employees with the right information at the right time, and they get their feedback through various channels.

3.1.7 Assess the cultural landscape.

Effects of cultural change should be identified early and addressed to avoid backlash at later stages.

3.1.8 Prepare for the unexpected.

This is achieved through continual assessment of impacts and the willingness to adapt to transformation

3.1.9. Speak to the individual.

This is intended to educate employees on the intended effects of change constituted, how it will be measured and what success or failures will be expected. By so doing, it will make people aware of the coming changes, and they feel involved in the change process.

3.2. Planning changes in health and social care

Planning for change in health and social care is necessary for the continuity of the organization. Any projected effect should be expected. Detailed plan including support after implementation should be documented to ensure that the project is implemented successfully. There is also the need to think of possible mishaps that can occur after implementation. Possible mitigation strategies should be developed to counter the mishaps.

During planning, the goals of the organization are identified, goals are set, tasks are outlined, and schedules of how to accomplish those tasks are developed. It also involves deciding what to do, how, and who will do the tasks. This stage assists in determining the direction of the project (Bourke et al. 2016). Planning also includes defining the health tribulations within the society, identifying needs that have not been met, analyzing the resources to meet them, setting goals, and setting action plans for the accomplishment of those programs. Planning also involves establishing policies, programs, objectives, schedules, and budget.

When planning, the following factors, and methods can be considered: stakeholders, staff, management styles, consultation, and communication. All these factors should be aimed at improving health outcomes to reduce inequalities in health and produce effective approaches to care. The change has to be clinically-based; hence, each proposal should then meet the local status. Therefore, the senior management should be at the forefront of the design and development, and patients and members of the public should also be engaged. Local authorities are relevant stakeholders and they can be integrated when planning.

3.3. Monitoring recent changes

To evaluate changes, it is crucial to start with weighing the evidence against each other as this is the best way for determining change. Several changes exist such as transformational, incremental; episodic, planned, and continuous changes. These changes may be considered by evaluating research, surveys, and sample assessments (Valentin, Schepman & Brinjzeels 2013). Data collection may be based on people’s opinions regarding on what they view to be the truth, beliefs in what people know, preferences in what they choose, behaviors in what they do, and attitudes in terms of what they need.

Basic questions can be asked that are based on the opening response, closed response through different scales that are agreeable, and ranking scales. When reviewing change through the survey, rewards and costs have to be taken into account; People should be more willing to help in evaluating the impact if there is a reward. Reliability and validity should be considered when reviewing the change.

Sampling technique is another method that can be used to monitor and evaluate the change. This approach provides sample statistics for classifying the targeted people through obtaining controllable objects of study and quantitative representation of resident’s distinctiveness.

Group forums can also act as a basis for reviewing changes in social care services. This platform ensures discussion is carried out either online or through gatherings. Through this avenue, messages are posted and people can hold conversations regarding different topics. Through group feedback, it makes it easy to learn and assess the effect of health services.

Monitoring also ensures the improvement of essential functions in the implementation of health services. It enables one to determine if the service is meeting the set objectives, identify program challenges and benefits, and areas to be revised. This is achieved through the analysis of program domains.

Conclusion

The paper has sought to assess the current transformations in health and social care settings. Economic factors, operational framework, policy environment, and knowledge were seen as the underlying factors that drive healthcare and social change. While the challenges and impacts of the change process were evaluated, effective service response mechanisms were proposed. Essential principles of change management were presented through Microsoft PowerPoint application. In the end, the paper highlighted planning, monitoring, strategy for quantifying change, social care policy, and tools for measuring change.

The Current Transformations in Health and Social Care References

Brown, K., & Osborne, S. P. 2012. Managing change and innovation in public service organizations. Abingdon: Routledge.

Bourke, A. et al 2016. Evidence generation from healthcare databases recommendations for managing change. Pharmacoepidemiology and Drug Safety.

Cameron, E. and Green, M., 2015. Making sense of change management: a complete guide to the models, tools, and techniques of organizational change. London: Kogan Page Publishers.

Epstein, M.J. and Buhovac, A.R., 2014. Making sustainability work: Best practices in managing and measuring corporate social, environmental, and economic impacts. San Francisco: Berrett-Koehler Publishers.

Hayes, J., 2014. The theory and practice of change management. Basingstoke: Palgrave Macmillan.

Swayne, L.E., Duncan, W.J. and Ginter, P.M., 2012. Strategic management of health care organizations. New Jersey: John Wiley & Sons.

Payne, M., 2014. Modern social work theory. Basingstoke: Palgrave Macmillan.

Thompson, N., 2015. Understanding social work: preparing for practice. Basingstoke: Palgrave Macmillan.

Kadushin, A. and Harkness, D., 2014. Supervision in social work. New York: Columbia University Press.

Huber, D., 2013. Leadership and nursing care management. London: Elsevier Health Sciences.

Valentijn, P.P. et al 2013. Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care. International Journal of Integrated Care, 13(1).

Effects of Caring for a Patient with Multiple Sclerosis

Effects of Caring for a Patient with Multiple Sclerosis Order Instructions: Hello writer sir, how are you today
Thank you so much for helping for this Assignment . This is an oral presentation supported by written papers.

So please write an essay on given topic and I will make an oral presentation from it. Case scenario for the assignment is as under , please have a look

• APA Referencing
• At least 15 genuine references from 2010 to 2016 study based,
• 90% references have to be research-based Journal article AND books
• Australian and New Zealand based study articles are preferable.
• Please have a look Rubric guideline for given topic, I need good grades in this assignment so please do me a favour and try to give me a best quality work

Case Study
Karen Bailey is a 39 year old who was diagnosed with remitting Multiple Sclerosis 4 years ago.
Karen is married to Geoff, and they have 3 children aged 3, 5, and 9 years old respectively. They live in their own home which is spread across two levels. Geoff is Karen’s primary carer – Geoff is a partner is an accountancy firm which involves a large amount of interstate travel. He is often not able to get home before 7.00 PM of an evening.
Karen now needs to use a walking frame to maintain her level of ambulation and is finding it increasingly difficult to mobilize easily. Karen’s sister, Lisa lives nearby and visits often. Lisa is keen to be involved in looking after her sister; however, Karen doesn’t want Lisa to see the extent of her condition or her lack of independence.
Karen continues to look after the children on a daily basis, however, some afternoons Karen finds this more difficult than others. Karen is finding that it is harder and harder to remain positive about her changing condition.
Karen has always enjoyed reading, however, due to deteriorating eyesight and weaker arm muscles, Karen is no longer able to focus on the text or hold the book. Lisa has arranged some talking books for Karen, however increasingly the concentration required to use these has become too tiring.
Geoff is struggling with the joint responsibilities of work and increasing role in Karen’s care. He goes into the office later in the morning after assisting her with a shower; however, this results in him coming home later in the evening. He has indicated that he feels increasingly powerless in this situation and is concerned about what the future holds for them.
TRIGGER
You are community nurse who has been allocated as Case Manager for Karen. When you arrive on your first visit Karen is home by herself and appears desperate to talk to you. Karen has a close friend, Bernadette, who is a naturopath. Bernadette is really trying to get Karen to try alternative therapies as she thinks that the medications Karen is taking are making her condition worse and thinks that an alternative approach to care would have a better chance of curing Karen.
Karen doesn’t know much about the medications but concerned that if she refused Bernadette’s offer, their friendship will be lost. This friendship is important to Karen because a number of her friends have severed contact with her. In conversation, Karen tells you that over the past couple of weeks, she has developed a number of bruises on her arms and legs. Bernadette has said that it must be Karen’s medications doing it to her and that means they must be toxic to her. Karen is unsure and asks what you think?
The following day you are working in the community health center when you get a phone call from Karen’s husband, Geoff. Geoff tells you that Karen had a fall in the lounge room last night and he needed to call the paramedics to lift her off the floor as he did not know how to do this. He sounds very stressed stating “I just don’t think I can do this anymore”. Geoff is not able to take any more sick days from work to care for the children and asks about what help is available.
Given the urgency of this situation, you visit Karen the same afternoon to assess the situation. When you arrive Karen is home alone. Karen is concerned about Geoff and has encouraged him to go to work. She is worried about her family and how they are coping. Karen has also noticed that she is now having some urinary dribbling. She tells you she had a fall last night and said this is happening on a regular basis as she needs to hurry to get to the toilet. Last night’s fall has shaken her confidence considerably and she now feels less able to be at home on her
own. When Karen discussed this with her husband, he said that he felt as if “their lives were falling apart”. Karen indicated her two elder children were responsible for many of the household chores such as washing and cleaning whilst her husband did the cooking and help with her showering.
Karen has developed a persistent dry cough and also has a fever. She has also been experiencing increasing symptoms such as blurred vision, difficulty with holding her walking sticks, is dragging her left foot as she walks and is now unable to hold heavy objects.
Karen’s voice is also becoming weaker and Karen is having difficulty being heard when she talks.

Question:- Physical impact of MS on Karen’s family.
In this question, you have to only focus on
Physical impact on Geoff (Karen’s husband) in the given scenario.
My thinking we can include these point in the given paper however if you think other better point to address the physical impact on Geoff, that will be great. It is only a suggestion.
• Geoff’s care burden as a primary carer
• Health-related issues with Geoff
• Increase responsibility
• Increase work hours to meet the financial need for the family
• Risk of injury
• Family disturbance and unhappiness with a relationship
• Sexual issues
• Other issues as you think will be beneficial to get the good marks

Effects of Caring for a Patient with Multiple Sclerosis Sample Answer

Physical Effects of Caring for a Patient with Multiple Sclerosis

Caring for a relative with multiple sclerosis can significantly affect the physical well-being of those providing care (Ramagopalan & Sadovnick, 2011). In most cases, it is usually a collective responsibility of other family members who are expected to concentrate on the sick. Irrespective of needed support, taking care of a person with multiple sclerosis can be challenging and involves cleaning, moving them around and interruption of sleep. The paper evaluates the physical effects that Geoff is likely to present while caring for his wife that suffers from multiple sclerosis (MS) based on a presented case scenario.

Geoff’s Care Burden as a Primary Care

Evidence-based practices indicate that caregivers endure so much in their everyday endeavors as far as caring for the sick are concerned. Caring for Multiple Sclerosis patients has not been an easy thing for Geoff who is certainly giving up largely because of the distress and hopelessness of Karen’s deteriorating condition. In reality, the increased responsibility threatens to impair not just Geoff’s everyday schedule but piles the mental stress that may lead to other complications (Wood et al., 2012).

Increase Responsibility and Increase Work Hours to Meet the Financial Need for the Family

Geoff is under intense pressure to juggle the demands of work and home responsibilities. At home, for instance, Geoff has to cook for Karen and children and ensures that Karen takes a bath with his assistance. This is evident for instance when Geoff goes to work late in the morning and also comes home late after work, perhaps because he has to work overtime to meet family obligations. The suggestion that Geoff is increasingly helpless about Karen’s current condition and what the future holds for the family explains just how excruciating the experience presents. The assertion that “I just don’t think I can do this anymore” demonstrates how depressed Geoff is and this trend is obviously leading to a change in physiological health habits (Hughes, Locock & Ziebland, 2013).

Health-Related Issues with Geoff

The concentration of caregiving afforded by Geoff to Karen is highly likely to lead to other health-related issues, whether quantified in terms of the amount of care provided (Simpson et al., 2011). Karen’s suffering has a bearing on Geoff’s wellbeing as well. What is more challenging is the fact that while Geoff is dedicated to providing the needed help to Karen, her condition seems to get even worse. In reality, it becomes frustrating laboring to provide help that is unable to enhance the quality of care, an aspect that culminates into negative health effects (Palmer, 2011).

Other health issues associated with Geoff include Karen behavior, mental impairment, functional disability; constant supervision of Karen to control self-injuries. In addition, Geoff is not only depressed but also distressed, which may adversely affect his physical health. For instance, based on the case, Geoff feels that their lives are falling apart due to Karen’s deteriorating condition. According to Jones et al., (2012) caring for a patient with multiple sclerosis is extremely challenging because the patient requires close supervision and depressed due to the changing condition. Based on the case, Karen finds it harder to look after her family while remaining positive about her new condition. These aspects are connected to adverse career outcomes (Latimer-Cheung et al., 2013).

Family Disturbance and Unhappiness with Relationship and Sexual Issues

As a result of Karen’s condition is likely to affect their sex relationship, family disturbance, and unhappiness. In the recent past, studies have concentrated on caring for a spouse leading to distress and carer’s perception of the level of pain the patient is experiencing (Bowen, MacLehose & Beaumont, 2011). In this case, Karen’s suffering is depicted in different ways; evident physical signs like blurred vision, unable to hold her walking sticks, dragging her left foot and difficulty in holding heavy objects. Additionally, Karen’s voice is becoming weak, especially; when she talks she cannot be heard. Karen’s suffering can lead to Geoff’s depression. It is evident that due to an increased burden of caring for Karen and other family responsibilities he is not only powerless but also worried about their future.

Geoff’s Care Burden as a Primary Care

The physical health of the primary carer is adversely affected due to Karen current condition. Increased stress levels, anxiety, and psychological health issues are common (Bozic et al., 2011). Much as Geoff has increased levels of depression, past studies demonstrate that he may present remarkable signs of depression (Sellner et al., 2011). In addition, depression and the burden of caring for Karen may reduce Geof’s functional condition. Therefore, significant levels of depression are common among people caring for patients with multiple sclerosis (Mansell, Beadle-Brown & Bigby, 2013). Furthermore, the majority of carer’s are depressed as well as psychological stress (Langdon, 2011). Anxiety and depression in primary carers can worsen, particularly if the patient is placed in a nursing home. The majority of primary carer’s that institutionalize a family member present high levels of depression similar to those when the patient was at home (Wingerchuk & Carter, 2014). A depressed career may have chronic disorders, dependence on drugs and anxiety disorder. On the other hand, depression is a primary condition related to suicidal thoughts (Benedict & Zivadinov, 2011).

Risk of Injury

As a family caregiver, Geoff is faced with the risks of medical depression because of caring for Karen who requires physical needs. As such, Geoff is highly likely to engage in detrimental behavior toward their loved one. Moreover, Geoff is also at an increased risk for poor physical health outcomes owing to depressive symptoms and mental health issues among caregivers, coupled with the physical pressure of caring for Karen who can hardly undertake on everyday activities like taking a shower, cooking, and other individualized activities. The beehive of activities that have a tall order on Geoff’s physical wellbeing in terms of increased rates of physical ailments such as; acid reflux, headaches and other discomforts. Moreover, these ailments can result from Geoff’s depleted immune response that leads to recurrent infections (Munger & Ascherio, 2011).

Effects of Caring for a Patient with Multiple Sclerosis References

Benedict, R. H., & Zivadinov, R. (2011). Risk factors for and management of cognitive dysfunction in multiple sclerosis. Nature Reviews Neurology, 7(6), 332-342.

Bowen, C., MacLehose, A., & Beaumont, J. G. (2011). Advanced multiple sclerosis and the psychosocial impact on families. Psychology and Health, 26(1), 113-127.

Bozic, C., Richman, S., Plavina, T., Natarajan, A., Scanlon, J. V., Subramanyam, M. … & Bloomgren, G. (2011). Anti‐John Cunnigham virus antibody prevalence in multiple sclerosis patients: Baseline results of STRATIFY‐1. Annals of Neurology, 70(5), 742-750.

Hughes, N., Locock, L., & Ziebland, S. (2013). Personal identity and the role of ‘carer’ among relatives and friends of people with multiple sclerosis. Social science & medicine, 96, 78-85.

Jones, R., Mackenzie, A., Greenwood, N., Atkins, C., & Habibi, R. (2012). General practitioners, primary care, and support for carers in England: can training make a difference. Health & social care in the community, 20(2), 128-136.

Langdon, D. W. (2011). Cognition in multiple sclerosis. Current opinion in neurology, 24(3), 244-249.

Latimer-Cheung, A. E., Pilutti, L. A., Hicks, A. L., Ginis, K. A. M., Fenuta, A. M., MacKibbon, K. A., & Motl, R. W. (2013). Effects of exercise training on fitness, mobility, fatigue, and health-related quality of life among adults with multiple sclerosis: a systematic review to inform guideline development. Archives of physical medicine and rehabilitation, 94(9), 1800-1828.

Mansell, J., Beadle-Brown, J., & Bigby, C. (2013). Implementation of active support in Victoria, Australia: An exploratory study. Journal of Intellectual and Developmental Disability, 38(1), 48-58.

Munger, K. L., & Ascherio, A. (2011). Prevention and treatment of MS: studying the effects of vitamin D. Multiple Sclerosis Journal, 17(12), 1405-1411.

Palmer, A. J. (2011). Economic Impact of Multiple Sclerosis in 2010: Australian MS Longitudinal Study.

Ramagopalan, S. V., & Sadovnick, A. D. (2011). Epidemiology of multiple sclerosis. Neurologic Clinics, 29(2), 207-217.

Sellner, J., Kraus, J., Awad, A., Milo, R., Hemmer, B., & Stüve, O. (2011). The increasing incidence and prevalence of female multiple sclerosis—a critical analysis of potential environmental factors. Autoimmunity reviews, 10(8), 495-502.

Simpson, S., Pittas, F., Van Der Mei, I., Blizzard, L., Ponsonby, A. L., & Taylor, B. (2011). Trends in the epidemiology of multiple sclerosis in Greater Hobart, Tasmania: 1951 to 2009. Journal of Neurology, Neurosurgery & Psychiatry, 82(2), 180-187.

Wingerchuk, D. M., & Carter, J. L. (2014). Multiple sclerosis: current and emerging disease-modifying therapies and treatment strategies. In Mayo Clinic Proceedings (Vol. 89, No. 2, pp. 225-240). Elsevier.

Wood, B., Van Der Mei, I. A. F., Ponsonby, A. L., Pittas, F., Quinn, S., Dwyer, T., & Taylor, B. V. (2012). Prevalence and concurrence of anxiety, depression, and fatigue over time in multiple sclerosis. Multiple Sclerosis Journal, 1352458512450351.

Public Health and Well Being Strategy

Public Health and Well Being Strategy Order Instructions: question and answer according to the marking guides attached

Public Health and Well Being Strategy Sample Answer

Public Health

Introduction

The concept of public health has grown in importance and stature since its inception in the UK.

The main aim of public health is the prevention of illness and diseases in the entire population as well as promoting and sustaining the health of the citizens. This is facilitated by recognizing many social factors that contribute to health (WHO, 2015).

This paper aims at investigating the roles of different agencies that work within the community to reduce the incidence of diseases. This paper will investigate both non-infectious and non-infectious diseases which are widespread as well as explore the various strategic approaches and statistical methods applied to evaluate, monitor, and regulate the incidence of the diseases. The paper will also explore the various effects of illness and diseases in the delivery of health care and social care services. The paper will put into consideration the current lifestyle in the community that impacts the delivery of quality health and social care services (Department of Health, 2013).

Roles of different agencies in the UK

Public health refers to science and art of ailment prevention and prolonging of life using planned efforts to help the society make informed choices. The main role played by the different agencies is to identify incidences of diseases within various communities. The different agencies involved in public health include International agencies such as World Health Organization (WHO) and European Union (EU); National level agencies (Government and UK Department of Health (DH) and the local authorities and local health trusts (Social welfare 2013).

The World Health Organization (WHO) has six core functions. To begin with, they provide strong leadership on critical health issues and engage in partnership especially in areas that are in need joint action. They are also responsible in research agendas that facilitate dissemination of knowledge on health issues. The organization also sets norms and standards that should be used to promote and monitor the effectiveness of specific interventions of public health issues. The organization facilitates the establishment of evidence-based policies that are ethical. This includes a provision of technical support by catalyzing change and developing sustainable institutional policies. WHO also monitors the health situation and evaluates the current health trends (Forest & Denis 2014).

The European Union has the responsibility of complementing the national policies. It does so by helping the EU affiliated governments to achieve the established shared objectives, pool resources so that they can generate the scale of economies as well as tackle the shared challenges. The role of this international organization also includes the promotion of a healthier lifestyle and ensuring equitable distribution of resources to tackle the serious health threats that are predominant among EU member countries (Social welfare 2013).

At the national level, the UK Department of Health (DH) leads the strategy, policy, and outcomes of health improvement. The agency leads by establishing policies that protect citizens from a range of health threats. It leads in emergency preparedness, providing health programs for Olympics and Paralympics et cetera. It helps the health care providers at the national level to harness the cutting edge in the advancement of medical science to improve health care. The agency also designs the systems for England public health.

The Department of Health (DH) helps the UK residents to have a better and longer life. The role of the agency is to lead, shape, and provide funds for the healthcare system in the UK. This ensures that people have adequate support as well as helping to, maintain the dignity of the citizens. The agency also creates national policies and healthcare legislation. It also supports the integrity of the healthcare system by ensuring delivery of quality care and accounting for the funds provided to it by parliament in a way which represents the interests of the patients. The agency also champions innovation and supports research and technology, transparency, openness, and honesty. This improves the out-patient care by establishing the safest and highest quality of healthcare services. Ultimately, the efficiency and productivity of the healthcare system are improved (Department of Health, 2013).

The local authorities have a convening role and also promote co-existence between the Local authorities and the GP consortia. The key role of the local authorities is to lead joint strategic needs assessments (JSNA) to ensure coordinated and coherent strategies. The agency also supports local voice and promotes patient’s autonomy. The local agency also leads to local health in order to prevent the occurrence of diseases. The agency promotes the commissioning of social care and Local NHS services to improve the delivery of quality care (Reiner et al. 2013)

Epidemiology of infectious and non-infectious disease

Epidemiology refers to the study of the distribution of infectious and non-infectious diseases, and the determinants of these health-related events within a specified population, and application of research studies to control the health issue. Epidemiology involves studying global patterns, risk factors, and preventive measures that can be applied to improve health issue.

A noninfectious disease is also referred to as a non-communicable disease. This refers to a health condition that is nontransmissible. More often than not, most non-communicable diseases are chronic and progress slowly. Examples include asthma, obesity, malignant disease. and cancer. Infectious diseases are highly contagious, which implies that they are transmitted from one person to another. They are often caused by pathogens. Examples of infectious diseases include HIV/AIDS, tuberculosis, influenza, childhood diseases, MRSA, influenza, food and water-borne diseases (Social welfare 2013).

The UK is reported to have the highest level of obesity in Western Europe. Obesity is a non-infectious disease and it refers to body mass index (BMI) that is between 25 and above. According to the Health and Social Care Information Centre, 24.9% of the population is obese and approximately 61.7% is overweight. The levels have increased in the past three decades, and it is projected that if intervention measures are not put in place, half of the population will be obese by 2050. This trend is attributed to the fact that most people have adopted modern lifestyles which includes unhealthy dietary and physical inactiveness. Obesity is the biggest health crisis in the UK because it is also associated with other health complications such as diabetes, cancer, and cardiovascular disorders (National Obesity Forum n.d).

The most common type of infectious diseases is influenza. The latest epidemiological reports indicate that influenza has continued to increase considerably. The influenza virus is the leading cause of respiratory tract infections, which is associated with severe complications which lead to hospital admission and mortality. The internet-based surveillance indicates that influenza affects 18.4 percent out of a population of 1000 people. However, 20-44 people report higher rates of infection which are reported at 23.1 percent out of a population of 1000 people (Social welfare 2013).

The effectiveness of different approaches as well as strategies of diseases control

There are various approaches being utilized by the Department of health in controlling obesity and influenza in the UK. Some of these approaches include screening, vaccination, legislation, education, and creating awareness and surveillance (Social welfare 2013).

The Department of health has established interventions that will help people make healthier choices by ensuring that they are in a position to make healthy dietary and to become more active. This includes programs such as Change4life. The department has established strategies that will help effective labeling of drinks and food which will help people to make informed choices. The legislation requires the factories to include ingredients such as calories. The National Institute of Health and Care Excellence (NICE) has established a series of initiatives that aim at reducing obesity. This includes improving the physical environment and leisure parks to improve the amount of physical activeness among the population (Public Health England 2014).

The departments at national and community level encourage the use of school-based programs as the main strategy to tackle obesity. For example, the Croydon Healthy Schools program was established in order to ensure that local schools support healthy food programs and promote physical activeness. The public health agencies at the national level deal with four specific networks including food, physical activity, alcohol, and health safety at the workplace. These initiatives have helped people to adopt healthy lifestyles. In addition, regular education has helped to reduce discrimination as well as enhance self-confidence among people with obesity (Social welfare 2013).

The Public health of England also conducts surveillance of the Influenza after every week to monitor the influenza activity at community and national level. Influenza is the leading cause of hospitalization in the UK. For this reason, the healthcare agencies at the government level (Department of Health) supported by the local authorities have developed an annual a flu program that seeks to vaccinate individuals at high risk of developing influenza. The high-risk individuals include older people, infants and toddlers, pregnant women, immune-suppressed, and those suffering from cardiac diseases. In addition, the program provides training to help the citizens in detecting signs and symptoms of influenza. The public health department also requires that any suspected case of avian flu must be reported to the nearest animal and Plant Health agency. This helps the agencies to effectively control the infection. A recent case of low severity (H5N1) avian flu was reported in Dunfermline early this year, but the agencies managed to control the infection by using restricted movement (Public Health England 2014).

The current priorities and approaches

The priorities for the delivery of health services are influenced by evaluating the burden of disease. The analysis of the community burden of disease provides the comparative assessment of the cost of health, injuries, risk factors and mortality rates. This is normally done using the disability-adjusted life year (DALY). DALY that normally evaluates the number of years lost as a result of premature deaths within a certain time (Social welfare 2013).

According to DALY report in the UK, the leading health burden is mental illness, heart complications, cancers diseases, and respirational diseases respectively. In 2010, the leading causes of DALY were cardiovascular disease, chronic osteoporosis (back pain), as well as chronic obstructive pulmonary disease (COPD). Most of these disorders are associated with unhealthy lifestyles such as poor dietary, alcoholism, smoking, and lack of exercises. Therefore, the current healthcare priorities in the UK include preventive services for mental health, smoking, diet control, alcoholism as well as promoting physical activeness. The second priority is to improve clinical services by providing adequate support for mental health services, respiratory disorders, and cardiovascular disorders (Public Health England 2014).

The approaches being used to provide healthcare include primordial prevention. This involves identification of legislation that aims at delivering quality services. Other approaches include education and awareness, environmental controls and social welfare. The second approach is through primary prevention. This primarily focuses on health promotion interventions such as health education on immunization, chemoprophylaxis, and prophylaxis. Environmental modifications will help to protect the community from various hazards in the environment. The nutritional interventions and behavioral changes will ensure that people adopt healthy lifestyles (Social welfare 2013).

The other approach is the secondary prevention which mainly focuses on halting the progression of the disease and prevents complications. The main activities in this stage include screening tests, laboratory findings, and adequate treatment programs. The fourth approach is through tertiary prevention. This involves the use of all interventions to limit disabilities and impairments associated with the health event and help promote a patient’s health condition. This mainly focuses on interventions that prevent disability limitation as well as rehabilitative services. Rehabilitative services are coordinated through medical, vocational, educational, and social training measures to help the patient retain their functional ability to the highest level (Public Health England, 2014).

The approaches being used include monitoring and surveillance. Monitoring is used to describe the performance and analysis of measurements that are aimed at evaluating environmental changes such as water quality and other forms of pollution, dietary intake et cetera. Monitoring also entails all other forms of measurements of health services and the extent to which patients adhere to the advice provided by healthcare professionals. On the other hand, surveillance is the inspection of the determinants of health, and the distribution of other health-related illnesses (Public Health England, 2014).

A relationship that exists between the prevalence of disease and the service requirements

There are considerably adequate healthcare resources including hospital, community health services, personal medical services, and community health services. The community health services providers (HCHS) and dental staffs are about 105,000. There are about 41 300 healthcare providers who provide consultation services and an additional 53,000 who provide training services. There is about 971,000 non-medical staff whereby 319,000 are qualified nurses, 136,000 are technical and therapeutic professionals, 187,000 in infrastructure support, and 36,000 are managers. In the new health and social care setting, these healthcare providers consist of clinical commissioning groups (Department of Health, 2013).

The UK health and well-being board brings together organizations to work in partnership in order to deliver power that advocates for the needs of communities and patients.

These healthcare professionals have combined efforts to help people lead healthier lives. This involves ensuring that people have adequate support, care, and treatment as needed, and in the most compassionate, respectful, and dignified manner. The specialists are working together to ensure that they provide evidence-based care. This is achieved by bringing in the multidisciplinary teams together in health and social care to manage healthcare efficiently and effectively. This facilitates timely referrals which are important in reducing the time for making the diagnosis. Although there have been massive improvements in healthcare, the public health of England continues to be burdened by diseases such as obesity and influenza. This often calls for strategic frameworks and policies (Department of Health, 2013).

Impact of current lifestyle choices on the health care future needs

The UK people’s health is determined by their lifestyle choices. This is attributed to the increased globalization and busy schedules that make it difficult for people to engage in a healthy lifestyle. For instance, obesity is associated with poor dietary and increased physical inactiveness. The food available in the UK today is just refined ingredients mixed with some chemicals. These food products are cheap and taste very good that one cannot have enough. This makes the food to become hyper-palatable which makes people eat them in high quantity due to food addiction. Food addiction is a complex issue that can be very difficult to overcome. This often leads to mental disorders and increases a person’s susceptibility to other infectious diseases such as influenza (Health Protection Agency 2010).

Obesity is associated with energy imbalance. The main variable factor and one that can be modified is physical activity. Most people are not active. Physical activity has continued to decline in developed countries. The pattern is being reflected in developing countries. Over the past decades, each household in the UK owns second-hand carts and appliances that help to cut on labor. Outdoor activities have also reduced considerably; consequently, one in every four people in the UK is at risk of becoming obese. The impact of physical inactivity affects the future of the healthcare industry because increases cardiovascular disease burden through the increased cost of preventive care (Department of Health 2013).

Most of the health complications are associated with behavioral risk factors. Chief among the behavioral risk factors include smoking and binge drinking. It has been hypothesized that smoking helps in reduction of weight gain. However, these beliefs are over-simplistic. Both smokers and non-smokers are at risk of becoming obese if they feed on unhealthy foods and are physically inactive. The impact of tobacco smoking and alcohol affects the future of the healthcare industry because it increases the cost of preventive care (Enfield 2013).

Priorities for people in the specific health setting

The well-being and health of the populace in this community are highly related to each other. According to WHO, health has a great influence on the nation’s economic development. The healthier a community is the more productive it becomes. The healthcare settings of a community are influenced by many factors such as communication, poverty and social services. These determinants can be categorized by many physical factors such as the individual health factors which include hormonal imbalance, genetic disorders, and immune system. These factors increase people’s risks of cardiovascular and metabolic disorders. These factors also affect the behavioral, cultural and psychological factors. For instance, stress is a psychological factor whereas unsafe sexual behavior, abuse of alcohol, and smoking are behavioral factors that have an impact on an individual’s health. (Public Health England, 2014).

The environmental factors involve all factors that affect the wellbeing of humans. These include safe water and a clean environment. Other factors include chemical factors, biological and physical environment. The socioeconomic factors such as income affect the well-being of an individual. For instance, in the UK, health disparities are evident between the high income and low-income earners. The high-income households get better medication and education and are less likely to be affected by infectious and non-infectious diseases (Social welfare 2013).

Priorities of elderly people’s health should be based according to the health issues facing the age group, and are projected to face the age group if not addressed adequately. Infectious diseases such as Influenza affects elderly people especially those living in low economic zones. Such diseases are associated with long term effects; hence, they need immediate and appropriate health solutions such as preventive management. Abuse of elderly people is another issue that must be prioritized. The elderly people are abused physically, emotionally and psychologically. The protection agency must ensure that they are adequately prepared to help the frail human beings. This is to ensure that they are housed, fed, and their healthcare is taken care of (Paterson 2014).

The effectiveness of strategies systems and policies

The effectiveness of the policies that are implemented in taking care of the elderly involves enactment of policies by the various agencies of the public health. There are various agencies that contribute to the enhancement of children’s health and are all working to meet the same goal. The partnerships established by these institutions are designed to facilitate the incorporation of effective healthcare services. These services include involvement of the PCTs, CCCs and other local authorities. Due to the modifications conducted in the white paper, these policies and systems have been found to be very effective in delivering care.H however; there are some areas where the ground level implementation has not been successful. In such instances, there is a need to establish more interventions to help implement the policies more effectively (Stewart, Cutler, & Rosen 2009)

Changes that could be established to improve the healthcare

The changes that are needed in the UK healthcare system are changes that will influence positive behavior. For example, there are limited opportunities that promote physical activity. In this context, public health agencies should respond to the private sector to ensure that recreational facilities are not interfered with to ensure that there is enough space for physical activity. This includes maintaining the cycle routes, sports areas, children playground areas and pedestrianization (Social welfare 2013).

The second priority is to change the local culture and beliefs of physical activity. Most people in the UK do not value physical activity. The public health agencies must put in place awareness programs that will help to ensure physical activity is valued by everybody in the community. The public health is also responsible for community safety. There have been few worries regarding personal security, especially when exercising. The public health must liaise with the community groups and the police to help restore a safe community (Public Health England 2014).

The public health community must work in partnership with groups such as educational institutions and communities to increase awareness of preventive measures such as healthy foods, physical activeness, and vaccination programs. The commissions should improve access to organic food at affordable prices especially among the socially marginalized people (Public Health England, 2014).

Task 3.4 Evaluation of an activity that has been implemented to promote behavior change

Under the Health and Social Care Act 2012, the main agency in charge of improving the health of the populace is the local authorities. They have a statutory function to improve public health by providing advice to the clinical commissioning groups. The local authorities are entrusted to deliver National Child Measurement Program. One such program is “cooking from scratch”. This is an initiative established by NHS and Bristol county council. The scheme targets to teach the low household income on ways to make simple healthy foods that can be achieved at a specific budget. The program also trains the community on the importance of physical activeness and adhering to vaccination programs. The program has been successful as it trains people from diverse settings including the elderly in community day care centers, staff working in these centers, youth clubs, and new mothers. This has helped to reduce the rates of obesity in this county (Public Health England 2014)

Public Health and Well Being Strategy References

Department of Health, 2013. “Making mental health services more effective and accessible.” Retrieved from https://www.gov.uk/government/policies/making-mental-health-services-more-effective-and-accessible–2

Winfield, 2015. Health and wellbeing strategy. Retrieved from http://www.enfield.gov.uk/healthandwellbeing/info/4/health_and_wellbeing_strategy[ Accessed May 24, 2016]

Forest, PG., & Denis, JL. 2014. Real reform in health systems: An introduction. Journal of Health Politics, Policy and Law 37(4). Retrieved from http://eds.b.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=74dd209f-1a28-44e5-ab25-1b9d89a63ad3%40sessionmgr113&vid=0&hid=126[ Accessed May 24, 2016]

Health Protection Agency, 2010. What does the Health Protection Agency do? [Online]. Available at: http://www.hpa.org.uk/AboutTheHPA/WhatTheHealthProtectionAgencyDoes/ [ Accessed May 24, 2016]

National Obesity Forum, n.d. Welcome to the National Obesity Forum [Online]. Available at: http://www.nationalobesityforum.org.uk/ [ Accessed May 24, 2016]

Public Health England. 2014. Public health training for health protection and allied professionals. Retrieved from https://www.phe-protectionservices.org.uk/hpet/[ Accessed May 24, 2016]

Paterson, J. (2014). Strategies for enhancing the delivery of person-centered care. Nursing standard 28(39); 37-43. Retrieved fromhttp://eds.b.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=67611298-afa4-41a9-ab58-a986835b5bd8%40sessionmgr198&vid=0&hid=126[ Accessed May 24, 2016]

Reiner, M., Et al. (2013) Long term health benefits of physical activity- a systematic review of longitudinal studies. BMC Public Health 13; 813

Stewart, S., Cutler, D. & Rosen, A., 2009. The New England Journal of Medicine. Forecasting the Effects of Obesity and Smoking on U.S. Life Expectancy [Online]. 361, p.2252-2260. Available at: http://www.nejm.org/doi/full/10.1056/NEJMsa0900459 [ Accessed May 24, 2016]

Social welfare. 2013. “The state of health care and adult social care in England.” Retrieved from http://socialwelfare.bl.uk/subject-areas/services-activity/health-services/carequalitycommission/168545state-of-care-201314-full-report-1.1.pdf[ Accessed May 24, 2016]

WHO (2015). An introduction to the World Health Organization. Retrieved From http://www.who.int/about/brochure_en.pdf[ Accessed May 24, 2016]

Heart Failure and Myocardial Infarction Case Study

Heart Failure and Myocardial Infarction Case Study Order Instructions: All research should be valid in STRICTLY AUSTRALIA. 18 APA references not older than 5 years. Only journals and articles. and research only strictly in Australia
not older than 5 years old.
This I easy case study so that want ref every 80 words

description – Case Study 1: Myocardial infarction with the history of stable angina and mitral valve stenosis
Mr. Tupa Savea is a 54-year-old male who has been transferred to the coronary care unit (CCU) from the emergency department for management of episodic chest pain. He has a history of stable angina and mitral valve stenosis. Mr. Savea is of Samoan background and has lived in regional Queensland for the last 20 years with his wife and children. He was brought in by ambulance having had chest pain and shortness of breath. He reports having similar symptoms on and off for the past two months but did not visit his GP as he assumed the discomfort was due to indigestion. Mr. Savea is an ex-smoker, tobacco-free for the last six months and a social drinker (approx. 10 units/week). He works full-time as an orderly at a local hospital and is active in the Samoan support community.
On assessment, Mr. Savea’s vital signs are PR 90 bpm and irregular; RR 12 bpm; BP 150/100mmHg; Temp 36.9°C; SpO2 98% on oxygen 8L/min via Hudson mask. He has a body mass index (BMI) of 35 kg/m2 indicating clinical obesity. Blood test results show elevated cardiac enzymes and troponin levels and cholesterol level of 8.9mmol/L. His ECG indicates that he has an ST segment elevated myocardial infarction. Mr. Savea was administered sublingual glyceryl trinitrate followed by morphine 2.5 mg IV for pain in the emergency department. He reports being pain-free on admission to CCU.

questions to be answered
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** The following questions must be answered for your chosen case study **
The following questions relate to the patient within the first 24 hours since admission to the emergency department (ED):
1. Outline the causes, incidence and risk factors of the identified condition and how it can impact on the patient and family (400 words)
2. List five (5) common signs and symptoms of the identified condition; for each provide a link to the underlying pathophysiology (350 words)
a. This can be done in the form of a table – each point needs to be appropriately referenced
3. Describe two (2) common classes of drugs used for patients with the identified condition including the physiological effect of each class on the body (350 words)
a. This does not mean specific drugs but rather the class that these drugs belong to.
4. Identify and explain, in order of priority the nursing care strategies you, as the registered nurse, should use within the first 24 hours post admission for this patient (500 words).

Heart Failure and Myocardial Infarction Case Study Sample Answer

Myocardial Infarction: Case Study

Causes, Incidence, and Risk Factors for Myocardial Infarction

Myocardial infarction (MI) is an impairment of heart functioning characterized by the diminished blood supply to cardiac muscles following myocardial ischemia (Wong et al., 2012). Myocardial cells are destroyed but not repaired as the rate of their degeneration exceeds the capacity of repair mechanisms which are usually slowed by poor blood supply (Burges, 2012). The causes of MI include myocardial ischemia that results when metabolic needs of the heart are too high and exceeding a certain threshold or ischemia that results after the coronary circulation is inefficient and affecting oxygen and nutrient delivery to heart muscles (Wong et al., 2012). In some cases, the two causes may co-occur and eventually result in MI.

The prevalence of MI in Australia is significantly high with data indicating a correlation between disease occurrence and age and sex(Wong et al., 2013). The Heart Foundation reported that in Australia, the disease has a higher prevalence among older persons, with more than 3,800 cases of male patients 85 years and above having been reported in 2011. On the other hand, about 11 cases of female patients of ages between 25 and 34 were recorded in the same year. Nevertheless, MI prevalence in Australia was reported to have been decreasing between the years 2007 and 2011 (2014).

Studies indicate that risk factors for MI are those that also increase people’s susceptibility to atherosclerosis (Wong et al., 2012). These include tobacco use, being of the male gender, positive family history for the condition, and pre-occurring conditions such as diabetes mellitus (DM), hypertension, and hyperlipidemia (Gehani et al., 2015). The risk of MI is highest in persons with multiple predisposing factors.

In the case of Mr. Savea, several factors could have predisposed him to MI. These include his history of tobacco use, being clinically obese, having high blood pressure, being at a considerably advanced age, and of course being a male. Research links components of tobacco to damage of blood vessels hence increasing the risk of atherosclerosis and MI (Wong et al., 2012). Obesity is also linked to diabetes and hyperlipidemia, both of which are risk factors for MI (Gehani et al., 2015). Age and gender are unavoidable risk factors for MI. Since MI prevalence has been linked to genetics, Mr. Savea’s family may also be susceptible to the disease. As Gehani et al. (2015) wrote, people whose family members have been victims of MI stand elevated chances of getting the condition.

5 Common Signs and Symptoms of MI

Signs and symptoms of MI	Underlying pathophysiology
Chest pain likened to a sensation of squeezing caused by application of pressure at the mid-thorax (Haasenritter et al., 2012)	Caused by hypoxia and ischemia result in MI. The impaired cardiac function also contributes to pain as muscles in other body parts do not get a sufficient supply of oxygen and nutrients hence becoming weak and unable to contract and relax normally. Reduced cardiac output also contributes to dyspnea hence causing the squeezed sensation (Heart Foundation, 2015a).
Loss of consciousness (Heart Foundation, 2015a)	Patients of MI may become unconscious due to the poor blood supply to the brain as manifested in the disease. The occurrence results from cardiogenic shock whereby the heart is unable to pump blood efficiently since cardiac muscles are damaged (McSweeney et al., 2010).
Tachycardia and hypertension (McSweeney et al., 2010)	Patients with MI often present with tachycardia and hypertension. The phenomena are linked to anxiety and pain that patient experience when they get other symptoms of the disease. The anxiety and pain stimulate the sympathetic system hence causing cardiac activation and vascular constriction. As a result, patients develop hypertension and tachycardia as secondary manifestations (McSweeney et al., 2010).
Shortness of breath and dyspnea (Heart Foundation, 2015a)	The symptom is associated with the damage and impairment of heart muscles that occur in MI. The functioning of the left ventricle is affected hence reducing its pumping ability. Consequently, ventricular failure precedes pulmonary edema. Accumulation of fluid in the lungs, in turn, reduces the pulmonary volume and hence causes difficulties in breathing (Heart Foundation, 2015a).
Increased perspiration (Heart Foundation, 2015a)	Diaphoresis that characterizes MI is due to the activation of the sympathetic pathway. Usually, the pathway is activated as a counter mechanism for the maintenance of arterial pressure which is usually high in patients with MI. The activation of the pathway is a compensatory mechanism effected via the baroreceptor response following decreased cardiac output (Haasenritter et al., 2012).

Pharmacological Treatment of MI

Several classes of drugs have been approved for the treatment of MI in Australia. These include beta blockers and angiotensin converting enzyme inhibitors (ACEIs) (National Prescribing Service, 2010). Drugs in the same class often work in a similar mechanism in MI treatment.

ACEIs

The pharmacodynamics of these drugs in treating MI includes causing vascular dilation hence reducing the myocardial afterload (Clauss et al., 2015). Song et al. reported that so as to attain optimal effectiveness, treatment is initiated with a low dose of an ACEI that has a short half-life. The dose is then titrated upwards until a stable maintenance dose is achieved within 24 to 48 hours. The short-acting agent may then be continued at the maintenance dose or replaced with a longer-acting agent (2015). Angiotensin receptor blockers (ARB) may be co-administered with ACEIs if the patient is intolerant to the latter (Gadzhanova et al., 2016). ACEIs are recommended for diabetic and hypertensive patients while contraindicated for those with low blood pressure or patients of kidney failure (Blood Pressure Lowering Treatment Trialists’ Collaboration, 2014). Some of the commonest ACEIs used in the management of MI include captopril, lisinopril, and ramipril (Monroy et al., 2014). Patient data collected in Mr. Savea’s case suggest high applicability of ACEIs.

Beta Blockers

The physiological effects of beta blockers include decreasing the force and rate of myocardial contraction and subsequent reduction of oxygen demand in cardiac muscles (Atrial Fibrillation Association Australia, 2014). The medication should be administered the earliest possible after the onset of symptoms, preferably within the first 12 hours of diagnosis (Scot, 2010). Early treatment with beta blockers does not only reduce the incidence of re-infarction, recurrent ischemia, and ventricular arrhythmias, but it also decreases the size of the infarct and so the chances of short-term death (Scot, 2010). The medications are particularly essential when the disease condition is characterized by poor oxygen supply owing to the drugs’ effects on reducing oxygen demand in the myocardia (Burges, 2012). Common beta blockers used in MI management include carvedilol, atenolol, and metoprolol (Martin et al., 2014). The drugs are also associated with hypotensive effects, and therefore, their use is safe in the case of Mr. Savea.

Post-Admission Nursing Care Strategies for Mr. Savea

Nursing care for the presented patient should prioritize patient comfort and safety (Martin et al., 2014). Measures that should be taken to ensure safety for the patient include facilitating the accessibility of intravenous drug therapy services (Branson &Johannigman, 2013). Safety should also be promoted by ensuring that the patient has access to resuscitation facilities, and he can be easily monitored and supervised. On the other hand, measures to increase the comfort of the patient include early administration of oxygen therapy, pain relievers, vasodilators, and anti-emetic medications(Branson &Johannigman, 2013).

Oxygen Therapy

The registered nurse should ensure that Mr. Savea receives oxygen therapy so as to avert arterial hypoxemia that could occur within 24 hours of admissions Martin et al. (2014) warned. The strategy would also facilitate the applicability of medications such as opioid analgesics whose use could cause hypoxia (Martin et al., 2014). Research also indicates that administration of oxygen to patients of MI would counter the development of infarcts hence reducing the possibility of short-term mortality, and subsequently increasing survival chances for the victims (Burgess, 2012).

Pain and Emesis Management

Mr. Savea presents with severe chest and abdominal pain, and therefore, the registered nurse should prioritize on relieving the pain. Opioids such as diamorphine would be applicable in analgesia as they are considered highly potent (Haasenritter et al., 2012). However, such drugs could induce emesis, and it would be necessary to counter the side effect using anti-emetic agents. Such drugs include metoclopramide and cyclizine (Department of Health and Human Services, 2012). The hypoxaemic effects of opioid analgesics should be countered by the use of oxygen therapy (Burges, 2012).

Venodilation

The nurse should also prioritize on increasing blood flow to the heart by using vasodilators. Nitrates would be an applicable class of drugs as they would reduce myocardial oxygen demand by decreasing both the preload as well as the afterload (Branson &Johannigman, 2013). By promoting cardiac blood flow, the drugs would also help in reducing pain associated with ischemia (National Prescribing Service, 2010).

Administration of Anti-Clotting Agents

After stabilizing the patient, the nurse should proceed with long-term measures to protect the victim’s myocardia. The approach involves re-canalizing the affected blood vessels so as to promote cardiac function (National Prescribing Service, 2010). Drugs that may be used for this case include aspirin (Heart Foundation, 2014). The patient should take the drug at a low dose on a daily basis if he can tolerate it. The Heart Foundation advised that thrombolytic agents may also be used for the protection of the myocardium. The agency illustrated that streptokinase is an example of an intervention that is thrombolytic and applicable in the management of MI (2015b).

Heart Failure and Myocardial Infarction Case Study References

Atrial Fibrillation Association Australia. (2014). Beta blockers. Retrieved from http://www.atrialfibrillation-au.org/files/file/Publications/AFA%20Australia%20Beta%20Blockers%20FACT%20sheet%281%29.pdf

Blood Pressure Lowering Treatment Trialists’ Collaboration. (2014). Effects of blood pressure lowering on cardiovascular risk according to baseline body-mass index: a meta-analysis of randomized trials. The Lancet, 385(9571), 867-874.

Branson, R. D., &Johannigman, J. A. (2013).Pre-hospital oxygen therapy. Respiratory Care, 58(1), 86-97.

Burgess, S. (2012). Oxygen therapy for myocardial infarction. Australian Journal of Paramedicine, 8(2), 1-3.

Clauss, F., Charloux, A., Piquard, F., Doutreleau, S., Talha, S., Zoll, J., & Geny, B. (2015).Angiotensin-converting enzyme inhibition prevents the myocardial infarction-induced increase in renal cortical cGMP and cGMP phosphodiesterase activities. Fundamental & Clinical Pharmacology, 29(4), 322-361.

Department of Health and Human Services. (2012). About medicines of nausea and vomiting. Retrieved from http://www.dhhs.tas.gov.au/__data/assets/pdf_file/0005/36950/Nousea_and_Vomiting_Mediciation_130509.pdf

Gadzhanova, S., Roughead, S., & Bartlett, L. (2016).Long-term persistence to mono and combination therapies with angiotensin converting enzymes and angiotensin II receptor blockers in Australia.European Journal of Clinical Pharmacology, 2016(1), 1-7.

Gehani, A., Hinai, A, Zubaid, M., Almahmeed, W., Hasani, M., Yusufali, A., & … Yusuf, S. (2015). Association of risk factors with acute myocardial infarction in Middle Eastern countries: the INTERHEART Middle East study. Preventive Cardiology, 21(4), 400-410.

Haasenritter, J., Stanze, D., Widera, G., Wilimzig, C., Abu Hani, M., Sönnichsen, A. C., Donner-Banzhoff, N. (2012). Does the patient with chest pain have coronary heart disease? Diagnostic value of single symptoms and signs – a meta-analysis.Croatian Medical Journal, 53(5), 432–441.

Heart Foundation. (2014). Australian Heart Disease Statistics. Retrieved from https://heartfoundation.org.au/images/uploads/publications/HeartStats_2014_web.pdf

Heart Foundation. (2015). Australian acute coronary syndromes capability. Retrieved from http://heartfoundation.org.au/for-professionals/clinical-information/acute-coronary-syndromes

Heart Foundation. (2015a). Will you recognize your heart attack? Retrieved from http://heartfoundation.org.au/images/uploads/main/Your_heart/Heart_attack_warning_signs_fact_sheet.pdf

Martin, L., Murphy, M., Scanlon, A., Naismith, C., Clark, D., & Faraoukwe, O. (2014).Timely treatment for acute myocardial infarction and health outcomes: An integrative review of the literature. Australian Critical Care, 27(3), 111-118.

McSweeney, J. C., Cleves, M. A., Zhao, W., Lefler, L. L., & Yang, S. (2010). Cluster Analysis of Women’s Prodromal and Acute Myocardial Infarction Symptoms by Race and Other Characteristics. The Journal of Cardiovascular Nursing, 25(4), 311–322.

Monroy, F., Ferrario, C. M., Hernandez, C., & Martinez, L. (2014).Comparative Effects of a Novel Angiotensin-Converting Enzyme Inhibitor versus Captopril on Plasma Angiotensins after Myocardial Infarction.Pharmacology, 94(2), 21-28.

National Prescribing Service. (2010). Ischemic heart disease. Retrieved from http://www.nps.org.au/__data/assets/pdf_file/0004/16969/ppr31.pdf

Scot, I. (2010). Up the dose of beta blockers after MI. Medical Journal of Australia, 2010(160), 435-442.

Song, P. S., Seol, S., Seo, G., Kim, D., Kim, K., Yang, J. &. . . Kim, D. (2015). Comparative study of angiotensin 2 receptor blockers.Journal of Cardiovascular Drugs, 12(4), 43-54.

Wong, C. X., Sun, M. T., Lau, D. H., Brooks, A. G., Sulivan, T., Worthley, I. M., & Sanders, P. (2013).Nationwide Trends in the Incidence of Acute Myocardial Infarction in Australia, 1993–2010. AJC, 112(2), 169-173.

Wong, C., Brooks, A., Leong, D., Thompson, K., & Sanders, P. (2012). The Increasing Burden of Atrial Fibrillation Compared With Heart Failure and Myocardial Infarction: A 15-Year Study of All Hospitalizations in Australia. Arch Intern Med, 172(9), 739-742.

Myocardial Infarction Assignment Available

Myocardial Infarction

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Thank you so much for helping for this Question Answer assignment. Case scenario for the essay topic is as follow.

• APA Referencing
• At least 30 genuine references from 2010 to 2016 study based,
• 90 % references has to be research based Journal article AND books
• Australian and New Zealand based study articles are preferable.
• Please have a look Rubric guideline for given topic, I need good grades in this assignment so please do me a favour and try to give me a best quality work

Word count: 1600 words (every question has a specific word count, which must be adhered to)
Instructions:
• The assignment is to be presented in a question/answer format NOT as an essay (i.e. no introduction or conclusion).
• Each answer has a word limit (1600 in total); each answer must be supported with citations.
• A reference list must be provided at the end of the assignment.
• Please refer to the marking guide available in the unit outline for further information.
** The following questions must be answered for your chosen case study **
The following questions relates to the patient within the first 24 hours since admission to the emergency department (ED):
1. Outline the causes, incidence and risk factors of the identified condition and how it can impact on the patient and family (400 words)
2. List five (5) common signs and symptoms of the identified condition; for each provide a link to the underlying pathophysiology (350 words)
a. This can be done in the form of a table – each point needs to be appropriately referenced
3. Describe two (2) common classes of drugs used for patients with the identified condition including physiological effect of each class on the body (350 words)
a. This does not mean specific drugs but rather the class that these drugs belong to.
4. Identify and explain, in order of priority the nursing care strategies you, as the registered nurse, should use within the first 24 hours post admission for this patient (500 words).

Case Study 1: Myocardial infarction with history of stable angina and mitral valve stenosis
Mr Tupa Savea is a 54 year old male who has been transferred to the coronary care unit (CCU) from the emergency department for management of episodic chest pain. He has a history of stable angina and mitral valve stenosis.
Mr Savea is of Samoan background and has lived in regional Queensland for the last 20 years with his wife and children. He was brought in by ambulance having had chest pain and shortness of breath. He reports having similar symptoms on and off for the past two months but did not visit his GP as he assumed the discomfort was due to indigestion. Mr Savea is an ex-smoker, tobacco free for the last six months and a social drinker (approx. 10 units/week). He works full-time as an orderly at a local hospital and is active in the Samoan support community.
On assessment Mr Savea’s vital signs are: PR 90 bpm and irregular; RR 12 bpm; BP 150/100mmHg; Temp 36.9°C; SpO2 98% on oxygen 8L/min via Hudson mask. He has a body mass index (BMI) of 35 kg/m2 indicating clinical obesity. Blood test results show elevated cardiac enzymes and troponin levels and cholesterol level of 8.9mmol/L. His ECG indicates that he has a ST segment elevated myocardial infarction. Mr Savea was administered sublingual glyceryl trinitrate followed by morphine 2.5 mg IV for pain in the emergency department. He reports being pain free on admission to CCU.

Explainations regarding question and answer

In regards to Q.2. you must link the signs and symptoms to the Pathophysiology.
• This means you need to research how it links to the symptom e.g. Chest pain.
• Why does that patient experience this?
• What is going on in the heart for them to experience this and must be supported by EBP literature.

In regards to Q 3

”Describe two (2) common classes of drugs used for patients with the identified condition ” therefore any two classes of drugs not necessarily the ones mentioned in case study, you can use any 2 classes of drugs related to patient’s conditions

Question 3 refers to your patients condition and why certain drug classes are used in the treatment and what physiological effects the drug class have on the patient’s condition which includes there mode of action.

In regards to Q 4

Identify and explain, in order of priority the nursing care strategies you, as the registered nurse, should use within the first 24 hours post admission for this patient”. Therefore it has not stated ED so it means in CCU the first 24 hours of admission to the hospital.

SAMPLE ANSWER

Question 1

Myocardial infarction refers to a condition that develops as a result of the irreversible necrosis of cardiac muscles due to prolonged lack of supply of oxygen (ischemia) (Caforio et al., 2013). Cardiac muscles require sufficient supply of blood rich in oxygen for nourishment and it is the role of coronary arteries to supply the blood. It is estimated that approximately 10 million patients suffer from myocardial infarction across the globe. In Australia, it is estimated that approximately 350, 000 individuals have had this condition at some time in their life. In 2013, the condition claimed about 8, 611 lives in Australia, an average of 24 individuals daily (Chew et al., 2013; Etaher et al., 2015).

Causes of Myocardial Infarction

Research by Reiter et al., (2012) indicates that coronary heart disease is one of the most common causes of myocardial infarction. This is a condition where by the coronary arteries harden and narrow due to the buildup of atheromas or fatty plaques in the walls of the arteries a condition referred to as atherosclerosis (Chaitman, 2012; Werdan et al., 2012). The atheromas consist of platelets, cholesterol, and clots. Over time, resistance of blood occurs in the vessels reducing blood flow or in severe cases causes when a blood clot forms complete obstruction occurs. Sudden severe spasm or tightening of coronary arteries can also cause myocardial infarction. This condition occurs regardless of whether the coronary artery disease is present or not. Some of the documented causes of coronary spasms include cigarette smoking, emotional stress, and exposure to extreme cold.

Risk Factors of Myocardial Infarction

The risk factors of myocardial infarction can be classified as adjustable risk factors and non-adjustable risk factors. Some of the adaptable risk factors include age whereby men that are over 45 year and women that are over 55 years are predisposed. Particular ethnicities such as African-Caribbean and African, family history, and a history of angina and other cardiac diseases are can also predispose an individual to develop myocardial infarction (Chew et al., 2013). Modifiable risk factors include obesity, smoking, diabetes, hypertension, lack of physical activity, and hypercholesterolemia.

Impact on Patient and Family

Myocardial Infarction (MI) makes patients to undergo extreme agony due to the severe chest pain it causes (Saaby et al., 2014). It also deteriorates the quality of life of the patient who may lose weight due to the lack of appetite, nausea, and vomiting that are accompanied with this condition. The family members of the patient are also affected because they are forced to change their lifestyle and take on some of the patient’s duties. If a man who is the primary provider of his family develops myocardial infarction, his wife may be forced to return to work and increase her hours of working and spending limited time with her kids. Family members are also required reschedule their plans and start making frequent hospital trips to visit the loved one in case he/she is admitted.

Question 2

Patients suffering from myocardial infarction are likely to report of having dyspnea (Thygesen et al., 2012; Steg et al., 2012). Research indicates that dyspnea is related to the degree of reflex stimulation of the command output in the central motor (Canto et al., 2012). It is also related to the intensity at which the activity of the respiratory muscles is hindered by mechanical abnormality such as restriction or obstruction. Myocardial infarction, weakens the pumping force of the cardiac muscles hence little blood accesses the lungs for oxygenation (Shah et al., 2015; Soliman et al., 2014). This elevates the partial pressure of CO₂ in the arteries initiating the release of chemoreceptors which in turn cause intense reflex stimulation on respiratory muscles causing dyspnea.

Angina pectoris is a common manifestation of myocardial infarction. This is a condition that is characterized with pressure sensation in the chest or chest pain. Occasionally, the pain radiates to the left shoulder or the jaw (Harrison et al., 2013; McAllister et al., 2012). This symptom arises when there is an increase in blood flow resistance in the epicardial arteries due to the development of atherosclerotic plaques. The resistance causes cardiac muscles to develop ischemia prompting the heart to react by sending pain signals.

Arrhythmias are also common presentation in patients with myocardial infarction. MI causes ischemia which in turn initiates cardiac automaticity that develops multiple arrhythmias both ventricular and atrial (Non, 2012). The enhanced activity arises due to delayed after depolarization and early after depolarization which triggers several spontaneous depolarizations that precipitate arrhythmias in the ventricles.

During physical examination, patients with MI report of having fatigue. Myocardial infarction triggers an increase in sympathetic cardiac drive which arises due to the release of sympathetic neurotransmitters such as noradrenaline and neuropeptide Y. An increase in sympathetic activity causes utilization of essential glucose in the body hence the patient cannot generate sufficient energy to perform physiological functions.

Sweating also occurs in patients with MI. This is due to the over-activation of the sympathetic nervous system, a body system that is in charge of the “fight” or “flight” response. The pain sensation in myocardial infarction causes the release of hormones such as adrenaline which trigger the sino atrial node and increase blood pressure consequently causing sweating.

Question 3

Thrombolytic Agents

More heart tissue dies with each passing minute after myocardial infarction. One way used to stop progression of cardiac damage is through restoration of blood flow as soon as possible. This can be achieved through breaking down the formed blood clots. In myocardial infarction, thrombolytic agents are administered to aid in dissolving of the thrombi (blood clots). They do this through activation of plasminogen, a product that is cleaved to form another product known as plasmin. Plasmin is an enzyme that lyses proteins, and therefore, it has the capacity of disintegrating cross-links between fibrin molecules that offer the primary structural integrity of the thrombi. Saaby et al (2013) enlightens that it is of great importance for clinicians to note that the efficacy of these fibrinolytic agents relies on the age of the thrombi. This is because older clots have more cross-link fibrin and are compacted hence they are quite difficult to lyse. In patients with acute myocardial infarction, the plasminogen activators should be given within a period of less than 2 hours. However, beyond this duration the efficacy of the drugs diminishes prompt administration of higher doses to attain the desired outcomes. Examples of fibrinolytic drugs include alteplase, streptokinase, retaplase, urokinase, and tenecteplase,

Beta-Blockers

This is another important class of pharmaceutical agents that is prescribed to patients with myocardial infarction. These drugs act by binding to the beta-adrenoceptors inhibiting the binding of epinephrine and norepinephrine to these receptors hence inhibiting physiological sympathetic activity that occurs through the receptors. In myocardial infarction, these agents have anti-anginal activity due to their hypotensive and cardiodepressant effects (Briffa et al., 2013). By reducing contractility, heart rate, and arterial pressure beta antagonists reduce the heart’s work as well as oxygen demand. This in turn improves the oxygen supply/demand ratio in the heart which relieves the patient of anginal pain that arises due to low oxygen supply to the cardiac cells. These agents also aid in inhibiting subsequent remodeling of the heart that has been shown to increase mortality among patients with myocardial infarction.

In addition, beta blockers have been shown to possess antiarrhythmic properties. It has been shown that activation of sympathetic activity increases automaticity of the sino atrial node. It also increases the velocity of cardiac conduction and activates ectopic pace makers. These are the effects that elicit cardiac arrhythmias. However, administration of beta blockers inhibits sympathetic activity hence reducing the occurrence of cardiac arrhythmias.

Question 4

Normally, the mortality of myocardial infarction rises when treatment is delayed and approximately half of patients die before hospitalization, within the first hour of onset of symptoms (Huynh et al., 2009). However, the prognosis of this condition improves tremendously whenever clinical interventions are put in place. Some of the strategies a registered nurse should consider when taking care of a patient with acute myocardial infarction include;

Management of acute pain

After admission, a nurse should monitor and document the pain characteristics. The registered nurse should obtain a full description of the pain from the patient including the intensity, location, characteristic, duration, and assist the patient in quantifying the pain by using other experiences in comparing it. This is an essential strategy because pain is subjective and clinicians should obtain proper description which provide a baseline for determine an effective therapy. The nurse should also instruct the patient to report pain as soon as possible and offer the patient with a quiet environment, comfort measures, and calm activities (Reichlin et al., 2012). In management of angina, the patient should be advised to do relaxation techniques such as breathing deeply and slowly, engaging in distractive behavior, guided imagery, and visualization. This will be important since it will help in decreasing the perception and pain response. More importantly, the health care provider should administer appropriate medication such as nitrates like nitroglycerin which induce coronary vasodilating effects increasing blood flow in the coronary arteries (Ye et al., 2013; Redfern et al., 2014).

Manage patient’s risk for decreased cardiac output

The clinician will auscultate blood pressure by comparing the BP in both arms when the patient is sitting, lying, and standing. The pulse quality of the patient will also be evaluated. This is because myocardial infarction causes a decrease in the patient’s cardiac output and irregularities such as dysrhytmias which require close monitoring and maintenance to be done. The patient will be provided small meals that are easily digested. This is because large meals have been shown to trigger myocardial workload and stimulate vagal activity leading to bradycardia and ectopic cardiac beats. The practioners will also limit the intake of caffeine or products containing caffeine because caffeine is a cardiac stimulant that increase the heart rate. Supplementary oxygen will also be administered depending on the severity of the condition.

Evaluation of the patient’s risk for ineffective tissue perfusion

The nurse should inspect cyanosis, mottling, pallor, and clammy skin. Reperfusion therapy can be used to open coronary arteries that are partially blocked before they are blocked totally (Sundararajan et al., 2016). Low-dose heparin will also be given as a prophylaxis in high risk individuals to reduce the risk of thrombus formation and thrombophlebitis.

Patient education

French et al, (2013) report that nurses should present information to the patient in different learning formats such as audiovisual tapes, programmed books, and question and answer sessions. The education will at reinforcing explanations of risk factors, medications, dietary and/or restriction of activity, and symptoms that require urgent medical attention (Peterson et al., 2012). In case the patient is engaging in risk factors that may worsen his/her condition, the nurse will warn him/her by giving a relevant rationale behind the warning. Finally, the nurse will lay more emphasis on the importance of follow-up care and suggest a number of community resources and support groups that should subscribe to.

References

Caforio, A. L., Pankuweit, S., Arbustini, E., Basso, C., Gimeno-Blanes, J., Felix, S. B., … & Klingel, K. (2013). Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. European heart journal, 34(33), 2636-2648.

Canto, A. J., Kiefe, C. I., Goldberg, R. J., Rogers, W. J., Peterson, E. D., Wenger, N. K., … & Canto, J. G. (2012). Differences in symptom presentation and hospital mortality according to type of acute myocardial infarction. American heart journal, 163(4), 572-579

Canto, J. G., Rogers, W. J., Goldberg, R. J., Peterson, E. D., Wenger, N. K., Vaccarino, V., … & NRMI Investigators. (2012). Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality. Jama, 307(8), 813-822.

Chaitman, B. R. (2012). Third Universal Definition of Myocardial Infarction.

Chew, D. P., French, J., Briffa, T. G., Hammett, C. J., Ellis, C. J., Ranasinghe, I., … & Redfern, J. (2013). Acute coronary syndrome care across Australia and New Zealand: the SNAPSHOT ACS study. The Medical Journal of Australia, 199(3), 185-191.

educatPeterson, G. M., Thompson, A., Pulver, L. K., Robertson, M. B., Brieger, D., & Wai, A. (2012). Management of acute coronary syndromes at hospital discharge: Do targeted educational interventions improve practice quality?.Journal for healthcare quality, 34(1), 26-34.

Etaher, A., Chew, D., Briffa, T., Ellis, C., Hammett, C., Redfern, J., … & French, J. (2015). Cardiac troponin type II myocardial infarction and late mortality: a report from the 2012 SNAPSHOT OF ACS Care Across Australia and New Zealand. Heart, Lung and Circulation, 24, S139.

French, J. K., Chew, D., Hammett, C. J. K., Ellis, C. J., Turnbull, F., Ranasinghe, I., … & Brieger, D. (2013). Acute coronary syndrome care across Australia and New Zealand. European Heart Journal, 34(suppl 1), P4045.

Harrison, R. W., Aggarwal, A., Ou, F. S., Klein, L. W., Rumsfeld, J. S., Roe, M. T., … & American College of Cardiology National Cardiovascular Data Registry. (2013). Incidence and outcomes of no-reflow phenomenon during percutaneous coronary intervention among patients with acute myocardial infarction. The American journal of cardiology, 111(2), 178-184.

Huynh, L. T., Chew, D. P. B., Sladek, R. M., Phillips, P. A., Brieger, D. B., & Zeitz, C. J. (2009). Unperceived treatment gaps in acute coronary syndromes. International journal of clinical practice, 63(10), 1456-1464.

managemBriffa, T., Chow, C. K., Clark, A. M., & Redfern, J. (2013). Improving outcomes after acute coronary syndrome with rehabilitation and secondary prevention. Clinical therapeutics, 35(8), 1076-1081.

McAllister, D. A., Maclay, J. D., Mills, N. L., Leitch, A., Reid, P., Carruthers, R., … & Clark, E. (2012). Diagnosis of myocardial infarction following hospitalisation for exacerbation of COPD. European Respiratory Journal,39(5), 1097-1103.

Non, S. T. (2012). New Zealand 2012 guidelines for the management of non ST-elevation acute coronary syndromes. The New Zealand Medical Journal (Online), 125(1357).

Redfern, J., Hyun, K., Chew, D. P., Astley, C., Chow, C., Aliprandi-Costa, B., … & Nallaiah, K. (2014). Prescription of secondary prevention medications, lifestyle advice, and referral to rehabilitation among acute coronary syndrome inpatients: results from a large prospective audit in Australia and New Zealand. Heart, heartjnl-2013.

Reichlin, T., Schindler, C., Drexler, B., Twerenbold, R., Reiter, M., Zellweger, C., … & Haaf, P. (2012). One-hour rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac troponin T. Archives of internal medicine, 172(16), 1211-1218.

Reiter, M., Twerenbold, R., Reichlin, T., Benz, B., Haaf, P., Meissner, J., … & Balmelli, C. (2012). Early diagnosis of acute myocardial infarction in patients with pre-existing coronary artery disease using more sensitive cardiac troponin assays. European heart journal, 33(8), 988-997.

Reiter, M., Twerenbold, R., Reichlin, T., Mueller, M., Hoeller, R., Moehring, B., … & Mueller, C. Z. (2013). Heart-type fatty acid-binding protein in the early diagnosis of acute myocardial infarction. Heart, heartjnl-2012.

Risk Chew, D. P., Junbo, G., Parsonage, W., Kerkar, P., Sulimov, V. A., Horsfall, M., & Mattchoss, S. (2013). Perceived risk of ischemic and bleeding events in acute coronary syndromes. Circulation: Cardiovascular Quality and Outcomes, 6(3), 299-308.

Saaby, L., Poulsen, T. S., Diederichsen, A. C. P., Hosbond, S., Larsen, T. B., Schmidt, H., … & Mickley, H. (2014). Mortality rate in type 2 myocardial infarction: observations from an unselected hospital cohort. The American journal of medicine, 127(4), 295-302.

Saaby, L., Poulsen, T. S., Hosbond, S., Larsen, T. B., Diederichsen, A. C. P., Hallas, J., … & Mickley, H. (2013). Classification of myocardial infarction: frequency and features of type 2 myocardial infarction. The American journal of medicine, 126(9), 789-797.

Shah, A. S., Griffiths, M., Lee, K. K., McAllister, D. A., Hunter, A. L., Ferry, A. V., … & Walker, S. (2015). High sensitivity cardiac troponin and the under-diagnosis of myocardial infarction in women: prospective cohort study.bmj, 350, g7873.

Soliman, E. Z., Safford, M. M., Muntner, P., Khodneva, Y., Dawood, F. Z., Zakai, N. A., … & Herrington, D. M. (2014). Atrial fibrillation and the risk of myocardial infarction. JAMA internal medicine, 174(1), 107-114.

Steg, P. G., James, S. K., Atar, D., Badano, L. P., Lundqvist, C. B., Borger, M. A., … & Gershlick, A. H. (2012). ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation.European heart journal, ehs215.

Sundararajan, K., Flabouris, A., Thompson, C., & Seppelt, I. (2016). Hospital overnight and evaluation of systems and timelines study: a point prevalence study of practice in Australia and New Zealand. Resuscitation, 100, 1-5.

Thygesen, K., Alpert, J. S., Jaffe, A. S., White, H. D., Simoons, M. L., Chaitman, B. R., … & Clemmensen, P. M. (2012). Third universal definition of myocardial infarction. Journal of the American College of Cardiology,60(16), 1581-1598.

Werdan, K., Ruß, M., Buerke, M., Delle-Karth, G., Geppert, A., & Schöndube, F. A. (2012). Cardiogenic shock due to myocardial infarction: diagnosis, monitoring and treatment: a German-Austrian S3 Guideline.

Ye, S., Muntner, P., Shimbo, D., Judd, S. E., Richman, J., Davidson, K. W., & Safford, M. M. (2013). Behavioral mechanisms, elevated depressive symptoms, and the risk for myocardial infarction or death in individuals with coronary heart disease: the REGARDS (Reason for Geographic and Racial Differences in Stroke) study. Journal of the American College of Cardiology,61(6), 622-630.

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Diagnostic Test Performed on a Person with Chest Pain

Diagnostic Test Performed on a Person with Chest Pain Order Instructions: Can use dot points and headings in answers to questions where appropriate.

APA Referencing

Diagnostic Test Performed on a Person with Chest Pain Sample Answer

Case Scenario

Diagnostic Test Performed When a Person Presents With Chest Pain

According to the scenario, Mr. Joseph Waters, a 76 –year- an old man married to Carol and a father of two is admitted in the emergency department for further diagnosis for chest pains.

Diagnostic Test Performed on a Person with Chest Pain

According to the case, Joseph was brought into the ED with a medical history depicting that he had been suffering from (CAD), Hypertension, Hyperlipidaemia, Chronic Renal Impairment, Chronic Bronchitis, and Gastro-Oesophageal Reflux Disease (GORD), According to the report, he was under medication that included: Enalapril, Atorvastatin, Aspirin, Pantoprazole, and Salbutamol. This paper, therefore, seeks to carry out an analysis of Mr. Joseph’s condition

Electrocardiogram (ECG): Performed to determine the electrical activity of a patient’s heart through the attachment of electrodes to the skin.

Blood Tests: Performed to check an increase in the level of enzymes found around the heart’s muscles. Damages to the heart cells may allow heart attacks to leak enzymes into the blood.

Chest X-rays: Allows a doctor to determine the condition of the lungs including the size and the shape of a patient’s heart and blood vessels.

Computerized Tomography (CT scan): Can be used to determine the blood clots in the patient’s lungs or to check the aorta to ascertain a patient does not have aortic dissections.

As determined, Mr. Water’s would be experiencing Epigastric chest symptoms from myocardial ischemia (Kiriş, Gülmen, Yılmaz, &Okutan, 2011). However, his condition may be ascribed to gastrointestinal (GI) that occurs in spite of the existence of diaphoresis. The symptoms in this case that may make it challenging to consider this ailment as myocardial ischemia. Additionally, sharp pains witnessed by the patient may also be attributed to a musculoskeletal etiology.
CAD is primarily caused when cholesterol-rich deposits build up along the linings of the artery thus causing the thickening of the arterial wall including the narrowing of the space between the arteries that allow blood flows to access the heart (Kiriş et.al.2011). This, therefore, limits the amount of blood being supplied to the heart muscles with oxygen, a factor that reduces the presence of atheromas.

As established in the patient’s medical history, CAD may result from the narrowing of the athermanous that subsequently occludes the vessels. An early contraction of Atheroma is considered to be prevalent from adulthood with the lipid core that is comprised of two constituents released from the necrotic cells thus depriving macrophages which migrates into the ingested lipids and intima (Kiriş et.al.2011). In this case, the patient’s connective tissue matrix is derived from the organs smooth muscle cells that are considered to migrate from the media to the intima where they are bound to proliferate and change their nature into phenotypical fibrous capsules around the core of the lipid.

In a case where the plague produces a stenosis diameter of >50%, chances of reduced blood flow are prevalent through the coronary artery, an aspect that may result in angina. As a result of this, an acute coronary case is likely to arise as a result of the formation of a thrombus that occurs as a result of the disruptions caused by the plague (Kiriş et.al.2011). When these plagues build up, the patient’s coronary arteries are narrowed, an aspect that decreases the manner in which blood flows to the heart. As a result of the decrease in blood flow, the patient is likely to suffer from chest pains also described as angina or other CAD symptoms. Complete blocking of the patient’s coronary arteries may result in heart failure.

CAD is a heart illness that develops as a result of the narrowing of the arteries within the heart. When these arteries narrow, it becomes difficult for blood and oxygen to reach the muscles of the heart, a factor that result in the development of CAD that can lead to heart failure (Kiriş et.al.2011). On the other hand, it is essential to consider that Ischemia refers to the restriction of blood flow and oxygen to the other parts of the body.

CAD and ischemic chest are related in terms of the consequences of results of arteries sclerosis that results from the hardening of the arteries and atherosclerosis that occurs as a result of the fatty deposits found within the arteries (Kiriş et.al.2011). In such an instance, the coronary arteries are affected by atherosclerosis of the arteries sclerosis, thus becoming occluded and resulting in the impairment of the blood supply to the hearts muscle.

Enalaprilat a medicine is mainly utilized in the treatment of high blood pressure in an adult and also the congestive heart failure. Additionally, this drug may also be used in treating the ventricles disorder that depicts the restrictions of the lower chambers of the heart in allowing blood flows to the heart (Kiriş et.al.2011). This disorder is known to decrease the capacity of the heart in pumping blood to the rest of the body. Considering that Mr. Waters experienced some Pain: 7/10 in left chest with a BP of 108/60 would indicate that he was suffering from the Left Ventricular Dysfunction as the factor that resulted in the description of Enalapril 10 mg BD. This, therefore, requires that the patient is observed for a period of two hours until the blood pressure stabilizes.

Enalapril’s mechanism of action can be depicted in the case of this patient that results in the suppression of the renin-angiotensin-aldosterone systems, an aspect that results in the decrease of plasma angiotensin II thus resulting in a decrease of the vasopressin activities and aldosterone secretions (Kiriş et.al.2011). In this case, treatment will incorporate the use of VASOTEC alone that will be conducted over 48 weeks with the aim of increasing the patient’s serum potassium levels.

Atorvastatin is a medicine that can be used in treating an elevated total cholesterol condition (LDL) with the aim of elevating HDL cholesterol. The primary aim of the use of this drug in Mr. Water’s condition was to lower the cholesterol levels of a prescription of Atorvastatin 40 mg daily. Atorvastatin is known as one of the efficient synthetic lipid-lowering agents that inhibits 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA). The use of this drug, therefore, catalyzes the conversion of HMG-CoA to mevalonate, an aspect that is essential in the biosynthesis of cholesterol (Kiriş et.al.2011). When the less cholesterol is produced, the liver is known to take more cholesterol from the patient’s bloodstream, an aspect that would result in the circulation of low levels of cholesterol in the blood.
Using the ABCDE framework to discuss Mr. Waters current observations

The ABCDE framework, in this case, can be used as an observational tool through the consideration of the following principles (Halpin & Riggins, 2014):

Airway (A): Airway obstructions are considered as life-threatening and would require immediate attention since they may result in hypoxia and damage the heart, kidney and the brain. In this case, it is important that:

An assessment is made on the signs of airway blockages on the patient.
The airway elements that block the airway are treated as a medical emergency
The patient is given Oxygen is at a higher concentration

Breathing (B): During the assessment process, it is vital to consider the patients breathing and diagnose the difficulties. Treatment should be directed to the life-threatening conditions.

Calculation (C): In the case of Mr. Waters, it is essential to take consideration of hypovolaemia which may result in shocks (Halpin & Riggins, 2014). In a case where there are no signs of a cardiac cause, it is advisable that Mr. Waters is put on intravenous fluid especially when his condition depicts a fast heart rate. Breathing problems are likely to lead to a problem in a patient’s circulatory state and should be treated as early as depicted.

Disability (D): There is a need for determining the patient’s conscious level through the use of an AVPU method. This determines the alertness and the manner in which the patient responds to painful stimuli or his unresponsiveness to all the stimuli’s (Halpin & Riggins, 2014). In order to determine Mr. Water’s response to painful stimuli, the application of a supra-orbital pressure would be effective.

Exposure (E): In order to determine Mr. Water’s full exposure to his body, it is imperative to minimize the aspect of heat loss as a way of respecting his dignity. In establishing the differences in the observations, it is important to consider that the patient’s HR increased to 115 from 113 with a BP of 110/63 from 108/60. On the other hand, the patients RR were irregular and increased to 31 from the original observation of 28.

Action to take while waiting to review Mr. Waters
1. Conducting an assessment
2. Controlling the patient’s airways distress
3. Consider the precipitating factors
4. Completing the patient’s respiratory assessment
5. Monitor the patients deteriorating or improving symptoms
6. Consider an assessment on the patient’s family support and teach them how stress levels may exacerbate the symptoms of the ailment
1. Water’s current medication includes Salbutamol PRN. It is essential to determine that this drug belongs to the class of medicines also known as β2-adrenergic agonists and that is inhaled through the mouth to aid in opening bronchial tubes and allow the passage of air into the lungs (Halpin & Riggins, 2014).
2. The mechanism of action of salbutamol

Salbutamol would be used in the case of this patient to stimulate β₂ adrenergic receptor considered as predominant in smoothing the bronchial muscles of the lung. This results in the activation of adenyl cyclase that results in the formation of the cyclic AMP (adenosine-mono-phosphate). The high levels of cyclic AMP have the capacity to relax the patient’s muscles, an aspect that decreases his airway resistance by lowering his intracellular concentrations of ionic calcium (Halpin & Riggins, 2014).

Bronchopneumonia is an acute inflammation of the lungs, primarily characterized by foci that are surrounded by parenchyma. This disease, therefore, produces a bacterium and affects the lobes being frequently determined as basal. Patients suffering from bronchopneumonia that is caused by bacteria as a result of invasions on the lungs parenchyma by the bacteria, an aspect that triggers the immune inflammatory response that fills the alveolar sacs with exudates (Halpin & Riggins, 2014). When the air sacs are filled with the exudates fluid through a process known as consolidation, the patient’s pulmonary lobes are affected.
1. Bacteria And Fungi
2. Streptococcus Pneumonia
3. Atypical Bacteria,
4. Mycoplasma Pneumoniae
5. Chlamydophila Pneumoniae
6. Legionella Pneumophila
Amoxicillin, in this case, belongs to the class of Amino penicillins that are considered as extended-spectrum antibiotics
As determined in Mr. Waters’s condition, in contracting community-acquired bronchopneumonia, it would be effective using amoxicillin in altering the actions of bacteria in the colon that encourages the growth of more bacteria which may result in the inflammation of the colon.
Immediate actions in order of priority
1. Ensure the patient is calmed while you call for help
2. It is important to Assess the patient’s failing organs
3. Assess clues to determine the cause
4. Act fast to clear blockages
5. It is also essential to Reduce the patient’s anxiety
6. Stabilize the patient from the obstructions caused by spasm and edema
7. Ensure the situation does not worsen
Cause of action in Mr. Waters case:

There is a need for determining the patient’s conscious level through the use of an AVPU method. This determines the alertness and the manner in which the patient responds to painful stimuli or his unresponsiveness to all the stimuli’s (Halpin & Riggins, 2014). In order to determine Mr. Water’s response to painful stimuli, the application of a supra-orbital pressure would be effective.

The likely cause of Mr. Waters’ septic shock
1. Weakened Immune Systems
2. Bacterial Infection
3. Fungi and Viruses
Clinical manifestations of septic shock Mr. Waters is showing

As detailed, septic shock is referred to as a systematic inflammatory response syndrome (SIRS) that document another infection. The clinical manifestation and features of this condition depend on a patient. In the case of Mr. Waters, the elements of fatigue, irritability, anxiety, rigors and fevers and the difficulties in breathing and the grunts determine that he is in a septic shock,

Stage 1: Non- progressive Shock: This shock occurs when blood flow is detected and several other systems are activated to maintain perfusion, the heart is prone to neat at a faster rate with the blood cells in the body turning smaller, a factor that restrains the circulation system thus resulting in a shock.

Stage II: Irreversible State: Occurs when the systems of the body fail to improve the process of perfusion and are reflected in the patient’s symptoms. As a result of this, oxygen is therefore deprived within the brain, a factor that results in the patient’s confusion and disorientation (Seymour & Rosengart, 2015). The deprivation of oxygen in the heart is likely to result in chest pains as well.

Stage III: This results when the heats functionality continues to go downwards, a factor that results in the shutting down of the kidneys thus injuring the body’s cells and tissues (Seymour & Rosengart, 2015). This stage may lead to a patient’s death.

The overall treatment goal in the shock

The primary goal of shock treatment is to achieve adequate delivery of oxygen in the tissues especially in patients who present symptoms of septic shock.

The medical management of septic shock

In this case, it is important to begin antibiotic therapies and proper dosages on the patient at an early stage. In order to correct the conditions of hypoxia, impaired tissue oxygenation, and Hypertension, there is a need for resuscitating the patient (Seymour & Rosengart, 2015). It is also important that a physician identify the sources of infection and determine effective approaches of controlling them, through the maintenance of adequate functions on organ systems. This, therefore, can be guided through the use of a cardiovascular monitoring tool.

The nursing management of septic shock

Nurses should consider early resuscitation therapy on patients who undergo septic shock. The patients should be admitted in the ED with clinical approaches to show there is no evidence of end-organ determined (Seymour & Rosengart, 2015). It is also essential to consider that these patients may not need invasive hemodynamic monitoring and may not require Intensive Care admissions.

Diagnostic Test Performed on a Person with Chest Pain References

Halpin, D. P., & Riggins, S. (2014). Management of coexistent carotid and coronary artery disease.Southern Medical Journal, 87(2), 187.Available From: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=9609241736&site=ehost-live (28^th April 2016)

Kiriş, İ., Gülmen, Ş., Yılmaz, S., &Okutan, H. (2011). Management of Concomitant Coronary and Bilateral Carotid Artery Disease: A Case Report. Journal of Cardiac Surgery, 22(2), 149-151. doi:10.1111/j.1540-8191.2007.00358.Available From: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=24181093&site=ehost-live(28^th April 2016)

Seymour, C. W., &Rosengart, M. R. (2015).Septic Shock.JAMA: Journal of The American Medical Association, 314(7), 708-717. doi:10.1001/jama.2015.7885. Available From: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=109024250&site=ehost-live(28^th April 2016)

Evidence Based Practice Project on Diabetes

Evidence Based Practice Project on Diabetes Order Instructions: Details: Identify research or evidence-based article that focuses comprehensively on a specific intervention or new diagnostic tool for the treatment of diabetes in adults or children.

In a paper of 750-1,000 words, summarize the main idea of the research findings for a specific patient population. Research must include clinical findings that are current, thorough, and relevant to diabetes and the nursing practice.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.

You are required to submit this assignment to Turnitin. Refer to the directions in the Student Success Center. Only Word documents can be submitted to Turnitin.

Benchmark Assignment: Evidence-Based Practice Project—Paper on Diabetes

1
Unsatisfactory 0-71%
0.00%
2
Less Than Satisfactory 72-75%
75.00%
3
Satisfactory 76-79%
79.00%
4
Good 80-89%
89.00%
5
Excellent 90-100%
100.00%
80.0 %Content

30.0 %Research or Evidence-Based Article Identified. Article Focuses on a Specific Diabetic Intervention or New Diagnostic Tool.
Research or evidence-based article not identified.
Research or evidence-based article identified but does not address a specific diabetic intervention or diagnostic tool.
Research or evidence-based article identified that focuses on a specific diabetic intervention or diagnostic tool in general.
Research or evidence-based article identified that focuses on a specific diabetic intervention and a diagnostic tool.
Research or evidence-based article identified that focuses on a specific diabetic intervention or diagnostic tool in a comprehensive manner, allowing all criteria of assignment to be fully addressed.
50.0 %Summary of Article Includes the Following Content: Discussion of Research Performed Clinical Findings, and Significance to Nursing Practice.
Content is incomplete or omits most of the requirements stated in the assignment criteria. Does not demonstrate an understanding of the basic principles. Does not demonstrate critical thinking and analysis of the overall program subject.
Content is incomplete or omits some requirements stated in the assignment criteria. Demonstrates a shallow understanding of the basic principles only a surface level of evaluation is offered, methods are described but flawed or unrealistic and strategies are discussed, but incomplete.
Content is complete but somewhat inaccurate and/or irrelevant. Demonstrates an adequate understanding of the basic principles. Reasonable but limited inferences and conclusions are drawn but lack development. Supporting research is inadequate in relevance, quality, and/or currentness.
Content is comprehensive and accurate, and definitions are clearly stated. Sections form a cohesive logical and justified whole. Shows careful planning and attention to details and illuminates relationships. Research is adequate, current, and relevant, and addresses all of the issues stated in the assignment criteria.
Content is comprehensive. Presents ideas and information beyond that presented through the course, and substantiates their validity through solid, academic research where appropriate. Research is thorough, current, and relevant, and addresses all of the issues stated in assignment criteria. Final paper exhibits the process of creative thinking and the development of the proposal. Applies the framework of knowledge, practice and sound research. Shows careful planning and attention to how disparate elements fit together.
15.0 %Organization and Effectiveness

5.0 %Thesis Development and Purpose
Paper lacks any discernible overall purpose or organizing claim.
Thesis and/or main claim are insufficiently developed and/or vague; the purpose is not clear.
Thesis and/or main claim are apparent and appropriate to the purpose.
Thesis and/or main claim are clear and forecast the development of the paper. It is descriptive and reflective of the arguments and appropriate to the purpose.
Thesis and/or main claim are comprehensive; contained within the thesis is the essence of the paper. Thesis statement makes the purpose of the paper clear.
5.0 %Paragraph Development and Transitions
Paragraphs and transitions consistently lack unity and coherence. No apparent connections between paragraphs are established. Transitions are inappropriate to purpose and scope. An organization is disjointed.
Some paragraphs and transitions may lack logical progression of ideas, unity, coherence, and/or cohesiveness. Some degree of organization is evident.
Paragraphs are generally competent, but ideas may show some inconsistency in the organization and/or in their relationships to each other.
A logical progression of ideas between paragraphs is apparent. Paragraphs exhibit a unity, coherence, and cohesiveness. Topic sentences and concluding remarks are appropriate to the purpose.
There is a sophisticated construction of paragraphs and transitions. Ideas progress and relate to each other. Paragraph and transition construction guide the reader. Paragraph structure is seamless.
5.0 %Mechanics of Writing (includes spelling, punctuation, grammar, language use)
Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice and/or sentence construction are used.
Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, and/or word choice are present.
Some mechanical errors or typos are present but are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.
The prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.
A writer is clearly in command of standard, written, academic English.
5.0 %Format

3.0 %Language Use and Audience Awareness (includes sentence construction, word choice, etc.)
Inappropriate word choice and lack of variety in language use are evident. The writer appears to be unaware of the audience. Use of ‘primer prose’ indicates writer either does not apply figures of speech or uses them inappropriately.
Some distracting inconsistencies in language choice (register) and/or word choice are present. The writer exhibits some lack of control in using figures of speech appropriately.
Language is appropriate to the targeted audience for the most part.
The writer is clearly aware of the audience, uses a variety of appropriate vocabulary for the targeted audience, and uses figures of speech to communicate clearly.
The writer uses a variety of sentence constructions, figures of speech, and word choice in distinctive and creative ways that are appropriate to purpose, discipline, and scope.
2.0 %Research Citations (In-text citations for paraphrasing and direct quotes, and reference page listing and formatting, as appropriate to assignment)
No reference page is included. No citations are used.
The reference page is present. Citations are inconsistently used.
The reference page is present. Citations are inconsistently used.
The reference page is present and fully inclusive of all cited sources. Documentation is appropriate and GCU style is usually correct.
In-text citations and a reference page are complete. The documentation of cited sources is free of error.
100 %Total Weightage

Evidence Based Practice Project on Diabetes Sample Answer

Evidence-Based Practice on Diabetes

Considering that Diabetes is a health concern in America, it is important that the diseases if efficiently diagnosed through the use of appropriate tools in order to have a clear understanding of its control, a factor that can be achieved through the education of patients (Nathan, Kuenen, Borg, Zheng, Schoenfeld, & Heine, 2012). This point to the fact that is easier to determine the appropriate interventions that can be applied in the management of this disease.

According to sources from the Centre of Disease Control in America, diabetes is highly increasing in with the number of affected individuals swelling up to 18.2 million from the initial figures that stood at 5.6 million between 2000 and 2010 (Nathan, et.al. 2012). In addition to this, it is significant to determine that CDC has also reported approximately 7 million individuals who are undiagnosed with the disease.

In this case, it can be established that diabetes requires the incorporation of early interventions since it is caused by an increase in patients insulin levels of an insufficient supply of insulin. If this disease is not detected in its early stages, it can result in the destruction of an individual’s body system (Nathan, et.al. 2012). Through the inclusion of evidence-based diagnostic tool, the state of this disease is likely to be identified in its early stages, a factor that will result in the deployment of early interventions and the training of the patients in its management.

There are two primary types of diabetes in which type 1 is likely to be diagnosed among the adults and children since as a result of the body’s failure to produce its function in the production of insulin (Nathan, et.al. 2012). According to the findings of research conducted by the American Association of Diabetes, close to 5% of patients suffer from this type of diabetes. The treatment approach of this type of diabetes includes the use of insulin therapy and other treatment methods.

Diabetes 2, which is the most widespread, occurs as a result of inadequate insulin in the body as well as poor utilization of insulin available in the body by the cells. This leads to an increase in the quantity of glucose in the body which has diverse impacts like kidney damage, eyes, nerves and the heart which can have fatal consequences (Nathan, et.al. 2012). Considering the fact that diabetes type 2 is complex to handle, it is vital its management and intervention be done during the early stages in order to avoid negative impacts on the body cells.

An Evidence-Based Diabetes Diagnostic Tool

It is essential for patients diagnosed with diabetes to partake regular health checkups including laboratory testing in clearly analyzing the proper treatment methods for these patients. In line with this, a laboratory testing toll known as AIC is considered efficient in the diagnosis of this disease. Over the past, the AIC testing toll was used in checking and determining the average glucose levels in a diabetic patient for a period of three months (Nathan, et.al. 2012). Physicians would, therefore, include the fasting blood glucose to establish the levels of glucose in the body, a factor that would result in the acquisition of wrong results especially in instances where a patient had not eaten.

However, current research on this evidence-based diagnostic tool has established that this evidence-based diagnostic tool known as AIC would give the physicians an understanding of a patient’s blood glucose level. This can be achieved through an averaged approach that bases in the percentage system without encountering diagnostic errors when the use of the fasting patient’s blood glucose testing is included (Nathan, et.al. 2012). The AIC test approach has been considered essential since it does not require a diabetic patient to fast for a period of eight hours before the test. In as much as this testing approach is considered crucial, some medical practitioners have termed it as confusing since it incorporates the average system which may be a challenging concept to depict. Through an AIC derived average glucose study, the average system was established to be easier for the patients and well as the medical personnel to understand.

The rationale behind the average glucose study was to clearly identify whether the accumulated AIC results could be articulated through the same units utilized in monitoring the daily levels of glucose in a patient’s body. As established, ADAG has considered as effective considering that it provided a mathematical equation that would be utilized in converting the achieved results that would establish the average glucose level (Nathan, et.al. 2012). ADAG, therefore, proved that through the trials that were conducted on 507 patients within ten different international centers, the results of an AIC would be expressed through an estimated average level of glucose by using a mathematical equation. Additionally, this study also confirmed that there are assumptions that the AIC tool represents only the average glucose estimates.

The methodologies that were employed in this research were directed towards doing a comparison of the values of AIC on each and every patient. This, therefore, required a daily glucose reading for a period of two days within the time intervals of four hours (Nathan, et.al. 2012). The research study, therefore, utilized close to 2700 glucose measurements that were effectively analyzed through the use of a linear regressive concept to determine the relationship with the results which were obtained before the research. It is therefore essential to establish that the AIC evidence-based diagnostic tool is effective in the identification of several diabetic patients as opposed to the other methods.

Evidence Based Practice Project on Diabetes References

Nathan, D. M., Kuenen, J., Borg, R., Zheng, H., Schoenfeld, D., & Heine, R. J. (2012). Translating the A1C Assay Into Estimated Average Glucose Values. Diabetes Care, 31(8), 1473-1478. doi:10.2337/dc08-0545. Retrieved From: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=34075496&site=ehost-live