Evidence based practice paper Assignment

Evidence based practice paper: Hand Hygiene in Healthcare setting

Order Instructions:

Describe a Clinical Problem that you see or have seen in practice. You will then revise or develop a policy, protocol, algorithm, or standardized guideline to be used in your practice site that is based on current research evidence. You are proposing the implementation of an intervention that is supported by research; thus you are proposing an evidence-based practice (EBP) project. You are not proposing a
study to be conducted in your agency.
Your final paper should be no more than 10 pages but your protocol, policy, or algorithm, and references for your project can be extra pages. This assignment is worth 100 points

Identify an area of interest: Is there a better way of doing something? Would another intervention based on research be more effective and improve patient outcomes? Is a policy, protocol, or algorithm in your agency out of date and in need of revision based on current research?

2. Provide some information (incidence of problem, morbidity and mortality rates, cost, etc.) from the healthcare literature and your agency that supports the fact that this is a patient care problem.
3. Review recent research and practice literature and select a specific intervention that might
address this patient care issue. The research-based intervention may be implemented in the form of a policy, protocol, algorithm, or standardized guideline that you could use to change patient care.

4. Identify what evidence-based intervention exists to improve current care in terms of patient, provider, or healthcare agency outcomes? Try to identify something for which you really
want an answer. You might get ideas from your unit nursing leader, other nurses, or patients
and families. Search current research journals online for interventions that have been studied.
5. Review a variety of evidence-based practice (EBP) Websites such as:

National Guideline Clearinghouse (http://www.guideline.gov)
Center for Disease Control (http://www.cdc.gov/Other/policies.html)

Professional Organization Websites Evidence-Based Guidelines

See Chapter 19 in Grove, Burns, and Gray (2013) textbook for more details on conducting EBP Projects and EBP websites.

6. Summarize what is known and not known about the problem area selected.
7. Revise or develop a policy, protocol, algorithm, or standardized guideline to be used in your practice site.
8. Provide a copy of the policy, protocol, algorithm, or standardized guideline with its references.

9. The steps of the protocol, policy, algorithm, or standardized guideline must be documented with current studies.
10. If a previous agency protocol or policy is revised, specify the changes made in the document.
11. Provide a reference list for your paper.

12. The references should include 7-10 quality research sources that support the intervention you have selected to implement in your practice site.

Grading Rubric
Introduction
Rubric
(0 – 10 Points)
Identifies problem in practice and the intervention to be used to address problem. Identifies the audience who will use the protocol, algorithm, or policy revised or developed.
Documents introduction.
Review of sources: What is known
(0 – 30 Points)
Summarizes or synthesizes current research knowledge that identifies what is known about the selected intervention.
Summary must be documented with studies from published sources.
Summary provides the knowledge base or research evidence for making a change in practice.
Review of sources: What is not known
(0 – 15 Points)
Summarizes or synthesizes what is not known in the area of the selected intervention.

Summary must be documented.
Section identifies the areas for further research.
Protocol, Algorithm, Policy, or Standardized
Guideline for Evidence-Based Project
(0 – 20 Points)
Provide a copy of the documented protocol, algorithm, policy, or standardized guideline. The steps of the protocol, algorithm, or policy are documented with current research sources.
Discuss your development of your protocol, algorithm, policy, or standardized guideline. If revised from previous agency protocol, identify the changes made.
(0 – 10 Points)
Indicate whether protocol or algorithm was developed; revised from an agency document; or obtained from a publication or website.
If based on existing document, include a copy of this document.
Briefly identifies any revisions you might have made to the existing document.
Format and Writing style is clear, complete, and concise. No grammar, sentence structure, or spelling errors. References APA (2010) Format. Limit the paper to 10 pages
(0 – 15 Points) The references need to include 7-10 published research sources. All sections of the paper must be documented with research sources. Include headings based on the paper guidelines.
Total Points Possible: 100

SAMPLE ANSWER

Evidence based practice paper: Hand Hygiene in Healthcare setting

Hand hygiene (HH) is known to prevent cross-infection in health care organizations, but there is poor adherence of health care workers to hand hygiene guidelines. Timely, easy access to both skin protection and hand hygiene is essential for satisfactory hand hygiene behavior. The use of alcohol-based hand rubs is necessary given that they are less irritating, they act faster, and require less time than traditional hand washing, and they also contribute to sustained improvement in compliance related to reduced rates of infection (Pittet, 2011). It is disquieting that the hospitalization of a patient may result in Hospital Acquired Infection (HAI), also known as nosocomial infection, and that poor hand hygiene is considered as a contributory factor. This paper provides an exhaustive description of hand hygiene; a Clinical Problem that I have actually seen in practice. Moreover, a standardized guideline is developed in this paper that would be used in my practice site and this standardized guideline is based on current literature evidence. In essence, I am proposing the implementation of an intervention that is supported by research; hence I am proposing an evidence-based practice (EBP) project.

The Clinical Problem of Hand Hygiene in Healthcare setting

Hand hygiene (HH) is the most effective and simplest measure for the prevention of nosocomial infections. In spite of advances in infection control as well as hospital epidemiology, the adherence of healthcare workers (HCWs) to the recommended HH practices is unacceptably low and patients remain susceptible to unintentional harm in health care settings (Maxfield & Dull, 2011). It is of note that the average adherence to HH recommendations varies amongst professional categories of HCWs, between hospital wards, according to working conditions, and according to the definitions utilized in various studies. In most instances, compliance to HH practices by HCWs is estimated as less than 50% (Boyce, 2014). In the United States, poor adherence has led to high mortality and morbidity considering that there are between 1.7 million and 2 million persons who get Hospital Acquired Infections every year, and 88,000 to 99,000 deaths are attributed to Hospital Acquired Infections every year (Al-Busaidi, 2013). Moreover, Hospital Acquired Infection affects almost 10 percent of hospitalized patients and it presents great challenges in hospitals. As a result, yearly medical expenditures have risen to roughly $4.5 billion in the United States (Al-Busaidi, 2013).

The practice of Hand Hygiene amongst health care workers is regarded as the single most clinical and cost effective measure for preventing nosocomial infection, a view that is recognized all over the world (Canham, 2011). The World Health Organization strongly stresses the vital need for HH during health care delivery in order to avoid possible infection as well as the consequent health problems; hence, the WHO’s Clean Care is Safe Care initiative launched in the year 2005. It is of note that this initiative provides new guidelines on HH training, observation, as well as performance reporting in health care settings (Kukanich et al., 2013).

The hands of nurses come in close contact with patients and they are usually contaminated through patient care, for instance while touching surfaces, materials or devices that are contaminated, or auscultation and palpation. As such, HH is seen as a cheap, vital, and most effective way to prevent cross infection (Cambell, 2010). This method is essentially aimed at saving lives and provides a safe treatment atmosphere for every health care worker and patient, irrespective of the setting. Bischoff (2000) stated that HH has to be considered after contact with high risk, infectious patients, and with contaminated materials or devices, as well as prior to invasive procedures. In essence, HH has to be advocated before a HCW begins work, at the end of her work, and after visiting the toilet/rest room. Even when nursing staffs spend a longer duration of time on HH, there hand hygiene technique is usually poor relative to other health care workers in terms of leaving large areas of the hand unwashed properly, including between fingers, nail beds, thumbs, as well as wrists (Maxfield & Dull, 2011).

Hand hygiene, in essence, is not just the responsibility of the nurses. Hand hygiene is a shared responsibility between patients, main leaders of the hospital, hospital administration, and other stakeholders. Boyce (2014) observed that patient involvement generally increases adherence to HH practice by 50 percent if, for instance, a straightforward question is asked of the HCW, like: have you washed your hands? Most patients think that asking health care workers to clean their hands before health care delivery is a disloyalty of trust. Moreover, some of them actually believe that they could be labeled as a troublemaker; hence, they choose not to ask. Patients typically feel reassured if they observe health care workers practice effective hand hygiene within the health care setting (Al-Busaidi, 2013).

Barriers to Hand Hygiene Practice in Health Care Settings

A lot of factors lie behind poor HH compliance amongst health care workers. Nursing staff members are ethically and professionally responsible for their actions. Nonetheless, some nursing staffs display low compliance since they perceive hand hygiene as not their problem; that it is instead something to do with the staffs of infection control. Moreover, nursing staffs usually fail to practice HH since they are very busy and they think that hand hygiene will take up their precious time (Canham, 2011). Additionally, they usually believe that gloves can be utilized as an alternative to HH, and this is a major misconception that contributes to poor adherence. Nurses often have the tendency of removing gloves without washing their hands. They also tend to use the gloves in delivering intended care to many patients. Even when nurses remove their gloves, just 20 percent of them actually wash their hands (Pittet, 2011).

Furthermore, nursing staff member usually avoid HH practice because they have the fear that skin problems for instance dermatitis might develop, particularly when alcohol hand-rubs are used in the hand hygiene practice – another misconception. They think that skin irritation occurs as a result of frequent HH practice (Whitby, 2006). Moreover, limited time, lack of organizational pledge to proper HH practice, increased workloads, lack of motivation, lack of role models amongst seniors or colleagues, under-staffing, and disagreement with protocols and guidelines all contribute to poor adherence to hand hygiene and infection control measures in health care settings. Maxfield and Dull (2011) observed that the dearth of hand hygiene facilities and products, for instance hand paper towels, non-antiseptic and antiseptic soaps, sinks, alcohol hand-rubs, and running water can also contribute to bad hand hygiene practice.

Another noteworthy barrier is a lack of awareness and scientific knowledge with regard to hand hygiene. Bischoff (2000) stated that the lack of appropriate infection control in training programs, where students watch their colleagues with patients, might actually result in bad HH practice. Otto and French (2009) in their study learned that the cultures and attitudes of nurses at work have a significant influence in clinical development of students, and for the students to be accepted in that culture, they have a tendency to follow their mentors and other health care workers. A case in point is that for a student to be perceived as being an effective team member, she/he tends to perform hand hygiene poorly and improperly, since this student wants to appear as busy as her mentors and believes that she does not have enough time to wash her hands (Al-Busaidi, 2013).

The behavior and attitudes of HCWs toward HH practice is an intricate issue that involves the perception of its efficacy, existing barriers, as well as beliefs and values of staffs. To attain high rates of compliance with hand hygiene practice, Otto and French (2009) suggested that those who default have to be disciplined as if they have breached hospital policy, and this should start with personal counseling to verbal warning, and at last to a written warning placed in the files of the defaulters.

Effective Hand Hygiene

Effective HH basically involves removing the visible soiling as well as the reduction of microbial colonization of the skin. The hands of HCWs could be contaminated by 2 sorts of pathogens: (i) resident – colonizing or normal – microorganisms, and (ii) transient – contaminating – microorganisms. Resident flora microorganisms are known to colonize the deeper layers of the skin, and unlike transient flora, they are not easy to remove mechanically; that is, through washing hands (Smith & Lokhorst, 2009). Luckily though, resident flora is less aggressive compared to transient flora, and is less likely to lead to serious infection. Examples of resident flora include negative staphylococci and Corynebacteria. It is of note that these bacteria are inclined to grow within the hair follicles and remain moderately dormant over time (Smith & Lokhorst, 2009).

Conversely, transient flora colonize the superficial layers of the skin for a short period of time. The nurses’ hands are frequently contaminated with transient flora through direct contact during every day patient care activities, equipment or environments. Nonetheless, transient flora can be removed easily through the use of mechanical methods, for instance friction in hand washing. Examples of transient flora include Candida species and Staphylococcus aurous. Transient flora are able to induce nosocomial infection amongst health care workers and patients (Al-Busaidi, 2013). Considering this information as regards resident and transient bacteria, effective hand hygiene practice either with the use of alcohol-based hand-rub or hand washing using antimicrobial soap, is clearly the way to reduce the risk of cross infection.

Research-Based Intervention in the form of a Standardized Guideline

Promotion of HH practices in health care settings is a significant challenge for infection control experts. Lectures and workshops, distribution of information flyers, performance feedback on adherence rates, and in-service education have all been linked to transient improvement. There is really not a single intervention that has repeatedly improved adherence to HH practices (Smith & Lokhorst, 2009). Given that nursing staff members are present twenty-four hours a day, seven days a week within the health care setting, it is of major importance to stick to HH standardized guideline and maintain patient safety. The following guideline should be followed by health care facilities.

Encourage effective hand washing

Effective hand washing, according to Pittet (2011), is the application of antimicrobial/antiseptic or non-antimicrobial/plain soap onto wet hands. The individual should then rub together both hands vigorously to form lather, and should cover base of the fingers, tops of the hands, all the surface of the palms, fingernails, wrists, thumbs, back of the fingers, and between fingers for a 60 seconds. The health care worker should ensure that his/her fingernails are short. Boyce (2014) reported that artificial fingernails are possible traps for bacteria and thus have to be avoided. Although chipped nail polish has the capacity of harboring bacteria, new nail polish on natural nails in fact does not worsen the microbial load. It is of note that wearing jewellery, for instance hand watches or rings, may actually bring about bacterial colonization on the skin beneath them. After the HCW has soaped and rubbed, she should rinse her hands thoroughly to remove all the lather on the hands. Hot water should not be used in rinsing given that it may lead to dryness of the skin (Al-Busaidi, 2013).

Hand drying is also of major importance in the prevention of cross infection in the health care setting since microorganisms are known to thrive in damp environments. Hand drying should be done before the HCW wears her gloves, as trapped moisture in the gloves may lead to irritation of the skin and increase the harboring of microorganisms (Whitby, 2006). Paper towels are very efficient in drying hands and the friction created whenever they are used actually improves the removal of microorganisms from the skin. The HCW must not touch the tap again after she has just washed her hands; she should use a paper towel in turning the water off. Even though hand driers are just as good as hand towels, paper disposable hand towels are generally more effective and are quicker. In essence, the friction that is produced through hand rubbing with soap vigorously and then hand drying using paper towels actually removes all the dirt as well as any loosely adherent flora; that is, small portion of resident flora and nearly all transient flora from hands (Smith & Lokhorst, 2009).

Encourage the use of alcohol hand-rub

There is sufficient evidence to recommend the alcohol hand-rub owing to its cost effectiveness and clinical benefits. Pittet (2011) pointed out that the likelihood of hand washing to wash away the skin’s fats and oils that are vital for healthy skin is less with the usage of hand-rub. Simply put, alcohol hand-rub will redistribute the lipids in the layers of the skin. In addition, alcohol hand-rub can dispense with paper towels. In his study, Cambell (2010) found that alcohol hand-rub actually consists of several emollients that are better tolerated by health care workers compared to hand washing. Cambell (2010) also found that quite a few factors including consistency, odor, and color of alcohol hand-rub products can influence health care workers’ acceptance of this product. Alcohol hand-rub dispensers could be positioned readily and accessed easily: at the bedside of patients, outside and inside of the rooms of patients, in waiting areas, next to computers, and even inside the nursing stations (Kukanich et el., 2013).

Effective usage of alcohol hand-rub basically implies that health care workers have to strictly comply with the manufacturer’s instructions, particularly with regard to the quantity used as well as the time required to completely fade away from the hands. In essence, the availability of alcohol hand-rub products at the point of care has to be supplemented by the availability of gloves in suitable sizes. From his study, Bischoff (2000) observed that hospitals that made clean gloves and alcohol-based hand rub readily available to HCWs saw improved compliance with hand hygiene.

Clarify misconceptions about the usage of gloves

To improve healthcare workers compliance with HH practice, it is of major importance to take into account the hindering factors and then turn them into factors that enhance compliance. The misconceptions of nurses regarding the use of gloves and skin complications should be clarified so as to attain a better compliance with HH practice. In essence, failure to remove gloves following contact with patient or between clean and dirty body site care for the same patient actually amounts to poor adherence to hand hygiene recommendations (Boyce, 2014). The nursing staffs need to be informed that it is ineffective to wash and reuse gloves between patient contact. Disinfection or hand washing has to be strongly encouraged following removal of gloves (Canham, 2011).

Provide Training and Education on Hand Hygiene

Proper education as well as follow-up training is key to identify situations in which HH is reasonable. Important educational materials that the hospital should use include the following: computer-assisted, interactive learning that is made available to the clinicians through the hospital’s intranet; and PowerPoint presentations and videotapes that illustrate the significance of good HH techniques in hospitals and other health care facilities. Hospitals should conduct educational programmes for employees that comprise instructions for appropriate method when using an alcohol-based hand-rub, or washing hands using water and soap. The hospital should make sure that health care workers comprehend the underlying principle for gloves and hand hygiene and can follow the best practices and enhance patient outcomes (Pittet, 2011).

Place promotional materials in noticeable areas

In essence, hand hygiene promotion posters should be placed in locations that are highly visible throughout the healthcare facility and a multi-modal campaign for improving performance should be initiated. Whitby (2006) pointed out that promotional material, for instance posters, could be placed in noticeable areas of the health care facility and they will be aimed at reminding patients, health care worker, as well as visitors about the significance of HH practice. In addition, the hospital can also place videos on the wards in order to show patients the importance of HH in the prevention of cross infection and to remind or ask health care workers to practice HH before health care delivery. In their study, Kukanich (2013) found that placing appropriate HH technique illustrations close to alcohol hand-rub dispensers or above sinks helped in improving compliance to hand hygiene. Moreover, Kukanich (2013) found that posters with pictures of renowned hospital physicians/personnel recommending hand hygiene also helped to improve compliance with hand hygiene in the health care facility. To motivate computer user to comply with hand hygiene practice, Smith and Lokhorst (2009) pointed out that messages on the subject of hand hygiene practice can be set on computer screensavers.

Hand Hygiene products should be always available, and in right places

The ward or unit manager should ensure that hand hygiene products are at all times available, and are actually in the right places. Some of these places include offices, nursing station, as well as outside and inside of all patient rooms. Studies have revealed that compliance by HCWs was substantially greater when alcohol-based rub dispensers were placed adjacent to the bed of patients compared to when they was just a single dispenser for every 4 beds (Al Busaidi, 2013). Moreover, in critical care settings, studies have indicated that the availability of alcohol-based hand-rub at the point of care actually minimized the time constraint related to HH during patient care and it predicted better adherence to HH practice. Pittet (2011) in a study of hand hygiene amongst doctors, learned that easy access to an alcohol-based hand rub was in fact an independent predictor of improved compliance to HH practice.

Recognize clinicians with good hand hygiene practice and create a culture of proper hand hygiene

It is of major importance for the health care organization to recognize nursing staff members with proper hand hygiene. This can be done, for instance, though announcement in the hospital’s newsletter. This will serve as a vital accolade that can actually encourage other nurses and health care workers to do likewise. The hospital should also create a culture that encourages staff members to remind each other as regards proper hand hygiene (Otto & French, 2009). In their study, Cambell (2010) found that when health care workers reminded each other and other health care workers to practice hand hygiene, there was a considerable increase in compliance to hand hygiene practice at the health care facility. All in all, the hospital should monitor compliance by HCWs with the recommended indications for HH, including real-time feedback to staff members.

Conclusion

In conclusion, the practice of Hand Hygiene amongst health care workers is regarded as the single most clinical and cost effective measure for preventing nosocomial infection. However, notwithstanding advances in infection control as well as hospital epidemiology, the compliance of clinicians with the recommended hand hygiene practices is unacceptably low and patients are very susceptible to inadvertent harm in health care settings. Hand hygiene is fundamentally aimed at saving lives and to provide a safe treatment atmosphere for every health care worker and patient, no matter the setting. In America, improper compliance with hand hygiene practices has led to high mortality and morbidity bearing in mind that there are more than 1.7 million persons who catch HAI every year, and over 90,000 deaths are attributed to HAI every year. Several factors actually contribute to poor hand hygiene compliance amongst clinicians. These include limited time, lack of organizational pledge to proper HH practice, increased workloads, lack of motivation, lack of role models, and under-staffing.

The proposed intervention as described in the guideline entails the following: making hand hygiene products always available and in the right places such as in nurse stations and at patient bedsides; and to recognize clinicians with effective hand hygiene practice and creating a culture of proper hand hygiene in the hospital. Moreover, the hospital should place promotional materials in noticeable areas, and provide education and training programs on the significance of proper and hand hygiene and how to actually practice effective hand hygiene.

References

Al-Busaidi, S. (2013). Healthcare Workers and Hand Hygiene Practice: A Literature Review. Diffusion, 6(1): 81-89

Bischoff, W. E. (2000). Handwashing compliance by health care workers: the impact of introducing an accessible, alcohol-based hand antiseptic. Arch Intern Med. 160(7):1017-21

Boyce, J. M. (2014). Preventing Infections: It’s in Your Hands. Medscape Infectious Disease.

Cambell, R. (2010). Hand-washing compliance goes from 33% to 95% steering team of key players drives process, Healthcare Benchmarks and Quality Improvement 17:1, 5-6.

Canham, L. (2011). The first step in infection control is hand hygiene, The Dental Assistant, 42-46.

Kukanich, K. S., Kaur, R., Freeman, L. C., & Powell, D. A. (2013). Original Research: Evaluation of a Hand Hygiene Campaign in Outpatient Health Care Clinics. American Journal of Nursing, 113(3):36-42

Maxfield, D. & Dull, D. (2011). Influencing hand hygiene at spectrum health, Physician Executive Journal 37:3, 30-34.

Otto, M. & French, R. (2009). Hand hygiene compliance among healthcare staff and student nurses in a mental health setting, Mental Health Nursing 30, 702-704.

Pittet, D. (2011). Improving Adherence to Hand Hygiene Practice: A Multidisciplinary Approach. Emerging Infection Disease Journal, 7(2): 32-8

Smith, J.M. & Lokhorst, D.B. (2009). Infection control: can nurses improve hand hygiene practice?, Journal of Undergraduate Nursing Scholarship 11:1, 1-6.

Whitby M. (2006). Why healthcare workers don’t wash their hands: a behavioral explanation Infect Control Hosp Epidemiol; 27(5):484-92.

We can write this or a similar paper for you! Simply fill the order form!

Policy Change in the Provision of Contraceptive Services

Order Instructions:

Remember that is a continues paper and I have listed reference number for my previous paper under this topic to help understand this paper. This is my policy change paper and the writer must refer back to other papers base on the references provided to be able to understand how to respond to this paper. Hear below are detail instructions on how to go about this paper and its critical that the writer follow strictly the instructions. Take note that no reference can be before 2010 , they most all be from 2010 and above as the affordable care act was pass in 2010. Also remember that they are 2 SECTIONS A and B, and both sections must have separate reference list 4 in each section , listed at the end of that section.

SECTION A (1 pages)

Remember to include a minimum of 4 references at the end of each section.
To complete this paper correctly, the writer must look take a look at 111521,111489, 111623 and 111582 (section B), 111623, and 111542. To be exact any of my past papers regarding policy change proposal as I had mentioned at the beginning that this paper will be a continues assignment.

Explain the three cost-effective recommendations for the policy change proposal below which you plan to implement in your proposed policy change. Be sure the recommendations include a way to reach a global market.
Hear below are some guidelines from the Prof on how to respond to this section and also an example to follow.

Fellow students,

This week we are developing commendations that you will use in your Unit 9 policy change proposal to implement your policy change. Remember you are trying to develop relationships to understand & support your proposed change and will help to convince others to do the same. And we are using an expository style writing 🙂

For example:

Engaging in public health social media campaign to educate the public about the use of and need for APNs in health care, focusing on filling the disparity gaps
Utilize lobbying groups and professional organizations to educate the public that employing nurse practitioners improves xxxxxx
Apply the amendment change utilizing the Incremental Change option, because this will allow for not only time for stake holders to buy into the proposed change but it will also provide for evaluation of any positive or negative changes that can be reevaluated and redesigned along the way to complete implementation of the proposed change.

Take note that you have to write in an expository style and Remember that the propose amendment is

The public policy problem is that section 2713 requires organizations to provide their workers with birth control as part of their insurance coverage. The public policy question is: should the federal government mandate that organizations can choose whether or not to provide contraceptive services to employees as part of their insurance coverage? The public policy resolution is an amendment to section 2713(a) (4) of PL 111-148 that would say: organizations – both for-profit and non-profit organizations – have the option of either offering their employees birth control as part of their insurance coverage or not to offer contraceptive services (Cauchi, 2014).

SECTION B (1 pages minimum).

Remember to also include 4 reference at the end of this section.

Since the implementation of a policy change proposal requires that it be communicated to a large number of stakeholders, do you think that there are drawbacks or advantages to the use of social media for this purpose?

Resources

American Nurses Association (ANA). (2011). Short definitions of ethical principles and theories. Familiar words, what do they mean? Retrieved from http://www.nursingworld.org/mainmenucategories/ethicsstandards/resources/ethics-definitions.pdf

American Nurses Association (ANA). (2012). The Supreme Court decision matters for registered nurses, their families, and their patients. Retrieved from http://www.anacalifornia.org/healthcarereform/SCOTUS-ToplevelanalysisJune292012-FINALwtag.pdf

Cauchi, R. (2014). State laws and actions challenging certain health reforms. Retrieved from http://www.ncsl.org/research/health/state-laws-and-actions-challenging-ppaca.aspx

Govtrack.us. (2012). Text of the repeal of Obamacare act. Retrieved from https://www.govtrack.us/congress/bills/112/hr6079/text

Public Law 111-148. (2010). An Act. Retrieved from http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf

The Staff of the Washington Post. (2010). Landmark: The inside story of America’s new health care law and what it mean for all of us. New Your, NY: Public Affair.

United States Department of Health and Human Services Health Resources and Services Administration (HRSA). (2013). Health workforce. Retrieved from http://bhpr.hrsa.gov/healthworkforce/supplydemand/usworkforce/primarycare/
SAMPLE ANSWER

Policy Change in the Provision of Contraceptive Services

SECTION A

The public policy (section 2713) has a problem since it requires all organizations to provide their employees with birth control measures as part of their insurance coverage. Due to this challenge, the public resolved to amend section 2713(a) (4) of PL 111-148 in order to allow nongovernmental organizations to have an option of either providing their employees with birth control as part of their insurance coverage or not to offer contraceptive (Cauchi, 2014). This article will basically address ways in which this public policy change could be implemented since policy change implementation requires that it be communicated to a large number of stakeholders.

One of the ways of implementing this public policy change is by carrying out campaigns in the public especially through the social media. Public social media campaigns are very necessary since they educate the public and the organization on the pros and cons of providing birth control as part of insurance coverage. This would therefore allow the public to debate comprehensively on the issue and eventually make informed. Therefore, policy implementation has to address organizational, professional and social affairs around which that policy has to be implemented. The recommendations for the implementation process of the policy change therefore have to be cost-effective (Holly, Salmond & Saimbert, 2012).

According to Shi & Singh (2012), adoption of this policy would mean employing practitioners that are more public. In order to ensure that the public appreciates the need and urgency of this move, lobbying groups and professional organizations would be mobilised to educate the public on the need to have these reforms

Afifi et al., (2013) states that, since the organizations are the ones mandated to adopt this policy change, the amendment change would be applied through use of the incremental change option. This option will allow the organizations and any other stakeholder’s time to digest the reforms by weighing the advantages and disadvantages of the reforms

References

Afifi, A. A., Rice, T. H., Andersen, R. M., Rosenstock, L., & Kominski, G. F. (2013). Changing the u.s. health care system: Key issues in health services policy and management. San Francisco, Calif: Jossey-Bass.

Cauchi, R. (2014). State laws and actions challenging certain health reforms. Retrieved from
http://www.ncsl.org/research/health/state-laws-and-actions-challenging-

Holly, C., Salmond, S. W., & Saimbert, M. K. (2012). Comprehensive systematic review for advanced nursing practice. New York: Springer Pub.

Shi, L., & Singh, D. A. (2012). Delivering health care in America: A systems approach. Sudbury, Mass: Jones & Bartlett Learning.

Shoniregun, C. A., Dube, K., & Mtenzi, F. (2010). Electronic healthcare information security. New York: Springer.

SECTION B

Since the implementation of a policy change proposal requires that it
be communicated to a large number of stakeholders, there are so many challenges and opportunities by this change in technology. First and foremost, privacy is a key factor in any health care system. Therefore, inappropriate sharing of information, and limits pertaining professionals has to be adhered to. How much that should be disclosed in relation to provision of contraceptives as a health care insurance cover is a factor that requires limits. According to Grol, Wensing, Eccles & Davis (2013), social media is still very young hence privacy is a feature that would be incorporated as this technology advances.

Marks (2012) states that the privacy of the patients, Health Insurance Portability and Accountability Act (HIPAA) regulations, and patient-professional boundaries has to be the guiding principles on what should be channeled through the social media. This is not an assurance at the moment for anyone using the social media for any form of campaign.

The social media also posses the challenge of evaluating the applications hence very few organizations are adopting them. However, more reports establish that the application is very easy to adopt only that it needs more labor in terms of human availability. Therefore in order to adopt this process more effectively, there need to be development of guidelines on how to use this social media by the organizations (Blas, Kurup & Światowa 2010).

However, according to Buse, Mays & Walt (2012), the social media is very effective since it reaches many people hence can be able to address a specific group of people especially those who use the social applications although some form of controlled analysis of social media is very necessary before establishing whether the approach is very effective . This would enable the campaign for implementation of the public policy change to reach a huge population of people.

References

Top of FormBottom of Form

Blas, E., Kurup, A. S., & Światowa Organizacja Zdrowia. (2010). Equity, social determinants and public health programmes. Geneva: World Health Organization.

Buse, K., Mays, N., & Walt, G. (2012). Making health policy. Maidenhead: McGraw Hill/Open University Press.

Holly, C., Salmond, S. W., & Saimbert, M. K. (2012). Comprehensive systematic review for advanced nursing practice. New York: Springer Pub.

In Grol, R., In Wensing, M., In Eccles, M., & In Davis, D. (2013). Improving patient care: The implementation of change in health care. Chichester, West Sussex: Wiley-Blackwell/BMJ Books.

Kawachi, I., Takao, S., & Subramanian, S. V. (2013). Global perspectives on social capital and health. New York, NY: Springer

Marks, R. (2012). Health literacy and school-based health education

We can write this or a similar paper for you! Simply fill the order form!

Drug Treatments for HIV/AIDS Term Paper

Drug Treatments for HIV/AIDS

Order Instructions:

Drug Treatments for HIV/AIDS
While HIV/AIDS is still currently incurable, the prognosis for patients with this infectious disease has improved due to advancements in drug treatments. Consider the case of Kristy Aney. Kristy was diagnosed with HIV in 1992 and was told she would survive, at most, 10 more years. Despite unfavorable odds, Kristy is still alive 20 years later. Since her diagnosis, she has witnessed tremendous improvements in HIV/AIDS treatments which have helped patients live longer with fewer side effects. While she acknowledges that these drug treatments have kept her alive, she fears that improvements in drug therapy have led to more people becoming complacent about the disease (Idaho Statesmen, 2012). In fact, the number of people living with HIV/AIDS in the United States is higher than it has ever been (CDC, 2012). This poses the question: Is there a relationship between drug advancements, societal complacency, and infection?
To prepare:
• Review Chapter 48 of the Arcangelo and Peterson text, as well as the Krummenacher et al. and Scourfield articles in the Learning Resources.
• Reflect on whether or not the prevalence of HIV cases might be attributed to increased complacency due to more advanced drug treatment options for HIV/AIDS.
• Consider how health care professionals can help to change perceptions and make people more aware of the realities of the disease.
• Think about strategies to educate HIV positive patients on medication adherence, as well as safe practices to reduce the risk of infecting others.

ASSIGNMENT PAPER:
WRITE
1) An explanation of whether or not you think the prevalence of HIV cases might be attributed to increased complacency due to more advanced drug treatment options.
2) Explain how health care professionals can help to change perceptions and increase awareness of the realities of the disease.
3) Describe strategies to educate HIV positive patients on medication adherence.
4) What are the safety practices to reduce the risk of infecting others?

Readings/Recommended References (you may choose your own textbook or article for this paper
• Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.
o Chapter 8, “Principles of Antimicrobial Therapy” (pp. 96–117)

This chapter covers factors that impact the selection of an antimicrobial treatment regimen. It also examines the clinical uses, adverse events, and drug interactions of various antimicrobial agents such as penicillin.
o Chapter 12, “Fungal Infections of the Skin” (pp. 141–149)

this chapter explores the pathophysiology of several fungal infections of the skin as well as related drug treatments and examines the importance of patient education when managing these infections.
o Chapter 14, “Bacterial Infections of the Skin” (pp. 158–172)

this chapter begins by examining causes of bacterial infections. It then explores the importance of selecting an appropriate agent for treating bacterial infections.
o Chapter 32, “Urinary Tract Infection” (pp. 474–480)

This chapter covers drugs used to treat urinary tract infections and identifies special considerations when treating geriatric patients, pediatric patients, and women.
o Chapter 35, “Sexually Transmitted Infections” (pp. 512–535)

this chapter outlines the causes, pathophysiology, and drug treatment of six sexually transmitted infections, including gonorrhea, syphilis, and human papilloma virus infection (HPV). It also examines the importance of selecting the proper agent and monitoring patient response to treatment.
o Chapter 48, “Human Immunodeficiency Virus” (pp. 748–762)

this chapter presents the causes, pathophysiology, diagnostic criteria, and prevention methods for HIV. It also covers various methods of drug treatment and patient factors to consider when selecting, administering, and managing drug treatments.
• Krummenacher, I., Cavassini, M., Bugnon, O., & Schneider, M. (2011). An interdisciplinary HIV-adherence program combining motivational interviewing and electronic antiretroviral drug monitoring. AIDS Care, 23(5), 550–561.
Retrieved from a collage Library databases.

This article analyzes medication adherence in HIV patients and examines factors that increase adherence as well as factors that contribute to termination or discontinuation of treatment.
• Drugs.com. (2012). Retrieved from http://www.drugs.com/

this website presents a comprehensive review of prescription and over-the-counter drugs including information on common uses and potential side effects. It also provides updates relating to new drugs on the market, support from health professionals, and a drug-drug interactions checker.
• Scourfield, A., Waters, L., & Nelson, M. (2011). Drug combinations for HIV: What’s new? Expert Review of Anti-Infective Therapy, 9(11), 1001–1011. Retrieved from a collage Library databases

this article examines current therapies and strategies for treating HIV patients. It also examines factors that impact selection of therapy, including drug interactions, personalization of therapy, costs, management of comorbidities, and patient response.
• Mayer, K. H., & Krakower, D. (2012). Antiretroviral medication and HIV prevention: New steps forward and New Questions. Annals of Internal Medicine, 156(4), 312–314. Retrieved from a collage Library databases.

SAMPLE ANSWER

Drug Treatment for HIV/AIDS

When HIV/AIDS was first discovered, many people in the United States were dying in large numbers. Due to advancements in treatment of the disease in later years, patients infected with HIV/AIDS can now live longer. Proponents to drug treatment to HIV/AIDS have pointed out that the impact from drug advancement is phenomenal, as it gives a vision of having a free HIV/AIDS world. However, some critics point out that these advancements in treatment lead to complacency. Therefore, the paper will engage in discussing critical issues emanating from the overall drug treatment to HIV/AIDS.

The increasing number of cases of HIV/AIDS is attributed to the increased complacency due to more advanced drug treatment options. This is because, health professionals have quit creating awareness of the possible adverse effects of the disease. The people of the United States have the illusion that, due to continuous advancement in drug treatment against HIV/AIDS, they are likely not to contact the disease (Arcangelo & Peterson, 2013). The advertisements that were used to encourage youths to use contraceptives such as condoms to save them from the epidemic are no longer used, or are used in minimal magnitude. Advancement in drug treatment has also led to more emergence of homosexual and heterosexual relationships that have led people to indulge in sexual activities not knowing well that they are actually making themselves susceptible to the epidemic.

Health care professionals can diminish the perception and increase awareness of the realities of the disease by taking a stand in creating awareness on same-sex affairs that greatly spread HIV/AIDS. This is because, same sex relationships increases transmission of the sexual-related disorder such as syphilis and gonorrhea, which gives a means for more transmission of HIV /AIDS. Medical practitioners should increase awareness on drug abuse. Anyone who abuses drugs should be counseled and treated to help them stop using the drugs and preventing HIV/AIDS infections (Arcangelo & Peterson, 2013). This is because contracting the disease is faster in people who abuse drugs. Most preferably, health professionals should formulate programs that give each and every generation of young people with information and intervention that aid them to develop life-long skills for avoiding behaviors that could lead to HIV/AIDS infections (Mayer & Krakower, 2012). Strategies to educate HIV/AIDS patients on medication adherence are crucial as far as drug treatment on HIV/AIDs is concerned. The strategy includes self-assessment tools that include questions about mental health status, substance abuse, environmental factors that may influence a patient’s ability to adhere to ART (Antiretroviral therapy) (Arcangelo & Peterson, 2013). Another strategy that can be used is assessment on cognitive functioning and a patient’s attitude towards taking ART. The final strategy that can be used is assessment of all those areas paints of a patient’s overall readiness to begin and maintain ART.

There are safety practices to reduce the risk of infecting others with HIV/AIDS. One of the safety practices is use of condoms consistently and correctly. The practice extends to choosing less risky sexual behaviors. This is because anal sex is the highest-risk sexual activity more than oral sex. Use of pre-exposure prophylaxis daily can also prevent intensity of spreading the disease to other people (Krummenacher, Cavassini, Bugnon, & Schneider, 2011). If a partner is infected with the disease, he or she should be advised to get and stay on treatment. ART is medically recommended to reduce the amount of HIV virus (viral load) in blood and body fluids, which can greatly reduce chances of transmitting HIV to sex partners if taken consistently and correctly.

In summary, continuous improvement in drug treatment to HIV/AIDS will continue to pose dangers of HIV/AIDS to people as neglect and irresponsibility are brought by the improvements. However, this trend can be reversed if medical practitioners engage in strategies and programs to create awareness of the adverse effects of the disease, and to install and educate on best safety measures to prevent widespread of HIV/AIDS.

References

Arcangelo, V., & Peterson, A. (Eds). (2013). Pharmacotherapeutics for advanced practice: A practical approach (3^rd ed.). Ambler, PA: Lippincott Williams & Wilkins.

Krummenacher, I., Cavassini, M., Bugnon, O., & Schneider, M. (2011). An interdisciplinary HIV-adherence program combining motivational interviewing and electronic antiretroviral drug monitoring. AIDS Care, 23(5), 550–561.

Mayer, K. H., & Krakower, D. (2012). Antiretroviral medication and HIV prevention: New steps forward and New Questions. Annals of Internal Medicine. 156(4), 312–314.

We can write this or a similar paper for you! Simply fill the order form!

The Globalization of Health Term Paper

The Globalization of Health

Order Instructions:

HLTH 8050 Week 9 Discussion
The Globalization of Health
Cell phones, video cameras, and other technologies are changing the way we live today. It is difficult to avoid the stories and images of poverty, human rights abuses, disasters, diseases, and other tragedies that plague people in rich and poor countries alike.
It is not just communications technology that is making the world a “smaller” place. Globalization is also exerting a powerful effect on the conditions in which people live and work, (i.e., the social determinants of health) and, thus, on health itself.

Discussion questions:

A brief summary on the effects of globalization on health in Russia.
Discuss one change in quality of life in post-transition Russia.
Also, explain one change in mortality in post-transition Russia.
Provide examples for both. Expand on your insights utilizing the Learning Resources.

Articles:
• Wilkinson, R., & Pickett, K. (2010). The spirit level: Why greater equality makes societies stronger. New York, NY: Bloomsbury Press.
o Chapter 13, “Dysfunctional Societies” (pp. 173–196)

• Averina, M., Nilssen, O., Brenn, T., Brox, J., Arkhipovsky, V. L., & Kalinin, A. G. (2005). Social and lifestyle determinants of depression, anxiety, sleeping disorders and self-evaluated quality of life in Russia: A population-based study in Arkhangelsk. Social Psychiatry and Psychiatric Epidemiology, 40(7), 511–518.

• Frieden, T. R. (2010). A framework for public health action: The health impact pyramid. American Journal of Public Health, 100(4), 590–595.

• Jones, C. P., Jones, C. Y., Perry, G. S., Barclay, G., & Jones, C. A. (2009). Addressing the social determinants of children’s health: A cliff analogy. Journal of Health Care for the Poor and Underserved, 20(Suppl. 4), 1–12.

• Perlman, F., & Bobak, M. (2008). Socioeconomic and behavioral determinants of mortality in post transition Russia: A prospective population study. Annals of Epidemiology, 18(2), 92–100.
Ray, R., Gornick, J. C., & Schmitt, J. (2010, July). Who cares? Assessing generosity and gender equality in parental leave policy designs in 21 countries. Journal of European Social Policy, 20(3), 196–216.

• Stuckler, D., King, L., & McKee, M. (2009). Mass privatization and the post-communist mortality crisis: A cross-national analysis. Lancet, 373(9661), 399–407.

• The PLoS Medicine Editors. (2010). Social relationships are key to health, and to health policy. PLoS Medicine, 7(8), 1–2.

• National Rural Health Mission. (2012). RSBY-Rashtriya Swasthya Bima Yojnab. Retrieved from http://www.rsby.gov.in/

• World Health Organization Western Pacific Region. (2009). Global health library. Retrieved from http://www.globalhealthlibrary.net/php/index.php?lang=en

Note: In the Search box, enter “China health outcomes” to locate various articles on this topic.

Please apply the Application Assignment Rubric when writing the Paper.
I. Paper should demonstrate an excellent understanding of all of the concepts and key points presented in the texts.
II. Paper provides significant detail including multiple relevant examples, evidence from the readings and other sources, and discerning ideas.
III. Paper should be well organized, uses scholarly tone, follows APA style, uses original writing and proper paraphrasing, contains very few or no writing and/or spelling errors, and is fully consistent with doctoral level writing style.
IV. Paper should be mostly consistent with doctoral level writing style.

SAMPLE ANSWER

The Globalization of Health

Globalization influences not only trade, finance, science, and environment, but also health and medical care. Communicable diseases like HIV, SARS, H1N1, and swine flu are some of the examples of the diseases that have spread globally. All these spread due to changes in the environment and lifestyle, which is a sufficient evidence that lifestyles are also rapidly changing. Some of the unhealthy ways of living include smoking and obesity. Other examples of globalization of health include international trade of health services, international movement of physicians and nurses, and movement of healthcare consumers (World Health Organization Western Pacific Region, 2009).

Globalization of health has directly affected the wellbeing of Russian population. From the onset, there are high rates of low mood and anxiousness among the Russian population. These health problems are as a result of poor nutrition due to low consumption of food and low payment of professionals. The depression is due to cigarette smoking and taking of alcohol in very large amounts. These health complications have greater influence on circulatory and gastrointestinal diseases (Averina et al., 2005). According to Frieden (2010), clinical interventions that need very small amount of interaction, day-to-day clinical care, health education, and counseling are some of the ways to sort out these health challenges.

The quality of life in post transition Russia has changed drastically. The people have developed poor eating habits. Most people depend on high levels of energy intake from fat. Consequently, this has resulted into increase in weight of individuals, hence, obesity in the older people. Health status of children is equally worrying, with most children having chronic malnutrition. This is also reflected in primary school going children whose health conditions are very poor. At birth, newborns develop disabilities and a high number of children are having physical complications. Poor quality of life is as a result of high poverty levels amongst the citizens. There is high inflation and decline in wages as a result of fluctuation in employment and income patterns (Wilkinson & Pickett, 2010). In order to address some of these challenges, Jones et al., (2009) give a summary of how to handle them. Perhaps, this problem could be solved by having improved health facilities and addressing both equity and factors that promote good health. Therefore, in order to realize low mortality rate post transition Russia ought to address the social determinants of health like empowering its citizens economically and also ensuring that there is equity. Equity involves improving the policies, practices, norms and values that control the distribution of resources. Furthermore, Jones et al., (2009) states that social determinants of health like poverty, automatically eliminate any health inequity.

There is a rise in mortality rate in post transition Russia due to income inequality, unemployment, labor turnover, migration, crime and divorce. These factors resulted into stress which is a major cause of death. Consequently, there was high death of men who were still very young and productive. Another factor that promoted increased death rate is huge increase the number of people and the amount of alcohol taken. The increased use of alcohol resulted into people killing themselves and some involving themselves in road accidents. The increased intake of alcohol is basically as a result of reduction in the amount of money used to buy the substance. According to Stuckler, King, & McKee (2009), the solution to high mortality rate is privatization of institutions especially in post Russian nation.

References

Averina, M., Nilssen, O., Brenn, T., Brox, J., Arkhipovsky, V. L., & Kalinin, A. G. (2005). Social and lifestyle determinants of depression, anxiety, sleeping disorders and self-evaluated quality of life in Russia: A population-based study in Arkhangelsk. Social Psychiatry and
Psychiatric Epidemiology, 40(7), 511–518.

Frieden, T. R. (2010). A framework for public health action: The health impact pyramid. American Journal of Public Health, 100(4), 590–595.

Jones, C. P., Jones, C. Y., Perry, G. S., Barclay, G., & Jones, C. A. (2009). Addressing the social determinants of children’s health: A cliff analogy. Journal of Health Care for the Poor and Underserved, 20(Suppl. 4), 1–12.

Stuckler, D., King, L., & McKee, M. (2009). Mass privatization and the post-communist mortality crisis: A cross-national analysis. Lancet, 373(9661), 399–407.

Wilkinson, R., & Pickett, K. (2010). The spirit level: Why greater equality makes societies stronger. New York, NY: Bloomsbury Press. o Chapter 13, “Dysfunctional Societies” (pp. 173–196).

World Health Organization Western Pacific Region. (2009). Global health library. Retrieved from http://www.globalhealthlibrary.net/php/index.php?lang=en

We can write this or a similar paper for you! Simply fill the order form!

Is the EU Closing the Gap on Health Inequities?

Order Instructions:

The World Health Organization and European Union (EU) DETERMINE Consortium has acknowledged gaps in health equities within and between member countries. A variety of efforts are underway to help close those gaps.

Discussion questions:
A brief comparison of the health status of the two EU countries you selected with that of the U.S. Then, describe two efforts in those EU countries to reduce health inequities. Explain what lessons can be learned from the EU efforts you selected that can be implemented in the U.S. nationally or by individual states. Explain how the community you live in might adapt these interventions. Expand on your insights utilizing the Learning Resources.

Articles:
• Gele, A. A., & Harsløf, I. (2010). Types of social capital resources and self-rated health among the Norwegian adult population. International Journal for Equity in Health, 9, 8–16.
Retrieved from the Walden Library databases.

• Commission of the European Communities. (2007). Together for health: A strategic approach for the EU 2008-2013 [White paper]. Retrieved from http://ec.europa.eu/health-eu/doc/whitepaper_en.pdf

• Equity Channel. (2013). Retrieved from http://www.equitychannel.net/

• EuroHealthNet. (2013). Health policies in the EU. Retrieved from http://eurohealthnet.eu/policy/health-policies-eu/

• European Commission. (2006). Tackling health inequalities in the EU: The contributions of Various EU-level actors. Retrieved from http://ec.europa.eu/health/ph_projects/2003/action3/docs/2003_3_15_rep2_en.pdf Read pages 1–17.

• European Commission. (2014). European Commission: Public health. Retrieved from http://ec.europa.eu/health/index_en.htm

• Stegeman, I., Costongs, C., Needle C., & DETERMINE Consortium. (2010). The story of DETERMINE: Mobilising action for health equity in the EU—Final report of the DETERMINE consortium. Brussels: Euro HealthNet. Retrieved from http: //eurohealthnet.eu/sites/eurohealthnet.eu/files/publications/DETERMINE-Final-Publication-Story.pdf

Wellesley Institute. (2011). The European portal for action on health equity. Retrieved from http://www.wellesleyinstitute.com/news/the_european_portal_for_action_on_health_equity/

Please apply the Application Assignment Rubric when writing the Paper.

I. Paper should demonstrate an excellent understanding of all of the concepts and key points presented in the texts.
II. Paper provides significant detail including multiple relevant examples, evidence from the readings and other sources, and discerning ideas.
III. Paper should be well organized, uses scholarly tone, follows APA style, uses original writing and proper paraphrasing, contains very few or no writing and/or spelling errors, and is fully consistent with doctoral level writing style.
IV. Paper should be mostly consistent with doctoral level writing style.

SAMPLE ANSWER

Is the EU Closing the Gap on Health Inequities?

A comparison of the health status of Belgium and Germany – two EU member states – with that of the United States reveals that in Germany, the life expectancy for women is 83 years and ranks 15^th worldwide, and that of men is 78 years and ranks 16^th. Rate of infant mortality is 3.54 deaths for every 1,000 births and ranks 212 globally (NationMaster, 2014). In Belgium, the life expectancy at birth for women is 83 years and ranks 16^th globally, and for men is 77 years, and ranks 25^th worldwide. The rate of infant mortality is 4.33 deaths for every 1,000 live births (NationMaster, 2014). In USA, life expectancy for women is 81 years and ranks 33^rd and for men is 76 years, ranking 30^th worldwide. Infant mortality rate in America is 6.06 per 1,000 live births, ranks 179 globally (NationMaster, 2014). As illustrated in the health status statistics, Europeans in the selected EU countries have higher life expectancies than Americans and infant mortality is higher in the United States than in Belgium and Germany.

The two efforts in both Belgium and Germany to reduce health inequities are as follows: (i) the actions taken concerning healthcare access include the improvement of quality as well as accessibility of healthcare, and the focus is on affordability (Commission of the European Communities, 2007). Moreover, the governments of Germany and Belgium have taken actions to ensure emergency medical aid for everyone, and they provide increased reimbursement to vulnerable groups who include cancer patients and those with chronic illnesses. They also undertake initiatives that target the decrease in price of drugs; maximum bill for costs of healthcare; and improving proximity of healthcare services (Equity Action, 2013). Furthermore, there is cross-sector policy plan aimed at fighting poverty and guarantee the right to health. The plan encompasses 12 measures including measures to increase the use of the 3^rd party payer system by the healthcare providers, and measures to increase hospital admission of poor people (Wevers et al., 2007).

(ii) Actions taken concerning prevention and health promotion include providing affordable, quality and durable housing for everyone, and stress management for persons living in poverty. They also include providing preventive health checks at school, and promotion of balanced and healthy nutrition in vulnerable groups and in the general population. There is also focus on occupational diseases and industrial accidents and in combating drug and alcohol use in working settings (Equity Action, 2013).

Lessons that Americans may learn from the EU efforts selected and that can be implemented in the United States by individual states or nationally are as follows: first, governments in the United States, be they state governments or the federal government, should establish a policy plan aimed at reducing poverty and guarantee every person’s right to health. This policy plan should include among others, measures to increase hospital admission for the poor Americans. Secondly, to reduce inequities in health, state governments in the U.S should provide increased reimbursement for groups that are vulnerable such as patients with chronic sicknesses. State governments should promote a balanced and healthy nutrition. Thirdly, stress management should be provided to poor people to reduce cases of suicide; preventive health checks be provided in American schools; and the federal government should ensure the availability of affordable, durable, and quality housing for all Americans. The federal government should also develop policies intended to reduce the price of medicines. The community that I live in might adapt these interventions by consuming more balanced and healthy nutrition; seeking durable and quality housing; and the poor in the community would get help to manage their stress. Community members would also be able to purchase medicines at affordable prices.

References

Commission of the European Communities. (2007). Together for health: A strategic approach for the EU 2008-2013 [White paper]. Retrieved from http://ec.europa.eu/health-eu/doc/whitepaper_en.pdf

Equity Action. (2013). What are Regions in the EU doing to Reduce Health Inequalities: Overview Report of Equity Action Regional Network Case Studies. Available at http://members.kwitelle.be/HEALTHEQUITY/_images/equityactionregionalcase_studyoverviewreport.pdf (Accessed October 9, 2014).

NationMaster. (2014). Health: Infant Mortality Rate – Countries Compared. Available at http://www.nationmaster.com/country-info/stats/Health/Infant-mortality-rate/Total (Accessed October 9, 2014).

Wevers, S., Lehmann, F., Nurnberger, M., Reemann, H., Altgeld, T., Hommes, M., Luig, H., & Mielk, A. (2007). Strategies for Action to Tackle Health Inequalities in Germany. BGG, 50(4): 484-91

We can write this or a similar paper for you! Simply fill the order form!

Antibiotic Resistance in Treatment of UTIs

Order Instructions:

Combine all elements completed in previous weeks (Topics 1-4) into one cohesive evidence-based proposal and share the proposal with a leader in your organization. (Appropriate individuals include unit managers, department directors, clinical supervisors, charge nurses, and clinical educators.)
For information on how to complete the assignment, refer to “Writing Guidelines” and “Exemplar of Evidence-Based Practice.”

Include a title page, abstract, problem statement, conclusion, reference section, and appendices (if tables, graphs, surveys, diagrams, etc. are created from tools required in Topic 4).

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center.

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.

SAMPLE ANSWER

Antibiotic Resistance in Treatment of UTIs

Abstract

Infections of the urinary tract are among the most prevalent infectious diseases that are also accompanied by a substantial financial burden on the patient and the entire healthcare system (Grabe et al., 2008). Urinary Tract Infections (UTIs) range from these affecting the urinary bladder to those affecting the kidneys. The infections are classified according to the site of infection. These include urethritis (urethra), vaginitis (vagina), pyelonephritis (upper urinary tract), and cystitis (urinary bladder) (Mazulli, 2012). Different pathogenic microbes can be attributed to the condition. These include bacteria from the staphylococcus species such as Staphylococcus saprophyticus, the Klebsiella species, Pseudomonas aeruginosa, enterococci bacteria and also from the yeast fungi which is common among women (Mazulli, 2012). However, the main causative agent in the community and hospitals is the bacterium Escherichia coli (E.coli) that is a normal flora in the bowel and accounts for approximately 75 – 95% of UTI cases (A.D.A.M Inc, 1997-2008). Antibiotics are commonly used in the prevention and treatment of UTIs. However, this frequent use of antibiotics has resulted into the development of antibiotic resistance and vaginal and intestinal dysbiosis. This has become problematic in the treatment of UTIs and this paper, therefore, provides evidence of the spread of antibiotic resistance in UTI treatment.

Problem Statement

The treatment and prevention of UTIs has most of the time involved the use of antibiotics as the first-line treatment. This often follows the isolation and culture of the etiological agent to select the appropriate antibiotic for use. However, today there is increasing resistance to most of the antimicrobial agents prescribed for the treatment of UTIs in both community and hospitals settings. This is spreading to even the most potent antimicrobial agents hence the need to establish alternative approaches for treatment.

For example, a study was conducted in India and was aimed at reporting the resistance pattern among the most common uropathogens that were isolated in a tertiary care hospital setting. The focus of this study was on resistance to ciprofloxacin (Mandal, Acharya, Buddhapriya, & Parija, 2010). Nineteen thousand and fifty samples were collected, cultured and the pathogenic microbes isolated. The susceptibility to antibiotic tests were done using the Kirby-Bauer disk diffusion method after noting the clinical and demographic characteristics of each patient. E.coli was isolated and out of the total samples selected 62% were sterile while 26.01% had significant growth (Mandal, Acharya, Buddhapriya, & Parija, 2010).

In addition, 2.3% had insignificant growth, and 9.6% of the samples were contaminated. The ciprofloxacin-resistant E.coli had a strong association with gynecological surgery among the female participants, UTI in adulthood, prior antibiotic use, and uropathy among men and complicated UTI among women (Mandal, Acharya, Buddhapriya, & Parija, 2010). The continuous of ciprofloxacin was, therefore, linked to the development of resistance in males, females, and in-patients. This indicates the need to rationalize the use of antibiotic treatment or most importantly develop alternative approaches.

Trimethoprim and Sulfamethoxazole are often used as a first-line treatment for UTIs. However, there is increasing resistance towards the drug that is resulting to a significant decrease in its use. This antibiotic is an inhibitor of the bacterial folate synthesis that is needed for the synthesis of thymidine hence the synthesis of DNA (Hilbert, 2011). These drugs are administered in a combined ratio of 1:5 (SXT) and the guidelines indicate that it should be avoided where the resistance reaches between 15% – 20% (Gupta et al., 2011).

The North American Urinary Tract Infection Collaborative Alliance (NAUTICA) conducted a study to analyze the development of resistance towards SXT. They used 1,142 Uropathogenic Escherichia coli UPEC isolates from 40 medical centers. The results revealed that 21% of the participants had resistant isolates (Hilbert, 2011). In another study conducted by the Arkansas River Education Service Cooperative (ARESC), a similar result was found and in this case the resistance was higher at 29%. Trimethoprim and Sulfamethoxazole inhibit the enzymes dihydrate folate reductase and dihydropteroate synthetase respectively. The resistance to the drug is mediated by gene transfer of the genes that are responsible for encoding the resistant enzymes (Hilbert, 2011). In a study conducted using 305 UPEC isolates revealed that 66% had encoded a dfr allele that encoded a trimethoprim-resistant dihydtrate folate reductase and 96% had a sul gene encoding for the sulfamethoxazole-resistant dihydropteroate synthetase (Hilbert, 2011). These genes appeared due to the continuous use of SXT, and their presence facilitate the spread of resistance elements among the bacterial population hence the increased resistance.

Finally, there is also the development of resistance to other aetiological agents for UTIs. For example, the Klebsiella species (K. pneumoniae) accounts for approximately 1-6% of the uncomplicated cases of UTIs (Schito et al., 2009). The bacterium is resistant to penicillin and nitrofurantion intrinsically and shows resistance to other common antibiotics used for the treatment of UTIs. Per Schito et al. (2009), a study conducted to establish the resistance of K.pneumoniae indicated 23% resistance to SXT, 21% to cefuroxime, 12% fosfomycin and 6% ciprofloxacin (Schito et al., 2009).

An earlier study by Kahlmeter in 2003 revealed similar results. In the two studies mentioned, the 94-99% of the isolates showed susceptibility to ciprofloxacin and 91-96% were susceptible to amoxicillin-clavulanic acid. However, due to the continuous use of the drugs today, there is increasing resistance (Hilbert, 2011). Moreover, K. pneumoniae accounts for 8-11% 0f catheter-associated UTIs (CAUTIs) within the hospital setting (nosocomial infections). In the above studies, 17-21% of isolates from individuals with CAUTIs were resistant to an extended spectrum of cephalosporins while 10% were resistant to carbapenems (Hilbert, 2011). This indicates the growing resistance of UTIs etiological agents to antibiotics and the need for new treatment approaches.

Conclusion

UTIs are among the most common forms infections today. Moreover, their prevalence is also on the rise including among men. Antibiotics have been for a long time the first line of treatment for infectious diseases. Treatment involves the isolation and culturing of isolates to identify the main causative agent. The common cause of UTIs is the bacteria E.coli; however, there are other species of bacteria that can also cause the disease. In the past, antibiotics were effective for UTI treatment, but due to the continuous use of the antibacterial drugs the bacteria are increasingly developing resistance. The resistance is developing as a result of mutations and other processes. The resistance is continuously increasing from the “weaker” forms of antibiotics to even those that were initially thought to be the most efficacious including the development of multiple resistance. Due to the increasing prevalence of UTIs and the resultant rise in resistance to antibiotics, it is imperative that alternative approaches of treatment should be employed.

References

A.D.A.M Inc. (1997-2008). Urinary Tract Infection. 1-4.

Grabe, M., Bishop, M. C., Bjerklund-Johansen, T. E., Botto, H., Çek, M., Lobel, B., et al. (2008). Guidelines on the management of urinary and male genital tract infections. European Association of Urology.

Gupta, K., Hooton, T. M., Naber, K. G., Wullt, B., Colgan, R., Miller, L. G., et al. (2011). International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis, 52, e103-120.

Hilbert, D. W. (2011). Antibiotic resistance in urinary tract infections: Current issues and future solutions. In P. Tenke (Ed.), Urinary tract infections (pp. 194-206). InTech.

Mandal, J., Acharya, N. S., Buddhapriya, D., & Parija, S. C. (2010). Antibiotic resistance pattern among common bacterial uropathogens with a special reference to ciprofloxacin resistant Escherichia coli. Indian J Med Res, 136, 842-849.

Mazulli, T. (2012). Diagnosis and Management of Simple and Complicated Urinary Tract Infections (UTIs). Can J Urol., 19 (Suppl 1), 42-48.

Schito, G. C., Naber, K. G., Botto, H., Palou, J., Mazzei, T., Gualco, L., et al. (2009). The ARESC study: an international survey on the antimicrobial resistance of pathogens involved in uncomplicated urinary tract infections. Int J Antimicrob Agents, 32, 407 -413.

We can write this or a similar paper for you! Simply fill the order form!

Positive Social Change in Community and the World

Positive Social Change in Community and the World Order Instructions: Share some of your ideas on how you can use the knowledge and insights gained in this course to promote positive social change in your community and the world.

Final Project (7–10 pages), not including the cover and the references:
In developing policy in the country you selected, consider the following:
• Explain the rationale for selecting the country (any African country).
• Describe the social determinants of health in the country that you would need to address. Explain why you need to address these determinants.
• Explain the possible public issues you might encounter in health literacy and cultural awareness in this country.
• Describe the relationship between health inequality/inequities and life expectancy for the population in your selected country.
• Describe two current efforts in this country (you selected) to reduce health inequities.
• Explain how you might develop a health policy so that it gets the support of the country you selected. Note: Take into account the culture of the country.
Use APA formatting for your Final Project and to cite your resources. Expand on your insights utilizing the Learning Resources.

Positive Social Change in Community and the World Sample Answer

Promoting positive social change in your community and the world

Reducing health inequities has the potential to bring about substantial gains in terms of improving health outcomes and increasing the life expectancy of disadvantaged groups. This paper looks into the social determinants of health for Botswana, a landlocked African nation located in the southern part of the continent. The possible public issues that I may encounter in health literacy and cultural awareness of Botswana are described exhaustively. The current efforts in Botswana to reduce health inequities are described, and an explanation is provided on how I might develop a health policy so that it gets the support for Botswana.

Positive Social Change in Community and the World and The choice of Botswana

Botswana was selected owing to the effort made by the government of Botswana to improve the health status of its people. Moreover, Botswana was selected because of the high prevalence of diseases particularly tuberculosis and HIV/AIDS in this country. It is of note that this southern African nation has been severely hit by the HIV/AIDS epidemic with 25% of the adult population – persons aged 15 years to 49 years – are infected and more than 90,000 children have lost either the mother or father (Clause et al., 2009). Owing to HIV/AIDS, life expectancy in Botswana dropped from 67 years in the year 1990 to 52 years in the year 2000. However, because of free universal antiretroviral treatment provided by the government since 2002, the life expectancy increased slightly to 54 years today (World Health Organization, 2013). The most prevalent diseases are respiratory such as tuberculosis and pneumonia, and intestinal such as digestive and diarrheal illnesses (Clause et al., 2009).

The Botswana government understands that people’s social development is integral to improving their health status. The government considers education as a foundation for life, thus is one of the main areas which has been targeted for reducing health inequities. This is true considering that the Ministry of Education has the biggest share of government financing. Additionally, 5 percent of health funding actually goes to education (Pleasant, 2013). Not-withstanding Botswana’s status as a middle-income nation, there are poor sections of society in which ⅓ of children have stunted growth and 1 out of 10 are underweight. In contrast, with the growing prosperity of lots of families, one out of 10 children is actually underweight (World Health Organization, 2013).

Positive Social Change in Community and the World and the Social determinants of health in Botswana

The conditions wherein people are born, live, grow, age and work, as well as the health system greatly determine the level of health that the people get to enjoy (CDC, 2014). These conditions are understood as the social determinants of health and include housing, socioeconomic status, access to services, transportation, environmental or social stressors, discrimination by the social group such as class, or gender. Others are education, culture, healthy child development, social support networks, as well as personal health practices and coping skills (CDC, 2014). It is of note that these social determinants are actually shaped by the distribution of power, resources, as well as wealth at local district and national levels. In turn, these are influenced by policy choices in the various sectors that are involved.

In Botswana today, there is a substantial homogeneity among various ethnic groups and the majority of them are quickly altering their lifestyles. Studies indicate that factors such as inadequate physical activity, cigarette smoking, substance abuse, unhealthy food habits, and alcohol abuse are common among adults in Botswana (Eyal et al., 2010). Even though the Botswana government is committed to alleviating the effects of climate changes, its impact is already clear. This could actually have a considerable impact on health, for instance, malaria prevalence is expected to rise as temperatures increase, and conditions are more favorable for mosquitoes to breed in rainy seasons. Moreover, the prevalence of cholera may rise in rainy seasons. With a decline in rainfall, production of food is expected to reduce and can result in malnutrition in the longer-term (Stover et al., 2008). I need to address these social determinants since they detract from or contribute significantly to the health of communities and health. Moreover, they influence the health of people in Botswana; hence, it is important to address them.

Possible public issues I may encounter in health literacy and cultural awareness in Botswana

Health literacy is understood as the ability of a person to get, process, and comprehend health information and services required to make suitable health decisions (Phaladze & Tlou, 2006). At present, I may encounter low health literacy in Botswana. Health facilities in Botswana are learning the significance of health literacy and they are developing health literacy programmes aimed at addressing the complexities that patients in this country have in getting and comprehending health information. In Botswana, health literacy depends on systemic and individual factors including the following: culture; context or demands of the situation; professional and lay knowledge of health topics; demands of the public health and health care systems; and communication skills of professionals and lay people (Pleasant, 2013).

Health literacy is founded on the notion that if individuals are more aware of the science behind their illness and the way their medicine works, then these people are more able to comprehend strategies for prevention, how they can decrease their infection risk, how the ARVs medications work, and the importance of adherence (Stover et al., 2008). The Botswana government has collaborated with the national nongovernmental organizations, the private sector and community-based organizations to address the epidemic of HIV/AIDS by increasing health literacy about this disease. The health literacy program was initially introduced in Botswana in 2007 (Bana, 2011).

Cultural awareness is an integral element of cultural competence. Cultural awareness is understood as being conscious, observant, and cognizant of differences and similarities between and amongst cultural groups (Eyal et al., 2010). Cultural sensitivity is of major importance to developing a policy that can be accepted by the government and people of Botswana. Working in the cultural context of Botswana could be both challenging and unique, and some experiences might be more difficult compared to other experiences. For instance, there is a stigma associated with HIV/AIDS since when someone dies of AIDS, many family members do not acknowledge it and rather claim that the person died of low blood pressure or another condition but not AIDS. Moreover, many men in Botswana are not receptive to the notion of having protected sex by using condoms and they claim that: one cannot taste a sweet with its wrapping on (Bana, 2011). Therefore, it is useful to understand such underlying ideologies to allow me to be culturally sensitive in my work. It is important to engage the people of Botswana in a discussion on condoms in order to dispel myths and offer correct information.

Relationship between health inequality/inequities and life expectancy for the population in Botswana

Inequities in health are unfair and avoidable systematic disparities in accessing and using health services between various social and economic groups. Ill-health and inequity are intertwined considering that unequal access to health services by gender, urban/rural location, and income groups leads to lower health outcomes for deprived groups (Clausen et al., 2009). Inequitable distribution of healthcare is a key challenge in Botswana given that the population is unevenly distributed and the country is large geographically. Attaining equitable universal health coverage calls for the delivery of necessary, accessible services for the whole population devoid of imposing an unaffordable burden on households or individuals.

In Botswana, Bana (2011) stated that socioeconomic status, urban-rural location, and insurance status are associated with access to health care, with people in the rural regions, the uninsured, and the poor experiencing greatest barriers to health care. Utilization of higher-level healthcare organizations in Botswana is greatest amongst the insured, urban and richer people. There are equality concerns since tertiary hospitals are mainly concentrated in the wealthier, urban regions of Francistown and Gaborone, and they are better specialized, equipped and resourced compared with the rural or district facilities (Bana, 2011).

Costs of accessing health care services could be very crippling for low-income and poor households. In essence, the poorest in Botswana bear a disproportionate cost of burden. The wealthy Botswanians and people living in cities and towns have ready access to high quality care whereas those who are poor, in rural areas lack access to quality health care and have limited access to care services since there are few and far between facilities in Botswana’s rural regions. Travel distance and costs of transportation are barriers to access to health care, particularly for rural, poor residents. This means that access barriers pertain to geographic inaccessibility of health facilities, especially in largely poorly resourced and rural districts (Phaladze & Tlou, 2006).

As a result of the inequities in health care, the life expectancy of people in Botswana at birth is 54.4 years – 60 years for females, and 48.8 for males. On average, the lifespan of poor people in the countryside with virtually no access to quality health care is 47.5 years whereas that of the wealthy Botswanians is 62.5 years (World Health Organization, 2013). The presence of inequalities because of differences in wealth means the need for a policy that will address the source of inequities between the poor and the rich.

Positive Social Change in Community and the World and Efforts in Botswana to reduce health inequities

Botswana strives to address the health inequities evident between and within districts in the state. The Botswana government has made several efforts aimed at reducing health inequities in the country and has adopted a multisectoral approach to health development and it acknowledges the concept of social determinants of health.

Healthy places – healthy people

The place wherein citizens live has a considerable effect on their health and their odds of enjoying flourishing, prosperous lives. Neighborhoods and communities that are socially cohesive, which ensure access to essential goods, are protective of the natural environment, and which are designed to foster good psychological and physical well-being are integral for health equity (World Health Organization, 2013). The government of Botswana has taken into consideration several areas in order to make living areas healthy and improve the levels of health equity. Housing and shelter: the NDP 10 affirms that the dignity of the poor Botswanians would be reinstated, and the quality of basic shelter would be improved through civil society schemes, Self Help Housing Agency (SHHA), and the Destitute Shelter Programme (World Health Organization, 2013). There are several schemes that provide housing to people of Botswana. However, the SHHA is the main scheme that focuses on the low-income population. Environment: regarding the disposal of human waste, the Botswana government has established programmes that relate to latrines. For instance, there is a change from using pit latrines to the use of water-born systems in towns and cities, or encouraging more environmentally friendly – ventilated improved – pit latrines in the rural regions in order to avoid contamination of underground water as it has happened in some areas. Disposal of solid waste is increasingly better managed using landfills (World Health Organization, 2013). Water: this is a key determinant of health. Provision of water is a key element of rural development in Botswana. The government supplies portable water to every recognized village and settlement in an effort to address health inequities.

Universal health care, and early childhood development and education

Health care systems are an important determinant of health. The National Development Plan seeks to ensure that Botswana’s population is within 5 kilometers of a health facility. The public sector is the key healthcare services provider, and provides roughly 80 percent of all health services via public healthcare organizations and facilities (World Health Organization, 2013). Health care services in Botswana are offered by a network of clinics in towns and villages throughout Botswana, and by referral to big state hospitals in Francistown and Gaborone. Basic health care in this country is available for a small cost in facilities that are state-run. Educational accomplishment is associated with improved health outcomes, to a certain extent, through its effect on adult income, living conditions, and employment. Botswana government’s 10^th National Development Plan encompasses the period from April 2009 until March of 2016. Chapter 7 of the NDP 10 – An Educated and Informed Nation – asserts that the objective of this particular plan is to provide a sufficient supply of competitive, productive, and qualified human resources. Moreover, it stresses that the sectors which contribute directly to this goal include youth, public service, education, health, finance and labor (World Health Organization, 2013).

How I might develop a health policy so that it gets support for Botswana

I might develop a health policy so that it gets the support of the people of Botswana by involving every important stakeholder in the development. These stakeholders comprise the government, nongovernmental organizations, and the citizens of this country. Their input will be of major importance in developing a health policy that will not only be relevant to Botswanians, but also one that all Botswanians can be receptive of. I will take into account the culture and beliefs of the people of Botswana in formulating the health policy so that they can find it applicable and improve their health outcomes.

Positive Social Change in Community and the World Conclusion

In conclusion, the country selected is Botswana, and it was selected owing to the high prevalence of HIV/AIDS and tuberculosis here. The most prevalent illnesses are respiratory such as tuberculosis and pneumonia, and intestinal such as digestive and diarrheal illnesses. Social determinants of health in Botswana include housing, socioeconomic status, access to services, transportation, and environmental or social stressors, and I will address them since they influence the health of people in Botswana. Presently, I may encounter low health literacy in Botswana. There are health equality concerns as tertiary hospitals are mainly concentrated in the wealthier, urban regions of Francistown and Gaborone, and they are better specialized, equipped and resourced compared with the rural or district facilities. The government strives to reduce health inequities by providing universal health care considering that HIV/AIDS medication are provided free of charge. It also seeks to provide adequate housing to all Botswanians and high-quality education. I will develop a health policy so that it gets support from the people of Botswana by taking into account the culture and beliefs of the people of Botswana, and involving all key stakeholders.

Positive Social Change in Community and the World References

Bana, R. (2011). The Importance of Cultural Awareness in Global Health – Experiences from Botswana. UBCMJ, 2(2).

CDC. (2014). Social Determinants of Health Maps. Available at http://www.cdc.gov/dhdsp/maps/social_determinants_maps.htm (Accessed October 6, 2014).

Clausen, T., Romoren, T. I., Ferreira, M., Ingstad, B., & Holmboe-Ottesen, G. (2009). Chronic Diseases and Health Inequalities in Older Persons in Botswana (Southern Africa): A National Survey. J Nutr Health Aging, 9(6): 455-61

Eyal, N., Hurst, S. A., Iorheim, O. F., & Wikler, D. (2010). Inequalities in Health: Concepts, Measures, and Ethics. Oxford, England: Oxford University Press.

Phaladze, N., & Tlou, S. (2006). Gender and HIV/AIDS in Botswana: A Focus on Inequities and Discrimination. Gender and Development, 14(1):23-35

Pleasant, A. (2013). Health Literacy: Improving Health, Health Systems, and Health Policy Around the World: Workshop Summary. Tucson, AZ: National Academies Press.

Stover, J., Fidzani, B., Molomo, B.C., Moeti, T., & Musuka, G. (2008). Estimated HIV trends and program effects in Botswana. PLoS ONE. 11/14;3(11):e3729.

World Health Organization. (2013). Integrating Social Determinants of Health in all Public Policies: The Case of Health Development in Botswana. World Health Organization. Regional Office for Africa.

Foregoing Curative Medical Treatment Due to Religious Beliefs

Order Instructions:

Select one of the following ethical issues in healthcare:

Foregoing curative medical treatment due to religious beliefs

Use the CSU Global Library and select Internet sources to conduct research on your chosen topic. Based on your research, provide the history of the issue from a legal, ethical, and moral perspective. In your paper address the following questions:

Do the consequences of actions always direct what is morally required?

What should happen when two principles come into conflict? For example, should patient autonomy be considered more important than beneficence? Defend your position.

Are moral and ethically rules always binding, or are they only guidelines to be assessed in each case? Defend your position.

Your paper should be 10-12 pages in length, well-written, and formatted per CSU-Global specifications for APA Style. Support your analysis by referencing and citing at least six (6) credible, peer-reviewed sources other than the course textbook (Ethics in Health Administration: A Practical Approach for Decision Makers, 2nd ed, by Eileen E. Morrison).

SAMPLE ANSWER

Foregoing Curative Medical Treatment Due to Religious Beliefs

Introduction

Healthcare professionals frequently find themselves in dilemmas as they undertake their chores at the workplace, with some directly confronting the ethical issues while others turning away. Usually, the moral courage that one possesses is what matters most as it, more often than not, helps the practitioners in addressing the various ethical issues that may present themselves; which could even involve doing something otherwise considered wrong. Inasmuch as there usually are predetermined courses of action considered ethically moral or otherwise, the consequences of the course of the action taken is what really matters (Stewart, Adams, Stewart, & Nelson, 2013). Because of this, an action that is otherwise not acceptable may have to be carried out in order to get to achieve a desirable consequence; for instance, according to most religious doctrines, abortion is not acceptable, even the conscience of the individual that may be involved may not allow it. However, if done for the sake of good will remains morally binding, for instance, the case of complications in pregnancy.

In order for us to get to understand the implications of the ethical issues pertinent with the health care practice, there is the need to understand the definition of nursing by the International Council of Nurses (ICN). Under it, the profession is defined as: “Nursing encompasses autonomous and collaborative care and communities of all ages, groups, families and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention f illness and the care of ill, disabled, and the dying people. Advocacy, promotion of safe environment, research, participation in shaping the health policy and in patient and health systems management, and education are also key nursing roles.” (ICN, 2011). As outlined by Morrison (2011), the definition incorporates the three fundamental components of bioethics. It is, thus, conceivable to say that the health practitioners have the obligation of developing a well-founded ground of ethical understanding with regards to the protection of the people; which is their sole duty.

Moral Courage

The ability of one to make the right decisions in such situations that involve moral and ethical issues is what is called moral courage. According to Day (2007), moral courage is “a trait displayed by individuals, who, despite adversity and personal risks, decide to act upon their ethical values to help others during difficult ethical dilemmas. As Hall (2014) asserts, such individuals tend to strive to see to it that the only do what is right, even in cases whereby most are expected to choose least ethical behavior, which could even be not taking any action.

Conflict of Principles

Religious, spiritual and cultural beliefs and practices remain very crucial in the lives of most patients, yet most health practitioners usually find themselves at the dilemma of whether to, how and when to address such issues when dealing with patients. In the past, the physicians were basically trained on the various ways of diagnosing and treating the various diseases, but with very little or no training on the spiritual approach to the ordeal. Besides, the professional ethics allows the professionals no chance of impinging their personal beliefs on their patients who are usually very vulnerable (Brierley, Linthicum, & Petros, 2013). The matter is even complicated further by the characteristic nature of most nations of religious pluralism, having a wide range of systems of beliefs: agnosticism, atheism to the very many religious assortments. Because of this, it tends to be very difficult getting to fully understand the religious beliefs of all the patients from all walks of life.

The very first temptation that would prove worthwhile in this case is for the professionals to fully avoid the doctor patient interactions with respect to their spiritual or religious beliefs. This simplest solution may never be the best as several studies have shown that the spiritual and cultural beliefs f various patients have been proved to be very important factors for the patients to be in a position of coping with relatively serious illnesses (McCormick et al, 2012). McCormick et al (2012), assert that the engagement of the spiritual beliefs of the patients in their healing process may be devised by the health practitioners through comparison of their own beliefs against those of the patients.

Case Scenario: Foregoing Curative Drugs due to Religious Beliefs

In some communities, there is too much belief in the traditional practices that accepting the modern medicines becomes very difficult. Such communities have a belief system in which they believe and may recognize the move towards accepting the western medicine as evil. In such a case, the patient may never be taken to the hospital, or worse still, after getting to the hospital refuse to take the prescribed medicine on the belief that it is against the doctrines of their religion. The most common cases, include, but not limited to; blood transfusion, abortion, taking of family planning pills and even the normal tablets.

Conflict in Principles

In case of the principles coming into conflict, there usually is the need to be very flexible as there are so many ways in which the situations may present themselves. For effective resolution of such conflicts, the ethical and professional principles, rather than the personal preconceived ideas, should always form the pillar for the effective decision making when it comes to ethics (ANA, 2011). The ethical behavior of nurses is usually guided by a set of principles contained in the American Nurses Association (ANA) Code of Ethics of Nurses (2001). It is expected of all the nurses that they uphold all the principles in the course of their practice of professional nursing, while, at the same time, the Cord of Ethics for Nurses encourages them to ensure consistency with their personal values. There is also emphasis on the need to hold open discussion with regards to conflicting ethical principles in such a manner that all the principles are placed at the same level and treated equally.

Autonomy versus Beneficence

Autonomy

Autonomy refers to the personal self-rule that is both free from controlling such interferences that may result from others and the personal imitations that my put meaningful choices at jeopardy. In the health care, autonomy forms one of the key guidelines for the clinical ethics. A point that must be noted is that when speaking of autonomy, it does not merely imply leaving the patients the freedom of making their own choices. Rather, the health practitioners are under an obligation to see to it that they create the conditions that provide room for the independent choices, thought under some guidance. The respects for autonomy scenarios include giving room for autonomous choices as well as respecting the right to self-determination of an individual.

It must be noted that the doctors are usually visited by the people because they may not be equipped with the necessary information or background necessary for the making of informed choices. Hence, it is the physicians that educate the patients in order for them to adequately understand the situations, including; addressing the fears and emotions that may interfere with the decision making ability of the patients. Confidentiality is another form of autonomy very crucial in administering the treatment to the patients.

Beneficence

Usually, this is an action done purely for the benefit of others through either removing harm or simply by improving their situations. Apart from being refrained from causing harm, the health practitioners are expected to see to it that they help the patients. Due to the nature of the relationship inherent between the patients and the physicians, the doctors have the obligation removing or preventing harm and balancing and weighing the possible risks against the possible benefits of any action.

Balancing of autonomy and beneficence

Amongst the most difficult and common ethical issues to tackle comes in when the patient’s autonomous decision comes into conflict with the beneficent duty of the physician, which is mainly looking after the best interest of the patient. For instance, a patient who has very strict religious background may refuse to take medicine, simply because they believe in spiritual healing. This may be so challenging, especially when the physician has successfully diagnosed the ailment and knows its cause well, hence, its prescription (ANA, 2011). At such a point, the physician may be under the challenge of whether to maintain the autonomy of the patient or take a beneficence action, which will violate the autonomous requirement of the patient. More often than not, the two are equally important, however, beneficence comes first as it is a matter of life and death.

Basically, the modern biomedical ethics are grounded on four principles, which balance categorical Imperative of Emmanuel Kant: you must always do the right thing no matter what it takes, and Utilitarianism of John Stuart Mill and Jeremy: make the best decision for everyone all around. When in combination, the principles are usually called Principalism.

Respect for autonomy: giving priority to the informed choices of the patient. This theory asserts that the practitioners need to see to it that the wishes of the patients are taken into consideration. As such, the wish by a patient to have a kind of special attention with regards to choice of the health care services administered should solely depend on the patient’s wish.

Non-malfeasance: do no harm

Beneficence: do what is best for the patient, regardless of their consent. This principle asserts that the consent of the patient may be overlooked in order to see to it that the course of action is for their own good. With this, the health care practitioners are expected to ensure the good of the patients even if it means doing what they don’t wish for. The ultimate consideration of the morality will lie in the consequences, and at times, even if a patient requested for the end not to have blood transfusion due to religious beliefs, they may eventually end up thanking the physician, rather than suing them (Morrison, 2011).

Justice: always balancing the social and individual costs, risks and benefits. The physician has the obligation of seeing to it that they properly advise the patients with respect to the possible risks involved to ensure they are well informed before getting to a medical ordeal.

Morals and Ethics

Most of the moral dilemmas that tend to arise in medicine are usually analyzed using the four aforementioned principles but with some consideration given to the resultant consequences, though the frameworks may have limitations. The judgment of the best consequences is not always clear, and din case the principles conflict, the ease of deciding on the best dominant is always very hard. Virtue ethics usually focuses on the nature of the moral agent rather than how right the course of action taken is. Usually, as a practitioner, the ethical principles, which guide what action to be taken do not usually take into account the moral agent’s nature (Cordella, 2012). To look into how binding the morals usually are, the “standard” Jehovah’s Witness case may be used.

A very competent adult believer loses too much blood due to bleeding in a vessel in an acute duodenal ulcer, and the only best chances of saving his life is by having a blood transfusion together with some operation done on him. In exercising his autonomous decision, the patient requests for surgery and treatment with the best non-blood products available, and refuses blood transfusion. He even accepts the risks that are pertinent with surgery without blood transfusion.

It is very important for the health practitioners to get to distinguish between morality and legally binding courses of actions as an action may be legal but not moral and vice versa. For instance, the resuscitation of a dying patient may be considered legal, but not moral. On the other hand, when a patient falls too sick at home, it may be moral to over speed to the hospital but illegal. Also, the physicians have the obligation of distinguishing between religion and morality. From instance, some of the religions believe in circumcising women while others recognize it as a sin.

Moral Frameworks

However, the moral theories tend to provide different frameworks upon which the nurses may be able to get clarification as well as view the patients’ disturbing situations. Widely used and applicable are three frameworks that may guide the physicians. The three basic broad categories of the moral frameworks are: virtue theory, deontological and utilitarianism theory.

Virtue theory

This theory exclusively probes the human morality. It gives very little attention to the regulations that people need to adhere to; rather, it puts more emphasis on what is deemed necessary in development of human characteristics considered as good, just like living a generous and kind life.

Deontological ethics

These are usually associated with the ethical and moral standards in the execution of the professional duties by the health professionals.

Utilitarianism theory

This is the belief that any form of action is considered as being right as long as it leads to the greatest good for larger number of people. As such, there usually is a calculation on the outcome of any particular action. As such, if a health practitioner considers an action as having high propensity of bringing good and happiness to larger number of people; it definitely is the right thing to do (Morrison, 2011). In other words, the utilitarianism tends to base its reasoning on the usefulness of the action that may make it be considered as moral or immoral; for the course of action to be considered as moral, the good outcomes have t outweigh the bad ones.

Moral principles

They are the broad and general statements of philosophical concepts that provide the foundations upon which the moral rules are founded.

The health practices usually come with too many challenges which leave the practitioners at a dilemma in more often situations than not. For instance; the debate n abortion, organ transplant, end-of-life issues, management of personal health information and the allocation of the scarce health resources. Looking into each of the aforementioned issues, it usually leaves the platform very open for the practitioner to decide what they deem right course of action to take. As put across by Elliot (2011), “Culture provides the rules or framework that guides us as we negotiate our way through our daily activities of life.” Through the assessment of the heritage of any particular patient helps the nurses to understand well how such a person relates to their surroundings, how they view health and wellness, their various ways of gaining and applying knowledge as well as any other area that may be of interest in health care provision.

Most of the nations of the world, for instance, in America, the populations are characterized by people of vast diversification in the religious, ethnic, sexual orientation and nationality. As such, the patients that visit the health centers present with themselves varied symptoms requiring medical attention, some based on illness while others grounded on the cultural and religious backgrounds of the patients.

As the patients are guided through any healthcare facilities of the dialysis unit, it is very recommended that the practitioners not only concentrate on the clinical needs, but also see to it that they identify the patient’s demographics and religious orientations amongst others. The problem very common is the avoidance of the common mistakes that greatly impact safety and quality and instead, pay too much attention on the nature of the illness and how the patient may be treated. In doing this, they are not really identifying with the patient in order to attend to them as an individual. A point that must be noted is that all patients have diversified characteristics and needs, both the clinical and non-clinical, which affects the manner in which they participate, receive and view their treatment (Morrison, 2011).

Unlike in the past when health provision was mainly limited to a particular community, mostly, where one came from, there have increasingly arisen changes due to the cultural and religious diversity. There is need for the healthcare providers to see to it that they are well conversed with all the possible cultural and religious traditions inherent in the societies within which they work. It is based on this challenge that the terminology ‘cultural competence’ came to be, whereby all the practitioners are expected to be able to work in the various cultural and geographical regions without much trouble (Cordella, 2012). This may only be so through getting to first and foremost understand the various cultures to help learn their beliefs.

A fact that all health care practitioners must come to terms with is the diversity in the religious beliefs inherent in the various cultures and people from different walks of life. The beliefs of the various patients tend to be aligned to their religious backgrounds, which may never be easy to change. Due to this, it is in order that all the professionals fully understand the possible challenges that they may expect, however, they should never let the various beliefs by such patients waver their conscious mind of making the right decisions to do good. Once a person believes in the consequence o the course f action they are about to take, they should do so without any fear.

Conclusion

In conclusion, we as health practitioners are faced everyday with caring for patients of different faiths, cultures and religions. It is important to always keep an open mind and allow yourself to try to understand the faith that our patients believe. Understanding other cultures and beliefs are critical in the healing process. In healthcare today as physicians, we need to keep an open and unbiased mind, treating everyone as equal. Through the development of proper cultural competence, we may help our patients by accepting their beliefs without abandoning our own personal customs. As health practitioners, we may not be able to change the beliefs of the various patients from the different walks of life as the populations continually get diversified, rather, there is need to remain open minded in order to accommodate the diverse beliefs. In addition, as long as we believe that the course of action that we are taking will lead to more good than bad, then the autonomous stake of the patients should always be put at stake. After all, they will eventually appreciate the results.

References

American nurses association ANA, (2011). Code of Ethics for Nurses with Interpretive Statements. Washington, D.C.: American Nurses Association.

Brierley, J., Linthicum, J., &Petros, A. (2013). Should religious beliefs be allowed to stonewall a secular approach to withdrawing and withholding treatment in children?. Journal of Medical Ethics, (9). 573. doi:10.1136/medethics-2011-100104.

Conflicts between religious or spiritual beliefs and pediatric care: informed refusal, exemptions, and public funding.(2013). Pediatrics, (5), 962.

Cordella, M. (2012).Negotiating Religious Beliefs in a Medical Setting. Journal Of Religion & Health, 51(3), 837-853.

Elliot G. (2011). Cracking the cultural competency code. Canadian Nursing Home, 22(1), 27-30.

Hall, H. (2014). Faith healing: religious freedom vs. child protection: the medical ethics principle of autonomy justifies letting competent adults reject lifesaving medical care for themselves because of their religious beliefs, but it does not extend to rejecting medical care for children. Skeptical Inquirer, (4). 42.

International council of nurses, (ICN). (2011). Nursing and health professions. 2011.

Krohn E. (2013). Recovering health through Cultural Traditions. Forth World Journal, 12.

Lamparello, A. (2001). Taking God Out of the Hospital: Requiring Parents to Seek Medical Care For Their Children Regardless of Religious Belief. Texas Forum On Civil Liberties & Civil Rights, 647.

Morrison, E. E. (2011). Ethics in health administration : a practical approach for decision makers / Eileen E. Morrison. Sudbury, Mass. : Jones and Bartlett Publishers, c2011.

Stewart, W., Adams, M., Stewart, J., & Nelson, L. (2013).Review of Clinical Medicine and Religious Practice. Journal Of Religion & Health, 52(1), 91-106.

We can write this or a similar paper for you! Simply fill the order form!

Intervention in Canada to improve health inequities

Order Instructions:

Although Canada is contiguous to the United States and has some cultural and historical similarities, Canada’s population enjoys a vastly superior health status. Reasons are many, can be traced historically, and are related to a different view of the role of government. The experience of Canada demonstrates that neither a heterogeneous population, nor a health system that has waiting lines for services, are reasons for poor health. By looking critically at what produces good health in Canada, much can be learned about steps the U.S. might need to take if population health is its goal.

The Canadian Best Practices Portal challenges Canadian public health practitioners and researchers to create upstream interventions aimed at the source of a population health problem or benefit. What is being done to address the influences on population health in Canada?
Search the Internet and scholarly research for examples of Canadian “upstream interventions” that can be put forth as examples of either effective or ineffective efforts to improve population health. This is a 4-5 pages):

The Assignment (4-5 pages):

1. Provide a description of an existing intervention in Canada, intended to improve health inequities. Include an explanation of the inequity and how the intervention targets upstream determinants of health.

2. Describe the organizations involved and/or social policies enacted in the implementation of the intervention.

3.Explain whether or not the intervention was/is successful and what lessons public health practitioners can learn from that experience that might improve population health in the United States.

Articles:

Dinca-Panaitescu, S., Dinca-Panaitescu, M., Bryant, T., Daiski, I., Pilkington, B., & Raphael, D. (2011). Diabetes prevalence and income: Results of the Canadian Community Health Survey. Health Policy, 99(2), 116–123.
Retrieved from the Walden Library databases.

Feeny, D., Kaplan, M. S., Huguet, N., & McFarland, B. H. (2010). Comparing population health in the United States and Canada. Population Health Metrics, 8, 8–18.
Retrieved from the Walden Library databases.

Kirkpatrick, S. I., & McIntyre, L. (2009). The Chief Public Health Officer’s report on health inequalities: What are the implications for public health practitioners and researchers? Canadian Journal of Public Health, 100(2), 93–95.
Retrieved from the Walden Library databases.

Vafaei, A., Rosenberg, M. W. & Pickett, W. (2010). Relationships between income inequality and health: A study on rural and urban regions of Canada. Rural and Remote Health, 10(2), 1430.
Retrieved from the Walden Library databases.

Health Council of Canada. (2010). Stepping it up: Moving the focus from health care in Canada to a healthier Canada. Toronto, Canada: Health Council of Canada. Retrieved from http://publications.gc.ca/collections/collection_2011/ccs-hcc/H174-22-2010-2-eng.pdf

Public Health Agency of Canada. (2013, July 12). Key element 4: Increase upstream investments. Retrieved from http://cbpp-pcpe.phac-aspc.gc.ca/population-health-approach-organizing-framework/key-element-4-increase-upstream-investments/
Public Health Agency of Canada. (2014). Retrieved from http://www.phac-aspc.gc.ca/index-eng.php

Please apply the Application Assignment Rubric when writing the Paper.

I. Paper should demonstrate an excellent understanding of all of the concepts and key points presented in the texts.
II. Paper provides significant detail including multiple relevant examples, evidence from the readings and other sources, and discerning ideas.
III. Paper should be well organized, uses scholarly tone, follows APA style, uses original writing and proper paraphrasing, contains very few or no writing and/or
spelling errors, and is fully consistent with doctoral level writing style.
IV. Paper should be mostly consistent with doctoral level writing style.

SAMPLE ANSWER

Health inequities are avoidable imbalances that contribute to poor health. Solutions for such inequities may be found in upstream interventions that address social, economic and environmental situations. Social determinants include preventative strategies such as physical activity and proper diet as important ways of preventing chronic diseases and improving overall health (Gore & Kothari, 2012). In Canada, Ontario implements interventions aiming to influence environmental and social factors to address inequities in health.

There is increasing prevalence of chronic disease among certain pockets of the Canadian population. Problems associated with the high cost of treating such diseases necessitate efforts to implement interventions targeting their underlying causes. Canada renewed its commitment to public health in 2003 in a response strategy targeted towards addressing Severe Acute Respiratory Syndrome through healthy living interventions. The associated cost of treating chronic diseases threatens the sustainability of the healthcare system. This realization informs the implementation of a healthy living intervention in Canada through development of chronic diseases prevention guidelines (Gore & Kothari, 2012).

In Canada, low economic social status is measured in terms of literacy and income levels. It determines citizens’ vulnerability to cardiovascular disease, diabetes, asthma and chronic obstructive pulmonary disease (Dinca-Panaitescu, Dinca-Panaitescu, Bryant, Daiski, Pilkington, & Raphael, 2011). Studies show higher prevalence of chronic disease and lower life expectancy in low -income areas as compared to wealthier areas. Research also shows that job insecurity, unemployment, part-time employment and temporary employment negatively affects health as it is associated with elevated levels of chronic diseases such as blood pressure and increased risk of death from cardiovascular diseases. Aborigines, immigrants and people of color also have low incomes and are at higher risks of stress that triggers development of chronic diseases (Gore & Kothari, 2012).

Canada implements health policies aimed at preventing chronic illnesses by addressing upstream causes encompassing lifestyle, socioeconomic and environmental factors. One example of the policies is the 2009 Canadian Cardiovascular Society Guidelines advocating for reduced salt and simple sugars intake. It promotes the replacement of saturated and trans-fats with unsaturated, as well as higher consumption of vegetables and fruits. The guideline also recommends greater attention to weight control to prevent obesity and ensure that more citizens maintain a healthy body weight (Raine, 2010).

Health boards received instructions on the appropriate way to evaluate the population needs and tailor interventions to the groups facing the highest risk. Another policy is the Ontario guidelines for healthy eating and active living that informs various interventions to address health inequities in Ontario (Gore & Kothari, 2012). Aboriginal people and new comers in Canada have a higher prevalence of chronic illness often because of poor nutritional decisions and lack of opportunities for physical exercise. To address inequities among aboriginal people, there is an initiative to provide recreation and fitness equipment and youthful fitness ambassadors in their various locations. Other interventions in the Ontario guidelines for healthy eating and active living include provision for a web and phone based dietitian serving populations in remote areas. It also includes providing fruits and vegetables to schools through partnership with the ministry concerned with agriculture. Efforts to encourage physical activity include collaboration with urban planning designers to ensure that cities promote healthy living and that schools have routes that encourage physical exercise through walking and biking. The local public health units also oversee the compulsory programs and 36 heart health community partnerships to reduce cardiovascular disease (Ministry of Health Promotion, 2006).

The Ontario plan on active and healthy living is also referred to as ACTIVE2010 supports communities to implement community sports and physical activity and nutrition projects (Ministry of Health Promotion, 2006). The plan adopted a multi-sectoral approach targeting the population on a variety of levels. It includes actors from NGOs, private industry, service providers, and communities. Partnership between actors in healthcare is imperative in addressing the wide-ranging impact of social determinants in populations residing in diverse settings (Gore & Kothari, 2012).

The government in Ontario supports the intervention through policies that guide enhanced physical activity in schools, providing access to nutritious foods to children and encouraging hygiene and safety in the environment. Community organizations actively participate through facilitating health promotion trainings to prevent the occurrence of chronic illnesses among at risk individuals. Private companies also participate by creating health and wellness programs for their staff including healthier food choices and exercise. Some companies in the food industry are also keen in providing healthier food selection and creating awareness on the same (Ministry of Health Promotion, 2006).

The physical exercise interventions are tenable and have resulted in substantial benefits to the population. The interventions assist Ontarians to become more physically active through community sports and physical activity projects that are largely supported through the communities in action fund. The implementation of the Ontario’s trail strategy also encourages physical activity through provision of outdoor walking spaces in various areas for all (Ministry of Health Promotion, 2006). In as much as interventions targeting to reduce salt content in packaged and restaurant foods are tenable, the dietary recommendations for preventing chronic diseases remain largely unmet in Canada. Only a few companies have positively responded to the guidelines’ recommendations. The industry progress is underwhelming because many other companies are yet to take voluntary measures to reduce salt in their food products. It shows that regulatory controls are necessary to increase the number of companies acting to reduce sodium levels in processed foods (Raine, 2010).

The Canadian Heart and Health strategy and Action Plan recommends that creating heart friendly environments through education, legislation, and policies aimed at promoting healthy eating and physical activity are efficient interventions in addressing upstream determinants of health. An examination of environment-based interventions to prevent cardiovascular diseases in Ontario and indicates that they failed to address the social causes or determinants of illnesses. Interventions in settings at schools, workplaces, government buildings and communities are insufficient in addressing unfavorable living conditions and factors that create inequity. There is need for greater political will to invest more aggressively in prevention to achieve success (Raine, 2010).

Complete success of the Ontario’s healthy eating and active living plan is dependent upon greater political will to support aggressive implementation including legislative measures. Public health practitioners in the United States must ensure that when adopting such interventions, there is a solid legal foundation to ensure success. The US requires implementing strategies that address health inequities emanating from low-income and racial factors are addressed through population specific measures. A multidisciplinary approach is also imperative in ensuring that communities, government agencies and private sector players coordinate their efforts. There must be enforceable laws on wellness programs, food industry parameters and urban planning. These factors coupled with concerted efforts between public health agencies, education, food and agriculture, companies and the communities provide prime conditions for success.

References

Gore, D., & Kothari, A. (2012). Social Determinants of Health in Canada: Are Health Initiatives There Yet? A Policy Analysis. Internatinal Journal for Equity in Health, 11(41), 1-14.

Ministry of Health Promotion. (2006). Ontario’s Action Plan for Healthy Eating and Active Living. Retrieved September 24, 2014, from www.mhp.gov.on.ca: http://www.mhp.gov.on.ca/en/heal/actionplan-EN.pdf

Raine, K. D. (2010). Addressing Poor Nutrition to Promote Heart Health: Moving Upstream. Canadian Journal of Cardiology, 21-24.

We can write this or a similar paper for you! Simply fill the order form!

West Nile virus infection Research Paper

West Nile virus infection

Order Instructions:

For the month of August, 12 new cases of tuberculosis and 12 new cases of West Nile virus infection were reported to a county health department. You are not sure if either group of cases is a cluster or an outbreak.

What additional information might be helpful in making this determination? Why? How would you obtain this information?

SAMPLE ANSWER

Week 4 discussion

Quick response is vital in case of any outbreak of diseases. Health departments and other agencies have the duty to act swiftly to contain these clusters or outbreaks. For instance, in this case where a country’s health department reported 12 new cases of tuberculosis and West Nile virus infections, it becomes critical to collect information quickly to determine whether it is a cluster or an outbreak for immediate action. The author deliberates on additional information required to make determination as well as reasons why and the process of obtaining information in such instances as tuberculosis and West Nile virus outbreaks.

To determine whether these cases are a cluster or an outbreak, it requires adequate information. Information pertaining to these cases will include the rate of occurrence of the diseases, the community or region affected and the frequency of the illness among many others. Outbreak occurs when the number of victims is more than the expected cases (Sterhr-Green, Paul, Voetsch & MacDonald, 2010).

This information is required because it helps to determine the number of people that are affected and in adopting appropriate strategies to counter the same (CIFOR, 2010). A cluster and an outbreak requires different strategies to contain further spread of the disease and therefore being armed with this vital information is essential to approaching the challenge amicably.

Obtaining this information is yet another important aspect in seeking to determine whether the case above is a cluster or an outbreak. One way of obtaining information is partnering with the health agency to come up with appropriate ways to get information on the ground (UIC, 2005). It is also important to partner with the community members and other leaders to help in establishing the causes and the time of the outbreak among other information. Information will also be obtained through interviews and administration of questionnaires with the victims and their close family members.

References

CIFOR. (2010). Investigation of Clusters and Outbreaks, Chapter 5. Retrieved from: http://www.cifor.us/documents/CIFORGuidelinesChapter5.pdf

Sterhr-Green, J., Paul, S., Voetsch, A., & MacDonald, P. (2010). Introduction to Outbreak Investigations, Jones & Bartlett Learning, LLC. Retrieved form: http://samples.jbpub.com/9780763784591/84591_CH02_FINAL.pdf

UIC. (2005). Investigating an outbreak. Retrieved from: https://www.uic.edu/sph/prepare/courses/PHLearning/EpiCourse/6InvestigatingAnOutbreak.pdf

We can write this or a similar paper for you! Simply fill the order form!